Coronary angiogram

Your angiogram will be performed at a hospital as a day case (this means you arrive and leave on the same day). You will be admitted to hospital approximately 2 hours before your procedure is due. A nurse will prepare you for the procedure. The procedure is performed in an X-ray room and can take anywhere from 20 minutes to one hour. You will be awake and lying completely flat. Your blood pressure and ECG will be monitored continuously during the test.

The test is performed through an artery at the top of the leg or in the arm. You will receive an injection of local anaesthetic over the artery to numb the area, so it should not be too painful. Once numb, a fine plastic tube (catheter) will be inserted into the artery and passed through to the heart. The catheter is moved through your blood vessels into the correct position in the heart. In order to see the blood flow in the arteries, a special X-ray dye is used that is injected through the catheter into heart. A series of pictures are taken. You will be able to watch the procedure on the TV screens if you wish.

Although local anaesthetic is used, there may be some discomfort as the catheter is first inserted into your artery. You will not feel the catheter moving in the body, but you may be aware of an occasional 'missed' heartbeat or extra beat. The X-ray dye sometimes causes a hot, flushing sensation which lasts a few seconds. Occasionally, people feel mild angina pain during the test - you should tell the doctor about the discomfort if you do. When the test is over, the catheters are removed. The puncture in the artery can be sealed either by pressure or with a special plug.

Some people feel a little 'washed out' after the test for a few hours. A nurse will examine you and monitor blood pressure and pulse several times after the test. Once recovered and mobile, you will be allowed home by the nurse. The place the catheter was inserted may be tender for a few days, and there may be a small bruise.

The person who first performed a coronary angiogram did it on himself. Since then many millions of angiograms have been performed. Serious complications are very rare, but because of the nature of the test, there is always a small danger. The chance of the test causing a serious complication is less than 1 in 1000. Your doctor will not have advised you to have a cardiac catheter test unless he felt that the benefits outweigh this very small risk. You should discuss any worries with him before the test.

Possible risks of a coronary angiogram include, but are not limited to, the following:

• bleeding from the catheter insertion site(s)
• damage to the vessel at the catheter insertion site(s)
• heart attack
• stroke
• stimulation of an abnormal heart rhythm
• infection of the catheter site (rare)

The amount of radiation from fluoroscopy used during an angiogram is considered minimal; therefore, the risk for radiation exposure is very low. If you are pregnant or suspect that you may be pregnant, you should notify your doctor due to risk of injury to the fetus. Radiation exposure during pregnancy may lead to birth defects. If you are lactating, or breastfeeding, you should notify your doctor.

For some patients, having to lie still on the procedure table for the length of the procedure may cause some discomfort or pain. There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

The results of the test will allow your doctor to decide on further treatment for your
heart condition. There are three possible paths:-

• You may be advised to continue with medication, which will be tailored to your results.
• You may be advised to have an angioplasty: this procedure is very similar to the angiogram, but involves stretching open the arteries, perhaps with insertion of a stent.
• You may be advised to have heart surgery.
• You will have the opportunity to discuss this with your doctor. If this is the first time that you have been diagnosed with heart disease it is natural to feel a little shocked. It can sometimes take a long time for the news to sink in, and you may feel anxious as to what it means for you, your family and loved ones and your work. There will be questions that will occur to you over the subsequent days.

Your doctor will ask you to make an appointment to see him after the angiogram; you may find it helpful to take with you a list of questions you wish to ask.