Risks and benefits of cardiac catheterisation

Overview

Cardiac catheterisation is a procedure where a thin, flexible tube called a catheter is guided through a blood vessel to your heart. It helps doctors diagnose and treat heart problems, such as blocked arteries or valve issues. The procedure is done in a hospital and you are awake but given medicine to relax.

Yes, it is one of the most common heart procedures performed in hospitals worldwide.

People who have symptoms of heart disease – such as chest pain, shortness of breath, or who have had a heart attack – may need this procedure. It can also be done for people with abnormal stress tests or known coronary artery disease.

Symptoms

Common symptoms

• Chest pain or discomfort (angina) that may spread to arms, neck, jaw or back.
• Shortness of breath during activity or when lying down.
• Feeling very tired or weak.
• An abnormal stress test or echocardiogram suggesting heart muscle not getting enough blood.

Symptoms in children

• Some children may need cardiac catheterisation for congenital heart defects. Signs include bluish skin, poor feeding, or failure to grow. The procedure can also be used to close holes or open narrow valves.

Symptoms in older adults

• Older adults often have the same symptoms, but may also experience confusion, dizziness, or fainting. They may be at higher risk of bleeding because of age or other medications.

Causes

Main causes

• The most common reason for needing cardiac catheterisation is coronary artery disease, where fatty deposits block the arteries that supply blood to the heart.
• It may also be used for valve disease, heart muscle disease (cardiomyopathy), or to check for congenital heart defects.

Risk factors

• Age – risk increases as you get older.
• Smoking or exposure to tobacco smoke.
• High blood pressure or high cholesterol.
• Diabetes or being overweight.
• Not being physically active.
• A family history of early heart disease.

When to see a doctor

See a doctor urgently if:

• If you have chest pain that is new, severe, or lasts longer than a few minutes, call your local emergency number immediately.
• Any chest pain that spreads to your arms, back, neck or jaw, or comes with shortness of breath, nausea, or light-headedness.

Book a routine appointment if:

• If you have been told you have a heart problem and your symptoms are stable, talk to your doctor about whether cardiac catheterisation might be helpful.
• If you have had an abnormal stress test or a heart scan that shows a possible blockage.

Diagnosis

Cardiac catheterisation is both a test and a treatment. You may be referred for it after other tests – like an ECG, stress test, or heart scan – suggest a problem. The procedure itself is often done to confirm the diagnosis and, if needed, treat it right away.

Tests that may be done

• Before the procedure, you may have blood tests, an ECG, and a chest X-ray to ensure you are safe.
• During cardiac catheterisation, a small amount of dye (contrast) is injected so that X-ray images show blood flow through your heart arteries.
• Pressures in the heart chambers are measured to check for valve or muscle problems.

What to expect at your appointment

You will be asked not to eat or drink for several hours before. The area where the catheter is inserted (usually the groin or wrist) is numbed. You will be awake but given medicine to relax. The doctor guides the catheter using X-ray images. If a blockage is found, they may open it with a tiny balloon (angioplasty) and often place a small mesh tube (stent). The whole procedure takes about 30 minutes to 2 hours. Afterwards, you will need to lie still for a few hours to prevent bleeding. Most people go home the same day or the day after.

Treatment

Cardiac catheterisation can treat heart problems at the same time it diagnoses them. The most common treatment is balloon angioplasty with a stent to open a blocked artery. This restores blood flow and relieves symptoms. Other treatments include closing holes in the heart, opening tight valves, or taking small tissue samples.

Self-care at home

• After the procedure, keep the insertion site (groin or wrist) dry and clean for about 24 to 48 hours.
• Avoid heavy lifting or strenuous activity for a few days as advised by your doctor.
• Drink plenty of fluids (unless told otherwise) to help flush the dye from your body.
• Watch for signs of infection: redness, swelling, or bleeding at the site.

Medical treatments

Your doctor may prescribe medicines after the procedure to prevent blood clots, lower blood pressure, or reduce cholesterol. Always take them exactly as prescribed and discuss any side effects with your doctor or pharmacist. Do not stop or change your medicines without your doctor's advice.

When is surgery considered?

If your blockages are too complex for catheter-based treatment, or if you have multiple blocked arteries or severe valve disease, you may need open-heart surgery (such as bypass surgery). Your doctor will explain the best option for your situation.

Living with this condition

After recovering from cardiac catheterisation, most people feel much better. You can return to normal activities within a few days. If you had a stent, you will take medicine to prevent clotting. You may need to avoid certain over-the-counter medicines – ask your doctor or pharmacist. Regular follow-up appointments are important.

Lifestyle tips

• Stop smoking if you smoke – your local health service can help.
• Manage stress through relaxation, meditation, or talking to a counsellor.
• Limit alcohol to no more than recommended levels (ask your doctor what is safe for you).

Diet and exercise

Eat a heart-healthy diet: plenty of fruits, vegetables, whole grains, and lean proteins. Reduce salt, sugar, and saturated fats. Ask your doctor when you can start exercising. Walking is a good start. Aim for at least 30 minutes most days, but listen to your body.

Mental health and emotional wellbeing

Having heart problems and undergoing a procedure can be stressful. You may feel anxious or down. This is normal. Talk to your doctor or a mental health professional. Many hospitals offer support groups or counselling. If you ever feel like you might harm yourself, reach out for help immediately.

Prevention

While cardiac catheterisation is usually needed to fix an existing problem, you can reduce your chances of needing further procedures by keeping your heart healthy: control blood pressure, cholesterol, and blood sugar; eat well; stay active; avoid smoking; and take prescribed medicines.

Vaccines

It is advisable to get an annual flu shot and other recommended vaccines to prevent infections that could affect your heart. Ask your doctor which vaccines are right for you.

Screening programmes

If you have risk factors for heart disease, your doctor may recommend regular blood pressure checks, cholesterol tests, and possibly a heart scan. Talk to your doctor about what screening is appropriate for your age and health.

Complications

If left untreated

• If the underlying heart problem is not treated, it can lead to a heart attack, heart failure, or an irregular heartbeat (arrhythmia).
• Blocked arteries can cause permanent damage to the heart muscle or lead to sudden cardiac arrest.

Long-term outlook

Cardiac catheterisation is a safe and effective procedure that helps millions of people every year. Most people feel better quickly and have a good recovery. However, like any medical procedure, there are risks – such as bleeding, infection, or an allergic reaction to the dye. Your doctor will discuss these with you before the procedure and take steps to minimise them. With proper care and lifestyle changes, the outlook for people who undergo cardiac catheterisation is very positive.

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