Cardiac Catheterization

Cardiac catheterization (cardiac cath or coronary angiography) involves threading a thin catheter through blood vessels to the heart to diagnose and sometimes treat heart conditions. It is the gold standard for evaluating coronary artery disease. Over 1 million cardiac catheterizations are performed annually in the US.

Cardiac catheterization is performed to diagnose coronary artery disease, evaluate chest pain (angina), assess heart valve function, measure pressures inside the heart, evaluate heart failure, and to perform interventions like angioplasty and stenting.

Fast for 6-8 hours. Inform your doctor about all medications, especially blood thinners, metformin (may be held), and allergies to contrast dye. Blood tests and an EKG are done beforehand. An IV is placed. The groin or wrist access site is shaved and cleaned.

Under local anesthesia with mild sedation, a catheter is inserted through the femoral artery (groin) or radial artery (wrist) and guided to the heart. Contrast dye is injected to visualize the coronary arteries on X-ray. If blockages are found, angioplasty/stenting may be done simultaneously. The diagnostic portion takes 30-60 minutes.

For radial (wrist) access: sit up immediately, wrist band removed in a few hours, go home same day. For femoral (groin) access: lie flat for 2-6 hours, may go home same day or stay overnight. Avoid strenuous activity for 2-5 days. Drink extra fluids to flush contrast dye.

Risks include bleeding at the access site, bruising, blood clots, arrhythmia, allergic reaction to contrast dye, kidney damage from contrast, heart attack, stroke, and rarely death (0.1-0.2%). Radial access has lower bleeding risk than femoral.

Non-invasive alternatives for diagnosis include coronary CT angiography (CTA), nuclear stress test, and stress echocardiography. However, these cannot provide treatment (stenting) and may still require catheterization if abnormalities are found.

Covered by Medicare and most insurance plans when medically indicated. Emergency cardiac catheterization for heart attack is always covered. Elective procedures may require prior authorization.