Heart Biopsy

Heart biopsy provides tissue samples directly from the heart muscle. Those tissue samples can be tested to see if your cardiomyopathy is caused by myocarditis or a virus. Knowing the cause can determine whether an underlying heart problem can be treated and if so, what treatment is best. Since this is not a risk-free test, I suggest you seriously quiz your doctor about the exact reasons he has ordered this test for you, just to be sure the information gained is worth the risk.

Taking The Test

You may be asked not to eat or drink anything after midnight the day before your biopsy. About one hour before the procedure, you may be given a mild sedative to help you relax, but not put you to sleep. If you want that sedative, you should be very assertive about it. Some cath labs do not routinely give a sedative and others are not too good about following your doctor's orders for one. Be firm about it (jump off the gurney and run down the hall in your gown screaming Fire! if necessary) and you'll get one. <g>
     looking into cath labBefore they cart you off to the lab, you'll be asked to shave one side of your groin, in the crease right where your thigh connects to your torso. They may reshave this once you are in the "cath lab" or room where the procedure is done. You will be asked not to wear your underwear and in just a hospital gown, you will be wheeled to the cath lab on a gurney.
     There, you'll be moved onto a table surrounded by high-tech medical machinery. Nurses will "paste" EKG electrodes on your chest and clean your groin area with an antiseptic solution. They will cover most of you with sterile towels. When your doctor arrives, he will inject your groin with a numbing medication. In many cases, this will not be your usual cardiologist, but someone who specializes in invasive procedures at that hospital, so don't be surprised if he's not your doctor. Introductions are in order, though. <g> This cardiologist is an interventional cardiologist, often just called an "operator."
     After the local anesthetic has numbed your groin, the doctor will make a small puncture in your groin and he will insert the catheter (a long, thin tube) into your blood vessel there. Dye will be injected intravenously into your bloodstream so the doctor can watch the catheter's progress on special x-ray machines.
     The dye may cause you to get very warm (flush), give you an urge to urinate or leave a bad taste in your mouth; These are all normal and will fade. You shouldn't feel any pain at all but there will be a sense of pressure which is rather unpleasant but bearable.
     The tube is guided to your heart. A special cutting tool, very small in size, called a forceps, is then guided via the catheter to your heart. It actually "snips" a tiny portion of heart tissue and is then retracted complete with tissue sample through the catheter. The sample is saved for study.

The biospy procedure is usually done at the end of a cardiac cath procedure that also measures heart function and different heart, blood vessel, and lung pressures. There are no nerve endings in the heart to detect pain, so the biopsy itself does not hurt. You will hear a zzzzzt sound as the sample is "snipped" but again, it does not hurt.
cath labIf you get dizzy, sick to your stomach, feel numb anywhere but your groin, or if you have chest pain, the doctor needs to know immmediately. One nurse should be focused on your face during the whole procedure; and make no mistake, she has power in that lab. If you have any of these symptoms or get upset or scared - even a little - you tell him (or her) and don't hold back. He or she has that job because he is no-nonsense and knows how to take charge. He will be sure the doc is aware of your problem and that it is addressed pronto.
     Once the cath is done, the catheter will be removed. You shouldn't feel this either, except for some pressure. A nurse will apply very firm pressure to the incision in your groin for at least 10 minutes (pushing down on that area). She will really be leaning on the bandage she has over your incision, so expect this to be uncomfortable, but it should be bearable. She'll then put a large dressing over your incision and you'll be wheeled back to your hospital room. Your time in the cath lab itself should be about 40 minutes.

Back in Your Hospital Room

When you are back in your room, they will move you back to your bed. You'll have to lie flat in bed for about 6 hours so the puncture site can heal enough not to bleed. Different hospitals use different methods at this point. Some place a small sandbag over your incision to keep pressure on it and prevent bleeding. Some actually put a clamp over the incision which clamps you to the bed to apply the pressure. That's considered kind of medieval now, though. <g>
     Although some staff still require you to lay completely flat, most should allow you to elevate your torso a bit for comfort and to make breathing easier. You can eat and drink normally again now if they'll let you be slightly elevated. You will have to use a bedpan or urinal for taking care of business at first. You'll have your vital signs and the incision checked often for the first few hours.
     After the required time has passed - usually 4 to 6 hours - you will have the sandbag or clamp removed and you'll be allowed to move around, although you should still take it very easy so you don't open that incision. Your doctor should discuss the results of the biopsy within a few days; the lab has to test the tissue samples first and then send the findings to your doctor.
     Please note: recently the AngioSeal device has been put into use. You may receive it. This is a device that takes the place of all that pressure and lying flat routine. It is basically a "plug" that seals the incision (cut) in your groin where the catheter went in. You can read about it here and here. The FDA released a warning letter about such devices in October of 1999 and you can read it here.

Some Possible Side Effects

cath labYou will have a bruise around the incision. You will probably also feel a hard lump there. The bruise will probably get worse for a day or two afterward. Both are normal and should disappear in about two weeks. You may develop a backache and a whole slew of sore muscles, aches, and pains from lying flat for too long, but eventually they will fade away.
     Now, don't panic at this paragraph, but it is something you should know. Cath is an invasive procedure and all invasive procedures are like surgery - there is definite risk involved. About 2 people out of every 1000 who have a cath die as a result. You can help minimize that risk yourself. Select a medical center that does a lot of caths every year (high volume). Also select a cardiologist (operator) who does a lot of caths every year. That means hundreds of caths every year! This really does reduce your risk. See this page for more. You also want to go to a large hospital doing lots of caths so they will have the facilities to handle an emergency if it happens.
     Sometimes a biopsy is taken via right heart cath (Swan-Ganz), which is done through the jugular in your neck. This is a slightly riskier procedure and I would question my doctor in advance to know if my biopsy is going to be taken via groin or neck. If neck, I would ask why. See this page.

How To Make It Easier

Because hospitals in general and cath labs in particular are very cold, I suggest you ask for a blanket or two to use whenever they aren't actually doing the procedure. Ask for the blankets before you leave your hospital room so you'll be sure to get them before you get cold. As usual, don't take your diuretics (Lasix [furosemide], Demndex [torsemide], Bumex, zaroxolyn) too close to test time because believe me, they aren't going to let you up to go pee during this one. <g>

All information on this site is opinion only. All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor. Use the reference information at the end of each article to search MedLine for more complete and accurate information. All original copyrights apply. No information on this page should be used by any person to affect their medical, legal, educational, social, or psychological treatment in any way. I am not a doctor. This web site and all its pages, graphics, and content copyright © 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004 Jon C.

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