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Cardiac Catheterization and Coronary Angiography

By

Thomas Cascino

, MD, MSc, Michigan Medicine, University of Michigan;


Michael J. Shea

, MD, Michigan Medicine at the University of Michigan

Reviewed/Revised Dec 2023
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Cardiac catheterization is a procedure that can measure heart function through a catheter inserted into a vein or artery and guided into the heart. Coronary angiography, which can be done during cardiac catheterization, is a type of medical imaging that uses x-rays and a contrast agent to produce images of blood vessels that feed the heart (coronary arteries).

Cardiac catheterization and coronary angiography are minimally invasive methods of studying the heart and the blood vessels that supply the heart (coronary arteries) without doing surgery. These tests are usually done when noninvasive tests Introduction to Diagnosis of Heart and Blood Vessel Disorders Sometimes, medical history and physical examination alone suggest to a doctor that the person has a heart or blood vessel disorder. However, special diagnostic procedures are often needed to... read more do not give sufficient information, when noninvasive tests suggest that there is a heart or blood vessel problem, or when a person has symptoms that make a heart or coronary artery problem very likely. One advantage to these tests is that during the test, doctors can also treat various diseases, including coronary artery disease Overview of Coronary Artery Disease (CAD) Coronary artery disease is a condition in which the blood supply to the heart muscle is partially or completely blocked. The heart muscle needs a constant supply of oxygen-rich blood. The coronary... read more Overview of Coronary Artery Disease (CAD) .

More than a million cardiac catheterizations and angiographic procedures are done every year in the United States. They are relatively safe, and complications are rare. With cardiac catheterization and angiography, the chance of a serious complication—such as stroke Overview of Stroke A stroke occurs when an artery to the brain becomes blocked or ruptures, resulting in death of an area of brain tissue due to loss of its blood supply (cerebral infarction). Symptoms occur suddenly... read more , heart attack Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) Acute coronary syndromes result from a sudden blockage in a coronary artery. This blockage causes unstable angina or a heart attack (myocardial infarction), depending on the location and amount... read more Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina) , or death—is 1 in 1,000. Fewer than 1 in 10,000 people undergoing these procedures die, and most of those who die already have a severe heart disorder or other disorder. The risk of complications and death is increased for older adults.

Cardiac Catheterization

This procedure is the only way to measure directly the pressure of blood in each chamber of the heart and in the major blood vessels going from the heart to the lungs.

In cardiac catheterization, a thin catheter (a small, flexible, hollow plastic tube) is inserted into an artery or vein in the neck, arm, or groin/upper thigh through a puncture made with a needle. A local anesthetic is given to numb the insertion site. The catheter is then threaded through the major blood vessels and into the chambers of the heart and/or into the coronary arteries. The procedure is done in the hospital and takes 40 to 60 minutes.

Various small instruments can be advanced through the tube to the tip of the catheter. They include instruments to measure the pressure of blood in each heart chamber and in blood vessels connected to the heart, to view or take ultrasound images of the interior of blood vessels, to take blood samples from different parts of the heart, or to remove a tissue sample from inside the heart for examination under a microscope (biopsy). Common procedures done through the catheter include the following:

If an artery is used for catheter insertion, the puncture site must be steadily compressed for 10 to 20 minutes after all the instruments are removed. Compression prevents bleeding and bruise formation. However, bleeding occasionally occurs at the puncture site, leaving a large bruise that can persist for weeks but that almost always goes away on its own. Alternatively, suture devices may be used to close the hole in the artery from the catheter.

Because inserting a catheter into the heart may cause abnormal heart rhythms Overview of Abnormal Heart Rhythms Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more Overview of Abnormal Heart Rhythms , the heart is monitored with electrocardiography Electrocardiography Electrocardiography (ECG) is a quick, simple, painless medical test that measures the heart’s electrical impulses. During an ECG, the heart's electrical impulses are measured, amplified, and... read more Electrocardiography (ECG). Usually, doctors can correct an abnormal rhythm by moving the catheter to another position. If this maneuver does not help, the catheter is removed. Very rarely, the heart wall is damaged or punctured when a catheter is inserted, and immediate surgical repair may be required.

Cardiac catheterization may be done on the right or left side of the heart.

Catheterization of the right side of the heart

Catheterization of the right side of the heart is done to obtain information about the heart chambers on the right side (right atrium and right ventricle) and the tricuspid valve (located between these two chambers) and evaluate the amount of blood the heart is pumping. The right atrium receives oxygen-depleted blood from the veins of the body, and the right ventricle pumps the blood into the lungs, where blood takes up oxygen and drops off carbon dioxide. In this procedure, the catheter is inserted into a vein, usually in the neck, arm, or the groin.

