Right Heart Catheterization
What is right heart catheterization?
Your doctor performs right-heart catheterization (cath) to determine how well your heart is pumping, and to measure the pressures in your heart and lungs.
In a right-heart catheterization, your doctor guides a special catheter (a small, hollow tube) called a pulmonary artery (PA) catheter to the right side of your heart. He or she then passes the tube into your pulmonary artery. This is the main artery that carries blood to your lungs. Your doctor observes blood flow through your heart and measures the pressures inside your heart and lungs.
As the catheter advances toward your pulmonary artery, your doctor measures pressures along the way, inside the chambers on the right side of your heart. This includes the right atrium and right ventricle. Indirect measurements of pressures on the left side of your heart are made, as well. Your doctor inflates a tiny balloon at the tip of the catheter, once it reaches your pulmonary artery. This pressure measurement is called the pulmonary artery occlusion pressure, or pulmonary capillary "wedge" pressure Your cardiac output—the amount of blood your heart pumps per minute—is also determined during a right-heart catheterization.
In some cases, you get intravenous (IV) heart medications during right-heart catheterization to see how your heart responds. For example, if the pressure in your pulmonary artery is high, your doctor will give you medications to dilate, or relax, the blood vessels in your lungs and lower the pressures. A health care provider will take several pressure measurements during the procedure to assess your body's response to the medications.
If output from your heart is low and/or the pressures in your heart and lungs are too high, your doctor will leave the PA catheter in place to monitor the effects of different IV medications. You will most likely be monitored in the intensive care unit (ICU) if this is the case. This allows your doctors to determine the best medication plan needed to improve your heart's function.
Why might I need a right heart catheterization?
Your doctor might perform a right-heart catheterization to assist in the diagnosis and/or management of the following conditions:
- Heart failure. A condition in which your heart muscle has become weakened, so that blood cannot be pumped efficiently. This causes fluid buildup (congestion) in your blood vessels and lungs, and or edema (swelling) in your feet, ankles, and other parts of your body.
- Shock. A syndrome that causes reduced flow of blood and oxygen to the tissues of your body. Shock can be caused by a sudden onset of heart failure (cardiogenic), severe bacterial infection of your blood stream (sepsis), or severe blood loss (hemorrhagic).
- Congenital heart disease. Defects in one or more heart structures that develop before birth. An example is ventricular septal defect. This is a hole in the wall between the two lower chambers of your heart.
- Valvular heart disease. Malfunction in one or more of your heart valves that may interfere with normal blood flow within your heart.
- Cardiomyopathy. An enlargement of your heart, due to thickening or weakening of your heart muscle. This can eventually lead to heart failure.
- Pulmonary hypertension. Increased pressures within the blood vessels in your lungs. This can lead to difficulty breathing and right-sided heart failure.
A right-heart catheterization with biopsy may also be performed as part of your evaluation before a heart transplant. Pressures in your pulmonary (lung) circulation need to be as low as possible in order for a donor heart to work as well as possible. Excessive pressures will make it difficult for the new (donor) heart to pump effectively. A right-heart catheterization will help to determine if pulmonary pressures can be decreased with special medications (vasodilators) to ensure successful transplantation.
Your doctor may have other reasons to recommend a right-heart catheterization with biopsy. This is especially true if you've already undergone a heart transplant in the past.
What are the risks of right heart catheterization?
Possible risks associated with a right-heart catheterization include:
- Bruising of the skin at the site where the catheter is inserted
- Excessive bleeding because of puncture of the vein during catheter insertion
- Pneumothorax (partial collapse of your lung) if your neck or chest veins are used to insert the catheter
Other, rare complications may include:
- Abnormal heart rhythms, such as ventricular tachycardia (fast heart rate in your lower heart chambers)
- Cardiac tamponade (fluid buildup around your heart that affects its ability to pump blood effectively)
- Low blood pressure
- Air embolism (air leaking into your heart or chest area)
- Blood clots at the tip of the catheter that can block blood flow
- Pulmonary artery rupture. This is damage to the main artery in your lung. This can result in serious bleeding, making it difficult to breathe.
For some patients, having to lie still on the cardiac catheterization table for the length of the procedure may cause some discomfort or back pain.
There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your doctor before the procedure.
How do I get ready for a right heart catheterization?
Your healthcare provider will explain the procedure to you and offer you the opportunity to ask any questions you might have about the procedure.
- You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.
- Notify your healthcare provider if you are sensitive or allergic to any medications, latex, tape, or sleep and numbing medicine, either local and general.
