Understanding

Cardiac Catheterization

How the Heart Works

■

Diagnosing and
■

Treating Coronary
Artery Disease
Diagnosing Heart
■

Valve Disease
 Looking into Your Heart Problem
Your may have signs or symptoms of heart trouble. Or, test results
may suggest that you have a heart problem such as coronary artery
disease (CAD) or valve disease. Left untreated, these conditions can
lead to a heart attack or heart failure. The good news is that cardiac
cath (catheterization) can help to confirm, and in many cases treat,
heart problems. Keep reading to learn how cardiac cath can help your
doctor form a treatment plan that’s right for you.

Signs of Heart Trouble

Your doctor may suspect that you have a
heart problem because:
■ You have angina. Angina can be a painful
or uncomfortable feeling in or near the
chest. It is a symptom of coronary
artery disease.
■ Stress testing indicates a problem
with your coronary arteries. A stress
ECG, echocardiogram, or nuclear
scan can show problems that occur
when the heart works harder.
■ You have symptoms of heart valve
or heart muscle problems. These
symptoms include weakness, dizziness,
shortness of breath, and swollen legs,
ankles, or feet.
■ An echocardiogram shows heart
valve or heart function problems.
This ultrasound of the heart can show
some details of the heart structure.

Angina often occurs during activities

that make the heart work harder, such
as climbing stairs.

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Diagnosing Heart Problems with Cardiac Cath
Cardiac cath is a common nonsurgical procedure. It is done using
a catheter (a long, thin, flexible tube). The catheter is inserted into
a blood vessel and guided to the heart. This allows your doctor to
gather information about the coronary arteries and the structure and
function of the heart. It’s also the first step in certain procedures to
improve heart function. Cardiac cath can:
■ Show whether the blood vessels supplying the heart muscle are
narrowed or blocked.
■ Show whether the heart is pumping normally and blood is flowing
properly through the heart.
■ Help your doctor to form a treatment plan based on test results.
■ Make treatment of certain heart problems possible.
■ Rule out certain heart problems.

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 How the Heart Gets Oxygen
The heart is a muscle that pumps blood throughout
the body. Like other muscles, the heart needs a steady
supply of oxygen to function. Blood carries oxygen
to the heart and the rest of the body through blood The lumen is the
vessels called arteries. In the heart, the coronary channel where
the blood flows.
arteries supply blood and oxygen to the heart
muscle. If the heart doesn’t get enough oxygen, The intima is the
smooth lining of
angina or a heart attack can result. the artery.

Healthy Coronary Arteries

Coronary arteries wrap around the surface of
the heart. Their job is to supply the heart muscle
with oxygen-rich blood. The amount of oxygen
the heart needs depends on how hard it’s
working. For example, exercise makes the heart
beat faster, increasing the muscle’s need for
oxygen. Healthy arteries can easily meet this
need. They have smooth, flexible walls that can
accommodate changes in blood flow.

Heart

Lungs The left main

coronary artery
divides into two
branches, described
below.
The circumflex
coronary artery
supplies blood to the
back and left side of
the heart.
The right coronary
artery supplies The left anterior
blood to the right descending
side and bottom coronary artery
of the heart. supplies blood to
the front and left
side of the heart.

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Coronary Artery Disease
Coronary artery disease starts when the lining
of a coronary artery is damaged. This is often
due to risk factors, such as smoking or high
blood cholesterol. Plaque (a fatty material
composed of cholesterol and other particles) Plaque Forms
The lining of the
then builds up within the artery wall. This artery is damaged. This
buildup (called atherosclerosis) narrows the allows plaque to form
between the layers of
space inside the artery. It also makes artery the artery wall.
walls less able to expand. At times when the
heart needs more oxygen, not enough blood The Artery Narrows
Plaque narrows the
can get through to meet the need. This can channel where blood
lead to angina. flows. The artery can’t
meet increased demands
for blood. This can lead
to angina.
Plaque Ruptures
Plaque deposits sometimes
rupture. A rupture can narrow
the artery even more. It can
also cause a blood clot to form.
This is part of the body’s
healing process, but
it can also be dangerous.

A Blood Clot Blocks the Artery

If a blood clot cuts off blood
flow in the narrowed artery,
angina or a heart attack results.

