Outpatient Cardiology Diagnostic Tests

Left heart catheterization is the passage of a thin flexible tube (catheter) into the left side of the heart. It is done to diagnose or treat certain heart problems.

How the Test is Performed

You may be given a mild medicine (sedative) before the procedure starts to help you relax. The health care provider will place an IV into your arm so that you can get medicine during the procedure.

You will lie on a padded table. Your doctor will make a small surgical cut on your body. A flexible tube (catheter) is inserted through the cut into an artery. It is most often inserted through the groin, but may be placed in your arm or wrist. You will be awake during the procedure.

Live x-ray pictures are used to help guide the catheters up into your heart and arteries. Dye will be injected into your body to highlight blood flow through the arteries. This helps show blockages in the blood vessels that lead to your heart.

The catheter is then moved through the aortic valve into the left side of your heart. The pressure is measured in the heart in this position. Other procedures, such as ventriculography to check the heart's pumping function and coronary angiography to look at the coronary arteries can be done at this time. Sometimes procedures to correct blockages in the arteries are then performed, such as angioplasty with or without stenting.

The procedure may last from less than 1 hour to several hours.

How to Prepare for the Test

In most cases, you should not eat or drink for 8 hours before the test. (Your health care provider may give you different directions.)

The procedure will take place in the hospital. You may be admitted the night before the test, but it is common to come to the hospital the morning of the procedure.

Your health care provider will explain the procedure and its risks. You must sign a consent form.

How the Test will Feel

You will be given medicine (a sedative) to help you relax before the procedure. However, you will be awake and able to follow instructions during the test.

You will be given local numbing medicine (anesthesia) before the catheter is inserted. You will feel some pressure as the catheter is inserted, but you should not feel any pain. You may have some discomfort from lying still for a long period of time.

Why the Test is Performed

The procedure is done to look for:

• Cardiac valve disease
• Cardiac tumors
• Heart defects (such as ventricular septal defects)
• Problems with heart function

The procedure may also be done to repair certain types of heart defects, or to open a narrowed heart valve.

When this procedure is done with coronary angiography, it can open blocked arteries or bypass grafts.

The procedure can also be used to:

• Collect blood samples from the heart
• Determine pressure and blood flow in the heart's chambers
• Examine the arteries of the heart (coronary angiography)
• Take x-ray pictures of the left side of the heart (ventriculography)

Swan-Ganz catheterization is the passing of a thin tube (catheter) into the right side of the heart and the arteries leading to the lungs. It is done to monitor the heart's function and blood flow. This test is most often done in persons who are very ill.

How the Test is Performed

The test can be done while you are in bed in an intensive care unit (ICU) of a hospital or in special procedure areas such as a cardiac catheterization laboratory.

Before the test starts, you may be given medicine (sedative) to help you relax.

You will lie on a padded table. Your doctor will make a small surgical cut near the groin or in your neck. A flexible tube (catheter or sheath) is placed through the cut into a vein. Sometimes, it will be placed in your arm. You will be awake during the procedure.

A larger catheter is inserted and carefully moved into the upper chamber of the right side of the heart. X-ray images may be used to help the health care provider see where the catheter should be placed.

Blood may be removed from the catheter to measure the amount of oxygen in the blood.

During the procedure, your heart's rhythm will be constantly watched using an electrocardiogram (ECG).

How to Prepare for the Test

You should not eat or drink anything for 8 hours before the test starts. You may need to stay in the hospital the night before the test. Otherwise, you will check in to the hospital the morning of the test.

You will wear a hospital gown. You must sign a consent form before the test. Your health care provider will explain the procedure and its risks.

How the Test will Feel

You may be given medicine to help you relax before the procedure. You will be awake and able to follow instructions during the test.

You may feel some discomfort when the IV is placed into your arm. You may also feel some pressure at the site when the catheter is inserted. In people who are critically ill, the catheter may stay in place for several days.

You may feel discomfort when the area of the vein is numbed with anesthetic.

