Cardiac Biopsy

A cardiac biopsy (or endomyocardial biopsy) is a procedure where a doctor takes small samples of your heart muscle tissue for analysis.

What is a cardiac biopsy?

A cardiac biopsy, also known as a heart biopsy or endomyocardial biopsy, is a procedure where a doctor takes a few small samples of your heart muscle tissue for examination.

Why do I need a cardiac biopsy?

You may need a cardiac biopsy if your doctor suspects a problem with your heart muscle or to monitor for rejection if you have had a heart transplant. 

Examples of heart muscle problems include:

  • Cardiomyopathy – weakening of the heart muscle
  • Myocarditis – inflammation of the heart muscle
  • Infiltrative disease – abnormal deposits in the heart muscle e.g. amyloidosis, sarcoidosis, haemachromatosis
  • Tumour or masses - if a mass is noted in the heart, a biopsy of the tumour may be required.

If you've had a heart transplant, you will need regular cardiac biopsies for the first year to look for rejection. After this you might need cardiac to check what level of immunosuppressive medication your need, or if rejection is suspected. 

What are the risks of having a cardiac biopsy?

As with any procedure, there are risks with a cardiac biopsy. Your doctor will explain the risks to you before you agree to the procedure. While serious risks are unlikely, there are some risks associated with a cardiac biopsy.

Common risks include:

  • Minor bleeding and bruising - at the puncture site
  • Arrhythmias – the catheter can irritate the heart and cause an abnormal heart rhythm, usually brief

Rare risks include:

  • Pericardial effusion or tamponade - fluid can accumulate around the heart. If this occurs, you may need urgent intervention to insert a tube or surgery to remove the fluid
  • Infection - germs could go into the blood stream during the procedure
  • Pneumothorax - during the insertion of the catheter, the lung can accidentally be punctured, causing it to collapse. If this occurs, a tube may need to be inserted into your chest
  • Thrombosis - blood clots can form around the catheter and travel to the lung
  • Injury of vein or artery - damage of the blood b=vessels can happen when attempting to insert the catheter

Extremely rare risks include:

  • Death – extremely rare but there is a risk

How do I prepare for a cardiac biopsy?

The day before the procedure: 

  • We will call you to tell you what time your procedure is and when you need to stop taking your blood thinners.
  • You can ask us any questions.
  • Please contact the Interventional Cardiology Services on (02) 8382 3484 with any queries or concerns

The morning of the procedure:

  • You can eat and drink as normal. You do not need to fast.
  • Do not take your immunosuppressants in case we need to take blood tests to check the drug levels.
  • Otherwise, you can take your usual medications, including for diabetes.
  • If you are taking blood thinners, follow the instructions from your doctor.

When you come to hospital:

  • Go to the:
    • Day Procedure Centre (DPC) on Level 5 of the Xavier building (if you are a public patient) and check in with the administration team or
    • Day of Surgery Admissions (DOSA) in the Private Hospital on Level 6 (if you are a private patient).
  • We will give you a hospital gown to change into.
  • You will need to take off any jewellery around your neck.
  • Please tell us if you experience claustrophobia or are feeling anxious as we can give you some medication to help calm you down.

We aim to complete your procedure at the scheduled time. Occasionally emergencies can result in longer wait times

What happens during a cardiac biopsy?

  • We will take you to the procedure room on a trolley or wheelchair.
  • We will ask you to lie flat on a narrow table. Let us know if you experience any back or breathing problems.
  • You will be awake throughout the procedure, unless we give you a light sedative.
  • Let us know if you would like us to play some music during the procedure to help you relax.
  • The procedure usually takes around 30 to 60 minutes.

During your procedure, your doctors and nurses will:

  • connect you to a heart, oxygen and blood pressure monitor
  • clean the skin over the neck or groin
  • cover the cleaned area with a drape (your face will be covered if we are going to use your neck vein)
  • give you a local anaesthetic to numb the area (this can be quite uncomfortable for some patients, but it is to ensure you don’t feel pain after)
  • put a tube into your vein
  • gently pass the biopsy forcep through the tube and advance it to the heart
  • take a few cardiac biopsy samples (usually four to five)
  • take blood tests (if needed) from the tube in your vein
  • remove the tube, apply pressure to stop any bleeding, then a dressing over the site

During the procedure, you:

  • might hear some unusual noises as we will use ultrasound and x-rays to make sure the catheter is in the correct position
  • will feel some stinging and slight pain when the local anaesthetic is administered
  • should only feel pressure (not sharp pain) after the local anaesthetic has taken effect
  • must tell us if you are feeling pain or discomfort
  • will feel brief heart beating sensations when the biopsy sample is being taken

What happens after a cardiac biopsy?

After your endomyocardial biopsy is finished, we will monitor you and offer you something to eat or drink.

Your doctor will organise an appointment to see you or call you to discuss the results. Most patients will go home the day of the procedure

If you have had a heart transplant you will need to attend the Heart and Lung Clinic before or after your cardiac biopsy

What do I do after a cardiac biopsy?

  • Apply light pressure to the site if you are straining, coughing or notice any bleeding.
  • You can expect some bruising and slight pain from the procedure site.
  • Leave the dressing on for 24 hours.Avoid heavy lifting for example more than 5kg for 24 hours.
  • You can return to your normal activities after 24 hours

If you start to notice bleeding at the procedure site:

  • Place firm pressure on it for 5 minutes.
  • After 5 minutes check procedure site for bleeding.
  • If still bleeding repeat steps 1 & 2 until bleeding has stopped.

If you experience any of these: 

  • uncontrollable bleeding or swelling from the procedure site
  • chest pain
  • fever or chills
  • increasing shortness of breath
  • increased dizziness, or fainting episodes 

Please seek immediate medical attention. Call Triple Zero (000) for ambulance or go to your nearest emergency department.

For further information, please refer to our SVHS Endomyocardial Biopsy Patient Information leaflet