Heart Attack
A heart attack (myocardial infarction) 
occurs when a coronary artery is
blocked by plaque or a blood clot.
When this happens, the heart muscle
beyond the blockage doesn’t receive
enough oxygen. That part of the heart
muscle begins to die. This damage
cannot be reversed. Though many
Blocked people survive heart attacks, a heart
artery
attack can be deadly.
Damaged
heart
muscle

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 How the Heart Pumps Blood
The heart is a system of chambers and valves that keep blood moving
in the correct direction. The heart muscle squeezes (beats) to move
blood in and out of the heart’s four chambers. (These chambers are
called ventricles and atria.) Four valves open and close to keep
blood moving in the proper direction through the heart.

Valves Direct Blood

Through the Heart Aorta
(to body)
With each heartbeat, valves open Pulmonary
and close. This moves blood in trunk
Aortic
the correct direction. (to lungs)
valve
■ Oxygen-poor blood is
pumped from the right atrium
through the tricuspid valve Left
Pulmonic
atrium
into the right ventricle. It is valve
then pumped through the Right atrium Mitral
pulmonic valve to the blood valve

vessel that leads to the lungs. Left

Tricuspid
There, it picks up oxygen and valve ventricle
returns to the heart through
the pulmonary veins. Right ventricle
■ Oxygen-rich blood is
pumped from the left atrium
through the mitral valve into
the left ventricle. It is then Oxygen-poor blood (blue arrows) is pumped
pumped through the aortic to the lungs. Oxygen-rich blood (red arrows)
valve to the aorta, so it can is pumped to the rest of the body.
travel to the rest of the body.

A valve opens A valve closes to

to let blood keep blood from
move forward. leaking backward.

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Valve Problems
Valve disease occurs when a valve doesn’t open or close properly.
When this happens, the heart has to work harder to move the same
amount of blood. Over time, this can cause the heart muscle to tire
and weaken, leading to heart failure.

Narrowed valve Leaky valve

Problems Opening (Stenosis) Problems Closing (Insufficiency)

Stenosis (also called valvular narrowing) Insufficiency (also called regurgitation)
occurs when a valve doesn’t open all the occurs when a valve doesn’t close tightly
way. Scarring or deposits of calcium can enough. A valve may have extra tissue, or
make a valve stiff and hard to open. This be loose or shortened. Or the structures
means that blood has to flow through a that support the valve may be torn. When
smaller opening. So the heart muscle has this happens, blood leaks backward through
to work harder to push blood through. the valve. The heart has to move some of the
Stenosis can get worse over time. same blood over again. Insufficiency can
also worsen over time.

Other Heart Structure Conditions

In addition to CAD and valve problems, cardiac cath is used to diagnose
other types of heart problems. These include heart muscle problems and
congenital heart problems.

Heart Muscle Problems Congenital Heart Problems

The heart muscle can weaken for many Most heart problems develop as people
reasons. A weakened heart loses the ability age. But some people are born with heart
to pump enough blood to the rest of the problems (congenital heart disease).
body. This is called heart failure. If you These problems include structural ones
have heart failure, cardiac cath may be such as a hole between two of the heart’s
used to find the cause so that the chambers. Cardiac cath can be used to
underlying problem can be treated. find out how a congenital problem is
affecting heart function.
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 Cardiac
Catheterization
During this procedure, catheters are
inserted into the coronary arteries and
chambers of the heart. This allows your
doctor to take pictures of the coronary
arteries and do tests inside the heart.
Based on the results, your doctor may
advise procedures to correct your heart
problem. Prepare for cardiac cath as
directed by your healthcare provider.

Preparing for the Procedure

■ Take medication as prescribed by your
doctor. He or she may prescribe new
medications or ask you to stop taking
certain medications before cardiac cath.
■ Do not eat or drink after the midnight
before the procedure.
■ Arrange for a ride home after the
procedure. Pack a bag in case you
need to stay in the hospital overnight.
■ Read and sign the consent form.
Be Sure to Tell Your Doctor:
About any medications you take.
Possible Risks ■

Include herbs, supplements, or

Any procedure involves some risk. over-the-counter medications.
Although complications of cardiac cath
are rare, risks may include: If you are allergic to iodine or
■

any medications. The x-ray dye

■ Bleeding from or infection of the used during the procedure
catheter insertion site contains iodine. If needed, you
■ Allergic reaction to the x-ray dye will be given medication to help
prevent an allergic reaction.
■ Abnormal heartbeat (arrhythmia)
If you are pregnant or think you
■
■ Tearing of the artery lining
could be pregnant. Cardiac cath
■ Kidney damage or failure may need to be postponed until
■ Heart attack, stroke, or death (very rare) after the baby is born.
■ The need for emergency cardiac
surgery (very rare)

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Before the Procedure
You’ll be taken to a prep room, where
you can change into a hospital gown. You
may be in the lab for a few hours, so
you’ll be asked to empty your bladder
and bowels. An IV line will then be
started. Medication or fluid may be given
through this line. Hair may be removed
from the area where the catheter is
inserted. Then you’ll be taken to the
cath lab.

