Coronary Angiography

Why am I having an angiogram?

An angiogram is performed to examine the heart (coronary) arteries.  You may be having an angiogram because you have suffered from chest pain or shortness of breath or because you have had a heart attack.  An angiogram is also needed if you have been recommended to have heart surgery, such as valve replacement.

What is an angiogram?

An angiogram (or cardiac catheterisation) is a special x-ray.  A catheter (long thin tube) is inserted into the femoral artery in the groin and directed up the aorta (the largest blood vessel at the back of the body) to the heart.  You will not be able to feel the catheter moving inside your body.  Dye (an agent that shows up on x-rays) is injected into the coronary arteries and an x-ray film is taken.  The dye is removed from the body by the kidneys over a few hours after the angiogram.  (The dye has no colour so your urine won’t change).

Admission to hospital

You will be admitted to hospital either the night before or on the morning of your procedure.  My secretary  will give you the details if you are to be admitted to a private hospital.  The booking officer of the Royal Melbourne Hospital will send you the details if you are to be admitted to RMH.  If you take WARFARIN (Coumadin or Marevan), a drug to stop blood clotting, you must notify my secretary or me as soon as possible.  You will need to stop Warfarin several days before the procedure and resume it afterwards.  We will tell you the exact details.  You can continue to take ASPIRIN (including Cardiprin, Astrix, Cartia, Solprin) and CLOPIDIGREL (Iscover or Plavix).

Before the angiogram

You should not eat or drink for 4 hours before the procedure but you should take all your usual medicines at the usual times with a small glass of water.  A blood test will be taken to check your blood count (haemoglobin), potassium level and kidney function.  An intravenous cannula will be inserted in a vein in your arm.

The Angiography

The angiogram will be performed in the Cardiac Catheterisation Laboratory (the Cath Lab) which is very similar to an operating theatre but with a special x-ray machine.  The staff in the Cath Lab are nurses and technologists.  There may also be a doctor who will assist me with the procedure.  If you have any questions or are concerned in any way please ask me or one of the staff.

The procedure will be done under local anaesthesia.  It is a bit painful when the anaesthetic goes in but the pain should not last long.  If it is really hurting, then let me know and we can fix that.  You may be given some sedating medicine through the intravenous cannula.  This will make you feel more relaxed.  If you feel very anxious then tell us. 

There will be one or two small cuts in the skin in the groin, about 3 millimetres long (less than 1/8th inch).  Usually the right groin is used.  Sheaths (tubes) will be placed in the artery and/or vein in the groin.  An x-ray will be used to guide the catheters to the right place.  The x-ray camera is mounted above you and will move around to take pictures from different angles.  You may wish to watch the TV monitor screen.

A dye will be injected to show up the arteries on the x-ray.  You may be asked to take a deep breath and stop breathing just when the x-ray films are being taken.  You should breathe normally when you are asked or after a few seconds.  You won’t be able to feel the dye going in except for one picture (usually the last one) when we show how strongly the heart is beating.  This feels like a hot flush passing all over you.

After the angiogram

In some patients a special plug (an “Angioseal”) is inserted at the end of the angiogram to seal the artery and stop bleeding.  If this is used you will be able to sit up immediately and get out of bed in two hours. If this cannot be used you will be moved out of the Cath Lab and the sheath will be removed from your groin.  Pressure will be applied for 10-15 minutes to stop bleeding from the artery or vein.  After you return to the ward, you should stay lying flat for 4 hours and in bed for 6 hours. 

If you have any pain or bleeding in the groin, notify the nursing staff.  I will discuss the results of the angiogram with you, and with your family if you wish.  I will arrange further tests, procedures or operations as required.

You will usually be able to go home later that day or the next morning. You should continue your usual medications, unless I have notified you of changes.  You should avoid strenuous activity and lifting for a week.  You can resume normal activities as soon as you feel comfortable.

Possible Problems

It is common to get a small bruise at the groin.  Sometimes the bruise is quite extensive but just in the skin without any swelling.  This will fade over a few weeks.  However, you may get significant bleeding, bruising or swelling at the groin site.  Let me know if this occurs.  Occasionally (about 1% of angiograms), a large bruise (haematoma) develops.  Occasionally, surgery is required to repair the artery in the groin.

Death, heart attack, stroke and kidney failure are rare complications of coronary angiograms.  They occur approximately once in 4000 procedures.  The information obtained from an angiogram is so valuable that the benefit outweighs this small risk.  We are much more likely to find a way of preventing you having a heart attack or dying than of causing this.

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