Heart Disease and the Heart Biopsy
A heart biopsy, also called myocardial biopsy or cardiac biopsy, is an invasive procedure to detect heart disease. It entails using a bioptome
(a small catheter with a grasping device on the end) to obtain a small piece of heart muscle tissue that is sent to a laboratory for analysis.
Why Do I Need a Heart Biopsy?
Your doctor uses a heart biopsy to:
- Evaluate or confirm the presence of rejection after a heart transplant.
- Diagnose myocarditis (inflammation of the heart muscle) or certain other cardiac disorders such as cardiomyopathy or cardiac amyloidosis if common diagnostic tools like echocardiogram, EKG, or chest X-rays are not as helpful, or if a patient's heart condition is dramatically worsening without apparent cause. A heart biopsy can correctly pinpoint a specific diagnosis in 10%-20% of cases.
How Should I Prepare for a Heart Biopsy?
To prepare yourself for a heart biopsy, you should know:
- The biopsy takes place in the hospital as an outpatient procedure. Typically, you come to the hospital the day of the test, but in some cases, you may be admitted the night before the procedure.
- You can wear whatever you like to the hospital, but it is a good idea to leave valuables, such as jewellery, at home. You will wear a hospital gown during the procedure.
- Your doctor or nurse will give you specific instructions about what you can and cannot eat or drink before the procedure. In general, food and fluids are restricted for 6 to 8 hours before the test.
- Ask your doctor what medications should be taken on the day of your heart biopsy. Be sure to tell your doctor if you are taking any nutrition supplements or herbal preparations, and tell your doctor which over-the-counter medications you are taking. Please bring a list of all of your medications and the current dosages with you.
- If you have diabetes, ask your doctor how to adjust your medications the day of your test.
- Tell your doctor and/or nurses if you are allergic to anything.
- Arrange for someone to drive you home after the test, as you may be groggy from the sedative given to numb the site where the catheter is inserted.
- If you normally wear dentures or a hearing device, plan to wear them during the procedure to help with communication. If you wear glasses, plan to bring them as well.
What Can I Expect During a Heart Biopsy?
- A health care provider will explain the heart biopsy to you, including the potential risks.
- After you change into a hospital gown, a nurse will start an intravenous (IV) line in your arm so that medications and fluids can be given during the procedure.
- You will lie on your back on a special table. If you look above, you will see a large camera and several TV monitors.
- A mild sedative medication will be given before the procedure to help you relax, but you will be awake during the procedure.
- The doctor will use a local anaesthetic to numb the area of your neck. A plastic introducer sheath (a short, hollow tube through which the catheter is placed) is inserted through a small incision and into a blood vessel in the neck. A bioptome is inserted through the sheath and threaded to the right ventricle. X-rays, called fluoroscopy, are used to position the bioptome properly.
- The bioptome is used to obtain samples of the heart muscle.
- When the samples have been collected, the catheter and sheath will be removed and firm pressure will be held over the area to stop bleeding.
- The procedure takes about 30 to 60 minutes. However, the preparation and recovery add several hours. You should be able to go home the same day of the procedure.
What Can I Expect After a Heart Biopsy?
Before you go home, a health care provider will tell you how to care for the wound site and when you can return to your regular activities.
When the results of the heart biopsy are available, your doctor will discuss them with you. If the results are negative, it means the heart tissue that was
analysed looked normal. A positive biopsy result could mean a cause of heart failure was found, such as inflammation due to an infection. If the biopsy
followed a heart transplant, it may indicate the presence of rejection cells.
Are There Risks with a Heart Biopsy?
The risks of a heart biopsy include:
- Puncture of the vein when the bioptome is inserted
- Aggravation of an existing arrhythmia (irregular heart beat)
- Puncture of the heart