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Coronary Angiogram and Coronary Angioplasty and Stent

What is a Coronary Angiogram?

An angiogram is a special type of X-Ray using dye to show if there is narrowing of the coronary arteries. The coronary arteries supply the heart with blood. Narrowing in these arteries can cause chest pain (angina) and a blockage can cause a heart attack. This test can also detect problems with the heart valves, or the pumping action of the heart. The result of the test will help your cardiologist to plan the best treatment for you. If the test shows a narrowing or blockage, it may be treated with coronary angioplasty.

How is it done?

The test is performed in the Cardiac Catheter Laboratory by the Cardiologist, assisted by nurses and technicians. The Cardiac Catheter Laboratory is like a small operating theatre. You will be given a mild sedative for relaxation, but you will be conscious during the test. A small tube called a catheter is inserted into an artery; usually in the groin or wrist (a local anaesthetic is used). The catheter is guided into the major artery of the body (called the aorta) and up to the coronary arteries under x-ray control.

What do I do on the day?

Please present yourself to the Admissions Desk at the relevant hospital. You will be directed to the appropriate ward. Do not drive yourself to or from the hospital, as someone must drive you home from hospital when you have had sedative drugs during on the day. Bring full details of Health Cover i.e. Private Health Insurance, Pensioner Health Benefit Card, Health Care Card, Medicare card or Repatriation Card. Bring a bag of personal items in case you need to stay in hospital overnight.

Can I eat and drink before my test?

If your angiogram is booked for the morning, do not eat or drink after midnight (morning medication can he taken with a sip of water) If you are booked for the afternoon, fast from 10am.

Do I take my medications on the day of the test?

Yes, and bring all your normal medications to hospital with you.

If you are taking blood thinning tablets (anticoagulants), including Warfarin, Coumadin, Marevan or Dindevan, Dabigatran (Pradaxa), Rivaroxaban (Xarelto), Apixaban (Eliquis) your doctor will tell you if you are to stop these and when. If you have not been told, ask your cardiologist by ringing The Cardiac Centre on 07 5591 6774.

Please continue taking all other medications including Aspirin. Coronary Angioplasty patients requires aspirin therapy and another drug called clopidogrel known as Iscover or Plavix, Ticagrelor (Brilinta), Prasugrel (Effient) you will be advised by your cardiologist if you need this drug and a script filled out for you in hospital.

If you are diabetic do not take your morning Insulin/diabetic tablets, but bring your medication with you. If you are on Metformin (Diabex, Diaformin) do not take this the day before or the day of the angiogram.

What happens during the test?

In the Cardiac Catheter Laboratory you will be assisted onto a firm table and connected to an ECG machine for monitoring throughout the test. Sterile sheets will be draped over you by nursing staff. The groin or wrist area will be prepared with sterile iodine solution, it may be cold. You will be given a mild sedative to make you slightly drowsy, but you will be awake and will not need a general anaesthetic.

A local anaesthetic is injected into the groin/wrist to numb the skin, and then a small tube called a catheter is inserted into the artery. This is guided up through the major artery of the body (called the aorta) until it reaches the coronary arteries, which run over the surface of the heart.

Once the catheter is in position the dye (contrast solution) is injected and the x-ray machine takes moving pictures of the coronary arteries.

You may experience a warm flushing feeling or an urge to urinate when the x-ray is taken of the main pumping chamber of the heart. This lasts for about 5 seconds and then fades, you will be told before this happens and it is of no consequence.

If you have any narrowing in one or more of the arteries requiring urgent treatment, your Cardiologist will discuss this with you at the time. Usually it is possible to repair the narrowing immediately by stretching the wall of the arteries with a small balloon. This is called a "Coronary Angioplasty" or PCI (percutaneous coronary intervention). Usually a small metal coil called a Stent is inserted into the artery to help keep it open and to prevent it from re-narrowing. It is common to experience chest pain whilst the balloon is inflated which will last for a few minutes and then subside. Should the pain continue or increase in intensity please tell the doctors and you will be given medication to relieve the pain. Your cardiologist will explain the procedure at each step.

Please Let The Doctors Know If You Experience Any Chest Discomfort During The Test.

How long does the test take?

A routine coronary angiogram takes approximately 30-45 minutes. If the procedure progresses to an angioplasty, then it can last 1-2 hours depending on the type of blockage.

What are the risks?

As with many medical tests there are some risks, although a coronary angiogram is generally considered to be quite a safe test. Serious problems during a coronary angiogram are rare (i.e. < 1 in a 100) but include heart attack, stroke, death, the need for urgent coronary bypass surgery (CABG) or a rapid heart rhythm disturbance causing you to faint. The possible complications of a coronary angioplasty are the same as for a coronary angiogram but the chances of having a heart attack or requiring urgent coronary bypass grafts are slightly higher. Approximately one patient in 100 suffers a heart attack, two patients in every 500 need urgent bypass surgery, and death in hospital occurs in about 4 patients in 1,000. These risks may vary, depending on individual circumstances. The risk of a complication is higher with advancing age, >75, recent large heart attack, diabetes, kidney failure and heart failure. The risks will be comprehensively explained by the doctor before the procedure.

What happens after my test?

You will need to lie flat for two hours, keeping your leg straight, to minimize bruising in the groin. Or often a collagen plug is inserted under the skin prior to removing the tube. This plug will dissolve over the next 90 days, you will be able to sit up shortly. Next you will need to sit up for a further two hours, and drink plenty of fluids to flush the kidneys. You should then be able to go home.

How will I get my results?

The coronary angiogram +/- angioplasty will be discussed with you after the test, and with any family or others as you dictate. Ongoing treatment will also be discussed and the need for any further follow up. Your referring doctor and local doctor will often get the results by fax that day and a completed letter sent to arrive for them within 5 working days.

Other discharge instructions

You are advised to rest quietly at home following your procedure.

Your cardiologist will advise you when you may resume your normal activities. Avoid straining and lifting any heavy objects for the first few days following your procedure to avoid the risk of injuring the puncture site before it has had sufficient time to heal. Remove the small plastic dressing over the puncture site the day after the procedure if it has not been removed already. Resume your usual diet and fluid intake. Resume your usual medications. If your groin wound starts to bleed or swell, lie flat and ask the responsible adult with you to press firmly on the site for 10 minutes.

Should this occur, please ring your doctor. If the angiogram was performed from the wrist sometimes the forearm or your wrist may ache or be quite painful a week after discharge, this is not uncommon, please use analgesia as needed, especially at night.Should you have any concerns or require further information immediately following discharge, please contact The Cardiac Centre (07) 5591 6774 between 9:00am and 5:00pm, Monday to Friday. If it is an emergency call 000 for an ambulance.

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