• Reference Number: HEY1566/2025
• Departments: Cardiology
• Last Updated: 31 May 2025

Introduction

This leaflet has been produced to give you general information about the invasive diagnostic procedure Coronary Angiogram (may also be referred to as cardiac catheterisation). Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

What is a Coronary Angiogram and why do I need one?

A coronary angiogram is a test that enables the doctors to look at your heart’s blood supply (coronary arteries), valves and sometimes the blood supply to your lungs in detail to help them diagnose heart conditions in order to decide on the best treatment for you. This procedure is usually done as a day case.

What does the Coronary Angiogram involve?

The angiogram is performed in our Cardiac Catheterisation Lab or “Cath Lab” and usually takes 20 to 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 and takes images to identify any narrowing or blockage in the arteries. Sometimes the doctor also takes a picture of the main pumping chamber of the heart. The contrast dye used 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?

Coronary Angiography is usually 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. There are many benefits associated with the use of x-rays, such as your doctor being able to see what their eyes cannot. X-rays involved with cardiac and interventional procedures lets your doctor see moving pictures of your heart, veins and lots of other organs, so that they can safely insert dyes, stents and other medicines. This is much safer than using invasive techniques such as surgery. X-rays are exceedingly safe but there is a degree of risk involved – you will receive a small dose of radiation which carries a low (less than one in one thousand) chance of side effects. Your doctor will never take an X-ray unless the benefit to you exceeds the risk.  This dose of radiation will be equivalent to what you receive in about four years from natural background radiation that is present in the surrounding environment.
• 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 admission?

You will be seen by the Cardiology Nurse Practitioners in a pre-assessment appointment in preparation for your procedure. You will have bloods taken an ECG and the nurses will explain the procedure in greater detail.

They will also discuss the following:

What to bring: Please bring your medications with you in the original boxes were possible. It is advisable to bring an overnight bag in case of any unforeseen circumstances.

Eating and drinking: You may eat and drink prior to your admission but we ask that you avoid caffeine on the day of your coronary angiogram.

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.

Medications that are usually stopped before the angiogram includes:

• Warfarin (a tablet to thin the blood). This is usually stopped 5 days before the procedure depending on the reason for Warfarin being prescribed.
• Direct 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 and Bumetanide, 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.

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

What will happen on the day?

You will need to be admitted to the Cardiology 5 Day Ward at Castle Hill Hospital. 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.

You will be allocated a named nurse who will look after you during your stay. They will get you ready for your procedure. This will include helping you into a hospital gown. Recording your blood pressure and other clinical observations. And inserting a cannula for any medications which may be required during the procedure. Once ready for you the nurses will take you down to the Cath Lab for the coronary angiogram.

Following the test, you will return to the ward.  If your wrist has been used, you may mobilise around the ward immediately.  You will have a pressure device on which 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 usually 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 to 8.00pm for 11.00am admissions.  It is advisable for relatives to telephone the ward between 11.00am to 12 noon and 4.00pm to 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 leaflet, please do not hesitate to contact the on pre-assessment team on tel: 01482461647.