Pulmonary artery catheterization Pulmonary Artery Catheterization Pulmonary artery catheterization can be used to measure pressure in the right heart chambers and to estimate pressure in the left heart chambers, the amount of blood the heart pumps per minute... read more , in which a balloon at the catheter's tip is passed through the right atrium and ventricle and lodged in the pulmonary artery (which connects the right ventricle to the lungs), is sometimes done during catheterization of the right side of the heart during certain major operations and in intensive care units.

Catheterization of the left side of the heart

Catheterization of the left side of the heart is done to obtain information about the heart chambers on the left side (left atrium and left ventricle), the mitral valve (located between the left atrium and left ventricle), and the aortic valve (located between the left ventricle and the aorta). The left atrium receives oxygen-rich blood from the lungs, and the left ventricle pumps that blood to the body. This procedure is usually combined with coronary angiography to obtain information about the coronary arteries.

For catheterization of the left side of the heart, the catheter is inserted into an artery, usually in an arm (near the elbow or wrist), neck, or the groin, and passed from that artery into the aorta, the large artery that carries blood from the heart.

Coronary Angiography

In angiography Angiography Angiography is a type of medical imaging that uses x-rays and a contrast agent to produce images of blood vessels. In angiography, x-rays are used to produce detailed images of blood vessels... read more , a radiopaque contrast agent Radiographic Contrast Agents Radiographic contrast agents are substances used to distinguish between internal structures in medical imaging, such as various types of x-rays and magnetic resonance imaging (MRI). During imaging... read more , which is a liquid that can be seen on x-rays, is injected into a blood vessel and x-rays are taken to produce detailed images of the blood vessel. Coronary angiography provides information about the coronary arteries, which supply the heart with oxygen-rich blood. Coronary angiography is done during cardiac catheterization of the left side of the heart because the coronary arteries branch off the aorta just after it leaves the left side of the heart (see Blood Supply of the Heart Blood Supply of the Heart The heart and blood vessels constitute the cardiovascular (circulatory) system. The heart pumps the blood to the lungs so it can pick up oxygen and then pumps oxygen-rich blood to the body.... read more ). The two procedures are almost always done at the same time.

After injecting a local anesthetic, a doctor inserts a thin catheter into an artery through an incision in an arm (near the elbow or wrist) or the neck or groin. The catheter is threaded toward the heart, then into the coronary arteries. During insertion, the doctor uses fluoroscopy (a continuous x-ray procedure) to observe the progress of the catheter as it is threaded into place.

After the catheter tip is in place, a radiopaque contrast agent is injected through the catheter into the coronary arteries, and the outline of the arteries appears on a video screen and is recorded.

Miniature ultrasound transducers on the end of coronary artery catheters can produce images of coronary vessel walls and show blood flow. This technique (intravascular ultrasound or IVUS) is being increasingly used at the same time as coronary angiography. Miniature pressure sensors on the tip of the catheter can determine how much the pressure changes before and after a narrowing in a coronary artery. This technique (called fractional flow reserve or FFR) is used to determine the severity of the blood vessel narrowing.

Coronary angiography is seldom uncomfortable and usually takes 30 to 50 minutes. Unless the person is very ill, the person can go home a short time after the procedure.

When the radiopaque contrast agent is injected into the aorta or heart chambers, the person has a temporary feeling of warmth throughout the body as the contrast agent spreads through the bloodstream. The heart rate may increase, and blood pressure may fall slightly. Rarely, the contrast agent causes the heart to slow briefly or even stop. The person may be asked to cough vigorously during the procedure to help correct such problems, which are rarely serious. Rarely, mild complications, such as nausea, vomiting, and coughing, occur.

Serious complications, such as shock, seizures, kidney problems, and sudden cessation of the heart's pumping (cardiac arrest Cardiac Arrest and CPR Cardiac arrest is when the heart stops pumping blood and oxygen to the brain and other organs and tissues. Sometimes a person can be revived after cardiac arrest, particularly if treatment is... read more Cardiac Arrest and CPR ), are very rare. Side effects of radiopaque contrast agents Side effects of radiopaque contrast agents Radiographic contrast agents are substances used to distinguish between internal structures in medical imaging, such as various types of x-rays and magnetic resonance imaging (MRI). During imaging... read more include allergic reactions and kidney damage. Allergic reactions to the contrast agent range from skin rashes to a rare life-threatening reaction called anaphylaxis Anaphylactic Reactions Anaphylactic reactions are sudden, widespread, potentially severe and life-threatening allergic reactions. Anaphylactic reactions often begin with a feeling of uneasiness, followed by tingling... read more . The team doing the procedure is prepared to treat the complications of coronary angiography immediately. Kidney damage almost always goes away on its own. However, doctors are cautious about doing angiography in people who already have impaired kidney function.

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