Why the Test is Performed

The procedure is done to evaluate how the blood moves (circulates) in people who have:

• Abnormal pressures in the heart arteries
• Burns
• Congenital heart disease
• Heart failure
• Kidney disease
• Leaky heart valves (valvular regurgitation)
• Shock

It may also be done to monitor for complications of heart attack and to see how well certain heart medicines are working.

Swan-Ganz catheterization can also be used to detect abnormal blood flow between two areas of the heart that are not normally connected.

Conditions that can also be diagnosed or evaluated with Swan-Ganz catheterization include:

• Cardiac tamponade
• Pulmonary hypertension
• Restrictive cardiomyopathy

Coronary arteriography, also known as coronary angiography, is an invasive procedure that involves cardiac catheterization. It's used to diagnose coronary artery disease.

Coronary arteriography, also called coronary angiography, is the standard diagnostic test for coronary artery disease, but because it's an invasive test it's often ordered only after you've had a series on noninvasive heart tests.

What Is Coronary Arteriography?

Coronary arteriography is a procedure in which a very thin catheter, or tube, is threaded through an artery from the groin, neck, or arm to the coronary arteries around the heart. The doctor uses this catheter to put a contrast dye into the blood of the coronary arteries. The dye shows up on X-rays and highlights the coronary arteries. The X-rays are called angiograms.

A doctor looking at these images can see whether you have a lot of plaque (fatty buildup) that is causing your coronary artery to be more narrow than normal. As plaque builds up, it is harder for oxygen-rich blood to get to the heart through the coronary arteries. This can cause chest pain, angina, and even heart attack. This is called coronary artery disease (CAD), also known as coronary heart disease.

It's worth noting that just because you have chest pain and other possible symptoms of heart attack does not mean that your angiogram will show signs of coronary artery disease. In fact, in a review of patient data from 238 patients who had cardiac catheterization because of chest pain, researchers found that only one-third had coronary artery disease.

Benefits and Risks of Coronary Arteriography Ultrasound

This relatively painless test takes less than three hours and gives a definitive answer to the question of whether — and where — you have buildup in your coronary arteries. In emergency situations, it may help open up a blocked artery to get blood flowing again.

Coronary arteriography is performed on millions of adults every year and has minimal risks associated with it. However you should be aware that:

• There is a risk of bleeding from the site where the catheter was first put into your body. You are usually advised to take it easy for a few days and not put any pressure on or near that location, other than the pressure applied by hospital staff immediately after the procedure.
• There is a small risk of infection or pain at the catheter site.
• Some people are allergic to the dye that's used to highlight coronary arteries.
• Rarely, cardiac catheterization causes damage to blood vessels.
• There are other rare complications, such as damage to the kidneys, the formation of blood clots, low blood pressure, or irregular heart beat.

You probably won’t be able to drive after the procedure, so make sure you have someone who can take you home.

People who are over age 75, have diabetes, have kidney disease, are female, or are receiving coronary arteriography on an emergency basis are more likely to have complications than other patients. Despite the possibility of damage to kidneys, coronary arteriography has been shown to be safe and informative in preparation for kidney transplants.

Although coronary arteriography remains the gold standard for diagnosing coronary artery disease, cardiac computed tomography (CT) is a noninvasive test that offers much the same information, according to researchers.

What are electrophysiology studies?

Electrophysiology studies (EPS) are tests that help doctors understand the nature of abnormal heart rhythms (arrhythmias).

Quick facts

• Electrophysiology studies test the electrical activity of your heart to find where an arrhythmia (abnormal heartbeat) is coming from.
• These results can help you and your doctor decide whether you need medicine, a pacemaker, an implantable cardioverter defibrillator (ICD), cardiac ablation or surgery. 
• These studies take place in a special room called an electrophysiology (EP) lab or catheterization (cath) lab while you are mildly sedated.

Why do people have electrophysiology studies?

