Definition and Overview
A right heart catheterization (RHC) is a diagnostic and monitoring procedure used to determine how well the heart is pumping blood and how much blood it is pumping per minute. It also measures the pressure in the heart’s arteries and in the lungs, and is considered as the only accurate way to measure the pressure in the pulmonary artery and to diagnose pulmonary arterial hypertension. It is also used to continuously monitor the status of a patient with pulmonary hypertension during the treatment process.
Who Should Undergo and Expected Results
A right heart catheterization is performed to diagnose several heart conditions and is often prescribed for patients who are suffering from or suspected of having:
Heart failure – A condition wherein the heart muscle becomes weak and cannot pump blood efficiently. This causes a clogging of blood in the blood vessels and lungs.
Congenital heart disease – A condition wherein there is an inborn defect in the heart structure; one example is a hole in the chamber walls of the heart, a condition called ventricular septal defect or VSD.
Cardiomyopathy – A condition wherein the heart becomes enlarged; this is a serious condition that may cause heart failure when not treated.
Pulmonary hypertension – A condition wherein the blood pressure within the blood vessels in the lungs are too high; this can cause breathing difficulties and an increased risk of heart failure, usually on the right side of the heart.
Valvular heart disease – A condition wherein one or more of the valves in the heart malfunction, affecting the normal flow of blood through the heart. This can be treated through a valve replacement or balloon valvuloplasty.
Cardiac shock – A condition that may reduce or restrict the flow of blood and oxygen from the heart to other parts of the body; this can be brought on by several possible causes, such as sudden heart failure, sepsis (infection of the blood stream), or hemorrhage (excessive loss of blood).
Heart biopsy – RHC can also be used to perform a biopsy, which is often needed in the evaluation process prior to a heart transplant.
Heart ablation – RHC can be used to perform an ablation; in this case, several catheters are placed in the arteries and radiofrequency energy is passed through them to reach the part of the heart that causes abnormal heart rate.
The procedure usually takes at least an hour, and the patient is taken to the recovery room right after the test as the anesthesia wears off. There are no restrictions when it comes to food and beverage after the procedure. Once the anesthesia has worn off, the patient can usually go home. The results of RHC, which will be analyzed by the doctor, will directly affect the course of treatment needed.
How Does the Procedure Work?
A right heart catheterization is usually an outpatient procedure unless it is used for monitoring a patient’s status during treatment. A cardiologist or a pulmonologist performs it in a hospital’s catheter lab. There are certain preparations required prior to undergoing the procedure. The attending physician assigned to a patient will instruct the latter regarding these preparations, which include the following:
- Patient is not allowed to take certain medications prior to an RHC.
- Patient should not eat or drink for several hours before the procedure.
- Patient will undergo some laboratory tests and medication allergy testing.
- Patient will be asked to empty his bladder before going to the cath lab.
- Patient should notify the doctor about any sensitivity or allergy to latex, tape, or local and general anesthesia.
- An IV line will be inserted in the patient’s hand or arm and will be used for administering necessary medications.
- Electrodes will be placed on the patient’s chest to monitor the heartbeat during the procedure.
During the procedure, the patient will be kept awake, but will be given medications to keep him calm and relaxed. Undergoing RHC may be uncomfortable for some, especially when the catheter is inserted through a small cut made in the skin so that it can enter the vein, which can either be in the groin or neck area. The designated area will be numbed prior to the insertion of catheter so the procedure is not really painful. The catheter will then be advanced through the vein and into the pulmonary artery, measuring blood pressure along the way, focusing on the right atrium and right ventricle of the heart.
Once the catheter is in place, the next steps to be taken will differ based on the purpose of the procedure. If necessary, some medications are injected through the IV line to check the response of the heart. These medications may cause the heart to relax or dilate the blood vessels to see if they effectively lower blood pressure.
The test also requires the patient to lie still for the entire length of the procedure, and this can be uncomfortable for some patients. If there are any concerns, these should be discussed with the doctor prior to the procedure.
Possible Risks and Complications
All medical procedures have risks and benefits; doctors only prescribe a specific procedure if its expected benefits outweigh the risks. The following are the risks associated with right heart catheterization:
- Bruising at the site of catheter insertion
- Excessive bleeding/hemorrhage due to punctured vein
- Partial lung collapse or pneumothorax
- Tachycardia, or when the heart’s rhythm becomes abnormal
- Cardiac tamponade, or when fluid builds up around the heart
- Low blood pressure
- Air embolism
- Blood clot
- Ruptured pulmonary artery
After the procedure, the patient will be under close monitoring for bleeding, blood pressure changes, and heart rate and breathing changes. The following symptoms should also be reported immediately to the doctor:
- Shortness of breath
- Difficulty breathing
- Chest pain
- Increased pain and swelling at the puncture site
- Numbness or tingling in the puncture site
- Excessive sweating
- Chest pressure
Patients are advised to follow the instructions given by the doctor after the procedure to help avoid post-procedure complications.
Davidson CJ, Bonow RO. Cardiac catheterization. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 20
Kern M. Catheterization and angiography. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 55