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.
Your doctor might perform a right-heart catheterization to assist in the diagnosis and/or management of the following conditions:
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.
Possible risks associated with a right-heart catheterization include:
Other, rare complications may include:
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.
Your healthcare provider will explain the procedure to you and offer you the opportunity to ask any questions you might have about the procedure.
Based on your medical condition, your healthcare provider may request other specific preparation.
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.
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:
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:
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