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Patient Information

Day case coronary angiogram

https://kingstonhospital.nhs.uk/information/day-case-coronary-angiogram

This offers information for anyone undergoing a coronary angiogram.

What is a coronary angiogram?

Coronary arteries graphic

A coronary angiogram (‘angiogram’) is a recognised method of improving the blood flow to the heart muscle.

It is the main investigation performed on people with symptoms which may indicate that the coronary (heart) arteries have become narrow or blocked.

An angiogram enables us to understand the exact position and severity of the narrowing or blockage, so we can decide the most appropriate treatment for you.

Symptoms of narrow or blocked coronary arteries include:

  • Heart attack
  • Chest pain
  • Chest tightness or discomfort
  • Pains in the jaw, throat or shoulders
  • Shortness of breath
  • Irregular heart beats
  • Heart murmur (heart valve problems).

What happens during an angiogram?

An angiogram is performed under local anaesthetic, but we may give you a sedative to help you relax if necessary. 

  • We insert a thin tube (a cardiac catheter) into your body. We can do this via two different entry points: the groin or the wrist. Your cardiologist will decide which is best for you, based on your needs.
  • If we go via your wrist, we insert the catheter in your radial artery (in your wrist). This approach is the most comonly used.
  • If we go via your groin, we insert the catheter in your femoral artery (the main artery in your leg).
  • The angiogram procedure is the same, whether we use your radial artery or your femoral artery.
  • Once inserted, the catheter is positioned in your heart.

We then inject a special dye through the catheter into your 3 main arteries and we record pictures of your arteries.

We also investigate your heart muscle function and heart valves during the procedure.

What are the benefits of an angiogram?

An angiogram gives us information about the blood pressure inside your heart and how well your pumping chambers and valves are working.

It shows whether there is any narrowing of your coronary arteries and demonstrates the position and the severity of any narrowing. This information is vital in helping us to plan your treatment.

What are the risks of having an angiogram?

A common after effect is bruising in the groin. This may be uncomfortable for a few days, but it is not serious.

There is a small element of risk, but serious complications are extremely rare.

In less than 1 in every 1000 tests complications such as heart attack and stroke may occur.

We would not recommend you have the procedure unless we feel the benefits far outweigh the risks.

Speak to your cardiologist if you are worried about the risks of the procedure.

Are there alternatives to having an angiogram?

Other tests are available to assess the arteries of your heart, but they do not offer the extensive information that is gained from an angiogram.

How do I prepare on the day of my procedure?

Do not eat after 6am on the day of your procedure

You may have clear, sugar free drinks (black tea or coffee, water) up to 7 am
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We will give you refreshments and a sandwich after your procedure.

How do I prepare if I am diabetic?

If you are diabetic, do the following:

  • Before 6am, have a light breakfast (such as tea and toast).
  • Before this light breakfast, take half of your usual morning dose of insulin.
  • Bring glucose sweets or digestive biscuits with you to the hospital.
  • Do not take your diabetic tables on the morning of the procedure.

If you take Metformin, stop taking it 2 days before your procedure. This will not affect your long term diabetic control. We will instruct you to restart your Metformin 2 days after your procedure.

What if I am on medication for other conditions?

  • Take all other medications as normal, with a little water. This includes aspirin and tablets for high blood pressure and diuretics.
  • It is recommended that you keep taking your diuretics, but if you are worried about taking diuretics because you have a long journey to hospital for your procedure, you can stop taking them.
  • Bring all your medications with you to hospital (including drops and lotions). This will be helpful to the doctors and nurses.
  • Take your medication(s) as normal during the day while you are in hospital.

What if I take warfarin or Fragmin?

If you take warfarinStop taking warfarin 4 days before your procedure.
Contact the clinic or doctor who supervises your blood tests and let them know the date of your procedure. They may recommend an alternative form of anticoagulation drugs.
We will give you a blood test at the hospital on the day of your procedure.
Bring your anticoagulant records with you to the hospital.
If you have Fragmin injectionsDo not inject your dose on the morning of the procedure. This will reduce the possibility of excessive bleeding during or after the procedure.

In rare cases where clotting levels have not returned to a safe limit, we will postpone the procedure to avoid medical complications.

What do I bring with me to the hospital on the day of the procedure?

  • Bring a dressing gown or robe, slippers and personal toiletries.
  • Bring your glasses and hearing aid(s).
  • Bring reading material if that will help you to pass the time after the procedure.
  • Do not bring large amounts of cash or jewellery because there is limited space for safekeeping.
  • Remove jewellery and nail varnish. You may wear light makeup if you wish.
  • You may find it helpful to bring a list of questions to ask your cardiologist.

Preparation for going home

You must make arrangements for someone to collect you and take you home after your procedure. Someone responsible must also stay with you overnight.

If you cannot arrange for a relative or friend to stay with you or accompany you home, we will not be able to carry out the procedure as a day case.

Contact the Cardiology Administrator if you need to cancel or reschedule your procedure (see Contacts section).

