Your coronary angiogram

A coronary angiogram is a test used to look at the main arteries that supply the heart with blood and oxygen. These blood vessels are known as the coronary arteries. This test shows your Cardiologist (specialist heart doctor) the exact location of these and seriousness of any narrowed areas in your coronary arteries. The test can also show your blood pressure, how well the chambers of your heart are pumping and the valves of your heart are working.

What happens before the procedure?

You will be seen in the Pre-assessment clinic beforehand. This will be done either at the cardiac catheter suite or at the same time as your appointment with the specialist cardiac nurse.

Once your pre-assessment has been completed we will arrange for you to come in for your angiogram.

Female patients

If you are or think you might be pregnant please ring the catheter suite on 020 8321 2618. For women aged up to 56 years, a pregnancy test will be carried out on your arrival on the day of your procedure.

Eating and drinking

Please follow the instructions given in your confirmation letter about when to eat and drink before your appointment. It is important that you stick to these.

Medication

For your pre admission appointment we will ask you to bring in a list of all your current medications. We will then advise you of any medications you need to stop before the procedure.

Warfarin and other anticoagulants

You may need to stop taking warfarin or other anticoagulant (such as apixaban, rivaroxaban, edoxaban or dabigatran) before your procedure. This depends on the type of procedure planned and your specific medical history; the team will discuss this with you.

On the day of your procedure please take the rest of your medication. As the test may take an hour you may prefer to take your diuretic (water tablets) after the procedure. Please bring all of your medication with you (including your diabetic medication or other specialist inhalers or creams).

Preparing to come to Hospital

Shaving

Please do not shave or remove the hair from your chest, arms or legs before coming to hospital. If needed, this will be done for you in hospital.

Hygiene

It is important to have a shower or bath before coming into hospital. Please ensure your nail polish is removed and that you are not wearing lots of make-up.

You will be in hospital for around 6 hours so please make sure you bring something to read or listen to with headphones. You will also need to bring slippers and a dressing gown. You will also need loose clothing to go home.

Coming in to Hospital

Please arrive promptly as stated the time on your letter. A number of tests will happen when you arrive so you are ready for your angiogram. These will be done by the nurse. You may need to repeat some of the questions asked in the pre assessment.

After this one of the specialist heart doctors performing the test will come and see you to consent you for the procedure. They will explain the risks and the benefits of the test and what it entails.

We will try not to keep you waiting but sometimes this cannot be avoided. We are the only catheter suite in the hospital so if there are emergencies, there can be delays to your case. We will do our best to keep you up to date and will always be happy to discuss things if you have concerns.

During the Procedure

You will be brought into the catheter suite by one of the members of the team. In the room you will meet the team looking after you - nurses, radiographer, physiologists and doctors.

You’ll be asked to lie on the x-ray table, and the physiologist will stick ECG stickers on you. Each member of the team in turn will introduce themselves and explain each of their roles in the lab. A safety check will be carried out and you will hear your name and other information about the case.

The setting up will take the longest part of the case.The area where the catheter will be inserted is cleaned. A sterile sheet is draped over you. This is clean so you need to make sure after this is put over you that you stay very still.

They will place some local anaesthetic where they will place the sheath. This will either be in an artery in your wrist or your groin. The anaesthetic is given using a very small needle – there will be some initial discomfort but this area will quickly become numb.

A small plastic tube is inserted into the groin or wrist and the catheter is inserted into the blood vessel and directed to the heart. Moving X-ray images are used as a guide. Once the catheter reaches the heart, a special dye is injected through the catheter. The dye highlights any narrowed areas or blockages in your arteries on the X-ray. The dye injection may cause you to feel a hot flushing sensation for a few seconds. You may feel an occasional missed or extra heartbeat. Sometimes, you may experience angina (pain in the heart), but it should not be worse than normal.

During the test, we check your heart rate and rhythm. If you have new pain or other symptoms, such as shortness of breath, please let either the doctor or nurse know. When we have finished taking the X-ray images, we will remove the catheter and apply firm pressure to stop any bleeding in your groin or wrist. On your wrist, we will place a tight band. Sometimes a small plug, called an Angioseal, is used to stop any bleeding from the groin.

