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There are many reasons why a patient might have to undergo cardiac catheterization. Symptoms such as ongoing chest pain, heartburn not responding to usual medication therapy, shortness of breath, fatigue with activity are some of the most common ones. Heart attack, angina, having an abnormal (positive) stress test and advanced disease of the heart valve are some of the more specific indications. This procedure happens at the hospital and is mostly considered a same day event. We can access both the arteries in the groin and wrist. Patients will be under twilight sedation. Using very small catheters, different equipment to perform ultrasound, pressure measurement and angiography using iv dye is performed. This allows for visualization of the coronary arteries and assessment of different levels of blockage which will then be treated accordingly with medications alone, ballooning and stenting known as angioplasty or at times will need open heart surgery. The squeeze ability of the heart muscle known as Ejection Fraction (EF) in addition to tightness or leakage of certain heart valves can also be evaluated with this method.