What happens when I arrive on the day of the procedure?

When you arrive at Rowan Bentall Wing reception desk, a senior nurse will take you to the ward.

  • The nurse will check your personal details, ask questions about your medical history, check your vital signs, weight, height and pedal pulses (pulses in your feet).
  • For female patients, they may record the date of your last menstrual period. If there is any chance that you may be pregnant, they will give you a pregnancy test.
  • Your consultant or doctor will explain the angiogram procedure to you and answer your questions. They will also ask you to sign a consent form.
  • When you have changed into a gown, a nurse will take you to the catheter laboratory where the procedure will take place.

Tell the nurse if you are allergic to iodine or have any other allergies.

What happens during the procedure?

You can expect the following during the procedure.

  • The doctor starts the procedure by cleaning the area of your wrist or groin with an iodine based antiseptic solution and covering it with sterile sheets.
  • An anaesthetist injects local anaesthetic into the area where the catheter will be introduced. You may experience a tingling sensation for a few seconds.
  • When the area of the skin is numb, the doctor inserts the catheter into the artery. You may experience pressure when the catheter is inserted.  If you wish, you can watch the screens to view the catheter being guided through the artery into your heart.
  • You may feel your heart flutter, speed up or miss a beat. This is normal and will only last for a short while.
  • When the catheter is in the correct position, we slowly inject a contrast dye. The doctor may ask you to cough, breathe deeply or hold your breath from time to time. This helps the dye to move through the heart’s bloodstream. You may feel a warm glowing, flushing sensation when the dye is injected, lasting a few seconds.
  • When the dye is injected, we take a series of X rays. To do this, we move the X ray machine around you and move the bed slightly to get the best position.
  • Some people experience a metallic taste in the mouth or a feeling of wanting to go to the toilet. These sensations are normal.
  • Throughout the procedure you are attached to a heart monitor machine.
  • The procedure takes approximately 15 to 30 minutes.

Tell the doctor if you feel sick, itchy or have chest pain or discomfort.

What happens after the procedure?

The following happens after the procecure.

After an angiogram with entry via the wrist

We remove the catheter (tube) before you leave the laboratory.

You return to the ward with a TR (trans radial) band which is a special type of plastic bracelet which includes a small balloon. The balloon presses hard on your artery to stop the bleeding. We will remove the bracelet before you go home.

Do not wear a watch or jewellery on this wrist for 7 days.
Do not allow blood pressure readings or blood samples to be taken from this arm for 36 hours.

After an angiogram with entry via the groin

Usually the nurse removes the tube from your groin once you return to the ward area.

We apply pressure to your groin to ensure there is no bleeding from your artery.

You must lie flat for at least 1 to 2 hours after we remove the tube.

You must keep your leg straight at all times during the period of bed rest. This is to prevent any bleeding when you start walking.

Sometimes we use an exoseal to seal the artery and ensure there is no bleeding. An exoseal is a small collagen (protein) plug which self-dissolves within 3 months.

In this situation, we remove the catheter tube in the ward recovery bay and insert the exoseal. The exoseal sometimes feels like a pea sized lump in your groin. This is normal and the feeling will reduce as it self-dissolves.

We will give you a card to carry during the 3 months that the exoseal is in place. This card will alert any doctor to the presence of the exoseal.

For all patients (groin entry and wrist entry)

A nurse checks your pulse and blood pressure. They also check the wound site at regular intervals.

Tell a nurse if you feel unwell after the procedure.

If you need the toilet, we will give you bedpans and urinals because it will be unsafe for you to get out of bed initially. As soon as your wound is stable, we will let you get out of bed.

It is important that you drink plenty of fluids to flush the dye out of your body after the procedure. We will offer you light refreshments while you recover.

Your doctors will tell you the results of your angiogram before you leave hospital. If the ward is particularly busy, this may not happen until late evening.

We hope to discharge you after you have been able to walk around safely for around 2 hours.

What further treatment might you recommend?

Depending on your angiogram results, we may prescribe medicines or we may suggest ‘coronary angioplasty with stents’. This means widening a narrow section of a coronary artery by using a balloon and a stent (small tube). Occasionally we suggest heart surgery.

Your cardiologist will discuss these options with you.

Coronary angioplasty with stents

Coronary angioplasty is a procedure where a narrowed section of a coronary artery is widened using a balloon and a stent (small tube) attached to a catheter.

  • We blow up the balloon at the tip of the catheter at the narrowed section of your artery. This widens the artery.
  • We leave the stent (tube) in place to keep the artery open.
  • This procedure is usually carried out via the artery in your groin.

More information

BHF logo
British Heart Foundation angiogram information
https://www.bhf.org.uk/informationsupport/tests/angiogram


Contacts

Cardiology Administrator, Monday to Friday 9am to 5pm 020 8546 7711 extension 2106
Cardiac Specialist Nurses (CNS), Monday to Friday 9am to 5pm 020 8546 7711 ext 6182
Kingston Hospital Bronte Ward 020 8934 2894 or 2895

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