A myocardial biopsy is a procedure where a healthcare professional takes one or more small samples of your heart muscle tissue for analysis. This test can help doctors diagnose conditions such as heart failure, heart muscle inflammation, or tumors.

Doctors usually perform myocardial biopsies in hospitals. These procedures can carry some risks, but your healthcare team will monitor you carefully and be prepared to manage any complications.

This type of test is typically only for when other less invasive tests are inconclusive.

Doctors can order myocardial biopsies to investigate and diagnose heart conditions that noninvasive tests can’t easily detect. Possible uses include:

  • Diagnosing cardiomyopathies: These are conditions that affect the heart muscle and the heart’s ability to pump blood effectively.
  • Monitoring heart transplants: A myocardial biopsy can help detect early signs of heart transplant rejection so doctors can quickly adjust treatment.
  • Detecting myocarditis: This test may help identify inflammation in the heart muscle, which may cause symptoms like chest pain, difficulty breathing, or irregular heartbeats.
  • Investigating unexplained heart failure: When doctors can’t identify the cause of heart failure with other tests, a biopsy may provide answers.
  • Identifying cardiac tumors: A myocardial biopsy can help determine whether any tumors are present in the heart muscle.

By examining your heart muscle cells, doctors can detect early signs of damage and may be able to prevent more serious complications.

Cardiologists (heart specialists) typically perform myocardial biopsies in a hospital’s catheterization lab or other special procedure room. Most people are admitted on the day of the procedure, although sometimes admission the night before is necessary.

Your doctor may have you avoid eating and drinking for a period of time before the procedure. They will provide specific instructions based on the scheduled time of your biopsy.

If you’re taking medications like blood thinners, your doctor may recommend stopping them 16 hours before the procedure and for 12 hours afterward to lower the risk of bleeding. Tell your doctor about any medications and supplements you take.

Before the biopsy, you’ll also undergo various tests — including blood tests, an electrocardiogram, or imaging tests — to confirm your heart is in good enough condition for the procedure.

Since you’ll receive a sedative for the biopsy, you’ll need to arrange for someone to drive you home afterward.

Before the procedure, a member of your care team will give you a sedative to help you relax. They will also numb the area where the catheter (thin tube) will be inserted, usually in your neck or groin, with a local anesthetic.

You will remain awake and positioned on your back during the procedure, allowing you to comfortably follow any instructions from your care team. Your cardiologist will then insert the catheter into one of your veins and carefully guide it toward your heart.

Your cardiologist will monitor the catheter’s placement using imaging techniques such as echocardiography (ultrasound) or fluoroscopy, a type of live X-ray that allows for real-time visualization of the catheter’s movement.

Then, your cardiologist will use a tool called a bioptome to remove small samples of heart muscle tissue. They may repeat this process until they collect three samples or more.

It typically takes several minutes to collect the samples. Although you may feel some pressure or discomfort at the insertion site, most people experience little to no discomfort during the removal of the tissue.

After the procedure, you’ll spend a few hours in a monitored recovery area. Your care team will check your heart rate, blood pressure, and the catheter insertion site to make sure there are no complications.

Before discharge, your doctor will explain the recovery process and let you know when to expect your myocardial biopsy results.

For the first few days, it’s important to avoid heavy lifting or intense physical activity to help prevent complications like bleeding or strain at the catheter site. Your doctor will provide specific instructions on when you can safely resume your usual routine.

Mild soreness or bruising at the catheter site is typical. However, contact your doctor if you experience increased pain, skin discoloration, swelling, or fever, as these could be symptoms of complications such as infections.

It may take a few days or longer to get your biopsy results. Once the results are available, your doctor will go over them with you and explain:

  • whether they detected any inflammation, infection, or unusual cells
  • what the findings mean for your heart health
  • the next steps for treatment or management based on the results

The test may not find any unusual heart tissue, but this doesn’t necessarily rule out heart problems. The biopsy could miss affected areas.

If the results are unsual, it indicates the test found irregular or damaged heart tissue. The results may be enough for your doctor to diagnose a condition, or you may need additional testing.

If your doctor has enough information to make a diagnosis, they’ll help you understand the next steps, such as creating a treatment plan.

Like any medical procedure, a myocardial biopsycarries some risks, including:

  • bleeding or bruising at the catheter insertion site
  • embolism (blood clots)
  • damage to blood vessels or heart tissue
  • arrhythmias (irregular heartbeats)
  • infection
  • pneumothorax (lung collapse)
  • rarer, more serious complications like cardiac perforation (tears in the heart chamber tissue)

Your healthcare team will take every precaution to help reduce these risks and monitor you closely throughout the procedure.

A myocardial biopsy is an uncommon procedure. Your doctor may only order it if other heart tests have been inconclusive.

If you need a myocardial biopsy, ask your doctor about preparing for the procedure and what to expect afterward.