Heart Health: An In-Depth Look at Heart Catheterization

Cardiologist and assistant performing a heart catheterization procedure in an operating room

As a former cardiac RN, I’ve discovered that most nurses know what a heart catheterization is. After all, we learn in nursing school about myocardial infarctions and how they may be treated. However, unless you’ve worked in critical care or on a cardiac/telemetry unit, you may not know what really happens in a heart catheterization or “heart cath” procedure. Let’s take a closer look.

Why is a heart catheterization performed?

A heart catheterization can be performed for a variety of reasons. It may be performed emergently, such as in the event of a myocardial infarction (MI, also commonly referred to as a heart attack), or it may be performed to diagnose conditions of the heart or to evaluate heart function.

A heart catheterization can be performed for the following indications:

  • Detect congenital heart defects
  • Perform tissue biopsies of the heart
  • Check for narrowing or blocked vessels that may be causing chest pain
  • Measure the pressure inside the heart
  • Measure the amount of oxygen inside the heart
  • Assess for problems with the valves of the heart

This procedure is performed by a cardiologist who is specially trained in performing heart catheterizations. Not all cardiologists perform heart catherization procedures. Some cardiologists perform the procedure but do not perform interventions, such as placing stents.

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Wrist versus groin

A heart cath requires access to the heart using an artery. In the past, cardiologists used the femoral artery, accessed through the groin. However, in the early 1990s, cardiologists in the Netherlands began performing the procedure using the radial artery with excellent results.  

According to Harvard Health, the radial artery “offers ready access to the heart and is sometimes easier to get at. Doing angioplasty through it also tends to cause less bleeding around the puncture after the procedure is over than the femoral approach.”

An international study, RIVAL, compared the two approaches. The study found that both approaches were equal in access to the heart (95%) and had equivalent rates of death, heart attack, and stroke within 30 days of procedure (3.2%). However, the radial approach boasted less bleeding at the site. Another bonus? Those with the radial approach do not have to have bedrest for several hours after the procedure.

Not everyone is a candidate for use of the radial artery, but if it is accessible and the cardiologist is trained, more and more patients are finding it an excellent alternative to the standard femoral approach.

The procedure

As with many other procedures, the patient will be nothing by mouth the day before. This is because there is the risk of aspiration during the procedure due to sedating medications. An intravenous line is placed in the hand or the arm to receive fluids as well as medications.

The cardiologist will select the area where a larger catheter will be placed. As discussed above, the catheter is typically placed in the wrist or the groin and is guided through a sheath. The sheath makes it easy to guide the catheter to the heart, where the procedure can take place.

Once the catheter and sheath are in place, the actual procedure can begin. Most of the procedures listed above involve coronary angiography. Coronary angiography involves the use of a contrast medium; the contrast allows the cardiologist to visualize the heart as the dye travels through the arteries. The dye will make it easy to visualize narrowing or blockages of the passageways of the heart, as well as issues with the heart valves.

A heart biopsy may be obtained at any point during a procedure by taking a sample for further testing.

An ablation is used to treat arrhythmias, or irregular heartbeats; an ablation uses either very cold or very hot temperatures to treat the arrhythmia. This destroys the tissue that is causing the issue, restoring the heart to sinus rhythm.

Angioplasty is one of the most common procedures; a tiny, inflatable balloon is inserted into the artery. This balloon is used to widen a narrowed artery. A stent may be placed inside the artery, in combination with angioplasty, to prevent further narrowing.

Thrombectomy involves the removal of blood clots in the heart. This prevents the blood clot from becoming dislodged and traveling to other organs, potentially causing issues such as strokes.

The importance of aftercare

The sheath is will be removed from the wrist or groin shortly after the procedure is complete. The nurse who removes the sheath will hold pressure to the site; this can be uncomfortable. If the cardiologist passed through the groin for the procedure, the patient will likely need to lie flat on his or her back for an extended period of time. This allows for healing and reduces the likelihood of bleeding at the arterial site.

The patient may get to leave the hospital that day, but often will stay overnight—or longer—depending on the reason for the procedure.

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Editor’s note: This post was originally published on February 12, 2020 and updated on February 23, 2021.

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