When someone’s heart doesn’t beat normally, doctors use EPS to find out why. Electrical signals usually travel through the heart in a regular pattern. Heart attacks, aging and high blood pressure may cause scarring of the heart. This may cause the heart to beat in an irregular (uneven) pattern. Extra abnormal electrical pathways found in certain congenital heart defects can also cause arrhythmias.

During EPS, doctors insert a thin tube called a catheter into a blood vessel that leads to your heart. A specialized electrode catheter designed for EP studies lets them send electrical signals to your heart and record its electrical activity.  

Doctors use EPS to see: 

• Where an arrhythmia is coming from.
• How well certain medicines work to treat your arrhythmia.
• If they should treat a problem by destroying the place inside your heart that is causing the abnormal electrical signal. This procedure is called catheter ablation.
• If a pacemaker or implantable cardioverter defibrillator (ICD) might help you.
• If you are at risk for heart problems such as fainting or sudden cardiac death due to cardiac arrest (when your heart stops beating).

During an EPS, about 3 to 5 electrically sensitive catheters are placed inside the heart to record electrical activity.

What are the risks of EPS?

Risks may include:

• Arrhythmia. During EPS you may have abnormal heart rhythms that make you dizzy. If this happens, your doctor may give your heart an electric shock to bring back a regular heartbeat.
• Blood clots sometimes can form at the tip of the catheter, break off and block a blood vessel. Your doctor may give you medicine to prevent blood clots.
• Infection, bleeding and bruising at the site where the catheter went in (groin, arm or neck). Your doctor or nurse will help you avoid these problems.

How do I prepare for EPS?

• Don’t eat or drink anything for 6 to 8 hours before the test.
• Tell your doctor about any medicines you take, including over-the-counter medicines, herbs and vitamins. He or she may ask you not to take them before EPS. Don’t stop taking your medicine until your doctor tells you to.
• Have someone drive you to your appointment and take you home.
• If you usually wear a hearing aid, wear it during your procedure. If you wear glasses, bring them to your appointment.

What happens during EPS?

At a hospital or clinic, doctors and nurses do EPS in a room that has special equipment for the tests. You may hear this room called the electrophysiology laboratory, or EP lab. Some call it the catheterization laboratory (cath lab). During the test:

• A nurse will put an IV (intravenous line) in your arm. You’ll get medicine (a sedative) that will help you relax. But you’ll be awake and able to follow instructions during the test.
• Your nurse will clean and shave the part of your body where the doctor will be working. This is usually in the groin but may be the arm or neck.
• You’ll be given a shot – a local anesthetic will be given — to make the area numb. Your doctor will make a needle puncture through your skin and into your blood vessel. A small straw-sized tube called a sheath will be inserted into your artery or vein. The doctor will gently guide several specialized EP catheters into your blood vessel through the sheath and advance them to your heart. A video screen will show the position of the catheters. You may feel some pressure in the area where the sheath was inserted, but you shouldn’t feel any pain.
• Your doctor will send small electric pulses through the catheters to make your heart beat at different speeds. You may feel your heart beat stronger or faster.
• Electrical signals produced by your heart will be picked up by the special catheters and recorded. This is called cardiac mapping and allows the doctor to locate where arrhythmias are coming from,
• Your doctor will remove the catheters and the IV line. Your nurse will put pressure on the puncture site to stop any bleeding. 
• EPS usually last 1 to 4 hours.

If the type and location of the arrhythmia is identified and an appropriate therapy decided, cardiac ablation or insertion of a pacemaker or ICD may be performed during or immediately after the EPS.

“I could feel my heart speeding up, which was weird. But it didn’t hurt. It was more like hiking up and down hills really fast.” Esmerelda, age 38

What happens after EPS?

You’ll be moved to a recovery room where you should rest quietly for 1 to 3 hours. During this time:

• Stay still as long as your nurse tells you to. Be sure to keep the arm or leg used for the test straight. 
• Your nurse will check on you often to see if there is bleeding or swelling at the puncture site. 
• After the sedative wears off, your doctor will talk to you about your test results. 
• Before you leave, you’ll be told what to do at home.

What happens after I get home?

