Before the procedure
Once you have checked in for your catheterization, you'll have your blood pressure and pulse checked. You'll be asked to use the toilet to empty your bladder.
You'll be asked to remove dentures and may need to remove jewelry, especially necklaces that could interfere with pictures of your heart. You'll wait in a pre-operating room until it's time for your procedure — you can often have someone wait there with you.
During the procedure
Cardiac catheterization is done in an operating room that has special X-ray and imaging machines that normal operating rooms don't have.
Cardiac catheterization is usually performed while you're awake, but sedated. However, certain procedures, such as ablation, valve repair or valve replacement, may be performed under general anesthesia.
An IV line will be inserted in your hand or arm, and will be used to give you any additional medications you might need during your procedure. You will also have monitors (electrodes) placed on your chest to check your heartbeat during the test.
Just before the procedure, a nurse or technician may shave the hair from the site where the catheter will be inserted. Before the catheter is inserted in your artery, you'll be given a shot of an anesthetic to numb the area. You may feel a quick, stinging pain before the numbness sets in.
After you feel numb, the catheter will be inserted. A small cut is made, if your leg is being used, to access an artery. A plastic sheath will be inserted in the cut to allow your doctor to insert the catheter.
What happens next depends on why you're having a cardiac catheterization. These are some of the common uses for cardiac catheterization:
- Coronary angiogram. If you're having this test to check for blockages in the arteries leading to your heart, a dye will be injected through the catheter, and X-ray images of your heart arteries will be taken. In a coronary angiogram, the catheter is usually first placed in the artery in your groin or wrist.
- Right heart catheterization. This procedure checks the pressure and blood flow in the right side of your heart. For this procedure, the catheter is inserted in the vein in your neck or groin. The catheter has special sensors in it to measure the pressure and blood flow in your heart.
Heart biopsy. If your doctor is taking a sample of heart tissue (biopsy), the catheter will usually be placed in the vein in your neck. Less often, it may be placed in your groin. A catheter with a small, jaw-like tip is used to obtain a small sample of tissue from your heart.
You may feel pressure as this catheter is being used, but you likely won't feel the actual tissue being snipped.
Balloon angioplasty, with or without stenting. This procedure is used to open a narrowed artery in or near your heart. The catheter can be inserted in either your wrist or groin for this procedure.
A long, flexible catheter will be threaded through your arteries to the narrowed artery. Then, a smaller balloon catheter will be fed through the flexible catheter and inflated at the narrowed area to open it. In many cases, your doctor will also place a mesh coil called a stent at the narrowed portion to help keep the artery open.
- Repair of heart defects. If your doctor is closing a hole in your heart, such as an atrial septal defect or patent foramen ovale, you will probably have catheters inserted in both the arteries and veins of the groin and neck. A device is then inserted into your heart to close the hole. In cases of heart valve leak repair, a clip or plug may be used to stop the leak.
Balloon valvuloplasty. This procedure is done to open up narrowed heart valves. The placement of your catheters will depend on which valve problem you have.
A catheter is threaded across the valve. A balloon is then blown up to make the valve open more easily. You may feel pressure as the catheters are inserted into your body, but you shouldn't feel discomfort from the balloon treatment itself.
- Valve replacement. This procedure is similar to ballon valvuloplasty, except that an artificial valve will be implanted in your heart to replace a leaky or narrowed heart valve.
- Heart ablation. In this procedure, you'll usually have multiple catheters placed in the arteries and veins of your groin or neck so that radiofrequency energy can be directed to the part of your heart causing abnormal heartbeats.
If you're awake during the procedure, throughout the procedure you may be asked to take deep breaths, hold your breath, cough or place your arms in various positions. Your table may be tilted at times, but you'll have a safety strap on to keep you on the table.
Threading the catheter shouldn't be painful, and you won't feel it moving through your body. Tell your health care team if you have any discomfort.
After the procedure
It usually takes several hours to recover from a cardiac catheterization. After your procedure is finished, you'll be taken to a recovery room while the anesthesia wears off. This usually takes about an hour. The plastic sheath inserted in your groin, neck or arm will be removed soon after the procedure unless you need to continue on blood-thinning medication.
After you leave the recovery room, you'll go to a regular hospital or outpatient room. After your catheter is removed, the technician or nurse who has removed your sheath will apply pressure to the insertion sites. If the groin is used, you'll need to lie flat for several hours after the procedure to avoid serious bleeding and to allow the artery to heal.
You'll be able to eat and drink after the procedure. The length of your stay in the hospital will depend on your condition. You may be able to go home the same day as your catheterization, or you may need to stay overnight or longer if you have an additional procedure, such as angioplasty and stent placement.