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Angiogram (cardiac catheterisation)

An angiogram is a test that’s used to find out more about your heart. It can help to show if blood vessels called coronary arteries, which supply blood to your heart, are narrowed or blocked. If they are, it can show where and how severely they are affected. It can also see how well your heart is pumping blood.

During an angiogram, your doctor will put a long, thin, flexible tube called a catheter into an artery in your groin or wrist. They will guide the catheter to your heart and inject a dye (contrast agent) through it. This will mean your heart and coronary arteries show up more clearly on X-rays.

Adults, children and newborn babies can all have an angiogram.

Your care may not be quite as we describe here as it will be designed to meet your individual needs. But you’ll meet the doctor carrying out your procedure beforehand to discuss what will happen.

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Preventing coronary heart disease
Dr Paul Zollinger-Read

Details

  • Preparation Preparing for an angiogram

    Your doctor will explain how to prepare for your angiogram. Let them know if you take any medicines and have any health conditions. Don’t stop taking any medicines unless they tell you to.

    It’s important that you don't eat or drink anything for a few hours before your angiogram. You’ll be given more details about this but if you have any questions, just ask.

    You’ll usually have an angiogram under local anaesthesia. This completely blocks pain from where the catheter enters your artery (in your groin or wrist) and you’ll stay awake during the procedure. Your doctor may give you a sedative too, which relieves anxiety and will help you to relax. You can have an angiogram and go home on the same day. You don’t usually need to stay in hospital.

    Your doctor will discuss with you what will happen before, during and after your procedure, and any pain you might have. You’ll be asked to sign a consent form so make sure you take the opportunity to ask questions about anything you’re unsure of.

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  • Special considerations Special considerations - pregnancy and breastfeeding

    If you’re pregnant, or think you might be, tell your doctor before your appointment as sometimes it’s better not to have X-rays during pregnancy. This is because your unborn baby could be exposed to the radiation and this could cause problems with its development. Whether or not you have the test will depend on various things, including how serious your heart condition is.

    Talk with your doctor to weigh up the benefits and risks for you and your baby to help you decide whether or not to go ahead. It may be possible to have the procedure and stop radiation reaching your baby by protecting your tummy (abdomen) with a lead shield.

    It’s possible that the contrast agent (dye) used in an angiogram could cross the placenta and affect your baby. Some types of contrast agent may be safer for you and your baby than others.

    If you’re breastfeeding, there’s a small risk that the contrast agent (and other medicines you’re given during an angiogram) could get into your breast milk. This could affect your baby and so you may be advised not to breastfeed for a day or so after your angiogram.

    Take the time to talk through everything with your doctor. That way you can make a decision you’re comfortable with based on what’s best for you and your baby.

  • The procedure What happens during an angiogram?

    An angiogram usually takes about half an hour.

    A radiologist (a doctor who specialises in using techniques such as X-rays to diagnose conditions) may do your angiogram. Or, a cardiologist (a doctor who specialises in conditions that affect the heart) may do it. A nurse and radiographer will be part of the team that look after you too. A radiographer is a health professional who is trained to take X-rays.

    You’ll have your angiogram in a room called a catheter lab. Your nurse will ask you to change into a hospital gown. A heart monitor will record your heart rate and rhythm during the procedure. Tell your nurse if at any time you feel unwell or get any discomfort.

    You’ll be asked to lie on a table and an X-ray machine will be positioned above your chest. Your doctor will inject local anaesthetic into your skin where the catheter will enter your artery – this is called the entry site.

    Your doctor will thread the catheter into the artery in your groin or your wrist. They will then move it up through your artery to the opening of your coronary arteries. Your doctor will use X-rays of your heart (shown on a screen) to carefully guide the catheter into your heart. When the catheter has reached the right place, your doctor will inject a dye (contrast agent) into the catheter. More X-rays will be done as the dye flows through your arteries and heart, and these show if there is any narrowing in them.

    You won’t feel the catheter in your artery but when the dye is injected, you may have a warm feeling throughout your body.

    Your doctor will remove the catheter when the test is complete. Either your nurse will press over the entry site for about 20 minutes or you’ll have a small collagen plug inserted to seal your artery. The plug usually dissolves in around 40 days.

