I can arrange for you to have a Coronary Angiogram at Colchester Hospital or at The Orwell Suite in The Essex Cardiothoracic Centre.
A Coronary angiogram is a procedure that shows up any narrowings or blockages in the arteries feeding the heart.
What does it involve?
Prior to the procedure, you will have an intravenous cannula (small plastic tube) inserted into a vein in your arm. This is so we can give you medication or fluids before, during or after the procedure. If you are having the procedure from the leg artery, the nurse may have to shave a little area at the top of you leg. She will also take some routine observations, eg blood pressure, and may do an ECG.
You will be taken into the cath-lab and asked to lie on a flat, thin bed. You will have ECG tabs put on your arms and legs and a clip put on your finger to measure the oxygen levels in your blood.
A coronary angiogram can be done from the artery in your wrist or occasionally from the artery at the top of your leg. The skin over this artery will be cleaned with antiseptic lotion. A large drape will then be used to cover you up and just expose this small area of skin. Local anaesthetic will then be used to numb the skin. This will sting a bit but for a few seconds only. You should not feel any pain during the procedure.
A needle is used to puncture the artery and a wire passed down this needle and into the artery. A plastic tube (called a sheath) is then passed over this wire, into the artery. The wire is then removed. A much longer, thinner, flexible tube (called a catheter) is put through this sheath and passed up the arteries in the body to the heart. An x-ray camera is used to check where the catheter goes. This camera will move around your body during the coronary angiogram but will not touch you.
The catheter is carefully placed at the origin of the coronary artery. Dye is injected down the catheter and a video of the images is recorded. When the dye enters your coronary arteries, it shows up on the x-ray. Any narrowings or blockages can then be easily seen. You should not feel the catheter moving inside you nor the dye being injected although occasionally people feel a hot flush or some mild chest discomfort for a few seconds.
In order to see all your coronary arteries, several different shaped catheters may be needed. These catheters can be removed and re-inserted through the sheath, without you feeling anything.
If the function of the heart needs to be assessed, a catheter is passed into the main pumping chamber of the heart (the left ventricle). A larger injection of dye is flushed through this catheter to show up the whole chamber. This gives a strange warm flush all over and you may feel as though you have wet yourself – you have not!
If you have the procedure from the wrist, a special wrist band will be strapped on to press on the hole as the sheath is removed. The nurse will gradually reduce the pressure on the band over the next hour or so.
If you have the procedure from the leg, a small plug may be inserted into the hole left by the sheath, when it is removed (this plug gradually dissolves over a number of days). Sometimes it is not possible to put a plug in, for example if the leg artery is diseased. Then the nurse just presses on the artery for 10-15 minutes until the artery seals up itself.
What preparation is needed?
Before an angiogram is done we need to check that your kidney function is normal and that you are not anaemic — if you have not recently had blood tests to check this then you will need these simple blood tests taken in the days leading up to your angiogram. You may also need a swab to check you don’t have the skin infection “MRSA” — the nurses at the Oaks hospital can arrange this and some GPs offer this service.
I don’t insist on you being starved in preparation for the angiogram but you should not have a large meal beforehand. It is very important that you take all your usually medication on the day of the angiogram unless you are given specific advice by the pre-assessment team.
Please bring all your medication with you (we can take a note of this and also give you any you need during your stay). You should bring a nightgown or similar clothing and slippers. You may wish to bring a book or magazine to read before or after the procedure. If you think you may find the procedure stressful, you may wish to ask for a sedative to be given just beforehand.
How long does it take?
Coronary angiography is done as a day case procedure. The actual procedure usually takes from 20 to 40 minutes to do. The recovery and monitoring period in the ward after can take a few hours (see next section).
What happens after
You go to the recovery ward. What happens there is determined initially by whether you had the procedure from the wrist or leg:
Wrist artery: The nurse will periodically reduce the pressure on the wrist-band. Eventually she will be happy to remove the wrist band. Having the procedure from the wrist means you can be sitting up straight away and in fact will usually just walk straight out of the cath lab into the ward!
Leg artery: If a plug was not inserted to close off the hole, the sheath is usually removed in the recovery ward. To do this, the nurse then needs to press firmly on the hole left by the sheath for about 10 minutes. The nurse will periodically check on your leg over the next hour or two, gradually get you sitting up and eventually sitting out of bed. If you have a plug inserted, the nurse will also make checks on you leg but will be able to get you up much quicker.
After the procedure, the nurses can usually give you an approximate time that you will be fit to go home. They can telephone someone to arrange for you to be picked up. You should not go home alone and you should not drive home. In fact, it is recommended that you do not drive for 24 hours afterward.
You will only need to stay in overnight if you do not have someone at home with you that night (or cannot stay with someone). If you have the procedure at the Angiogram Suite in Colchester, I can arrange an overnight bed at The Oaks and transport to get you there. If you have the procedure at The Essex Cardiothoracic Centre, you can stay over in the Orwell Suite private ward.
What are the risks?
The commonest problem is bruising at the site where the artery was punctured.
Serious complications are very rare. Cardiologists quote a risk of less than one in a thousand of any of these serious complications. These complications include
- A Stroke
- A Heart Attack
- Damage to the artery in the leg or wrist used for the procedure
- The need for emergency angioplasty to open up a blocked coronary artery
- The need for emergency bypass surgery to get round a blocked coronary artery
- Dying – this is exceptionally rare
My complications rates are very low and I work closely with my team at Colchester to constantly monitor and improve the patient experience. To this end, I perform most of my coronary angiograms from the wrist artery and use the latest generation of catheters and sheaths.
What are the benefits?
Coronary angiography is the clearest way to look at the coronary arteries. It gives the most definitive answer to the question “do I have coronary artery disease and what can be done about it”.
Since it is invasive and carries some risk, guidelines recommend we use coronary angiography if it is very likely that you have coronary artery disease. There are other tests that can help in deciding how likely this is (exercise treadmill test, stress echo, perfusions scans and CT coronary angiography). The description of chest pain that you give and the presence of any other risk factors also help weight up which test is the most appropriate.
Coronary angiography is most often used to help diagnose angina. Narrowings or blockages in the heart’s arteries are the commonest causes for angina. The test is also done if you have a heart attack to see if the artery can be re-opened.
Other uses for coronary angiography include helping to determine the cause of heart failure or rhythm abnormalities and as part of the work-up for heart valve surgery.