A coronary angiogram is a procedure that allow us to see the arteries that supply blood to the heart very clearly. These arteries, called coronary arteries, can become narrowed with plaque, leading to a reduced blood supply to the heart (called ischaemia) and potentially a heart attack.
The angiogram can be performed as a procedure on its own, or in some cases, the person doing the procedure can also try and fix the problem during the same case – called percutaneous coronary intervention.
Before the procedure day
- A cardiologist will have to refer you to have this procedure, if they think it is indicated. It’s often performed to investigate patients with symptoms of a reduced blood supply to the heart (ischaemia).
- The hospital that will perform the procedure will send you some paperwork to complete, that may include insurance details, health information (including medications, previous medical conditions, and allergies), and the contact information of your next of kin.
- Once this paperwork has been sent in, you will be provided with a date to have the test done. You will be told that you are to have nothing to eat from the midnight prior to the day of the procedure being done.
On the day
- You will be admitted (sometimes very early, before 7am) to the ‘day procedure unit‘ or ‘recovery’ area of the cardiac ward. It’s important you bring an overnight bag (change of clothes, toiletries etc.) because if something needs to be fixed, and it can be done in the same sitting, then you may stay overnight. It is also useful if you can also bring a copy of a list of your medications, or if you don’t have one, the actual medications themselves in a container. If you have copies of any letters from your cardiologist, or results from tests, it’s very useful to bring them as well. Don’t forget that there may be a significant waiting period either before and after the period so have a good book, a tablet, or a laptop about to keep yourself entertained. After the procedure you may be lying flat for a while (several hours), and something you can do without sitting up is helpful. Pack some snacks as well for afterwards!
- Often here you will be ‘consented‘, meaning one of the doctors on the cardiology team (but not necessarily the person doing the procedure) will explain the procedure, the reasons, the risks, the benefits and the alternatives. Hopefully by now you have been well informed but this is a good opportunity to ask any last minute questions before you go ahead.
- The nurses here may prepare you for your procedure. Coronary angiograms can be performed from multiple different places, with the two most common being the femoral artery (either side of your groin) and the radial artery (running along your arm). One of the nurses will shave both of these areas (or give you the electric trimmer so you can do it) so hair isn’t in the way when the procedure is being done. Often both areas will be prepared, just in case one method doesn’t work when you are on the table.
- Once you are settled in and changed into a patient gown, the nurse will notify you of the time of your procedure. One of the issues with giving a specific time is that the procedure can take varying amounts of time – if there are no blockages, you may be done in half an hour, but if you require a stent to be inserted, it can take over 90 minutes. Because of this, and the potential for emergency cases, your case can be delayed for several hours or even cancelled. Unfortunately the only way around this would be to perform your angiogram and stenting on separate occasions – which is not ideal.
Going to the lab
- Once you are ready for the procedure, you will be wheeled (usually by bed, but occasionally wheelchair) to the ‘Cath Lab‘, the room in which the procedure gets performed. Immediately prior to the procedure a nurse will ‘check you in’, which means that they will check your history, your blood tests, medications, allergies, and confirm that you have signed the consent form. This is a good chance to use the bathroom as you may be lying flat for a prolonged period – during and after the procedure – and there will not always be the ability to use the toilet.
- You will then be placed on the cath lab table – a long, thin bench which can be moved by your doctor during the test so they can see different parts of your heart. You will see a large square pillar hovering above you (and when you walked in, you may have seen a similar one underneath – in the picture above, the C-shaped structure on the left hand side is the X-ray machine). This is the X-ray machine, and the device at the bottom sends low dose X-rays through you to the one at the top, and the image is sent to the screens at your left, which can be seen by your doctor. The vast majority (over 99%) of cardiologists will be performing the procedure from your right side.
- A ‘time out’ will be performed – this is where the doctor doing the procedure and the nurses involved in the case stop, check your identification details, confirm your allergies, and confirm that you know what procedure you are going for.
- Now the team will prepare you for the procedure. To do this, it is important you keep your hands by your side and stay nice and still.
- A standard coronary angiogram, which means just taking the pictures of your arteries without trying to fix anything immediately, takes between 30 and 45 minutes.
- You will get some medication to help you feel relaxed (sedation), but you will still be awake during the procedure.
- The first section is preparing a ‘sterile field’. This means that either your groin or wrist will be washed with an antiseptic solution, and then you will be covered with a large sterile drape.
- All of the specially cleaned equipment is then placed on top of this, so it is incredibly important that you do not move at all from this point forward – not even to scratch your nose (if you need your nose scratched, just let one of the staff know – they’re used to it!).
- The doctor performing the procedure will then inject a small amount of local anaesthetic into the area – this will feel like a sharp sting when the needle goes in, then a little more stinging when the anaesthetic goes in. Although this bit is a little uncomfortable, the area will go numb after this. You may feel some pushing, but nothing sharp.
- The doctor will then insert a small (usually 11cm) tube into the area (either groin or arm) – this tube (called a sheath) acts as a one way valve so the catheters can go up to your heart.
- Now the doctor will pass a long thin tube (catheters) up towards the heart, and through them they will inject some dye (contrast), and using foot pedals, they will take X-rays so they can see the arteries around your heart.
- The X-ray machine above and below you will be moved around at different angles to take some more pictures of your heart.
- The doctor will swap the catheter (or sometimes, use the same one) to a different shaped one to take pictures of the artery on the other side of your heart.
- Finally, at your doctor’s discretion, they may take a picture of the main pumping chamber of your heart, called your left ventricle. To do this, a larger amount of dye is injected rapidly into the heart, and when it gets pumped around your body, you will feel a hot flush. Some people get a burning feeling in their ears, and others feel a sensation of having used their waterworks, but it’s just the effect of the dye.
- And that’s it! All the pictures are taken and your doctor will review them. They will be able to tell you very quickly if there is a problem that needs fixing. Occasionally, they will need to review your images on a workstation outside to get a better look.
After the procedure
- There are three main outcomes for an angiogram – you have no major blockages that require a stent or surgery, and just medications can be used (medical therapy), you have one or two major blockages that require a stent to be inserted, or finally you have multiple severe blockages, or a blockage in a place that would be dangerous to insert a stent, and you need coronary artery bypass graft surgery.
- If you need a stent, the doctor may go ahead and perform that at the same sitting. If the outcome is one of the other two, then the procedure is over.
- Even though the catheters are removed, you will still have the little short tube (sheath) still in your wrist or groin. If the procedure was done from your wrist, the tube will get removed while you are still in the lab and a tight band will be placed on your wrist. If the procedure was from your groin, then the tube will remain in place and it will be removed by one of the nurses back in the recovery area where you came from.
- It is critically important that you do not move at all while that tube is in your groin – because it is in an artery (a high pressure blood vessel), when it does come out firm pressure needs to be applied immediately – the nurses in the recovery area will do that under controlled conditions. Any movement here can cause significant problems. Usually once the tube has been removed you will need to remain flat for a few more hours before you can get slowly get up – the nurses will walk you through your hospital’s protocol.
- If you had the band applied to the wrist, it will feel quite tight but you should still have good blood flow to your hand. If you feel discomfort or tingling in your hand, notify the nurses immediately. They will slowly loosen the band over the following few hours. You should not use that hand for the next 48 hours, to allow the artery to heal.
After an angiogram, you can usually go home the same day. If a stent was required, you will be watched overnight and discharged the following day.
Hopefully this was useful for you – if you have suggestions, please let us know!