Coronary catheterisation is an investigation that studies the coronary arteries of the heart with the view to:

• Identifying the potential anomalies of the blood flow due to the stenosis (narrowing) of the coronary arteries;
• Intervening in order to dilate the affected coronary artery if there is a stenosis or an obstruction.

This procedure is recommended when the physician suspects the presence of a myocardial infarction or of angina pectoris, more precisely in case of:

• Persistent chest pain (see the characteristics of angina pectoris);
• Black outs, syncopes (i.e. fainting, loss of consciousness) in patients with cardiovascular risk factors (arterial hypertension, hypercholesterolaemia, diabetes mellitus etc.);
• Abnormal electrocardiogram (ECG) (changes that are specific to an ischaemic cardiac disease, arrhythmias);
• Changes that are specific to an ischaemic cardiac disease identified during cardiac echography;
• During the exploration of a dilated cardiomyopathy (when the heart is dilated and we need to identify the cause);
• Anomalies in the biological tests (increase in the number of cardiac enzymes or troponin).

This investigation uses X-rays and a iodine-based contrast substance. Its aim is to offer the cardiologist the possibility of visualising the coronary arteries by making them opaque.

A catheter is introduced inside the blood veins (femoral artery) and manoeuvred inside the heart where it injects the contrast substance that mixes in with the blood. Thus the vascularisation system of the heart becomes visible (in X-ray images due to the radiopaque properties of iodine).

How is coronary catheterisation performed?

A cardiologist who is superspecialised in Interventional Cardiology will perform the procedure. During the exploration, the patient lies down on his back. The cardiac rhythm and the arterial pressure are constantly monitored.

The procedure is performed in sterile conditions and under local anaesthesia. The cardiologist starts by disinfecting the skin at the base of the thigh and administers the local anaesthesia. After the area is anaesthetised, the cardiologist introduces the catheter into the femoral artery. This catheter is then manoeuvred up to the origin of the coronary arteries. The entire procedure is monitored on a screen. Then, the cardiologist injects the contrast substance that makes the vascular network of the heart become visual on the screed.

If an obstruction is identified, the cardiologist will perform a coronary angioplasty that dilates the narrowed blood vein by using a balloon and possibly a stent as well (see coronary angioplasty). The procedure takes about 30 minutes - 1 hour.

After finishing the investigation the catheters are removed, the vein located at the puncture place of the femoral artery (at the base of the thigh) is compressed and a compressive dressing is applied for 24 hours. The patient must remain immobile, on his back, in bed for 24 hours. This is necessary in order to avoid bleeding in the puncture place of the femoral artery. In the hours after the procedure you can eat and drink normally.

Is coronary catheterisation painful?

The local anaesthesia consists of a simple sting, followed by the puncture of the femoral artery. This part is slightly unpleasant, but not painful, since the entire procedure is performed under local anaesthesia.