Cardiac catheterization (also called cardiac cath or coronary angiogram) is an invasive imaging procedure that allows your doctor to evaluate your heart function. Cardiac catheterization is used to:
- Evaluate or confirm the presence of coronary artery disease, valve disease or disease of the aorta
- Evaluate heart muscle function
- Determine the need for further treatment (such as an interventional procedure or coronary artery bypass graft, or CABG, surgery)
During a cardiac catheterization, a long, narrow tube called a catheter is inserted through a plastic introducer sheath (a short, hollow tube that is inserted into a blood vessel in your leg or arm). The catheter is guided through the blood vessel to the coronary arteries with the aid of a special x-ray machine.
Contrast material is injected through the catheter and x-ray movies are created as the contrast material moves through the heart’s chambers, valves and major vessels. This part of the procedure is called a coronary angiogram (or coronary angiography).
Coronary artery disease is the narrowing or blockage of the coronary (heart) arteries. After an interventional procedure, the coronary artery is opened, increasing blood flow to the heart.
The digital photographs of the contrast material are used to identify the site of the narrowing or blockage in the coronary artery.
Additional imaging procedures, called intra-vascular ultrasound (IVUS) and fractional flow reserve (FFR), may be performed along with cardiac catheterization in some cases to obtain detailed images of the walls of the blood vessels. Both of these imaging procedures are currently only available in specialized hospitals and research centers.
With IVUS, a miniature sound-probe (transducer) is positioned on the tip of a coronary catheter. The catheter is threaded through the coronary arteries and, using high-frequency sound waves, produces detailed images of the inside walls of the arteries. IVUS produces an accurate picture of the location and extent of plaque.
With FFR, a special wire is threaded through the artery and a vasodilator medication is given. This test is functionally performing a very high quality stress test for a short segment of the artery.
What is an interventional procedure?
An interventional procedure (also called angioplasty) is a non-surgical treatment used to open narrowed coronary arteries to improve blood flow to the heart. An interventional procedure can be performed during a diagnostic cardiac catheterization when a blockage is identified, or it may be scheduled after a catheterization has confirmed the presence of coronary artery disease.
Interventional procedures include balloon angioplasty, stent placement, rotablation or cutting balloon.
Will I be awake during the procedure?
Yes. You will be given a mild sedative to relax you, but you will be awake and conscious during the entire procedure. The doctor will use a local anesthetic to numb the catheter insertion site.
Cardiac catheterization is not considered a surgical procedure because there is no large incision used to open the chest, and the recovery time is much shorter than that of surgery. In some cases, surgery may be recommended afterward, depending on the results of the procedure.
Where is the catheterization performed and who performs it?
Cardiac catheterizations are performed in the Cardiac Catheterization Laboratory. Catheterizations are performed by a specially-trained cardiovascular invasive physician and a cardiovascular team of cardiology fellows, nurses and technicians.
How long does the procedure last?
The cardiac catheterization procedure itself generally takes 30 minutes, but the preparation and recovery time add several hours to your appointment time (five to nine hours or longer). Please plan on staying at Cleveland Clinic all day for the procedure.
What are the possible risks?
Your cardiologist will discuss the specific risks and potential benefits of the procedure with you.Some of the possible risks of cardiac cath include:
- Allergic reaction to the medication or contrast material used during the procedure
- Irregular heart rhythm
- Bleeding at the catheter insertion site
- Continued chest pain or angina
- Mild to moderate skin reactions (like a sun-burn) from X-ray exposure
- Kidney failure
- Heart attack, blood clots, stroke or death
- Acute closure of coronary artery
- Emergency coronary artery bypass graft (CABG) surgery
There may be other possible risks. When you meet with your doctor, please ask questions to make sure you understand why the procedure is recommended and what all of the potential risks are.
Preparing for the Procedure
Please discuss all of your allergies with your doctor, especially those listed below.
- IVP Dye/Contrast Agent Allergy, Iodine Allergy
- Latex/Rubber Products Allergy
Discuss your medications with your physician - he or she may want to stop or adjust the doses several days prior to or on the day of the procedure, especially those listed below.
- Anticoagulant Medication
- Diabetes Medications
Blood Work, EKG, Chest X-ray:
Ask your physician if all of the required pre-procedure tests have been completed or are scheduled before your cardiac catheterization procedure.
What to Bring
- We recommend bringing a family member with you to wait with you before the procedure.
- Please bring a robe with you to wear as you wait for the procedure.
- We recommend that you wear comfortable, easy-to-fold clothing.
- You may be admitted to the hospital after the procedure, so pack toiletries and any other items you would like to make your stay more comfortable. Your family member can retrieve these items from your car when you need them. Please leave all valuables at home or with a family member.
- A responsible adult MUST drive you home after the procedure. You will not be discharged unless there is someone available to drive you home.
Instructions for going home after the procedure
A responsible adult MUST drive you home. You will not be discharged unless there is someone available to drive you home.
If you have more than a two-hour drive home, we suggest that you stay overnight in a hotel for your comfort. The Medical Concierge can help you make arrangements. Then have your family member drive you home the next morning, after you have rested.
During your drive home, stop every hour and walk for five to 10 minutes. If you are traveling home by plane, stand up to stretch your legs and walk in the aisle at least every hour.
Please ask your doctor when you can resume driving.
Please ask your doctor if you have any questions about cardiac catheterization.