- If you are pregnant or suspect you may be pregnant, you should notify your healthcare provider.
- Notify your healthcare provider of all medications (prescription and over-the-counter) and herbal supplements that you are taking.
- Notify your healthcare provider if you have a history of bleeding disorders, or if you are taking any anticoagulant (blood-thinning) medications. These may includes warfarin, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop some of these medications before the procedure.
- Notify your healthcare provider if you have a pacemaker or an implantable defibrillator.
- If you have an artificial heart valve, your healthcare provider will decide if you should stop taking warfarin before the procedure.
- You may be asked not to eat or drink anything after midnight, or within eight hours before the procedure.
- If the insertion site is in your groin, the area around your groin may be shaved.
Based on your medical condition, your healthcare provider may request other specific preparation.
What happens during a right heart catheterization?
Your doctor will perform your right-heart catheterization in the cardiac catheterization lab or in a special department. If you are critically ill, your doctor may do the procedure in the ICU. The procedure may also be performed on an outpatient basis, or as part of your hospital stay. The procedure may vary, depending on your condition and your doctor's practices.
- You will need to remove any jewelry or other objects that may interfere with the procedure. You may wear your dentures or hearing aids if you use either of these.
- You need to remove your clothing and will be given a gown to wear.
- You will need to empty your bladder before the procedure.
- An intravenous (IV) line will be started in your hand or arm before the procedure, for injection of medication and to administer IV fluids, if needed.
- You will lie on your back on the procedure table.
- You will be connected to an electrocardiogram (ECG) monitor. This machine records the electrical activity of your heart during the procedure, using small, adhesive electrodes. Health care providers will monitor your vital signs during the procedure. These are your heart rate, blood pressure, breathing rate, and oxygenation level.
- Your healthcare provider may give you a mild sedative to help you relax, but you will not be put to sleep.
- Sterile towels will be placed over your chest and neck if your neck vein is used.
- If your groin is used, sterile towels will be place over your groin area.
- Your healthcare provider will clean and numb the skin over your neck or groin, with a local anesthetic. A small needle will be used to find your vein. Then, your doctor will insert a thin tube called a catheter into your vein. You may feel some burning or stinging when the numbing medication is given, and some pressure as the needle punctures your vein.
- Your doctor will place an introducer sheath (a slightly larger, hollow tube) into your vein first, and will then insert the PA catheter through the introducer. You may feel some pressure as the introducer is placed. Once the PA catheter is in place, your heart pressures will be measured.
- Intravenous heart medications may also be given to evaluate your heart's response. It may take about 30 minutes to monitor your heart's response to the medications.
- Once all the necessary information has been obtained, your medical team will remove the catheter and introducer, unless they decide you need additional monitoring in the ICU.
What happens after a right heart catheterization?
Medical staff will put pressure over your insertion site for a minute or two, to make sure you are not bleeding. If the catheter was placed in your groin vein, pressure will be placed over the insertion site for a few minutes longer.
If your neck vein was used (most commonly), you will be allowed to sit up comfortably. If your groin was used for the procedure, you will have to lie flat in bed for a few hours so the puncture site can heal properly.
You can eat and drink normally after the procedure. The nurse will monitor the insertion site for bleeding and check your blood pressure, heart rate, and breathing while you recover. Let the nurse know if you have any chest pain or difficulty breathing.
Your doctor will discuss the findings of the right-heart catheterization and plans for treatment, if needed. Most of the time, you will be able to go home a few hours after the procedure.
Once at home, you should monitor the insertion site for bleeding, unusual pain, swelling, and abnormal discoloration or temperature change at or near the insertion site. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small bandage, or dressing, notify your healthcare provider.
It will be important to keep the insertion site clean and dry. Your healthcare provider will give you specific bathing instructions.
You may be advised not to participate in any strenuous activities. Your healthcare provider will instruct you about when you can return to work and resume normal activities.
Notify your healthcare provider to report any of the following:
- Shortness of breath or difficulty breathing
- Fever and/or chills
- Increased pain, redness, swelling, or bleeding or other drainage from the insertion site
- Coolness, numbness and/or tingling, or other changes in the affected extremity
- Chest pain/pressure, nausea and/or vomiting, profuse sweating, dizziness, and/or fainting
Your healthcare provider may give you additional or alternate instructions after the procedure, depending on your particular situation.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- The risks and benefits of the test or procedure
- When and where you are to have the test or procedure and who will do it
- When and how will you get the results
- How much will you have to pay for the test or procedure