Your Coronory Angiogram Information for patients This information leaflet is for patients who are going to have a coronary angiogram. It has been prepared to give you a greater understanding of what the procedure involves. It may not answer all of your questions and if you do have any concerns, please do not hesitate to ask. The angiogram will be performed at Harefield Hospital.
The Heart The Heart is divided into four chambers – the right atrium, right ventricle, left atrium and left ventricle. The right side of the heart pumps blood into the lungs (to obtain oxygen). The left side of the heart pumps blood around the body. The heart has its own blood supply called the coronary arteries. These are the right coronary artery and the left coronary artery. The left coronary artery has two main branches – the circumflex and the anterior descending artery. Pain, called angina, occurs when the blood supply to the heart is not sufficient to provide enough oxygen for the heart. This pain can occur after exertion or at rest.
Date: April 2011 Review Date: April 2013 Ref: PI ID:136
What is a coronary angiogram? A coronary angiogram is an investigation to detect signs of heart disease such as narrowing of the coronary arteries or damage to the heart valves or muscle. It may also be called a cardiac catheterisation.
Benefits The benefit of having this investigation is that it gives the doctors information on your coronary arteries and heart valves. This will help the doctors provide the best management for your medical condition.
Alternatives There are other investigations available but these will have been discussed with your Cardiologist.
The evening before the test The evening before coming into hospital you will be required to shave from your umbilicus (belly button) to mid thigh (front and back) of your right leg. If you are unable to manage some or all of your shave before admission, don’t worry – a nurse will help you when you come to the ward. (You do not need to shave your pubic area).
Medication Please bring all of your tablets, in their original packets, with you to the ward. IMPORTANT: WARFARIN Patients on Warfarin tablets should stop taking them 3 days before admission. If you have an artificial heart valve or a history of a stroke then your Warfarin should be stopped only on the night before admission. If you have any doubts regarding Warfarin please discuss them with your anticoagulant clinic doctor or the consultant under whose care you are being admitted.
The morning of the test Please telephone the ward or admissions department before you leave home to make sure a bed is available for you. All valuables should be left at home. The wards at Harefield Hospital are mixed sex. You should take all of your usual morning medication (except Warfarin). You may prefer to leave out any ‘water tablets’ and take them after the test. Please remember to check your admission letter to see when to stop eating – your medication should be taken before this time. If you are a diabetic taking the tablet Metformin, you will need to stop taking this for 48 hours before coming into hospital for your procedure and for 48 hours afterwards. You may have sips of water until the procedure. Please bring any completed documentation with you. It is important that you arrive on time.
The procedure This is undertaken in a special room set up like an operating theatre. The following staff are present during the angiogram: •
Doctor
•
Nurse
•
Cardiac technician
•
Radiographer
You will be asked to walk to the room when it is time for your test. If you are unable to walk we will provide a wheelchair. An angiogram takes 30-40 minutes to perform. During the test your doctor and nurse will be with you at all times. You will not be asleep for the test, but medication may be given to help you relax. Once inside the room, you will be asked to lie on a special X-ray table whilst an X-ray machine rotates around you and takes pictures at various stages during the test. The catheter tube may be introduced into the artery in your right groin, left groin or right wrist. The doctor will advise you of which artery on the day. First, you will be given a local anaesthetic over the artery. Then, under X-ray guidance your cardiologist will guide a long narrow tube (catheter) to the arteries in your heart. A dye is then injected through the tube so that these arteries can be seen on an Xray screen.
The pumping action of the heart and the function of the heart valves can also be seen by moving the catheter slightly and injecting more dye. You may experience chest pain or discomfort during the procedure, it is important to tell your doctor or nurse so that they can give you pain relieving medication. In some people, the dye can cause a hot flushed feeling, nausea or a sensation of wanting to pass water, but this lasts momentarily. X-ray pictures are taken as the dye flows through your heart. These pictures are transferred to film and reviewed by your consultant. When the tube is removed from your groin or wrist, firm pressure is applied to prevent any bleeding or bruising. A dressing may be applied to your groin before returning to the ward. Sometimes the doctor will seal the artery with a small collagen plug.
