CARDIAC ANGIOGRAM

What is an Angiogram?

A coronary angiogram, also known as coronary angiography, is a special x-ray of your heart’s arteries to see if they are narrowed or blocked. The test involves putting a long thin tube into an artery in your groin or wrist. The tube is moved up the artery until it reaches the heart. A special dye is injected into the arteries of the heart so that x-rays may be taken. The x-rays provide detailed information about the state of your heart and whether your coronary arteries have become narrowed or blocked.

Why do I need an Angiogram?

You may have had chest pain or a heart attack caused by narrowed coronary arteries. The degree of narrowing in your coronary arteries must be assessed to see if you could benefit from a procedure, such as angioplasty or bypass surgery to relieve your symptoms.

What to expect prior to the procedure

Do not eat or drink anything 6 hours prior to your procedure.
Your doctor will visit you to explain the procedure and answer any questions you may have. You will be asked to sign a form consenting to the procedure.
You will be shaved in the area where the catheter will be inserted, asked to remove all jewellery and change into a hospital gown.
Many people are given a sedative about an hour before the test to help them relax. You will, however, be awake throughout the procedure.
You will have an IV cannula inserted into a vein in your arm so that medications can be given during the test.
In the majority of cases, people are admitted and released from hospital on the day of the test.

What to bring to hospital on the day of the procedure

Loose and comfortable clothing to wear home.
A book or magazine to keep you occupied.
Your usual medications. You should discuss your medicines with your doctor prior the procedure, especially if you take blood thinners such as Warfarin or Heparin. If you have diabetes, your doctor will need to give you special instructions about the morning of your procedure.
If you have had a chest x-ray performed in the last 6 months please bring it.
Make sure you have a shower before coming to hospital.
Do not bring any valuables, jewellery or excess money.
Mobile phones must be switched off inside the hospital.

During the procedure

You will be transferred to the Cardiac Catheter Lab.
ECG leads will be put on you so that your heart will continually be monitored throughout the procedure.
Your groin and wrist will be washed with Betadine and then the doctor will inject a local anaesthetic into this same area. Once this is done, a plastic tube will be inserted into your artery. This can sometimes cause a momentary pain.
You will be able to watch the monitor and see images of your coronary arteries throughout the procedure. The table you are lying on will move during the procedure.
When the dye is injected you may momentarily get a feeling as through you’ve wet yourself.
Once the procedure is finished you will be moved back to bed and transferred to cardiac recovery. Your blood pressure and pulse will be checked and the plastic tube will be removed from your groin or wrist.

What are the possible complications?

As with many medical tests, there are some risks but serious problems are rare. Most people have no trouble, and the benefits usually far outweigh the risks. You and your doctor will discuss any possible problems that could occur.

Risks

Procedural risks are summarised below:

Death - frequency 1 in 1,000 cases performed.
Heart attack - frequency 1 in 2,000 cases performed.
Stroke - frequency 1 in 1,500 cases performed.
Disturbance of cardiac rhythm - frequency 1 in 250 cases performed. This includes potentially life threatening irregularities that require resuscitation.
Vascular complications related to catheter entry site - frequency 1 in 200 cases performed. This includes mild bruising, formation of a haematoma (collection of blood in the tissues) and aneurysm formation that may require surgery. Significant blood loss needing transfusion is rare as is occlusion of the leg or arm artery (depending on how your study is performed). The latter will require urgent surgery.
Reaction to dye - frequency 1 in 250 cases performed. This is usually minor and results in hives but on rare occasions it can lead to shock (dramatic fall in blood pressure).
Worsening of kidney function. Assuming kidney function is normal o begin with, the frequency is less than 1 in 200 cases performed. More than 75% of patients that develop kidney failure recover completely but permanent impairment of kidney function needing dialysis can occur, especially if there is a pre-existing abnormality.
Catheter perforation of heart chambers - frequency 1 in 3,500 cases performed.
Other complications which include infection (local and general) - frequency 1 in 350 cases performed.

In total, 1.7% of patients may be expected to experience one of the aforementioned complications, whereas 98.3% of patients will have no complications from the procedure. It is important to understand these are average risk rates based on a large series of 60,000 patients. Your individual risk may be higher or lower depending on your age, sex, presence of diabetes, state of your heart muscle, baseline kidney function and nature of your presentation - specifically whether your symptoms are of an unstable nature or not. These issues can be discussed with your cardiologist who is well aware of the risks involved and would have taken them into account before recommending study.

After the procedure

You will be moved to the ward or recovery area to rest in bed for at least 4 hours. If a seal is used in your groin, you will only need to rest in bed for 2 hours. After remaining flat for the first hour, the head of your bed can be raised to 30 degrees. You must keep your arm or leg straight until the nurses tell you otherwise, as any movement could cause the area to bleed.

In most circumstances, you will be discharged after 4-6 hours. Some people need to stay longer for further monitoring. You will need to increase your oral fluid intake after the procedure as the x-ray dye passes through your kidneys.

Your blood pressure and pulse will be taken frequently after the procedure. The nurses will be checking the puncture site in your groin or wrist to monitor for any bleeding or swelling. They will also be checking that the circulation in the same leg or arm is normal. You should not have any pain. It is important to tell the nurses if you do.

Your doctor will visit you and explain the results of the test. Depending on the amount of disease in the artery, treatment may involve medication, coronary angioplasty or bypass graft surgery. Your doctor will discuss the options with you.

You will need someone to take you home after the procedure. Due to the medication given during the procedure, you will not be allowed to drive or use heavy machinery for 24 hours following your angiogram.

Once home, make sure you relax and take it easy. Do not undertake any strenuous tasks. The puncture site may ooze a little, which is normal. If the site starts to bleed or begins to swell, you should apply firm pressure with a clean pad, maintain the pressure for 10-15 minutes and contact your doctor. If the site is still bleeding, you will need to call for an ambulance.

If you have further questions regarding this procedure, please ask your nurse or doctor for clarification.