Angiogram (cardiac catheterisation)

An angiogram is a type of test to look at blood vessels. An angiogram of your heart (coronary angiogram) can check the blood vessels supplying your heart. It’s also called coronary angiography and is part of cardiac catheterisation.

About angiogram

A coronary angiogram procedure involves threading a fine tube called a catheter into an artery in your wrist or groin and then to your heart. Your doctor injects a special dye (contrast) through the catheter to show up your coronary arteries on an X-ray. The coronary arteries supply blood to your heart. If these are narrowed or blocked, an angiogram can show where and how serious the blockage is.

A coronary angiogram is part of a cardiac catheterisation procedure. Cardiac catheterisation doesn’t always involve having an injection of dye. Doctors may use cardiac catheterisation to look at the structure of your heart and coronary arteries, how your heart works, and how your heart and lungs work together. They may also use cardiac catheterisation to diagnose or treat heart conditions.

Why have an angiogram

Your doctor may suggest a coronary angiogram test to check your coronary arteries. This may be part of cardiac catheterisation, which can be used to diagnose certain heart conditions, including:

• coronary heart disease
• heart rhythm disturbances such as ventricular tachycardia
• problems affecting the valves of your heart
• other problems affecting how well your heart works

Your doctor may also perform a coronary angiogram to look for any damage to your heart after a heart attack. If your doctor finds blocked or narrowed arteries during the angiogram, they may be able to treat your condition with coronary angioplasty (stenting). This is often done as part of the same procedure.

Your doctor will discuss with you why they’re recommending a coronary angiogram and the benefits and risks of the procedure. They’ll explain whether they plan to do the procedure using an artery in your wrist or in your groin. Using the wrist artery is a newer technique that’s associated with fewer complications and a shorter stay in hospital. But it can be more challenging because the wrist artery is smaller. Sometimes the artery in your groin may have to be used instead.

Who shouldn’t have an angiogram

Most people can have an angiogram. But your doctor may advise against it if you have certain other conditions that can increase your risk of complications. These may include:

• an infection
• uncontrolled high blood pressure
• unstable arrhythmias
• a condition causing bleeding
• kidney problems
• an allergic reaction to the dye in the past

You should let your doctor know if you’re pregnant or breastfeeding. They’ll advise if an angiogram is suitable for you.

Preparation for angiogram

Your doctor will explain how to prepare for your angiogram procedure. Let them know if you take any medicines or have any health conditions or allergies. You may need to stop taking certain medicines but only do this with your doctor’s advice.

If you smoke, it’s a good time to try to stop before you have an angiogram. Smoking increases the risk of heart problems during and after surgical procedures. It also increases your risk of infection and other complications after surgery. You can get help with stopping smoking from a pharmacist, your local NHS Stop Smoking Service or your GP.

You’ll have your angiogram in a cardiac catheter laboratory (‘cath lab’) at a hospital. You’ll need to stop eating and drinking a few hours before your procedure. Your doctor will explain exactly how long for.

On the day of your procedure, your doctor will meet you to check you’re still happy to go ahead. They’ll explain what will happen before, during and after an angiogram procedure. If you’re unsure about anything, don’t be afraid to ask. It’s important that you feel fully informed. You’ll be asked to sign a consent form before the procedure.

You usually have an angiogram under local anaesthesia. This numbs the area where your catheter is inserted (in your groin or wrist) and blocks painful sensations. You’ll stay awake during the procedure. Your doctor may give you a sedative to help you relax. You can usually go home the same day and won’t need to stay in hospital overnight.

Angiogram procedure

An angiogram procedure usually takes about half an hour. But this will depend on lots of things, including where the artery is. Using your wrist artery may take longer than using your groin artery. An interventional cardiologist – a specialist doctor who performs heart procedures – will usually do the procedure. There will be nurses and technicians assisting too.

Your nurse will ask you to change into a hospital gown. You’ll be shown into the catheter laboratory. You’ll need to lie flat on a padded table to have your procedure. You’ll have a heart monitor to record your heart rate and rhythm, and a finger probe to measure your oxygen levels. Tell your nurse if you feel unwell or uncomfortable at any time.

Your doctor will clean the skin around your wrist or groin where the catheter will enter your artery – this is called the access site. They’ll then inject the local anaesthetic to numb the area. You may feel some discomfort when you have the injection. If it’s through your groin, the local anaesthetic may cause pins and needles and tingling in your leg on that side.

