Angiogram (cardiac catheterisation)

An angiogram (also called a cardiac catheterisation) 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 angiogram
Diagnosis of heart conditions
Preparing for angiogram
What happens during angiogram
What to expect afterwards
Recovering from angiogram
What are the risks?

About angiogram
An angiogram (cardiac catheterisation) 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 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 see how well your heart is pumping blood.

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

If you’re pregnant, you will be advised not to have an angiogram, as there is a risk the radiation may affect the development of your baby. If you are, or think you may be, pregnant, tell your doctor before your appointment. He or she will discuss alternatives to the procedure.

Diagnosis of heart conditions
Symptoms such as breathlessness, chest pains, dizziness, fainting and palpitations can indicate that you have a problem with your heart. Conditions of the heart and blood vessels are usually identified and treated by a specialist doctor called a cardiologist.

Preparing for 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) about two days before the angiogram. You may also need to shave your groin area.

Your hospital will ask you 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 anaesthetic. This completely blocks feeling 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.

What happens during angiogram
An angiogram usually takes about 30 minutes.

A cardiologist, cardiac physiologist (a health professional trained to investigate the function of the heart to help diagnose heart conditions) or 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.

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. Local anaesthetic will be injected into your skin where the catheter will enter your blood vessel – this is called the entry site.

Your doctor will thread a catheter into an artery in your groin, or less commonly in 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 spot, 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 the blood vessels or problems in the heart.

You won’t feel the catheter in your artery, but when the dye is injected, you may have a warm feeling or a slight burning sensation.

The catheter will be removed when the test is complete. Your nurse will either press firmly over the entry site for up to 10 minutes or insert a small collagen plug called an angioseal to help seal the blood vessel. The plug usually dissolves in 60 to 90 days. Your nurse may give you a card with information about the plug to carry with you for up to three months.

What to expect afterwards
You will need to lie flat on your bed 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.

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

Your results will usually be sent in a report to the doctor who recommended your angiogram. Other findings may be discussed before you leave the hospital. If you have sedation, 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 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.

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 the following:

•    Mild chest pains or a fluttery heartbeat during and immediately after 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 and an unexpected reaction to the anaesthetic.

Other less common complications of an angiogram are listed here.

•    Allergic reaction to the dye – medicines are available to help treat this.
•    Arrhythmia (irregular heartbeat) – this often improves on its own.
•    Haematoma (build-up of blood under the skin) – this can happen if the blood vessel is damaged and may require surgery to drain the area.
•    Damage to blood vessels leading to the heart – this 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 a blood vessel. There is a risk these may block the blood supply to the heart or brain and trigger a heart attack or stroke.

The exact risks are specific to you and differ for every person, so we haven’t included statistics here. Ask your doctor to explain how these risks apply to you.