After the procedure When you return to the ward, your nurses will check your blood pressure, pulse, and the access point in your groin and the pulses in your feet. You must lie flat in bed and keep your right leg straight (not rigid) for the first hour. You may eat and drink after returning to the ward unless the doctor tells you otherwise. Once you can, it is important to drink a lot to help eliminate the dye from your body. If you have a cough or sneeze, put your fingers over the dressing and hold it firmly. You will need to stay in bed for 2-6 hours after the procedure to allow the hole in the artery to seal over. If an angioseal (a small collagen plug) is used, your stay in bed may be shorter. If your right arm has been used, a small incision is made and this is stitched at the end of the angiogram. Afterwards your arm should be kept straight for two hours. This arm should be rested and not used for carrying goods until the soreness has gone away. The stitches will dissolve in about seven days.
Results of the angiogram The doctor will discuss the results with you. You may find you need: •
No treatment
If no abnormalities are found in your coronary arteries, you may not require any further treatment or follow-up. • Medical therapy Your consultant may decide to keep you on your existing tablets, or your medication may need to be changed.
•
Angioplasty and stent insertions
This procedure is similar to an angiogram but uses a special balloon catheter to open the blocked artery. A short, small metal cage is usually then placed in the artery.
Cardiac surgery This improves the blood supply to the heart. It is usually called ‘bypass surgery’. If you need surgery, an appointment will be made for you to see a cardiac surgeon. If you have any questions, please do not hesitate to ask either your doctor or one of our nurses.
Going home Most patients go home on the day of their procedure (day case), providing all has gone well. You should not drive for 24 hours after your angiogram. If you have had a heart attack, you should not drive for a month.
At home You may contact the ward for advice, but if you feel you need treatment urgently, please contact your General Practitioner (GP) or go to the nearest Accident and Emergency department. Please note that Harefield Hospital does not have an Accident and Emergency but Hillingdon Hospital does.
Activities •
Work
It is usual to have a few days off work. Please check this with your doctor. • Exercise For the first few days you should avoid exercise while the puncture wound in your groin heals completely. You should then build up gradually. Take a rest after exercise and avoid heavy lifting. You should be back to normal within a week. If in doubt about specific exercises, please ask your doctor or nurse. • Sex Don’t be afraid to resume sexual relations when you feel able. Initially, whilst you are still recovering from your angiogram, it may be easier for you and your partner to find the position most comfortable for you. Do not exert yourself.
Risks and complications As with any procedure on your heart, there are risks. These differ for each individual patient. When you sign the consent form, your doctor will explain any risks occurring more frequently than one case in a hundred, as well as any risk of death or stroke, no matter how small. If you wish to be advised of other risks, which rarely occur, please ask for these to be explained. The most common complication is bruising in the groin. This is not serious but can be inconvenient. It is usual to expect a little tenderness for a few days. Complications of the procedure may include a heart attack caused by a sudden blocking of the artery. This will require urgent treatment or emergency surgery. These are very rare (1 in 3000 angiograms).
Risk of radiation from X-rays Radiation is used as sparingly as possible and the benefits far outweigh the risks to your health. If you have any concerns, please contact us. Female patients – if you are pregnant or think you may be pregnant please tell us before your treatment.
Lifestyle advice Please speak to your named nurse or contact our Hillingdon cardiac rehabilitation nurse during office hours for guidance on adopting a healthier lifestyle tel: 01895 279919.
Useful Addresses HILLINGDON HOSPITAL Pield Heath Road Uxbridge Middlesex UB8 3NN www.thh.nhs.uk Main Switchboard: 01895 238282
Dr R Grocott-Mason, Consultant Cardiologist Dr S Dubrey, Consultant Cardiologist Dr Rob Smith. Consultant Cardiologist Drayton Ward: 01895 279520 C.C.U: 01895 279695 Cardiac Rehabilitation Team: Call the main switchboard and ask for bleep 5551 ECG department: 01895 279248 HAREFIELD HOSPITAL Hill End Road Harefield Middlesex UB9 6JH Tel: 01895 828534 MCU Bay 2: 01895 828644 MCU Bay 4: 01895 828667 Day Case Unit: 01895 828803 ROYAL BROMPTON HOSPITAL Sydney Street London SW3 6NP Tel: 020 7352 8121 www.rbh.nthames.nhs.uk
Further Information British Heart Foundation Tel: 08450 708070 www.bhf.org.uk
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