• Reference Number: HEY-807/2021
• Departments: Cardiology
• Last Updated: 28 February 2021

Introduction

This leaflet gives you about the diagnostic test known as a coronary angiogram (or cardiac catheterisation) and explains what is involved.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion.  If after reading this you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is an angiogram?

An angiogram is a test that enables the doctors to look at your heart’s blood supply (arteries), valves and sometimes the blood supply to your lungs in detail in order to decide on the best treatment for you.

What does the angiogram involve?

The angiogram is performed in our Cardiac Catheterisation Laboratory or “Cath Lab” and usually takes 20 – 30 minutes.  During the procedure you will lie on the X-ray table and be attached to a heart monitor.  The procedure is usually carried out from your wrist or the top of your leg.  The skin is cleaned with antiseptic and your body is covered in a large sterile sheet.  Using local anaesthetic to numb the skin (this may sting) a small tube (sheath) is placed into the artery at your wrist (radial artery) or the top of your leg (femoral artery).  Through this sheath a long, fine tube (catheter) is passed through the blood vessels up to your heart.  X-ray dye is injected into the heart’s arteries whilst the X-ray machine moves around to identify any narrowing or blockage.  Sometimes the doctor also takes a picture of the main pumping chamber of the heart.  This can give you a ‘hot flush’ which travels all over the body.  It might make you feel as if you have wet yourself (though you will not have done).  This sensation usually lasts no more than a minute or two.

What are the risks

Angiography is a very safe test, but there is a small risk of complications that you need to be aware of.

• Bruising: It is common for bruising to appear around the site where the needle has been inserted.  Damage to the artery is uncommon, occurring in about 1 in every 500 procedures.
• Reaction to the dye:  If you have ever had a test that uses radio-opaque dye and you have had a reaction to it, you should tell the doctor or nurse before you have your angiogram.  A reaction may take the form of a rash or itching, or very rarely a more severe allergic reaction.
• Radiation:  Angiography is performed using X-rays so you will be exposed to a small amount of radiation.  The risks from this are extremely small; however, you must inform the medical staff if there is any possibility that you may be pregnant.
• Serious complications: The risk of death as a result of an angiogram is around 1 in 10,000 procedures.  Other serious complications such as heart attack and stroke are also very rare occurring in less than 1 in 1,500 procedures.

How do I Prepare for the test?

You should eat a light meal before your admission and you may drink clear fluids up until the time of the procedure.  A sandwich and drinks will be offered after the procedure.

Medication:  You should continue to take your medications as normal.  However, there are some instances where we will advise you to alter your tablet treatment before coming in to hospital. This will be discussed with the nurse practitioner at pre-assessment.

It is very important that you bring with you all your tablets and the doses prescribed whenever you attend the hospital.

Medications that are usually stopped before the angiogram includes:

• Anticoagulant Warfarin (a tablet to thin the blood). This is usually stopped 5 days before the procedure depending on the reason for Warfarin being prescribed.
• Newer Oral Anticoagulants (a tablet to thin the blood) such as Apixaban, Rivaroxaban, Edoxaban and Dabigatran. These are usually stopped 2 days before the procedure
• Water tablets, such as Furosemide, are usually not taken on the day of the procedure.
• Nebulisers should be used as normal.  Please bring your portable nebuliser machine with you if needed.

In case of any unforeseen circumstances, it is recommended that you bring an overnight bag.

What will happen on the day?

You will need to be admitted to the Cardiology 5 Day Ward where you will be allocated a named nurse who will look after you during your stay.  Patients admitted at 7.30am usually have their procedure between 8.30am and 1pm.  Those admitted at 11am normally have their procedure between 1.30 pm and 6pm.  As emergencies take priority, delays sometimes occur.

Please inform the ward of any anticipated delay in your arrival time.

What happens afterwards?

Following the test, you will return to the ward.  If your wrist has been used, you may mobilise around the ward immediately.  The pressure device will gradually be reduced then removed and a dressing applied.  If your leg has been used you will need to remain in bed for up to two hours, any pressure devices will be gradually reduced then removed and a dressing applied.  You will be allowed home once the dressing on your groin or wrist has been checked.

You must have a responsible adult to collect and escort you home after your angiogram.  If you are unable to arrange for a friend or relative to bring you in and take you home please contact your doctor’s surgery who will help make alternative arrangements.  Public transport is not advised for travel home.  It is not always possible for the Ambulance Service to take patients home after 5.00pm, so please try to make alternative discharge arrangements if your anticipated discharge time is after 5.00pm.  As a rough guide discharge is usually mid to late afternoon for 7.30am admissions and between 6.00pm – 8.00pm for 11.00am admissions.  It is advisable for relatives to telephone the ward between 11.00am – 12 noon and 4.00pm – 5.00pm respectively for updates.

You should rest for the remainder of the day, drink plenty of fluids but avoid alcohol for the first 24 hours.  You may resume normal activities, including work 3 days after the test unless advised otherwise.

Please note that you should not drive for 3 days after the procedure.

Should you require further advice on the issues contained in this advice sheet, please do not hesitate to contact the Clinic on telephone number (01482) 461647 or the Cardiology Day Ward (01482) 461518.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.