Follow the instructions your nurse or doctor gave you, including taking any new medicines that were prescribed. Most people can start eating food and taking their medicines within 4 to 6 hours after the test. Most can do their usual daily activities the day after the test. Don’t drive for at least 24 hours.

The puncture site may be sore for several days. A small bruise at the puncture site is normal. If the site starts to bleed, lie flat and press firmly on top of it. Have someone call the doctor or EP lab.

What should I watch for?
Call 9-1-1 if you notice:

• A sudden increase in swelling around the puncture site.
• Bleeding doesn’t slow down when you press hard on the site.

Call your doctor right away if you notice:

• Your arm or leg that was used for the sheath feels numb or tingles.
• Your hand or foot feels very cold or changes color.
• The puncture site looks more and more bruised.
• The puncture site begins to swell or fluids begin to come from it.

What is a peripheral angiogram?

A peripheral angiogram is a test that uses X-rays and dye to help your doctor find narrowed or blocked areas in one or more of the arteries that supply blood to your legs (View an animation of an angiogram). The test is also called a peripheral arteriogram.

Why do people have peripheral angiograms?

Doctors use a peripheral angiogram if they think blood is not flowing well in the arteries leading to your legs or, in rare cases, to your arms. The angiogram helps you and your doctor decide if a surgical procedure is needed to open the blocked arteries. Peripheral angioplasty is one such procedure. It uses a balloon catheter to open the blocked artery from the inside. A stent, a small wire mesh tube, is generally placed in the artery after angioplasty to help keep it open. Bypass surgery is another procedure. It re-routes blood around the blocked arteries.

What are the risks of peripheral angiograms?

Serious risks and complications from peripheral angiograms are very unlikely. But in rare cases:

• A thin tube (catheter) that doctors insert into your artery during a peripheral angiogram damages the artery. Emergency surgery may be needed to restore blood flow to the artery.
• People have allergic reactions to the dye used in the test. Tell your doctor if you are allergic to dyes, iodine or shellfish.

How do I prepare for a peripheral angiogram?

• Your doctor will give you instructions about what you can eat or drink during the 24 hours before the test.
• Usually you’ll be asked not to eat or drink anything for 6 to 8 hours before your peripheral angiogram.
• Tell your doctor about any medicines (including over-the-counter, herbs and vitamins) you take. He or she may ask you not to take them before your test. Don’t stop taking your medicines until your doctor tells you to.
• Tell your doctor or nurse if you are allergic to anything, especially iodine, shellfish, latex or rubber products, medicines like penicillin, or X-ray dye.
• Leave all of your jewelry at home.
• Arrange for someone to drive you home after your angiogram.

What happens during the peripheral angiogram?

A doctor with special training performs the test with a team of nurses and technicians. The test is performed in a hospital or outpatient clinic.

• Before the test, a nurse will put an IV (intravenous line) into a vein in your arm so you can get medicine (sedative) to help you relax. You’ll be awake during the test.
• A nurse will clean and shave the area where the doctor will be working. This is usually an artery in your groin.
• A local anesthetic will be given to numb the needle puncture site.
• The doctor will make a needle puncture through your skin and into your artery, and insert a long, thin tube called a catheter into the artery. You may feel some pressure, but you shouldn’t feel any pain.
• The doctor will inject a small amount of dye into the catheter. This makes the narrowed or blocked sections of your arteries show up clearly on X-rays. The dye may cause you to feel flushed or hot for a few seconds.
• A peripheral angiogram usually takes 1 to 3 hours from the time you arrive until the catheter is removed.

“I watched the whole thing on the screen. It was a pretty easy procedure.” Shirley, age 77

What happens after the peripheral angiogram?

• You will go to a recovery room for 6 to 8 hours.
• To prevent bleeding, the nurse will put pressure on the puncture site. After about 45 minutes, the nurse will remove the pressure and check for bleeding.
• The nurse will ask you not to move the leg used for the catheter.
• The nurse will continue to check often for bleeding or swelling.
• Before you leave, the nurse will give you written instructions about what to do at home.

