Who needs a coronary angiogram?
There are several groups of patients who may require coronary angiography including individuals who have suffered a heart attack, patients with risk of heart disease who have symptoms of chest pain and or breathlessness. Sometimes coronary angiography is used to evaluate the condition of the arteries of the heart in patients undergoing heart valve surgery.
What is the purpose of a coronary angiogram?
The purpose of a coronary angiogram is twofold:
- First, to confirm the presence or absence of narrowing or blockages
which signifies disease in the coronary arteries, which provide the
blood supply to your heart muscle. - Second, for patients with confirmed heart disease, the angiogram is a map of all the problem areas of the blood supply of the heart, which will allow doctors to make a risk assessment of the disease and plan further treatment.
How is an angiogram done?
The angiogram is performed with a local anaesthetic injection and sometimes with mild sedation and can be done as a daycare procedure. However, it is more commonly performed with an overnight hospital stay for safety reasons.
The procedure involves a needle puncture of the skin followed by inserting a long thin tube (called a catheter) into a blood vessel in the hand or leg and this is then threaded through the circulation and into the coronary vessels. A dye is then injected through the catheter into the arteries of the heart to allow X-ray images to be obtained. The images give a detailed and accurate representation of coronary anatomy.
Is an angiogram risky?
It is generally safe, although there is a small risk of complications. Most complications are minor and seldom harmful including bruising at the needle puncture site, allergy to the dye causing rashes, mild asthma, nausea and vomiting. Major complications occur rarely in experienced hands. However, despite all precautions taken, approximately 1 in 1000 patients may suffer a heart attack or stroke or major bleeding due to the invasive nature of the procedure. The risk of complications however should be balanced against the risk of the medical problem which is being treated, during the decision-making process. It is therefore important that you understand why you are having the test done.
This is why your doctor will only advise the procedure if necessary. Catheter angiography is usually not used to” checkup” your heart as there are now safer options available for this purpose eg stress ECG or ECHO, CT scanning etc.
What happens during the procedure itself?
Patients usually fast for 4-6 hours before and are sometimes given a light sedative (pill) before the procedure. The angiogram itself is performed in a cardiac catheter laboratory which is essentially an operating theatre with an X Ray imaging system. You will lie on a table where the X ray machine is able to move around you to take multiple pictures of your heart from different angles to build an accurate picture of your coronary arteries. You will be awake during the test and will be able to see and hear the staff work around you. Your ECG, blood pressure and oxygen levels will be monitored in real time to ensure your safety.
After the procedure you will rest a short while in the recovery area before going back to your hospital bed. Most patients will be able to eat and drink straight away. If the procedure is done through your hand, you will be able to walk around. Procedures done through the leg will require the patient to lie in bed for 6-8 hours to prevent severe bruising or bleeding from the leg wound.
Aftercare
After it is over, most patients find the procedure to be less difficult than initially feared (which is understandable!). The doctor/staff will check your wound and discuss the findings and treatment as well as your medicines before your discharge and arrange any required follow-up.
It is advisable to rest for at least a few days before resuming your normal activities especially if you had the angiogram is done through the leg (this approach is sometimes necessary for technical reasons).
During your recovery, take your medicines as advised and be on the lookout for any signs of bleeding or increased bruising/swelling (this is rare ) at the wound site. If this occurs, compress the bleeding site and seek medical attention to minimize further complications.
It is also important to keep your follow-up appointment if arranged, to monitor your progress as well as to discuss any remaining questions or concerns that you may have.
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