You will get a mild sedative 30 minutes before the procedure. A cardiologist will cleanse the site and numb the area with a local anesthetic. Then a catheter will be inserted into a vein in your neck, arm, or groin.

The catheter will be moved into the right side of the heart. As the catheter is advanced, the doctor can record pressures from the right atrium and right ventricle.

Contrast material ("dye") is injected into the right side of the heart. It helps the cardiologist determine the size and shape of the heart's chambers and evaluate their function as well as the function of the tricuspid and pulmonary valves.

The actual angiography will only last a few seconds, but the entire procedure will take longer, and if combined with other procedures may be considerably longer. 

You will not be allowed to eat or drink for 6 to 8 hours before the test. The procedure takes place in the hospital or a specialized procedure unit. Generally, you will be admitted the morning of the procedure. However, you may need to be admitted the night before.

A health care provider will explain the procedure and its risks. You must sign a consent form.

You will be given local anesthesia where the catheter is inserted. Afterward, the only thing you should feel is pressure at the site. You will not feel the catheter as it is moved through your veins into the right side of the heart. You may feel a flushing sensation or the feeling that you need to urinate as the dye is injected.

Right heart angiography is performed to assess the blood flow through the right side of the heart.

Normal results include:

• Cardiac index is 2.8 to 4.2 liters per minute per square meter (of body surface area)
• Pulmonary artery systolic pressure is 17 to 32 millimeters of mercury (mm Hg)
• Pulmonary artery mean pressure is 9 to 19 mm Hg
• Pulmonary diastolic pressure is 4 to 13 mm Hg
• Pulmonary capillary wedge pressure is 4 to 12 mm Hg
• Right atrial pressure is 0 to 7 mm Hg

Abnormal results may be due to:

• Abnormal connections between the right and left side of the heart (congenital heart disease)
• Abnormalities of the right atrium, such as atrial myxoma (rarely)
• Abnormalities of the valves on the right side of the heart
• Abnormal pressures or volumes, particularly lung problems
• Weakened pumping function of the right ventricle (this could be due to many causes)

Risks of this procedure include:

• Cardiac arrhythmias
• Cardiac tamponade
• Embolism from blood clots at the tip of the catheter
• Heart attack
• Hemorrhage
• Infection
• Kidney damage from the dye
• Low blood pressure
• Reaction to contrast dye or sedating medicines
• Stroke
• Trauma to the vein or artery

This test may be combined with coronary angiography and left heart catheterization.

Angiography - right heart; Right heart ventriculography

Kern MJ, Seto KH, Herrmann J. Invasive hemodynamic diagnosis of cardiac disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 22.

Valente AM, Dorfman AL, Babu-Narayan SV, Krieger EV. Congenital heart disease in the adolescent and adult. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 82.

Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2023;82(9):833-955. PMID: 37480922 www.ncbi.nlm.nih.gov/pubmed/37480922/.

Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.