    If you had the catheter inserted into your wrist, you’ll be given a tight band to wear around your wrist. You’ll need to keep this on for two to three hours after your angiogram.

  • Aftercare What to expect afterwards

    If your angiogram was done through your groin, you’ll need to lie flat for a few hours so your artery can seal properly. Your nurse will regularly check your blood pressure, heart rate and where the catheter entered. If you had the angiogram through your wrist, you’ll probably be well enough to get up an hour or so after the procedure.

    You’ll usually be able to go home when you feel ready but make sure someone can take you.

    If a cardiologist did the procedure, they may talk through your results with you before you go home. If a radiologist did your angiogram, they will send a report to the doctor who referred you to have the test or will contact you to discuss your results.

  • Heart treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including heart treatment.

  • Recovery Recovering from an angiogram

    Take it easy for the rest of the day after having an angiogram. And don’t do any vigorous exercise or heavy lifting for about five days.

    Keep the dressing over your wound (entry site) for 24 hours. You can then have a shower and carefully remove it.

    Having a sedative may cause you to be less coordinated, and you might find it difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important.

    If you need to – perhaps because you have a holiday booked – you should be able to fly the next day. But be sure to check this with your doctor before having the test.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with having an angiogram. We haven’t included the chance of these happening as they are specific to you. Ask your doctor to explain how the risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of an angiogram may include:

    • mild chest pains or a fluttery heartbeat during the procedure
    • bruising and swelling where the catheter entered your artery

    Complications

    Complications are when problems occur during or after the procedure. Possible complications of an angiogram include bleeding during or very soon after the procedure, infection or an unexpected reaction to the local anaesthetic.

    Other possible complications of an angiogram are explained here.

    • An allergic reaction to the dye. This usually gets better within a day but there are medicines to both help prevent and treat this.
    • Kidney damage caused by the dye used in an angiogram. This is usually temporary and your doctor will take steps to minimise this risk, such as making sure you have enough fluids in your body.
    • Irregular heartbeat (arrhythmia). This can happen as a result of having a catheter within your heart or because of the dye injection. It will usually settle by the end of the procedure.
    • Build-up of blood under your skin (haematoma). This can happen if blood leaks out of the blood vessel during an angiogram. You may need to have the haematoma drained.
    • Heart attack or stroke. Very rarely, the tip of the catheter can dislodge a blood clot or fatty plaque from the wall of your blood vessel. There is a risk that these may block the blood supply to your heart or brain and trigger a heart attack or stroke.

    It’s possible for an angiogram to be fatal although this is very rare. The risk is higher in people who already have other conditions, such as problems with their lungs or kidneys. Ask your doctor for more information. They will only recommend you have the test if they feel the benefits of having it outweigh any risks.

  • FAQs FAQs

    Is the angiogram procedure the same in children?

    Answer

    The procedure is exactly the same but children sometimes have a general anaesthetic. The staff at the hospital will take every step to care for your child during the procedure.

    Explanation

    It’s important not to move during an angiogram. Because young children may find it difficult to keep still for the time the procedure takes, it’s usually done under general anaesthesia. This means your child will be asleep during the angiogram.

    The staff doing your child’s angiogram will adjust the radiation doses to your child’s size because children are more sensitive to radiation. The staff will also make sure the type of contrast agent (dye) used and the catheters to deliver the dye are appropriate for your child.

    Your child’s doctor will ask you about their health and medical history before the procedure. It’s important to tell them if your child is taking any medicines, or has any allergies or medical conditions.

    Although there are risks from having an angiogram, this procedure may be able to diagnose or treat your child’s heart condition quickly and safely. This could mean your child won’t need further procedures, such as surgery.

    If you have any concerns, talk to their doctor. Your child may be able to have an alternative procedure.

    What type of dye is used during an angiogram?

    Answer

    The dye is a liquid called a contrast agent and it usually contains the chemical iodine. This stops X-rays from passing through your blood vessels so they show up more clearly on the images that are taken.

    Explanation

    The heart and blood vessels are difficult to see on X-ray images. Contrast agents (also known as contrast media or dye) are often used to highlight heart muscles and blood vessels, and make them easier to see.

