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Angiogram (cardiac catheterisation)

An angiogram is a test used to diagnose certain heart conditions.

You will meet the doctor carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About an angiogram

An angiogram is a procedure that can help to diagnose heart conditions. It involves putting a long, thin, flexible tube called a catheter into a blood vessel in your groin or wrist. The catheter is then guided to your heart and a special dye (contrast agent) is injected through the catheter, so that X-ray images show your heart and coronary arteries more clearly.

An angiogram can help to find out if the blood vessels to and from your heart are narrowed or blocked, and if so, where and how badly they are affected. It can also be used to see how well your heart is pumping blood.

An angiogram can be done on adults, children and newborn babies.

Preparing for an angiogram

Your doctor will explain how to prepare for your procedure. For example, you may be asked to stop taking anticoagulant medicines (such as warfarin) a few days before the angiogram. However, it's important to follow your doctor's advice. Similarly, don't stop taking any medicines unless they tell you to.

You will be asked not to eat or drink anything for a few hours before you have the angiogram.

The angiogram is usually done as a day case under local anaesthesia. This completely blocks pain from where the catheter enters your blood vessel (in your groin or wrist) and you will stay awake during the procedure. You may be offered a sedative during the procedure. This relieves anxiety and will help you to relax.

Your doctor will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

Special considerations – pregnancy and breastfeeding

If you’re pregnant, or think you might be, tell your doctor before your appointment. Your doctor will discuss with you whether having an angiogram while you’re pregnant is appropriate.

If you’re breastfeeding, tell your doctor before your appointment. There is a small risk that the contrast agent and any other medicines you have during your angiogram could get into your breast milk. This could affect your baby. Your doctor will discuss with you whether you need to plan not to breastfeed for a short time after your angiogram, or whether there is an alternative procedure you can have.

See our frequently asked questions for more information.

What happens during an angiogram?

An angiogram usually takes about 30 minutes.

A cardiologist (a doctor who specialises in conditions affecting the heart), cardiac physiologist (a health professional trained to perform cardiac investigations) and a radiographer (a health professional trained to perform imaging procedures) will carry out the test. A nurse will usually stay with you throughout the procedure.

Angiograms are carried out in special rooms that are designed to contain all the equipment that is needed for the procedure. You will be taken into one of these rooms, which are often located in the hospital’s X-ray department. You will be asked to change into a hospital gown.

You will be connected to a heart monitor that records your heart rate and rhythm during the procedure. Tell your nurse if at any time you feel unwell or experience any discomfort.

You will lie on a table and an X-ray machine will be positioned above your chest. Your cardiologist will inject local anaesthetic into your skin where the catheter will enter your blood vessel – this is called the entry site.

Your doctor will thread the catheter into the artery in your groin or your wrist, and move it up through the vessel to the opening of your coronary arteries. Your healthcare team will take X-ray images of your heart and your doctor will look at the images on a monitor to carefully guide the catheter into your heart. When the catheter has reached the right place, your doctor will inject a special dye into the catheter. More X-ray images will be taken as the dye flows through your blood vessels and heart. Your doctor will look at these on the monitor to see if there is any narrowing in your blood vessels.

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

You will have the catheter removed when the test is complete. Your nurse will either press firmly over the entry site for up to 20 minutes or insert a small collagen plug called an arteriotomy closure device (commonly an angioseal type) to help seal the blood vessel. The plug usually dissolves in 60 to 90 days.

If the catheter is inserted into your wrist, you will be given a tight band to wear around your wrist for two to three hours after your angiogram.

What to expect afterwards

If your angiogram was performed from the groin, you will need to lie flat for a few hours to allow the blood vessel to seal properly. Your nurse will regularly check your blood pressure, heart rate and the catheter entry site. If it was done from the wrist, you should be well enough to get up an hour or so after the procedure.

You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home.

The cardiologist performing the angiogram will usually discuss the results with you before you go home. Alternatively, your results may be sent in a report to the doctor who recommended your angiogram, who will arrange to see you to discuss the results. Other findings may be discussed before you leave the hospital. If you were given the sedative during your procedure, it's a good idea to have someone with you if the results are being discussed immediately after the procedure, as you may not remember the details clearly.

Recovering from an angiogram

Take it easy for the rest of the day and don't do any vigorous walking or heavy lifting for the first few days after you have an angiogram.

The dressing covering the entry site on your skin can be removed and changed if needed after 24 hours. You can have a shower and carefully pat dry your wound afterwards.

Sedation temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations and always follow your doctor's advice.

What are the risks?

Angiograms are commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

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 an angiogram
  • bruising and/or swelling at the catheter entry site

Complications

Complications are when problems occur during or after the procedure. Most people are not affected. The possible complications of an angiogram include bleeding during or very soon after the procedure, infection or an unexpected reaction to the anaesthetic.

Other less common complications of an angiogram are listed below.

  • Allergic reaction to the dye. This happens in around one in 100 people having an angiogram, but medicines are available to help treat this.
  • Irregular heartbeat (arrhythmia) – this is caused by the catheters within the heart or the dye injection, and will settle by the end of the procedure.
  • Build-up of blood under your skin (haematoma) – this can happen if your blood vessel is damaged and you may require surgery to drain the area.
  • Damage to the blood vessels leading to your heart – you will require urgent surgery to repair the damage.
  • 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. This happens in about five in 10,000 people who have an angiogram.
  • Fatality. This is very rare and happens in less than one in 10,000 people during or after an angiogram. The risk is increased in people who already have other conditions, such as problems with their lungs or kidneys.

As with every procedure, there are some risks associated with having an angiogram. Ask your doctor to explain how these risks apply to you.

 

Produced by Louise Abbott, Bupa Health Information Team, July 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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