From the First ECG to the Cath Lab

Blood tests

A small blood sample shows cholesterol, blood sugar and kidney function and, when needed, markers of heart strain or heart muscle damage.

ECG

Small stickers on the chest record the heart’s electrical activity. It can show rhythm problems, signs of reduced blood flow or an old heart attack.

Holter and 24-hour blood pressure

A small recorder worn at home for a day or longer catches rhythm problems or blood pressure swings that a short visit can miss.

Echocardiogram

Ultrasound pictures of the heart’s chambers, valves and pumping strength, much like a scan in pregnancy.

Stress test

The heart is monitored while you walk on a treadmill, or ultrasound pictures are taken under effort or medication, to see how it copes with exercise.

Cardiac CT

A fast scan that measures calcium in the heart arteries (calcium score) and, with contrast given into a vein, shows narrowings without a catheter.

Possible risks: Contrast can strain the kidneys or cause an allergic reaction, and there is a low dose of X-rays.

Transesophageal echo (TEE)

A thin ultrasound probe passed into the esophagus gives close-up pictures from behind the heart, for valves, clots or holes between the chambers.

Possible risks: A sore throat for about a day; rarely, a reaction to the sedation or an injury to the throat or gullet.

Coronary angiography

A thin catheter, usually through the wrist, shows the heart arteries on X-ray. It is the most precise way to see narrowings, and treatment can follow in the same session if needed.

Possible risks: Bruising where the catheter goes in is common. Rarely: bleeding, a reaction to the contrast, strain on the kidneys or rhythm problems; very rarely a heart attack or stroke (well under 1 in 100).

Pressure and imaging inside the artery

During angiography, a pressure wire (FFR/iFR) shows whether a narrowing really limits blood flow, and IVUS/OCT shows the vessel wall and the stent from the inside.

Possible risks: The same as for angiography, with a very small added risk of injury to the artery wall from the wire or the imaging catheter.

Prevention and medication

High blood pressure, cholesterol, diabetes and lifestyle come first. Many narrowings are treated with medication alone, with a personal plan to lower your risk.

Balloon and stent (PCI)

A narrowed artery is opened with a balloon and usually a drug-eluting stent, through the wrist under local anesthesia. In selected cases a drug-coated balloon treats the artery without leaving a stent.

Possible risks: Those of angiography, plus a small risk of injury to the artery, a heart attack during the procedure or a clot in the stent. Blood thinners are needed afterwards and raise the risk of bleeding.

Complex coronary intervention

Left main and bifurcation disease, and arteries blocked for months (chronic total occlusion), can often be treated with a catheter, planned with imaging and discussed with the heart team when surgery is an option.

Possible risks: Higher than for a simple stent, depending on the arteries and your overall health. They are weighed against the alternatives, including bypass surgery, before you decide.

Treating hard calcium

Heavy calcium can stop a stent from expanding. Rotational atherectomy, intravascular lithotripsy (shockwave) or cutting balloons prepare the artery first.

Possible risks: Those of a stent procedure, plus a small risk of a tear or perforation of the artery, or of slow blood flow during the treatment.

Structural heart closure

Catheter closure of the left atrial appendage, an alternative to lifelong blood thinners for selected patients, and of holes between the upper chambers (ASD/PFO).

Possible risks: Bleeding or bruising in the groin, rhythm problems or a clot on the device; rarely, the device moving out of place or fluid around the heart.

Second opinion and follow-up

Advised to have a stent or bypass? Bring your angiogram for review. After a heart attack or stent, follow-up covers medication, activity and checks that the treatment works.