So you need a heart catheterization or angiogram. This is a statement that can cause a great deal of anxiety. It is however a common and safe procedure. A cardiac catheterization or cath for short is a diagnostic procedure that allows your cardiologist to visualize your coronary (heart) arteries and evaluate them for blockages. Your trip to the cath lab will be hosted by a number of technicians and nurses specially trained to assist your cardiologist with the procedure. Once you are on the table they will prep (clean your groin area) and drape (cover you with sterile sheets). All of this is done to protect you from infection. The staff will wear blue gowns and masks just as if you were having surgery. Once the cardiologist is ready you will be given some intravenous medications to relieve pain and anxiety and to cause some short term memory loss. This is the best part for many because your memory of the procedure will be hazy and at best a big blank.

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A cath is made up of three separate procedures:

1. Left Heart - A catheter is inserted into the large femoral artery located in the groin and advanced through the aorta to the left side of the heart into the left ventricle (the main pumping chamber). Pressures are measured in the aorta and the left ventricle. Occasionally the right side of the heart will need to be studied and a second catheter will be inserted into the femoral vein to the right side of the heart.
2. Left Ventricular Angiogram - Radiological contrast media sometimes called x-ray dye is pumped through the catheter in the left ventricle allowing the cardiologist to visualize the motion of the walls of the pumping chamber and determine your ejection fraction or the amount of your hearts pumping power.
3. Coronary Angiogram - special shaped catheters are inserted into the openings of the coronary arteries. These are the arteries located on the outside of the heart and are responsible for supplying the \heart with blood flow. They are the culprits that become blocked and cause heart attacks. The cardiologist can view that shape of the inside diameter or lumen of these arteries by injecting a small volume of contrast (dye).

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At the end of the procedure the catheters are withdrawn and a small suture or collagen plug is inserted via a small catheter to control any bleeding and to allow you to be out of bed in a shorter time frame. You will be taken to the recovery area and your cardiologist will come by once you are awake with a working memory and discuss the findings of your cath. If significant blockages were discovered, you may have had an additional procedure to open those such as angioplasty or stenting. Those procedures are discussed in a separate article. If no additional procedure is needed, you are usually discharged in 2 to 3 hours, from the hospital. Your recovery after discharge includes no lifting greater than 10 pounds, no strenuous activity, and no driving for about 5-7 days.

With any procedure, there can be risks. Cardiac catheterization offers the benefit of being the "Gold Standard" test. That means that at the current time no test is more accurate in determining if you have coronary artery disease (blockages). The risks include a 1-3 chance in 1000 of stroke, heart attack, emergency bypass surgery, or death. There is less than a 1% chance of bleeding that is severe enough to require a transfusion or a surgery to repair the artery.

In sum, a cardiac cath is a safe and accurate means of determining the presence of coronary disease with minimal discomfort.