Cardiac Biopsy

A cardiac biopsy is a procedure where a doctor takes a few small samples of your heart muscle tissue for analysis.

What is a cardiac biopsy?

A cardiac biopsy, also known as a heart biopsy or myocardial 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?

If your doctor suspects a problem with your heart muscle, you may need a cardiac biopsy. A cardiac biopsy can help to diagnose:

  • Rejection after heart transplant – causing heart tissue damage
  • Cardiomyopathy – weakened heart muscle
  • Myocarditis – inflammation of the heart muscle
  • Cardiac amyloidosis – abnormal protein (amyloid) in the heart tissue which makes it hard for the heart to work properly

What are the risks of having a cardiac biopsy?

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 – irregular heart beat that will settle by itself after the biopsy is taken

Uncommon risks include:

  • Arrhythmias lasting over a longer time – that may need an electric shock to correct
  • Damage to the vein or artery - in the neck
  • Bleeding – at the biopsy site

Rare risks include:

  • Blood clots – in the neck vein
  • Infection - needing antibiotics
  • Stroke – causing disability
  • Death – extremely rare

How do I prepare for a cardiac biopsy?

  • Before a cardiac biopsy you can eat and drink as normal -  and take your usual medications (unless your doctor gives you specific instructions).
  • You’ll be required to have a blood test within three days before your procedure - if you take blood-thinning medications, such as warfarin.
  • You’ll be asked to wear a hospital gown and remove all jewellery - just before your procedure

What happens during a cardiac biopsy?

Your cardiac biopsy procedure takes place in the hospital. You will be taken to the procedure room on a trolley or wheelchair and asked to lie on a narrow table. You will be awake throughout the procedure but if you feel very anxious before the procedure you can ask the nurse if it is possible to receive a tablet to help you relax.

During your procedure, your doctor will:

  • Explain the procedure to you and ask you to sign a consent form - to agree to the procedure
  • Connect you to a heart monitor - to record your heart rate, blood pressure and blood oxygen levels
  • Clean the skin - over the neck
  • Place sterile sheets - on your chest and neck
  • Clean the skin - over the neck
  • Give you local anaesthetic - to numb the area (this may sting a little when it is given)
  • Gently pass a catheter wire inside a vein - until it reaches the heart
  • The doctor uses x-ray images - to see the position of the wire catheter
  • Insert a sheath (small plastic tube) into the vein using the wire as a guide - this will feel like pressure in the neck
  • A bioptome (or pincer) is used to take very small tissue samples - one to two millimetres of the heart muscle. Normally, the doctor needs to take five tissue samples for analysing. This part of the procedure is painless, however you may feel some extra heartbeats during the biopsies
  • The doctor removes the catheter sheath - and applies pressure to where the catheter sheath was inserted

The procedure usually takes less than an hour.

What happens after a cardiac biopsy?

To prevent bleeding, you will be asked to apply light pressure to the site for a further 10 minutes and also if you need to sneeze, cough, laugh or bend over. You will be able to eat and drink normally.

Most people can return to their normal activities the next day, although you’ll be advised to avoid heavy lifting for 24 hours.

When the results of the cardiac biopsy are available, your doctor will discuss them with you.

Once you return home, if you experience any swelling, increased pain or bleeding in your neck, fever or chills, dizziness or chest pain, contact your doctor.

You can also read our Cardiac Biopsy Patient Information brochure for more information.