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Cardiac catheterization

What is a cardiac catheterization exam?

During a cardiac catheter examination, a thin, flexible plastic tube (cardiac catheter) is pushed through a vessel to the heart. The doctor usually chooses a vessel in the groin or on the wrist. Doctors also call the insertion of the catheter "inserting a cardiac catheter" or "inserting a cardiac catheter". A contrast agent can be injected through the tube in order to make the heart structures and vessels more visible on the X-ray image.

In addition, various parameters (pressures and flow velocities in the heart) can be measured with the aid of the cardiac catheter, which provide information about the working force of the heart muscle. Sometimes a cardiac catheter examination is also used to obtain a tissue sample from the heart (myocardial biopsy).

The heart catheter examination is roughly divided into two procedures - depending on which half of the heart is examined: left heart catheter and right heart catheter.

Left heart catheter (arterial catheter)

The left heart catheter can be used to examine two aspects of the heart in particular:

Coronary angiography

Coronary angiography is the most common reason for a cardiac catheterization. The coronary arteries (coronary arteries) are examined carefully - those vessels that supply the heart with a wreath-like structure around the heart muscle. If the coronary arteries are heavily calcified and thus increasingly narrowed (stenosed), the heart muscle is no longer adequately supplied with blood and oxygen. One then speaks of coronary heart disease (CHD). CHD often manifests itself as typical chest pain or a feeling of tightness or tightness in the chest (angina pectoris). For example, the pain can radiate to the left arm, stomach, shoulder or jaw. The acute occlusion of a coronary artery is known as a heart attack - a life-threatening emergency.

For a coronary angiography, the heart catheter is carefully advanced over the groin or wrist to the heart. The exit of the coronary arteries from the aorta (body artery; originates from the left ventricle) is probed. Then contrast agent is injected into the coronary artery through the catheter and an X-ray film of the heart is taken at the same time (angiography). In this way you can discover any bottlenecks (stenoses).

The narrowed vessel can then be expanded with the help of a balloon inserted into the artery (balloon dilatation) and held open with a stent.

Laevocardiography / ventriculography

In this variant of the cardiac catheter examination, the left ventricle and the function of its heart valves are assessed. For this purpose, contrast agent is injected into the heart chamber while fluoroscopy is taking place at the same time. The doctor can then use the X-ray film to assess the heart's beating power, for example. This cardiac catheter examination is usually performed together with and immediately before a coronary angiography.

Right heart catheter (venous catheter)

With this type of cardiac catheter examination, the focus is on the right half of the heart. You can find out more about this in the article right heart catheter.

When do you do a cardiac catheterization?

There are several reasons for a left heart catheterization exam. Examples are:

  • Coronary heart disease (CHD)
  • Heart attack
  • Congenital heart defects
  • Heart valve diseases (especially before surgery)
  • After a heart transplant
  • Diseases of the heart muscle (cardiomyopathies)
  • Myocarditis

Cardiac catheterization can be dangerous in certain circumstances. Their use must then be carefully considered. This applies, for example, to:

  • Uncontrolled high blood pressure
  • Decompensated heart failure
  • Renal dysfunction
  • Fever / infection
  • Overactive thyroid gland (hyperthyroidism)
  • Contrast agent allergy
  • Uncontrolled coagulation disorder
  • Acute gastrointestinal bleeding
  • pregnancy

Because of this, doctors carefully consider when to perform a cardiac catheterization exam. Because every cardiac catheter procedure should also bring a therapeutic benefit for the patient that exceeds the associated risks.

Examination is important for these diseases

Read here for which diseases the examination can be useful:

What do you do during a cardiac catheterization?

A cardiac catheter examination is usually done in a clinic. Sometimes, in uncomplicated cases, you can have the cardiac catheter examination done on an outpatient basis in a specialized practice.

The procedure takes place in the cardiac catheter laboratory, similar to an operating room. It is carried out by specially trained, so-called interventional cardiologists (specialists in heart diseases).

Before the cardiac catheter examination, the attending physician will explain the procedure in detail and discuss possible risks and complications with you. In addition, the doctor will ask you about any previous illnesses (especially of the thyroid gland and kidneys) and ask whether you are taking any medication. You may have to stop taking these (e.g. anti-coagulant preparations) before the examination. Preparation also includes an EKG and routine laboratory blood tests. The doctor will also examine you physically and collect current blood pressure values. You should be on an empty stomach for at least six hours before the cardiac catheterization.

Cardiac catheterization: procedure

For the cardiac catheterization, an intravenous line will be placed on your arm so that medication can be administered quickly in an emergency. In the cardiac catheterization laboratory, you are then placed on the examination table so that the doctor can work well with the C-shaped X-ray arch. A continuous ECG and blood pressure measurement is connected, and a finger clip measures the oxygen content in the blood. The groin or arm is then disinfected and locally anesthetized for the vascular puncture - general anesthesia is not necessary.

The vessel is then punctured using the so-called Seldinger technique. With a left heart catheter, the doctor pierces an artery, usually the radial artery on the wrist (today's standard) or the femoral artery in the groin. After the puncture, a sheath is inserted through which various wires and fine tubes are pushed over the vessel to the heart. The doctor can then use the X-ray machine to assess the position of the catheter. The examination is not painful. Sometimes patients feel a slight tugging or a warm feeling when the contrast agent is injected.

Cardiac catheterization: duration

The duration of the examination depends very much on the circumstances. It takes about 30 minutes, but it can also take a lot longer. If a pure angiography is performed, one is usually finished faster than if one or more stents are implanted.

When the cardiac catheter examination is over, the catheter and the sheath are removed. To avoid rebleeding, the area must then be closed for several hours. Doctors usually use special pressure bandages for this. If a vessel has been punctured in the groin, patients must also remain in bed for the first few hours and stretch their legs.

Many people are very excited because of the procedure so close to their hearts. In this case, you can be given a light sedative before the examination begins.

What are the risks of a cardiac catheter examination?

Complications are possible with a cardiac catheter examination: Although now a frequently used routine procedure, a cardiac catheter examination also carries risks. Serious complications, however, are rare and occur mainly in emergency patients. Possible complications are, for example:

  • Perforation of the heart ("perforation")
  • Heart attack
  • Arrhythmia
  • Reduced blood flow in the brain (cerebral ischemia)
  • Pulmonary embolism
  • Acute kidney failure
  • Contrast agent allergy
  • Complications at the puncture site (bleeding, inflammation, nerve damage)
  • Expansion or closure of the punctured vessel
  • Wound healing disorder

In only a very few cases, a cardiac catheter examination is fatal. Cardiac catheter risks with puncture in the groin are greater than with puncture on the wrist.

More about the symptoms

The examination can be useful if the following symptoms occur:

What do I have to consider after a cardiac catheter examination?

After completing the cardiac catheterization examination, it is particularly important that you remain in bed for the time being. This will prevent secondary bleeding. This is especially true if a vessel has been punctured in the groin. In addition, you should not drive a car for 24 hours afterwards. In the first few days after the examination, you should not carry heavy loads and avoid excessive exertion. Depending on the extent of the procedure, you may need to stay in the hospital for a few more days for monitoring - for example if during Cardiac catheterization a stent has been implanted.

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