What you can expect

Before the procedure

Before a cardiac catheterization, you will likely have your blood pressure and pulse checked. You may be asked to use the toilet to empty your bladder.

You may be asked to remove dentures and any jewelry, especially necklaces that could interfere with pictures of the heart.

Sticky patches (electrodes) will be placed on your chest to monitor your heartbeat before, during and after the procedure.

A nurse or technician may shave the hair from the site where the catheter will be inserted.

During the procedure

Cardiac catheterization is usually done in the hospital in a room with special X-ray and imaging machines. Like an operating room, the cardiac catheterization lab is a sterile area.

A specialist will insert an IV into your forearm or hand and give you a medication called a sedative to help you relax. The amount of sedation needed for the procedure depends on your health conditions and why you're having the procedure. You may be fully awake or lightly sedated, or you may be given general anesthesia (fully asleep).

During cardiac catheterization, one or more catheters are passed through a blood vessel in the groin, wrist or neck, depending on the reason for the procedure, and guided to the heart.

The area where the catheter will be inserted is numbed, and then a small cut is made to access the blood vessel. A plastic sheath is passed into this opening 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. During this test to check for blockages in the arteries leading to the heart, a dye is injected through the catheter, and X-ray images of the heart arteries are taken. The dye helps blood vessels show up more clearly on the X-ray images. In a coronary angiogram, the catheter is usually first placed in the artery in the groin or wrist.
• Cardiac ablation. In this procedure, a doctor uses heat or cold energy to create tiny scars in your heart to block abnormal electrical signals and restore a normal heartbeat.
• Right heart catheterization. This procedure checks the pressure and blood flow in the right side of the heart. A catheter is inserted in the vein in the neck or groin. The catheter has special sensors in it to measure the pressure and blood flow in your heart.

• Balloon angioplasty, with or without stenting. This procedure is used to open a narrowed artery in or near the heart. The catheter can be inserted in either the wrist or groin for this procedure.

  The catheter is guided to the narrowed artery. Then, a smaller balloon catheter is inserted through the flexible catheter and inflated at the narrowed area to open it. Often, the doctor will also place a mesh coil called a stent at the narrowed part to help keep the artery open.

• Heart biopsy. If the doctor is taking a sample of heart tissue (biopsy), the catheter will usually be placed in the vein in the neck. Less often, it may be placed in the groin. A catheter with a small, jaw-like tip is used to obtain a small piece of tissue from the heart.
• Repair of congenital heart defects. If the doctor is closing a hole in the heart, such as an atrial septal defect or patent foramen ovale, catheters may be inserted in both the arteries and veins of the groin and neck. A device is then inserted into the heart to close the hole.
• Balloon valvuloplasty. This procedure is done to widen a narrowed heart valve. The placement of the catheters depends on the specific type of heart valve problem. A catheter is threaded across the valve. A balloon is then inflated to make the valve open more easily.
• Heart valve replacement. A catheter is used to implant an artificial valve in the heart to replace a narrowed heart valve. For example, a procedure called transcatheter aortic valve replacement (TAVR) uses a catheter to replace a faulty aortic heart valve.

If you're awake during a cardiac catherization procedure, you may be asked to take deep breaths, hold your breath, cough or place your arms in various positions throughout the procedure. The 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 shouldn't feel it moving through your body. Tell your doctor or nurse if you have any discomfort.

After the procedure

You'll likely spend several hours in a recovery room after the procedure while the sedation wears off.

After you leave the recovery room, you'll usually be moved to a regular hospital or outpatient room. After your catheter is removed, a technician or nurse will apply pressure to the insertion sites. If the catheter was placed in the groin area, you may need to lie flat for several hours after the procedure to avoid serious bleeding and to allow the artery to heal.

How long you need to stay in the hospital depends on your overall health and the reason for the catheterization.

The area where the catheter was inserted may feel sore for a few days. Tell your doctor if you have any bleeding or new or increased swelling or pain at or near the access site.