Invasive cardiovascular evaluation 

1. Right heart catheterization : The right heart catheterization is done in the catheterization lab. During the procedure you will lie flat on a table and EKG patches will be placed on your chest and connected to a monitor so that the activity of your heart can be closely monitored. A small catheter is then inserted in either the jugular vein in your neck or your groin area and passed into the right chambers of your heart. The area will be numbed with medication before the catheter is inserted to minimize any discomfort. The doctor records the information about how your heart is functioning during the procedure. Once the necessary information is recorded, the catheter is removed and a bandage is placed at the insertion site.
2. Diagnostic Angiography : An arteriogram or angiogram is an x-ray exam of the arteries, which is used to diagnose blockages or other abnormalities of the blood vessels.  An interventional radiologist inserts a small tube (catheter), which is about the size of the tip of a pencil, through a small nick in the skin into an artery. The radiologist guides the catheter into the artery to be studied by manipulating it while watching on an x-ray monitor, using a fluoroscope.  A contrast medium (x-ray dye) is then injected through the catheter while x-rays are taken, to visualize the blood vessels
3. Intracoronary Ultrasound : This procedure uses high frequency sound waves, or ultrasound, to evaluate the heart and determine different treatment needs. A miniature sound probe (transducer) is placed on the tip of a catheter and threaded through the coronary arteries to the heart where it emits sound waves to create the images.
4. Coronary Doppler Flow : Doppler flow is a type of ultrasound that uses sound waves to measure the flow of blood through a blood vessel. Waveforms of the blood flow are shown on the ultrasound screen.
5. Intracardiac Echocardiography : Intracardiac Echocardiography (ICE) uses sound waves to produce images of the heart in the same way that a transthoracic or "regular" echocardiogram does. However, with Intracardiac Echocardiography, a tiny catheter with an ultrasound sensor is passed into the heart where excellent images of the heart can be seen.
6. Electrophysiology testing and arrhythmia management : An electrophysiology (EP) study is a test that can precisely record the electrical activity inside the heart. It is often used to determine whether there is an extra electrical pathway inside the heart and, if so, where it is located. During an EP test, one or more thin, flexible wires are inserted into veins in the arm, groin, or neck and threaded into the heart. Small electrical conductors called electrodes are positioned inside the heart to measure electrical signals. The wires transmit information about the electrical activity to a machine that measures and records the activity.