In the Cath Lab

Once in the cath lab, you’ll lie on an x-ray
table. You will be given a sedative to help you
relax. You may remain awake throughout
the procedure:
■ The skin in the area of the insertion site is
numbed. An introducing sheath is inserted
into an artery in the groin, arm, or wrist.
The sheath remains in place during the
entire procedure.
Arm
■ If you are having a right-heart cath, a sheath insertion
site
will also be placed in a vein in the same area.
(Veins are blood vessels that carry blood back
to the heart.) Wrist
insertion
■ A catheter is slid over a guide wire. The guide site
wire is then inserted into the sheath and
threaded through the blood vessels to the
heart. Since blood vessels have no pain nerves,
you won’t feel this. Groin
insertion
■ The guide wire is removed, leaving the catheter site
in place.
Catheter
■ During the procedures that follow, the guide
wire and catheter may be removed and replaced
several times. This is done to reach each of the
coronary arteries or heart chambers.

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 Viewing and Treating Coronary Arteries
Angiography involves taking x-ray pictures of blood vessels. These
x-rays can show the location and severity of blockages in the vessels.
This can help in forming a plan to open or bypass these blockages.

Coronary Angiography
Coronary angiography is a way
of taking x-ray pictures of the
arteries in the heart. X-ray dye is
injected into the arteries through
the catheter. This allows them to
show up on x-rays. You may feel a
warm flush as the dye reaches your
bloodstream. Several images are
then taken, showing the locations
of any blockages. Your doctor may
ask you to hold your breath or to
cough. As pictures are taken, the
lights may be dimmed and you
may hear the noise of the camera.

Angiography Results
After the procedure, your doctor
will discuss the results with you.
This may occur while you’re still on
the table or after you’ve been moved
to another area. In many cases,
angioplasty and stenting can be
used to improve blood flow. These
procedures may be done right away
or scheduled for a later date. But
depending on factors, including
the number and locations of
blockages, your doctor may advise
coronary artery bypass surgery Narrowing in the artery is
instead. This surgery will be shown in the circle above.
planned for a future date.

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Procedures to Open Arteries
These procedures are done using
catheters and are often performed
right after angiography. The most
common are:
■ Balloon angioplasty. The catheter
is used to insert a special balloon into
the artery. The balloon is inflated and
deflated one or more times to open the
artery. This is often followed by place-
ment of a stent.
■ Stenting. A wire mesh tube (stent)
is inserted into the artery to hold it
open. This device is left in the artery
permanently. Your doctor may advise
using a drug-eluting stent. This is a
stent that releases medication over time
to help keep scar tissue from forming A balloon flattens plaque A stent is permanently
as the artery heals. This may prevent a against the artery walls placed in the artery to
new blockage from forming in the during balloon angioplasty. hold it open.
same place (restenosis).

Surgery to Bypass Blockages Bypass

Bypass surgery may be advised when grafts
blockages can’t be opened with angioplasty
or when angioplasty is not the best treat-
ment. This surgery will most likely be
scheduled at a later date. Bypass surgery
creates a new route around the blockages
in the arteries. This allows increased
blood flow to areas of the heart that
haven’t been getting enough blood.
For this surgery, a blood vessel from
the leg, arm, or chest is used to make
each bypass.

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 Diagnosing Heart Structure Problems
With cardiac cath, tests can be done to measure pressures within
the heart. If needed, ventriculography (x-ray pictures of the left
ventricle) is performed. This information helps your doctor
evaluate and treat valve and heart muscle problems.

Heart Structure Tests

Cardiac cath is used to perform tests of heart
structure and function:
■ Direct pressure measurement. Instruments Catheter
are used to measure pressures within the
heart. These pressure measurements show Aorta
whether blood is flowing properly through
the valves. They also show whether the heart
Left
muscle is pumping correctly. Both sides of ventricle
the heart will most likely be tested. For a
right-heart cath, a catheter is guided through
a vein to the right side of the heart. For a
left-heart cath, a catheter is guided through
an artery to the left side of the heart. This ventriculogram shows a left
ventricle at the start of a
■ Ventriculography. X-ray pictures are taken contraction.
of the left ventricle, the heart’s main pumping
chamber. X-ray dye is injected through the
catheter into the left ventricle. This chamber
then shows up on an x-ray. You will feel a
warm flush as the dye is injected.