What happens after I get home?

• Drink lots of liquids to make up for what you missed while you were preparing for the angiogram and to help flush the dye from your body. For most people, this means drinking at least 6 glasses of water, juice or tea.
• You can start eating solid food and taking your regular medicines 4 to 6 hours after your angiogram.
• Don’t drive for at least 24 hours.
• The puncture site may be tender for several days, but you can probably return to your normal activities the next day.
• Your doctor will get a written report of the test results to discuss with you.

What should I watch for?

A small bruise at the puncture site is common. If you start bleeding from the puncture site, lie flat and press firmly on that spot. Ask someone to call the doctor who did your peripheral angiogram.

Call your doctor if:

• Your leg with the puncture becomes numb or tingles, or your foot feels cold or turns blue.
• The area around the puncture site looks more bruised.
• The puncture site swells or fluids drain from it.

Call 9-1-1 if you notice:

• The puncture site swells up very fast.
• Bleeding from the puncture site does not slow down when you press on it firmly.

Cerebral angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the brain.

How the Test is Performed

Cerebral angiography is done in the hospital or radiology center.

• You lie on an x-ray table.
• Your head is held still using a strap, tape, or sandbags, so you do not move it during the procedure.
• Before the test starts, you are given a mild sedative to help you relax.
• Electrocardiogram (ECG) is used to monitor your heart activity during the test. Sticky patches, called leads, will be placed on your arms and legs. Wires connect the leads to the ECG machine.

An area of your body, usually the groin, is cleaned and numbed with a local numbing medicine (anesthetic). A thin, hollow tube called a catheter is placed through an artery. The catheter is carefully moved up through the main blood vessels in the belly area and chest into an artery in the neck. X-rays help the doctor guide the catheter to the correct position.

Once the catheter is in place, the dye is sent through the catheter. X-ray images are taken to see how the dye moves through the artery and blood vessels of the brain. The dye helps highlight any blockages in blood flow.

Sometimes, a computer removes the bones and tissues on the images being viewed, so that only the blood vessels filled with the dye are seen. This is called digital subtraction angiography (DSA).

After the x-rays are taken, the catheter is withdrawn. Pressure is applied on the leg at the site of insertion for 10 to 15 minutes to stop the bleeding or a device is used to close the tiny hole. A tight bandage is then applied. Your leg should be kept straight for 2 to 6 hours after the procedure. Watch the area for bleeding for at least the next 12 hours.

How to Prepare for the Test

Before the procedure, your health care provider will examine you and order blood tests.

Tell the provider if you:

• Have a history of bleeding problems
• Have had an allergic reaction to x-ray contrast dye or any iodine substance
• May be pregnant
• Have kidney function problems

You may be told not to eat or drink anything for 4 to 8 hours before the test.

You must sign a consent form. Your provider will explain the procedure and its risks. When you arrive at the testing site, you will be given a hospital gown to wear. You must remove all jewelry.

How the Test will Feel

The x-ray table may feel hard and cold. You may ask for a blanket or pillow.

Some people feel a sting when the numbing medicine (anesthetic) is given. You will feel a brief, sharp pain and pressure as the catheter is moved into the body.

The contrast may cause a warm or burning feeling of the skin of the face or head. This is normal and usually goes away within a few seconds.

You may have slight tenderness and bruising at the site of the injection after the test.

Why the Test is Performed

Cerebral angiography is most frequently used to identify or confirm problems with the blood vessels in the brain.

Your doctor may order this test if you have symptoms or signs of:

• Abnormal blood vessels (vascular malformation)
• Aneurysm
• Narrowing of the arteries in the brain
• Vasculitis
• It is sometimes used to:
• Confirm a brain tumor
• Evaluate the arteries of the head and neck before surgery
• Find a clot that may have caused a stroke

In some cases, this procedure may be used to get more detailed information after something abnormal has been detected by an MRI or CT scan of the head.

This test may also be done in preparation for medical treatment (interventional radiology procedures) by way of certain blood vessels.