Cardiac catheterization for unstable angina

If you come to the emergency room because of unstable angina, your treatment will depend on your doctor's assessment of your condition. If you are at low risk of a heart attack, your doctor will most likely give you medicines to stabilize your condition and help prevent a heart attack.

If you are at high risk of a heart attack, you may benefit from emergency angioplasty with stenting or bypass surgery.

To decide which treatment is right for you, a cardiac catheterization will be done first. However, the decision to perform cardiac catheterization is not automatic, because there are some risks associated with this test.

For people who are considered good candidates for cardiac catheterization, the test is generally very safe. The vast majority of people who have the test do not experience any complications, and for those who do, the complications are usually very minor, such as bruising around the site where the catheter is inserted.

Your doctor may or may not recommend cardiac catheterization while you are still in the hospital. In some cases, your doctor may recommend that you schedule this test in the near future. In general, the decision to use cardiac catheterization is based on your risk of heart attack:

• If you are at high risk for a heart attack, your doctor probably will recommend cardiac catheterization.
• If you are at low risk for a heart attack, your doctor probably will first try treating your angina with medicines. After your angina has stabilized, your doctor may try noninvasive testing such as SPECT imaging, stress electrocardiogram, or stress echocardiogram.

Most doctors think that some "high-risk" people still may benefit from cardiac catheterization while they are in the hospital even if their unstable chest pain symptoms respond to medicine. This group includes people who are at very high risk for having a future heart attack or dying because they have severe heart failure.

If you do not have cardiac catheterization in the hospital, your doctor may use additional tests to make sure it is safe for you to go home. One test your doctor might use is a stress electrocardiogram.