Once the area is numb, your doctor will make a small cut in the skin of your groin or wrist. They’ll thread a catheter into the artery and towards your heart using real-time X-ray images to carefully guide the catheter. When the catheter has reached the right place, your doctor will inject the dye and take more X-rays as the dye flows through your arteries and heart. These will show up any narrowing or blockages. You won’t feel the catheter in your artery, but you may notice a warm flush throughout your body when the dye is injected.

Your doctor will remove the catheter when the angiogram is finished.

Aftercare for angiogram

TThe access site, where the catheter entered your artery, needs to be sealed. There are different ways of doing this, depending on whether the access site was in your wrist or groin.

If you had your angiogram through your wrist, you’ll be given a tight band to wear around your wrist. This can be gradually loosened. You’ll need to keep this on for a few hours after your angiogram procedure until the bleeding stops.

If the catheter was put in through your groin, you may have a small plug called an Angio-Seal put in to seal it. This dissolves on its own over the next few weeks. Sometimes your doctor may prefer to apply a pressure pad to the wound, rather than using a plug.

You’ll need to lie flat for a few hours so your artery can seal properly. You’ll need to keep your leg (or arm if your wrist was used) as straight as possible to reduce bleeding. Your nurse will regularly check your blood pressure and heart rate. They’ll also check your wrist or groin for bleeding, swelling, and pain. You’ll need to drink plenty of fluids to help flush the dye out of your body.

You’ll usually be able to go home when you feel ready but make sure someone can take you. You shouldn’t drive immediately after an angiogram.

Recovery from angiogram

You’ll usually feel back to normal on the same day. If you’ve had a sedative, you may feel tired after your angiogram, but should be back to normal within a few days. It’s important to take it easy for the rest of the day after your procedure, to allow the access site time to heal. You can have a shower the following day, but try to keep the area dry. Don’t do any vigorous exercise or heavy lifting for about three days.

If you have any problems with the access site after you get home from the angiogram, contact the hospital ward where you had the procedure. Your nurse should give you a contact number before you go home.

If you had a sedative, you may find that you’re a little unsteady on your feet or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important. Always follow your doctor’s advice.

Side-effects of angiogram

Side-effects affecting the access site (where the catheter entered your artery) are common after an angiogram. Side-effects include:

• the access site feeling tender and numb
• swelling at the access site
• bleeding
• bruising

These effects should disappear on their own after a few days. If they continue or get worse, contact the hospital where you had the angiogram.

Generally, having an angiogram catheter in your wrist will cause fewer side-effects than having the test through your groin. Sometimes though, having the procedure through your groin will be the best option.

You may also get some side-effects during the procedure. These include the following.

• Mild chest pains or a fluttery heartbeat. This is quite common and usually goes away quickly on its own. But, if necessary, your doctor will be able to treat it straightaway.
• The dye may cause a warm flushing sensation in your body. It may make you cough or feel sick. These symptoms are usually mild and disappear quickly but tell your nurse or doctor straightaway if you notice them.

Complications of angiogram

Serious complications from an angiogram are rare. Any complications tend to be mild and can be easily treated. You’re more likely to have complications if you already have other health conditions, such as diabetes or kidney problems. It will also depend on the exact procedure you’re having done.

Complications of angiogram include the following.

• Haematoma. This is a build-up of blood under your skin. It usually goes away on its own. But sometimes it forms a pulsating lump called a pseudoaneurysm (‘false aneurysm’). You may need treatment to get rid of it.
• Allergic reaction to the dye. Allergic reactions include a rash, red and itchy eyes, vomiting, breathing problems, and changes to your heartbeat. Your doctor will have medicines available to treat an allergic reaction if it happens.
• Kidney problems. Sometimes, the dye can cause kidney problems, especially if your kidneys already don’t work very well or you have other medical conditions. Your doctor will ask you about your medical history and, if necessary, can take measures to reduce your risk.
• Infection. Signs of infection include your wound becoming red, hot and swollen, and leaking pus within a few days of your angiogram. You may need a course of antibiotics.
• Catheter-related complications. Very rarely, the tip of the catheter can dislodge a blood clot or fat deposit from the wall of a blood vessel. There’s a risk this could lead to a heart attack or stroke. It’s also possible for the catheter to tear an artery wall. You’ll need further treatment if this happens. .