Test Results
Your doctor will recommend a treatment plan
based on test results. Most valve problems do
not need immediate treatment. Depending on
the type of heart problem and how severe it is,
your doctor may suggest:
■ Medication to help control the problem
and relieve symptoms.
■ A catheter procedure to open a valve A prosthetic (substitute) valve can be placed in
(valvuloplasty). the valve opening and anchored in position.
■ Surgery to repair or replace a valve.

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After Catheterization
If you only had testing done, you may be able to leave the
hospital within 2 to 8 hours. If angioplasty, stenting, or other
treatments were performed, you may stay overnight. In either
case, you will be sent home once your condition is stable.

Closing the Insertion Site

The sheath in your groin, wrist, or arm
will be removed, and the insertion site
closed. This may be done while you are
still in the cath lab. Or, it may be done
after you have been moved to a hospital
room. You may need to keep still, with
your leg or arm straight, for 2 to 6 hours.
How long depends partly on the insertion
site and the type of closure performed.
During this time you may not be able to
get up to go to the bathroom. Staff will
help you keep comfortable while you rest.

Monitoring Your Condition

You will be closely monitored until
you’re ready to go home. Your pulse and
blood pressure will be checked often. Be
sure to tell the nurse or doctor if you
have angina or any other symptoms. The
IV line will remain in place until shortly
before you leave. Your blood may be
tested to assess your condition. You may
also have an electrocardiogram (ECG).

Going Home
You can go home when:
■ The insertion site is not bleeding.
■ You can urinate.
■ Your doctor has reviewed your condition
and given his or her okay.

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 Recovering at Home
Depending on the procedures done, you may go home the same day or
stay overnight. Follow your doctor’s instructions on homecare. Depending
on the results of the tests, you may need follow-up treatment. Make an
appointment with your doctor to discuss the next steps.

At Home
You can resume most normal activities soon When to Call Your Doctor
after the procedure. Be sure to: In the 2 weeks after cardiac cath,
■ Take medications as directed by your call your doctor if you notice any
doctor. This is crucial to the success of of the following:
the procedure. ■ The insertion site is increasingly
■ Shower or take sponge baths for a few days painful, swollen, red, warm to the
if your insertion site was in the groin. touch, or is draining.
Don’t swim or soak in a tub. ■ The insertion site is bleeding.
■ Avoid lifting anything over 10 pounds ■ You have fever.
for at least 3 days. Your doctor can give
you more specific guidelines. ■ You have angina.
■ Avoid strenuous activities for about a ■ You can’t urinate, or you have
week. Ask your doctor when you can blood in your urine.
resume driving, exercise, and sex. ■ You have severe pain, coldness,
■ Talk with your doctor about when you or a bluish color in the leg or arm
can return to work. where the catheter was inserted.
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Your Follow-Up
Diagnosing your heart problem is the first step in forming a treatment
plan. The goal of this plan is to help you stay healthy and active. After
seeing your test results, your doctor may recommend further procedures
or surgery. Or you may be able to control your heart problem with
medications and lifestyle changes.

Procedures and Testing

Your doctor may recommend surgery to
correct a valve or artery problem. Or you may
need no treatment at this time. In either case,
you may need to have blood tests and heart
function tests from time to time. Talk with
your doctor about what kinds of tests you’ll
need, and how often.

Taking Care of Your Heart

Your doctor will most likely prescribe
medications for your heart. Depending on
the type of heart problem you have, he or she
may also suggest lifestyle changes. To take
good care of your heart:
■ Take medications as directed. Medications
can help the heart work better and relieve
symptoms. Taking them correctly reduces
the risk of heart attack or heart failure.
■ If you smoke, quit. Smoking and other
forms of tobacco use harm the blood vessels
and heart. Ask your healthcare provider for
help in quitting.
■ Exercise. Frequent moderate exercise can
improve fitness. Talk with your doctor about
how to exercise safely.
■ Learn to manage related conditions.
Diabetes, high blood pressure, high cholesterol,
and obesity can harm your heart health. Your
doctor, a dietitian, and other specialists can
help you learn how to better control
these risk factors.

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Procedure Checklist
Follow any instructions given to you by your doctor. Before the
procedure, be sure to:

■ Discuss your medications with ■ Do not eat or drink after the midnight
your doctor. before the procedure.
■ Ask your doctor what kinds ■ Pack a bag in case you need to stay
of treatment may be possible in the hospital overnight.
depending on the results of ■ Arrange for a ride home after
cardiac cath. the procedure.
■ Read and sign the consent form.

This product is not intended as a substitute for professional medical care.

Only your doctor can diagnose and treat a medical problem.
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