Main content

Cardiac Catheterization and Coronary Angiogram

Cardiac catheterization is used to diagnose and plan the treatment for many heart diseases. At CPMC in San Francisco, catheterizations are frequently performed to measure the pressure within the heart’s chambers, collect samples of heart muscle, measure blood oxygen levels and blood flow in the heart’s chambers, and evaluate heart muscle pumping ability. This enables the cardiologist to access who how well the heart is function. During cardiac catheterization, x-ray images, called angiograms, are usually recorded to examine the blood vessels supplying the heart muscle. This is necessary to determine the need for bypass surgery, angioplasty, or stent placement.

Read the Learning About Your Health Document on Cardiac Catheterization

How is a Cardiac Catheterization Performed? | Cardiac Catheterization Procedures | Indications for Cardiac Catheterization | Complications and Risks

How is a Cardiac Catheterization Performed?

To perform a cardiac catheterization, a small needle puncture is made by the cardiologist at the catheterization site, usually at the groin. The specialist inserts a thin, hollow tube, the catheter, into a vein or artery. The catheter is carefully advanced through blood vessels using fluoroscopy, real-time radiology, and into the heart chambers or coronary arteries. The catheter may be used to inject iodine-based dyes for angiography, producing immediate “live” x-ray images for the cardiologist to visualize, evaluate, and record heart problems. If need be, the specialist can use catheters to open narrowed arteries, with balloon angioplasty or stent placement or other corrective procedures to increase blood flow.

Back to top

Cardiac Catheterization Procedures

A wide variety of catheterization procedures are available in our cardiac catheterization laboratories throughout San Francisco. These are just some of our more advanced cardiac catheterization services and procedures:

Percutaneous Coronary – (balloon) Intervention (PCI):
Once the catheter is in place, using a balloon attached to the tip, the cardiologist inflates the balloon compressing plaque and dilating the diameter of the blood vessel. The balloon is deflated and removed along with the catheter. Many times a coronary stent is placed in the blood vessel to prevent restenosis or blockage recurrence.

Atherectomy:
When the removal of plaque is necessary, the catheter is fitted with a special mini high-speed drill at the tip. The plaque or blockage can be shaved off and vacuumed out or vaporized. Atherectomy is performed in conjunction with PCI through one of the large groin vessels.

Ventricular Angiogram (Ventriculogram):
A catheter, for dye injection, is directed into the heart’s main pumping chamber, the left ventricle. The dye provides detailed images to access the pumping ability of the ventricule, and identify leaky valves, heart defects, or abnormal blood flow.

Coronary Flow Reserve (CFR) Measurements:
Cardiac catheters equipped with sensor-tipped guide wires measure coronary flow reserve assessing the functional severity of coronary artery stenosis and microvascular disease. CFR measurements provide objective data that complement angiography for clinical decision-making.

Intravascular Ultrasound Imaging (IVUS):
A miniature ultrasound transducer, mounted on the tip of the cardiac catheter produces IVUS images. Guided by X-ray, the transducer is inserted into a coronary artery producing real-time high-resolution images of the vascular lumen (internal cavity of the veins and arteries), and the arterial wall (vessel and related structures). IVUS allows physicians to closely inspect a suspicious coronary segment analyzing artery walls and plaque prior to PTCA as the ultrasound catheter moves through the vessel.

Pericardiocentesis:
The heart muscle is surrounded by a protective fluid-filled membrane, cushioning and lubricating the heart, called the pericardium. Due to a variety or reasons, from myocardial infarction and congestive heart failure to infection or trauma, the pericardial fluids build up and compress the heart constricting pumping action. In the cardiac catheterization lab the excess fluid is removed to reduce heart muscle constriction and evaluate the cause of fluid buildup. A needle is inserted through the skin and guided into the pericardial sac to aspirate fluid.

Heart Biopsy:
Small samples of heart muscle tissue are removed using cardiac catheterization. Tissue samples are sent to the lab to view heart cells under a microscope, helping physicians determine diagnosis of heart infection, virus, or heart failure of unknown origin. In the cardiac catheterization lab physicians insert the catheter into either the jugular or the femoral vein and then thread it into the heart.

Indications for Cardiac Catheterization

Indications may include:

Angina that is not easily controlled with medication, that disrupts daily routine, occurs at rest, or recurs after heart attack

Heart failure with suspected coronary artery disease

Heart valve disease with symptoms (e.g., shortness of breath)

Markedly abnormal stress test results

Recurring chest pain of unidentified cause

Complications and Risks

There are always risks with any medical procedure, and serious risks, such as stroke or heart attack, from this procedure are approximately 1 in 1,000.

Allergic reaction to iodine-based dye

Bleeding or bruising at catheter insertion site

Damage to veins or arteries, leading to bleeding around the heart or heart attack

Infection at insertion site

Temporary knot under the skin at insertion site

Kidney damage or kidney failure

Emergency heart surgery

Death

Identifying the Best Treatment Options and Cardiac Catheterization Specialist for You

Our commitment at CPMC is to help each patient identify the best doctor for their diagnosis and course of treatment. To find the best specialist for Cardiac Catheterization , we want to empower our patients to participate in their health care journey. This means encouraging a frank discussion with the doctor about Cardiac Catheterization, to identify all appropriate treatment options as well as to discuss symptoms, issues, outcomes, etc., when relevant for Cardiac Catheterization. The first step of your journey is research - using online tools such as CPMC's to investigate and understand Cardiac Catheterization. The second step is to schedule an initial consultation with a physician or specialist. In some cases, you'll need to go through your primary care physician if you do not have a referral. If you already have a referral,you can schedule an appointment directly with the Cardiac Catheterization specialist. The third step is for the specialist in Cardiac Catheterization to meet with you and review your history. As part of the diagnosis, you may need testing, so the doctor (surgeon or specialist) can discuss your treatment options and the both of you can determine your best course of action. We have patients at CPMC coming from throughout the San Francisco Bay Area, Northern California, and many from throughout the United States with respect to Cardiac Catheterization. Whether you are from San Francisco, Marin, the San Francisco Bay Area generally or any other location, our physicians will provide the hands-on care you deserve.

Back to top

California Pacific's Heart and Vascular Center

California Pacific's Heart and Vascular Center is supported by one of the best heart hospital/center networks in the USA, offering quality, comprehensive patient-centered cardiovascular care by a team of top heart surgeons and physicians with leading-edge technology. Serving the entire San Francisco Bay Area, including San Francisco and Marin County, as well as the entire Northern California region, our team has many of the best cardiovascular surgeons and physicians in California and the United States.
Back to top