- Clinical science
Cardiac catheterization is a procedure used in the diagnosis and treatment of cardiovascular conditions. It involves the insertion of a catheter into a cardiac vessel (coronary catheterization) or chamber by way of a suitable vascular access (usually a femoral or radial artery). Once in position, a cardiac catheter can help evaluate the blood supply to the cardiac musculature (angiography) or open up narrowed or blocked segments of a coronary artery by means of a coronary angioplasty with stenting (percutaneous coronary intervention, or PCI). Additionally, it can be used to perform a cardiac tissue biopsy, open narrowed heart valves via valvuloplasty, examine electrophysiological pathways, or measure pressure and oxygen levels in different chambers (hemodynamic assessment). The procedure is associated with a low rate of complications, with the most common among these being bruising and bleeding at the site of IV access. Rarer, more severe complications include arrhythmias, cardiac arrest, embolization of existing plaques, and infection.
- Sites of IV access
- Imaging: A contrast dye is injected via the catheter, and is visualized with serial x-ray imaging.
- Preprocedural investigations
- Contrast-enhanced radiological analysis of the heart cavities (ventriculography) or coronary arteries (coronary angiography).
- PCI/surgery: to assess the exact location and extent of coronary vessel narrowing before possible
- Valvular or myocardial diseases with symptoms (e.g., shortness of breath)
- Recurring chest pain of unidentified cause
- Preoperative evaluation prior to noncardiac and planned cardiac surgery (CABG) in high-risk patients
- To detect and quantify the presence of an intracardiac shunt
- A therapeutic procedure carried out during cardiac catheterization; in which a blocked coronary vessel is opened and appropriate blood flow is restored. A balloon catheter is used to dilate the narrowed section, with/without the placement of a stent to keep it patent.
- Procedure: a catheter is inserted through the IV access site → a deflated balloon catheter is advanced into the obstructed artery → balloon is inflated at the obstructed/narrowed section → the narrowing is relieved → stent may/may not be deployed to keep the blood vessel open
- Types of stents
- Testing of the electrical conduction system of the heart to assess electrical activity and conduction pathways via a cardiac catheter
- The passing of a balloon-tipped, multi-lumen catheter (Swan-Ganz catheter) into the right side of the heart and the pulmonary artery to monitor pressure within the heart (intracardiac pressure) and pulmonary arterial pressure.
- In heart failure, cardiomyopathy, congenital heart disease, and valvular disease: helps measure pressure, oxygen, and cardiac output of the right heart to assess the severity of dysfunction. Also helps measure (PCWP), which can be used to diagnose the severity of left ventricular failure and mitral stenosis.
- In suspected pulmonary hypertension: helps measure mean pulmonary arterial pressure (mPAP) and central venous pressure (CVP)
- Procedure: venipuncture (groin, arm, neck) → advancement of the Swan-Ganz catheter into the right heart
- Absolute contraindication: patient refuses to undergo the procedure
- Relative contraindications: comorbidities in which the risks associated with coronary angiography are greater than the benefits of securing the diagnosis
- Special consideration: Abnormal results on a are a contraindication for radial access.
We list the most important contraindications. The selection is not exhaustive.
Complications at the site of vascular access
- Superficial hematoma formation
- Most common cause of unexpected mortality after diagnostic or interventional cardiac catheterization
- Often asymptomatic
- Suprainguinal tenderness and fullness
- Sudden flank or back pain with hemodynamic instability
- Prompt diagnosis is a priority: CT with contrast of the abdomen and pelvis in hemodynamically stable patients or sonography in unstable patients
- Predominantly supportive treatment: careful monitoring, fluid resuscitation, blood transfusion, and normalization of coagulation factors if abnormal
- Surgical repair
- Endovascular management options like intra-arterial embolization or stent-grafts to stop the bleeding
- Open surgery to control active bleeding and/or to remove a large retroperitoneal hematoma
- Arterial injury (can include laceration, arteriovenous fistula formation, or thrombosis)
Complications at the cardiac level
- Myocardial infarction
- Arrhythmias can be induced by catheter introduction into the right or left ventricle.
- Spontaneous coronary artery dissection (SCAD) in the artery affected by acute coronary occlusion
- Injury to coronary vasculature by the catheter (e.g., dissection of coronary artery wall)
- Hypersensitivity to contrast media
- Acute kidney injury (see also )
Cholesterol embolization syndrome
- Definition: embolization of cholesterol released from atherosclerotic plaques or common vessel wall deposits
- Clinical features
- Amorphous, eosinophilic material in the vessel lumen
- Spindle-shaped vacuoles (“cholesterol clefts”)
- Symptomatic treatment
- Termination of anticoagulant therapy , initiate statin therapy
- The prognosis is poor even with optimal treatment.
- Most common complication: restenosis
- Stent thrombosis (0.5–5%)
- Vascular complications
- Infection (localized or generalized bacteremia)
We list the most important complications. The selection is not exhaustive.
(CABG)/aortocoronary bypass (ACB)
- See also “Procedure” in .