Coronary Angiogram

The doctors and staff at GKNM Hospitals are pleased that you are considering us for your Coronary Angiogram. We would like to take the time to briefly discuss the process of undergoing Coronary Angiogram. Your physician has discussed the indications for surgery and the criteria that must be met prior to your Coronary Angiogram. This information is designed to offer additional information on your preparation before surgery, the surgery itself, and the road to recovery after your procedure.

A Coronary Angiogram is a technique that uses X-ray imaging to see your heart’s blood vessels, which are called the coronary arteries. The test is done to see if there’s a restriction in blood flow going to the heart.

Coronary Angiograms are part of a universal group of procedures known as Cardiac Catheterizations. Cardiac catheterization procedures can both diagnose and treat heart and blood vessel conditions. A Coronary Angiogram, which can help diagnose heart conditions, is the most common type of Cardiac Catheterization procedure.

During a Coronary Angiogram, a form of dye that is detectable by an X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), presenting a detailed look at the blood vessels. If necessary, your doctor can open the clogged heart arteries (angioplasty) during the same session as the Coronary Angiogram.

Some of the common reasons that your doctor may recommend that you have a Coronary Angiogram would be:

• Symptoms of coronary artery disease, such as chest pain (angina)
• Pain in your chest, jaw, neck or arm that can’t be explained by other tests
• New or increasing chest pain (unstable angina)
• A heart defect you were born with (congenital heart disease)
• Abnormal results on a non-invasive heart stress test
• Other blood vessel problems or a chest injury
• A heart valve problem that requires surgery

Because of the invasive nature of the investigation, angiograms are usually not done until after non-invasive heart tests have been performed, such as an electrocardiogram, an echocardiogram or a stress test.

In a few cases, Coronary Angiograms are performed on an emergency basis. In all other cases, they are scheduled in advance, giving you time to prepare. Angiograms are performed in the catheterization (cath) lab of a hospital. Your health care team will give you specific instructions and talk to you about any medications you already take.

General guidelines include:

• Don’t eat or drink anything after midnight before your angiogram.
• Take all your medications to the hospital with you. Ask your doctor about whether or not to take your usual medications.
• If you have diabetes, ask your doctor if you should take insulin or other oral medications before your angiogram.
• If you have any allergies, you must let your doctor know. If you have previously been affected by intravenous contrast medium (the dye used for kidney X-rays and CT scans), you must also tell your doctor about this.
• As the procedure is usually carried out using the big artery in the arm or groin, you could be asked to shave the skin around this area and you may receive a sedative to relieve anxiety.
• The team will perform a physical exam and check your vital signs – blood pressure and pulse.
• You’ll also empty your bladder and change into a hospital gown. You may have to remove contact lenses, eyeglasses, jewellery and hairpins.

• The patient/attender consent is obtained before the procedure after briefing the process of angiogram.
• You will be instructed to lie on the X-ray table, usually on your back. You may have a needle put into a vein in your arm, so that the Cardiologist can give you a sedative or painkillers. You may have a monitoring device attached to your chest and finger, and may be given oxygen through small tubes in your nose.
• The skin near the point of insertion, probably the arm or groin, will be cleaned with antiseptic, and then the rest of your body will be covered with a theatre towel.
• The skin and deep tissues over the artery will be numb due to the local anaesthetic and a needle will be injected into the artery. Once the Cardiologist is satisfied that this is correctly positioned, a guide wire is placed through the needle, and into the artery. Then the needle is withdrawn, allowing a fine plastic tube called a catheter to be placed over the wire and into the artery.
• The Cardiologist uses the X-ray equipment to make sure that the catheter and the wire are placed at the right position and then the wire is withdrawn.
• A special dye, contrast medium, is then injected through the catheter and X-rays are taken. The dye is easy to see on X-ray images. As it travels through your blood vessels, your doctor can notice its flow and identify any blockages or constricted areas.
• Depending on what your doctor discovers during your angiogram, you may have additional catheter procedures at the same time, such as a balloon angioplasty or a stent placement to open up a narrowed artery.
• Once the Cardiologist ascertains all the appropriate X-rays results and all the information required has been obtained from the patient, the catheter will be removed.