Heart Catheterization

Your cardiologist may recommend a heart catheterization to diagnose and treat heart disease which may be caused by blocked arteries. This is a common procedure and is performed in a cardiac catheterization laboratory, usually in a hospital. Many blockages can be fixed with angioplasty which typically involves placing a stent which is mounted on a balloon across the blockage. The stent is left behind and the balloon is removed after inflation.

Heart Catheterization Procedure

An Angiogram of Heart Arteries During a Procedure

Magnified View of a Coronary Stent

WHAT HAPPENS BEFORE THE HEART CATHETERIZATION?
  • You will need to arrive to the preparation and recovery area of the catheterization lab a few hours before the scheduled procedure.
  • Do not eat or drink anything after midnight the day before.
  • An IV will be started in your arm so that medications can be given by the nurses for the procedure as well as medicine to help you relax.
  • Labs will be checked to make sure the procedure will be safe for you.
  • The risks and benefits of the procedure will be explained to you, and you should make sure all of your questions are answered before the procedure starts.
WILL I BE ASLEEP?
  • Typically the goal during a heart catheterization is to achieve “Moderate Sedation” where the patient is very relaxed and sometimes sleeps through the procedure though is not “all the way out”.
  • We are not stingy with medication and the goal is to keep you comfortable throughout the procedure so, if you are in any discomfort or anxious, please tell your nurse!
DURING THE PROCEDURE

Numbing medicine will be injected under the skin in the wrist or groin over the artery where a small tube will be inserted (like a large IV). After the initial “bee sting” of the numbing medicine, you should only feel pressure. The remainder of the procedure is generally not uncomfortable. Some things you may feel are:

  • Skipped beats
  • Pressure at the sheath site (wrist or groin)
  • Chest pressure or heaviness during stent placement

You will probably hear the doctors, nurses, and cath lab technicians talking to each other throughout the procedure. This is normal and you can always ask how things are going. You may be able to see some of the pictures of your heart during breaks in the procedure if circumstances allow.

HOW ARE PICTURES TAKEN OF THE HEART?
  • Pictures of the heart arteries are taken using an X-ray camera (fluoroscopy) while contrast dye is injected through a long plastic tube called a catheter directed into the heart arteries (coronary arteries).
  • Your cardiologist will look at the arteries at several different angles to assess for blockages.
  • The pressures inside the heart are often measured and often the pumping function is assessed if needed.
WHAT IF A BLOCKAGE IS FOUND?
  • If a blockage in an artery is found your cardiologist will make a decision as to whether it should and can be fixed with a stent, which is a mesh wire cylinder. If so, a wire is placed across the blockage and a stent mounted on a small balloon is run across.
  • The balloon is inflated to expand the stent and this pushes the blockage material into the wall of the artery. The stent stays behind in the artery like scaffolding to keep the blockage recoiling.
  • Blood thinners are then necessary to prevent blood clots from forming on the stent and are an absolute necessity until your doctor says you can stop them.
  • Most patients stay at least one night in the hospital after a heart stent is placed but in some cases this may not be necessary.
WHAT IF I NEED BYPASS SURGERY?
  • If blocked arteries are found which are too complex or too numerous for stenting to be a safe and durable procedure, bypass surgery may be recommended.
  • Depending on the situation you may be able to meet with the surgeon on another day after you recover from the catheterization. However, in some cases, it is best to stay in the hospital for surgery if necessary in the following days.
  • Typically 4-6 weeks of recovery can be expected.
HOW LONG WILL I NEED FOR RECOVERY FROM A HEART CATHETERIZATION?
  • This varies but in general you can be back to normal activities within a week.
  • If your catheterization is done through the wrist artery it is best to treat the wrist as if it is broken for 3-5 days.
  • Likewise if it is done through the groin artery, we prefer you don’t do any squatting, bending at the waist or heavy exertion for 3-5 days so the artery can heal appropriately.
  • If you receive a stent, we generally advise taking it easy for a week but this can vary depending on your individual circumstances.