Coronary Angiography

The ultimate test for coronary arteries

Coronary angiography is a test that uses a dye and special x rays to show the inside of your coronary arteries. Narrowing or blockage of the arteries may limit the blood flow to the heart muscle and cause chest pain called angina. A catheter, fine plastic tube, is guided into the heart to examine the coronary arteries. A special contrast dye which shows up on x-rays is injected into the arteries and allows the doctor to see any blockages or narrowings that may be responsible for symptoms.

A coronary angiogram is a diagnostic test, not a treatment, and you will not notice any improvement afterwards. The aim of coronary angiogram is to provide important information about your heart and its blood supply, which is crucial in deciding on the best course of treatment for you. This may be conservative therapy (treatment with tablets), angioplasty (also called PCI, percutaneous coronary intervention, a catheter treatment usually with insertion of stent, a short metallic mesh) or coronary artery bypass grafting (CABG, a surgical procedure where a blood vessel is removed from one part of the body and placed on the heart to “bypass” a blocked coronary artery).

Dr Kirk performs private coronary angiograms at the Lister Hospital.

Indications

Acute stage of the heart attack

Significant anginal (chest pain) symptoms despite treatment with tablets

Inconclusive or conflicting results of non-invasive tests for chest pain or inability to undergo non-invasive testing

Typical chest pain symptoms in patients with high pre-test probability of coronary disease

Risks and complications

Coronary angiogram is a safe and routine procedure. The risk of serious complications is about 0.1 % (1 person out of 1000) which in most cases is much less than the risk of leaving the patient without the necessary tests and treatment. This is an average figure for all cases and the risk will vary depending on your circumstances; Dr Kirk will be more than happy to discuss any specific further risks or concerns with you. The risk involves the following:

•Damage to the artery in the leg or arm where the catheters are inserted. A bruise occurs commonly but a major problem is very rare.

•Heart rhythm problem; occasional extra beats (ectopics) are normal; significant arrhythmia requiring medication or electric shock is unlikely.

•Reduction in kidney function. The contrast dye used can in rare circumstances, especially in people with pre-existent kidney problem, cause kidney function to deteriorate. It is usually a temporary problem that will resolve with time.

•An allergic reaction to the contrast dye, most common is sickness or skin rash.

•Damage to a coronary artery causing a heart attack and requiring treatment with PCI (angioplasty) or an emergency CABG (coronary artery bypass operation).

•Stroke and death, the risk is less than 1:1000 for a routine diagnostic coronary angiogram.

Before the procedure

Please bring all your medications with you on the day of the procedure. If you have diabetes, please follow the instructions given to you. If you take Warfarin, you will be given advice for managing your medication before, during and after the procedure. You will also need to have a blood test at an anticoagulation clinic about a week after your angiogram, to ensure your levels have stabilised. If you have diabetes and are taking Metformin tablets, you should stop taking the tablets the day before your procedure. Do not stop taking other diabetic tablets.

You can drink water, clear tea and black coffee (without milk) up to 2 hours before the procedure. Milk, food, sweets, tea or coffee with milk can be taken up to 6 hours before the angiogram. Chewing gum and smoking not permitted on day of angiogram. Please take all your regular medication (except metformin) as usual with a sip of water.

Please bring your dressing gown and slippers with you. During your admission, you will be asked to put on a gown and paper pants. Your details will be checked and a name band placed on your wrist. The procedure is performed in Angiography Suite also called Catheter Laboratory, a special x-ray room which looks like a small operating theatre.

Just before the procedure, Dr Kirk will again explain the test to you and answer all your questions prior to you signing the consent form for the procedure. A small needle will be put in your arm.

During the procedure

There will be several members of staff in the room during the procedure including Dr Kirk, nurses, a cardiac technician and a radiographer. During coronary angiogram, you will be kept on your back on an x-ray table. Your heart beat will be monitored using electrodes and ECG machine. The radiographer will move the table and camera into position so that the x-ray pictures can be taken. A local anaesthetic will be used to numb the wrist (less often groin) and usually sedation will be given to help you relax. Once numb the I will insert a small tube, called a sheath, into the artery. A catheter is then inserted through the sheath and guided through the artery until it reaches the heart and the origin of the coronary arteries. Low dose x-rays are used to guide the catheter into the right position. Once the catheter is in position a special dye will be injected in the catheter which will flow though your coronary arteries and outline them on an x ray. When the test is over, the catheter will be removed and the access site will be closed up and bandaged. The procedure usually takes about 30 mins

After the procedure

After the procedure you return to the ward where staff will monitor your blood pressure and pulse. They will also check the wound and circulation of blood in the limb that was used. After a period of resting in bed you will be allowed to get up. Your nurse will keep you informed of your progress. I will explain the results of the angiogram and tell you about further treatment if necessary. A letter will be sent to your GP confirming this information. You may eat and drink. It is important to drink plenty of fluid as this will help to flush the contrast dye through your kidneys. Providing there are no complications, you will be allowed to go home approximately 2.5 hours after the procedure. If the test was performed via the wrist artery, the dressing can be removed in 24 hours.

During the first 48 hours after your angiogram your activities should be restricted. To ensure recovery of the artery, you should not do any heavy lifting and bending for the first 24-48 hours. It is normal to feel some discomfort from the wound and a painkiller, such as Paracetamol, is usually helpful. Do not take Aspirin as a painkiller.

You must not drive for 24 hours after discharge. Please arrange for a responsible adult to drive you home and stay with you for 24 hours. If the wound begins to bleed, you or other responsible adult should press firmly over the wound area for 10 minutes.