Right Heart Catheterization

What is right heart catheterization?

Right heart catheterization is an invasive test that can show how well your heart is pumping. It measures blood pressure and oxygen in your lungs and the right side of your heart. It’s also called pulmonary artery catheterization. You may hear it referred to as a Swan-Ganz catheter.

To perform the test, your healthcare provider will use a thin, flexible tube called a catheter. They'll insert the catheter into a blood vessel in your neck, groin or arm. Then they'll thread it through the right side of your heart into your pulmonary artery, the main artery that carries blood to your lungs.

What is the purpose of a right heart catheterization?

Healthcare providers use right heart catheterization to diagnose and manage many conditions, including:

• Cardiogenic shock.
• Cardiomyopathy.
• Congenital heart disease.
• Heart failure.
• Heart valve disease.
• Pulmonary hypertension.

You may also need right heart catheterization before or after organ transplantation or placement of a left ventricular assist device.

What's the difference between right and left heart catheterization?

Right heart catheterization and left heart catheterization have important differences.

For right heart catheterization, your healthcare provider threads the catheter through a vein into the right side of your heart. For left heart catheterization, your provider threads the catheter through an artery (femoral, brachial or axillary artery) to the left side of your heart.

Right heart catheterization measures pressure in your right atrium, right ventricle and pulmonary artery. Left heart catheterization measures pressure in your left ventricle, assesses your aorta and aortic valve, and checks your coronary arteries for blockages. The procedure is often called cardiac catheterization or coronary angiography.

Who performs right heart catheterization?

Right heart catheterization occurs in a cardiac catheterization laboratory, or “cath lab.” It’s performed by a team of professionals, usually led by an advanced heart failure cardiologist or an interventional cardiologist.

How do I prepare for right heart catheterization?

Your healthcare provider will give you specific instructions on how to prepare. Instructions may include:

• Tell your healthcare team about all medications you’re taking. This includes prescriptions, supplements and over-the-counter drugs. You may have to stop taking some for a short while, such as blood thinners (anticoagulants).
• Plan for someone else to drive you home afterward.
• Take off any jewelry and nail polish.
• Do not eat or drink anything for six to 12 hours beforehand.

What can I expect before a right heart catheterization procedure?

Just before the procedure, your healthcare provider will:

1. Ask you to change into a hospital gown and empty your bladder.
2. Instruct you to lie down on an exam table.
3. Attach small patches called electrodes to different areas on your chest to record your heart’s activity.

Most of the time, right heart catheterization is such a quick procedure that it doesn’t require sedation. In some cases, however, you may need an IV inserted into a vein in your arm to deliver fluids and sedative medications.

What can I expect during a right heart catheterization procedure?

Right heart catheterization takes about an hour. But the entire process, including preparation and recovery, can take several hours.

You’ll be awake during the procedure. Your healthcare provider will:

1. Clean and shave the area where the catheter will enter your body (groin, arm or neck).
2. Administer a local anesthetic to numb the area.
3. Use a special needle or cutting tool to puncture the blood vessel where the catheter will enter. This may be the femoral vein in your leg, jugular vein in your neck or a vein in your arm.
4. Insert the catheter, and slowly advance it to different positions in your heart and blood vessels.
5. Take measurements or tissue samples as needed.
6. Ask you to hold still, change positions or breathe in certain ways.
7. In certain cases, your healthcare provider may ask you to exercise (use a foot pedal) during the test to see how the pressure in your heart responds.
8. Administer IV medications to see how your heart responds.
9. Remove the catheter, and close the incision.

What can I expect after right heart catheterization?

After the procedure, your healthcare team will remove the electrodes and IV. They’ll move you into a recovery room, where your team will monitor:

• Bleeding.
• Blood pressure.
• Heart rate.
• Temperature.

What is the recovery time after right heart catheterization?

Your healthcare team will monitor you for a couple of hours. Most people can go home after that, but you may need someone else to drive you home. If the test shows a severe problem, you may have to stay at the hospital for additional tests or treatments.

Does right heart catheterization hurt?

Throughout the procedure, tell your healthcare provider what you’re feeling. You may experience some pain from the injection to numb the area and when the catheter goes in. You may also experience:

• Flutters in your chest or skipped heartbeats when the catheter touches the walls of your heart.
• Headache.
• Lightheadedness.
• Nausea.
• Pressure as the catheter moves through your veins.
• Urges to cough.
• Warmth or flushing from medications.

What are the risks of right heart catheterization?

Right heart catheterization is generally safe. But it's an invasive procedure with certain risks, including:

• Allergic reactions to medications or materials.
• Arrhythmia.
• Artery damage.
• Bleeding or bruising at the insertion site.
• Blood clots.
• Cardiac tamponade, heart attack or stroke.
• Infection.
• Collapsed lung.

When should I know the results of right heart catheterization?

Your healthcare provider will likely talk to you about the results before you go home, or you’ll schedule a follow-up appointment.

How can I take care of myself after right heart catheterization?

Your healthcare provider will give you specific instructions on how to take care of yourself after right heart catheterization. They may ask you to:

• Avoid bending, lifting, pushing or pulling for several hours or days.
• Avoid using heavy machinery, including a car, if you received a sedative.
• Drink plenty of fluids.
• Keep the bandage on the insertion site for one or two days.
• Put an ice pack on the area to reduce soreness or swelling.
• Wait to shower for 24 to 48 hours after the procedure. Don’t take baths until the incision completely heals. Pat the incision dry rather than rub it.

When should I call my doctor after right heart catheterization?

After right heart catheterization, seek medical attention if you experience:

• Bleeding or a lump at the catheter site.
• Fast or irregular heartbeat.
• Leg, arm or hand that hurts, looks blue, feels cold or seems numb.
• Loss of consciousness.
• Signs of a heart attack: chest pain or pressure, excessive sweating and shortness of breath.
• Signs of infection: fever or red streaks, pus, swelling or warmth near the insertion site.

A note from Cleveland Clinic

Right heart catheterization is a test that evaluates pressures in your right atrium, right ventricle and pulmonary artery. It can help healthcare providers diagnose and manage several conditions. Your healthcare provider will explain why you need the test, how to prepare and what the results mean.