After the Procedure

After the test, we will take you back to the ward, where you will be able to have some food and drink when you feel ready. You will need to rest for one to two hours so we can monitor you. Your cardiologist will look at the angiogram and may suggest one of the following:

• Your arteries do not have any significant narrowing in them and you do not need any further treatment.
• Continuing on medication to treat your arteries; some changes to your medications may be necessary.
• Having treatment to widen your coronary artery using coronary angioplasty. We have a separate leaflet called “Your coronary angioplasty”. Please ask us if you would like a copy.
• Having surgery to redirect blood around the blocked arteries, by using another vein or artery. This is known as a coronary artery bypass graft. This will be discussed at a meeting and a further appointment will be sent out in the post to you.

Going home

Most patients are able to go home on the day of the test.

Before you go home, we will ask you to walk up and down the ward a few times just to make sure that the hole in your wrist or groin is sealed.

You will have a dressing applied and the nurse will tell you when to remove this. You may have a little bruising and tenderness.

If you have any questions once home, the Cardiac Catheter Suite staff will be available until 6pm. The contact number is 020 8321 2618. After 6pm please call Syon 1 on: 020 8321 5130.

However if you are experiencing chest pain, palpitations or dizziness please go to your nearest Accident and Emergency Unit, or call 999.

Work: It is normal to have a few days off after this test. Please discuss this with your team as it may differ according to your profession.

Exercise: Stop exercising for the first couple of days so the wound site has time to heal properly. After this, with guidance from your specialist team, you can gradually build up your exercise.

Hygiene: Please do not have a bath in the first 24 hours.

What is the Benefit for this procedure?

A coronary angiogram gives a better understanding of your heart and how well it is working. It means your consultant can plan the best treatment for your condition.

Are there any alternative tests?

Currently, this is the best way of finding out exactly where the narrowed areas in the coronary arteries are and is an essential test if you are going to have surgical or catheter treatment for your coronary artery disease.

Other tests such as a perfusion scan, CT scan, MRI scan and exercise tests can tell us if you have coronary artery disease, but cannot show where and how severe the narrowed areas are

What are the potential complications and risks?

As with all medical procedures, this test carries some risks. But it is important to remember that we only carry out the procedure if the benefits outweigh the risks involved.

An angiogram is a relatively straightforward and safe procedure and serious complications are rare. The overall risk of a serious complication is less than 1 in 1,000 people.

The risk is factored on your overall health and the condition of your heart. Your cardiac team will go through this with you in more detail.

Minor risks

• When the tube is removed, it may cause more bleeding in about 1% of people - this means more pressure will be applied.
• In 5% it can also cause bruising. This can be painful but should go down after a couple of days. A small hard lump (haematoma) under the skin can also form. This will gradually go and normally needs no intervention.
• Fainting (vasovagal) affects 1 in 100 patients. It is treated by either lowering your head or lifting your feet. Sometimes medication is given. Fluid is given into the vein to bring your blood pressure and heart rate back to normal.
• You may develop an abnormal heart rhythm. This happens to less than 1 in 100 patients during the procedure. This may be treated with medication or a short electrical pulse to the relevant area in the heart to restore normal.

Major Complications

• Damage to the artery where the catheter was inserted can lead to a defect known as a radial or femoral aneurysm. This happens to less than 1% of patients. It may mean you need to stay in hospital and, occasionally, an operation to repair the aneurysm is required.
• Damage to these vessels can also cause bleeding or a blockage. This would need an invasive procedure or an operation to correct, meaning a stay in hospital. This is extremely rare and happens to about 1 in 1000 patients.
• The test may cause damage to a coronary artery, causing it to suddenly narrow or block. This is known as a myocardial infarction (heart attack) and affects less than 0.5 per cent (one in 200) of patients who have this test. It can be treated in the catheter lab or with surgery.
• Stroke affects less than one in 100 patients.
• Damage to your kidneys may occur. If your kidney function is poor we will give you fluids to protect your kidneys before and after your angiogram.
• Some patients may experience an allergic reaction to the dye or the medications we use. This will be treated with some intravenous medication.