    The contrast dye used during an angiogram is usually iodine-based. It’s a liquid and usually you pass it out of your body when you go to the toilet. There’s a small risk of having an allergic reaction to the contrast agent. It’s important to tell your doctor if you have any type of allergy. If you have asthma, you may be more likely to be allergic to the contrast agent too.

    As the contrast dye reaches your heart, you may feel a warm, flushing sensation or a fluttery heartbeat. You may also get a metallic taste in your mouth, feel light-headed, sick or itchy. Usually, these symptoms are mild and disappear quickly but do tell your nurse or doctor if you get any of them.

    Contrast agents can sometimes cause problems if your kidneys don’t work very well. Be sure to tell whoever is doing your angiogram if you have kidney problems so they can use a different contrast agent. Contrast agents can also cause kidney problems if you take metformin, a common treatment for diabetes. Again, make sure you tell the doctor doing your procedure if you take this medicine.

    Why do I need to stop taking warfarin before an angiogram?

    Answer

    Warfarin can increase your risk of bleeding during and after an angiogram.

    Explanation

    Warfarin is a medicine that can stop your blood clotting. It can help reduce the chance of your blood clotting if you have a health condition that makes this more likely, such as atrial fibrillation. It helps your blood to flow around your body and stops any clots forming in your heart or blood vessels. This also means that your blood doesn’t clot easily when you bleed.

    Your doctor may ask you to stop taking warfarin before your angiogram to reduce your risk of bleeding during, and immediately after the procedure.

    Your doctor will give you more information about how to prepare for your angiogram and what medicines you can take.

  • Resources Resources

    Further information

    Sources

    • Angiography. The Merck Manuals. www.merckmanuals.com, published January 2015
    • Cardiac catheterization of the left heart. Medscape. www.emedicine.medscape.com, published 8 April 2014
    • Cardiac catheterisation. PatientPlus. www.patient.co.uk/patientplus, reviewed 21 December 2012
    • Catheter angiography. Radiological Society of North America. www.radiologyinfo.org, published 12 February 2014
    • Therapeutic cardiac catheterizations for children with congenital heart disease. American Heart Association. www.heart.org, published 24 September 2013
    • Avila ML, Shah PS, Brandão LR. Different unfractionated heparin doses for preventing arterial thrombosis in children undergoing cardiac catheterization. Cochrane Database of Systematic Reviews 2014, Issue 3. doi:10.1002/14651858.CD010196.pub2
    • Coronary angiogram. British Heart Foundation. www.bhf.org.uk, accessed 2 March 2015
    • Contrast materials. Radiological Society of North America. www.radiologyinfo.org, published 7 March 2013
    • Radiation dose in X-ray and CT exams. Radiological Society of North America. www.radiologyinfo.org, published 10 August 2014
    • Radiology FAQs. Royal College of Radiologists. www.rcr.ac.uk, accessed 2 March 2015
    • Hon LQ, Ganeshan A, Thomas SM, et al. An overview of vascular closure devices: what every radiologist should know. Eur J Radiol 2010; 73(1):181–90. doi:10.1016/j.ejrad.2008.09.023
    • Durham KA. Cardiac catheterization through the radial artery. AJN 2012; 112(1):49–56. www.nursingcenter.com
    • British Cardiovascular Society. Fitness to fly for passengers with cardiovascular disease. Heart 2010; 96:ii1–ii16. doi:10.1136/hrt.2010.203091
    • What is cardiac catheterization? National Heart Lung and Blood Institute. www.nhlbi.nih.gov, published 30 January 2012
    • What parents should know about medical radiation safety in pediatric interventional radiology. The Alliance for Radiation Safety in Pediatric Imaging. www.pedrad.org, accessed 2 March 2015
    • ACR manual on contrast media. American College of Radiology. www.acr.org, published 2013
    • Standards for intravascular contrast agent administration to adult patients. Royal College of Radiologists. www.rcr.ac.uk, published 2010
    • Bonow RO, Carabello BA, Chatterjee K, et al. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. Circulation 2008; 118:e523–661. doi: 10.1161/CIRCULATIONAHA.108.190748
    • Anticoagulation – oral. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published February 2015
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 3 April 2015
    • Angiogram. Society for Vascular Surgery. www.vascularweb.org, published January 2011
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