Cardiac catheterization, often referred to as cardiac cath or heart cath, is a medical procedure used to examine how well the heart is functioning. It is one of the most common heart procedures. The procedure involves the insertion of a catheter (a long, thin tube) into a large blood vessel, typically through a puncture in the skin, to access the heart and its surrounding blood vessels.

The primary purposes of cardiac catheterization include:

1. Diagnosing Heart Problems: It helps examine how well the heart functions and identify various heart issues.
2. Coronary Angiography: This involves taking X-rays using contrast dye injected through the catheter. It helps to look for narrowed or blocked coronary arteries.
3. Percutaneous Coronary Intervention (PCI): Procedures such as coronary angioplasty with stenting can be performed. Stenting helps to open up narrowed or blocked segments of a coronary artery.
4. Measuring Heart Pressures: It allows for checking the pressure in the four chambers of the heart.
5. Blood Sampling: Blood samples can be taken to measure the oxygen content in the heart’s chambers.
6. Evaluating Heart Function: It assesses the ability of the heart’s pumping chambers to contract.
7. Identifying Structural Defects: The procedure can help identify defects in the heart’s valves or chambers.
8. Biopsy: A small piece of heart tissue can be removed for examination under a microscope.

How does the cardiac catheterization process work?

The cardiac catheterization process involves several key steps, which are outlined below:

1. Preparation:
   • Before the procedure, patients receive instructions regarding fasting (usually no food or drink for 6-8 hours prior).
   • An intravenous (IV) line is placed in a vein in the arm to administer sedatives and medications.
2. Anaesthesia and Site Preparation:
   • A local anaesthetic is applied to numb the area where the catheter will be inserted, typically in the groin or wrist.
   • The skin is cleaned and sterilized to minimize the risk of infection.
3. Insertion of Catheter:
   • The doctor makes a small puncture in the skin and inserts a needle into a large blood vessel (usually the femoral artery in the groin).
   • A thin, flexible tube called a sheath is then placed into the vessel to allow the catheter to be inserted.
   • A catheter (a long, thin tube) is guided through the sheath and into the blood vessel, using imaging technology (like fluoroscopy) to visualize its path as it is threaded toward the heart,
4. Diagnostic and Interventional Procedures:

Once the catheter is in place, various diagnostic tests can be performed

• • Angiography: A contrast dye is injected through the catheter to visualize blood flow in the coronary arteries using X-ray imaging.
  • Pressure Measurements: The catheter can measure blood pressure in the heart’s chambers and blood vessels.
  • Biopsy: A small tissue sample may be taken for further examination.
  • Therapeutic procedures such as angioplasty (to open blocked arteries) or stenting (to keep arteries open) can be performed during the same session.

5. Completion of the Procedure:

• The catheter and sheath are removed after the necessary tests and interventions are completed.
• Pressure is applied to the puncture site to prevent bleeding; sometimes, a closure device is used to seal the site.

6. Recovery:

• Patients are taken to a recovery room, where they must lie flat for a few hours to ensure proper healing at the puncture site.
• Vital signs, including heart rate and blood pressure, are monitored during recovery.
• Patients are advised to report any unusual symptoms, such as swelling, pain, or bleeding at the puncture site.

7. Post-Procedure Instructions:

• Before discharge, patients receive written instructions on care at home, including medication management and follow-up appointments.

This structured approach ensures cardiac catheterization is performed safely and effectively, providing valuable insights into heart health and enabling necessary interventions.

What are the potential risks associated with the procedure?

The potential risks associated with cardiac catheterization include:

1. Bruising and Bleeding: Minor bruising at the puncture site is common, and there is a risk of bleeding that may require additional medical attention.
2. Infection: There is a small risk of infection at the puncture site or within the bloodstream.
3. Reaction to Contrast Dye: Some patients may have allergic reactions to the contrast dye used during the procedure.
4. Abnormal Heart Rhythm: The procedure can sometimes lead to irregular heartbeats.
5. Blood Clots: There is a risk of blood clots forming due to the procedure.
6. Damage to Blood Vessels or Heart: The catheter can potentially cause damage to blood vessels or the heart itself.
7. Heart Attack: Although rare, there is a risk of a heart attack occurring during or after the procedure.
8. Stroke: There is a minimal risk of stroke associated with the procedure.
9. Side Effects from Sedation: Patients may experience side effects from medications that help them relax, such as nausea or vomiting.

While cardiac catheterization is generally considered safe, patients should be aware of the risks and discuss any concerns with their healthcare team prior to the procedure.

References:

Echocardiography: Diagnostic Cardiac Ultrasound Scan

How does Intravascular Ultrasound quantify Plaque?