What is an endomyocardial biopsy?

An endomyocardial biopsy is a procedure in which your cardiologist takes samples of heart tissue to help in the diagnoses of various cardiac conditions.

Why do I need a endomyocardial biopsy?

Your cardiologist will use the results of your biopsy to

  • Diagnose myocarditis (inflammation of the heart muscle)
  • Diagnose cardiac amyloidosis (infiltration of your heart muscles with a protein called amyloid that can cause heart failure)
  • Assess for the presence of rejection after heart transplant

How should I prepare for procedure?

Before the day of the procedure

  • The doctor will explain how the procedure is performed, the risks and benefits and expected duration of stay in the hospital.
  • Informed consent will be obtained.
  • Routine blood tests and ECG will be done before the procedure.

Instructions for medications

  • Blood thinners should be stopped 2 days before the procedure at the advise of your doctor. These include:
  1. Warfarin (Coumadin; Marevan)
  2. Dabigatran (Pradaxa)
  3. Apixaban (Elequis)
  4. Rivaroxaban (Xarelto)

Please discuss with your doctors if Aspirin and/or Clopidogrel needs to be stopped before the procedure.

On the day of the procedure

  • ARRIVE PUCTURALLY – Proceed to the admission office where the staff will settle you comfortably in your room.
  • FASTING - You may drink water, consume a light breakfast (eg cereal/eggs/toast/milo) 4 hours before your procedure. Please keep nil by mouth thereafter. Food will be provided for you after the procedure.
  • MEDICATIONS - Please consume all your prescribed medications with plainwater on the morning of your procedure. Bring all your medications with you.
  • ATTIRE - Come in casual comfortable attire and bring your toiletries, an extra set of clothes & undergarments.
  • ALLERGIES – Please inform your doctor if you are allergic to any drugs, latex, tape, local or general anesthesia (numbing medicines or medicines used to make you sleepy).
  • A SMALL IV CANNULA will be inserted in one of the veins of your hand to facilitate administration of medications.

Where is the procedure performed?

This test is usually done as a Day Surgery procedure in the Cardiovascular Lab in the X-ray department (not in the operating theatre).

How is the procedure performed?

Before the procedure

  1. You will be asked to empty your bladder before the procedure.
  2. You will change into a hospital gown and brought to the Cardiovascular Lab where your cardiologist together with a specialized team of cardiac technologists, radiographers and nurses will be on standby to do the procedure.
  3. The nurse will record your height, weight and blood pressure and insert an intravenous (IV) cannula into a vein in your arm.
  4. You will lie on a movable X-ray table equipped with X-ray cameras and heart monitors.
  5. Three electrodes (small flat sticky patches) will be placed on your chest wall and attached to an ECG monitor that charts your heart’s electrical activity during the test.
  6. A mild sedative may be given and this will make you sleepy but arousable.
  7. You will be covered with a sterile drape and a nurse will clean your neck or groin (depending on the access site chosen by your cardiologist) with a cool antiseptic solution.

During the procedure

The procedure is broken up into 2 parts. The first part is obtaining vascular access and the second part is obtaining the pressures in your heart and the required physiological measurements.

Obtaining vascular access

  • A local anaesthetic is injected into the skin of your neck or groin, causing a temporary stinging sensation. Once the site is numb, a small 2-3 mm plastic sheath is inserted into the internal jugular vein or femoral vein.
  • This step typically takes 5 to 10 mins.

Obtaining the endomyocardial biopsy

  • A bioptome (a small catheter with a grasping device on the end) will be inserted through the sheath and threaded to your right ventricle. A x-ray camera may be used to position the bioptome properly.
  • Small samples (size of the head of a pin) of your heart muscle with be taken for analysis.
  • This step typically takes another 30 to 60 mins.

How does the doctor use the results to treat me?

Your cardiologist will explain to you the of the histological analysis of the heart muscle and discuss with you the options of treatment.

What happens after the procedure is completed?

  • The sheath in your neck or groin will be removed with a pressure dressing compressing the site of puncture.
  • You will be brought back to the day surgery ward to rest for a few hours.
  • You will be able to have your breakfast or lunch with your medications.
  • Once the puncture site is stable with no bleeding, you will be able to leave the hospital.
  • Clear instructions about how to take care of the access site following the procedure will be given.
  • It is recommended that you do not drive after the procedure and have someone accompany you home after the procedure to rest.
  • An appointment will be given for your follow-up visit.

Is this procedure safe?

In recommending this procedure, your cardiologist has balanced the benefits and risks of the procedure against the benefits and risks of not proceeding. Your doctor believes there is a net benefit to you going ahead. This is a very complicated assessment.

Common risks (more than 5%)

  • minor bleeding and bruising at the puncture site
  • abnormal heartbeat lasting several seconds which settles by itself

Uncommon risks (1-5%)

  • Unable to get the catheter into the leg vein - the procedure may be changed to the opposite leg or to a different approach e.g. the neck or an arm vein
  • Abnormal heart rhythm that continues for a long time - this may need an electric shock to correct.
  • The femoral artery (in the groin) is accidentally punctured - this usually just requires pressure on the artery.
  • Unable to get any heart samples - this may be due to scarring of the heart.

Rare risks (less than 1%) 

  • Infection - this will need antibiotics.
  • Allergic reaction to the local anaesthetic - this may require some medication to treat.
  • A hole is accidentally made in the heart or the heart valve - this will need surgery to repair.
  • Damage to the nerve in the leg.
  • Air embolism - Oxygen may be given.
  • Stroke
  • Death as a result of this procedure is extremely rare.

Don't wait for your symptoms to worsen.

Early intervention can save your life.

Heart conditions left unchecked can lead to serious consequences. Seek peace of mind.  Seek early intervention.

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