What happens during a cardiac catheterization?

For a heart catheterization a doctor will use a local anesthetic so the skin is numb and people don't feel pain. A right heart catheterization test, used to confirm a diagnosis of pulmonary arterial hypertension (PAH), involves putting a thin tube called a catheter into a large blood vessel and guiding it to the right side of the heart.

A heart catheterization test does not hurt.

A heart (cardiac) catheterization is a test where small catheters are placed outside the arteries right at their origin. X-ray dye is injected through the catheters to take pictures of the heart, its chambers and arteries in multiple views and also to measure pressures in the heart chamber, all of which can be used to help diagnose different types of heart artery and heart muscle diseases.

Cardiac catheterization takes about an hour. You'll be relaxed but awake, because you might be asked to breathe deeply or cough. Here is what will happen:

  • Local anesthetic. The doctor will inject numbing medication where the catheter will be inserted. This usually feels like a pinprick with some burning, and only lasts a few seconds.
  • Inserting the catheter. Your doctor will insert a sheath into a blood vessel. You'll feel some pressure at first. The catheter will be put into the sheath and threaded to your heart.
  • Locating the problem. The doctor will inject contrast dye through the catheter. For a few seconds, you'll feel a warm sensation. X-rays will be used to show the contrast dye on a screen.
  • Removing the catheter. The catheter will be withdrawn, and the sheath will be removed. The site may be closed with a stitch or closure device.

Generally, a cardiac catheterization follows this process:

  • Once you are in the procedure room, you will move onto the x-ray table. You will lie on your back with a pillow under your head.
  • The nurse will give you medication through the IV line in your arm or hand. The medications will help you relax and make you drowsy. You will still be able to talk and follow directions, such as holding your breath.
  • A member of the cardiovascular team will begin to clean the area with a special soap. You will be asked to keep your hands by your side to help keep the area sterile and to decrease the risk of infection. A large sterile sheet will be placed over you to keep you warm and maintain a sterile area.
  • The skin will be numbed with a local anesthetic similar to the medicine your dentist uses. Once your skin is numb, you will only feel pressure at the site during the procedure.
  • A full heart catheterization is usually complete in about 30 minutes. The catheters used are similar to a large IV catheter. You will not feel pain or the catheter moving once it is in place.
  • When the catheter is in position, a dye is injected into the catheter to form a picture of your arteries. You may feel some warmth in your neck, arms, legs and abdomen for a few seconds as the dye is injected.
  • At this time the doctor and radiology technologist may ask you to hold very still or take a deep breath when the table and camera move to take pictures from different angles.
  • The x-ray picture of the dye injection creates a map of your heart arteries called an angiogram. At this time the doctor will be able to see blockages in your arteries and will discuss several methods of treatment procedures with you. Sometimes these procedures are done immediately and during the catheterization.

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