What is Coronary angiography
Coronary Angiography is a specialised x-ray examination that assesses the blood vessels that supply the heart muscle. The heart muscle acts as a pump which pumps blood around the body. Blockages or narrowing's in the heart arteries may cause chest pain / discomfort or shortness of breath. These symptoms, known as angina, are usually most obvious on exercise.
The benefits of Coronary angiography
The Coronary Angiogram procedure may also include a study of the heart valves, the Aorta and the main pumping chamber of the heart known as the left ventricle. The results of the Angiogram are used to help determine the most appropriate treatment for you. The angiogram is performed using local anaesthetic sometimes with light sedation. The procedure is performed through a small plastic tube called a ‘sheath’ inserted into an artery in your wrist (Radial) usually on the right side, although can be left or in your groin (femoral). The Consultant performing the procedure will determine which of these arteries will be used on the day.
What does having a Percutaneous Coronary Intervention (PCI) mean?
The term percutaneous coronary intervention (sometimes called PCI, angioplasty or stenting) describes a range of procedures that treat narrowing or blockages in the coronary arteries which supply blood to the heart.
A small inflatable balloon on the tip of a narrow tube (called a catheter) is passed through the artery in either your wrist or groin until its tip reaches the narrowed section in the coronary artery.
The balloon is gently inflated so that it squashes the fatty tissues responsible for narrowing the artery. A stent, a short tube made of metallic mesh, is usually inserted. As the balloon is inflated, the stent expands so that it holds open the narrowed artery. The balloon is then let down and removed, leaving the stent in place.
The procedure typically takes between 45-90 minutes depending on how many narrowings need to be treated.
During the procedure you may experience some chest discomfort and if so please mention this to one of the members of the team and they will do what they can to help relieve it.
When will I find out the results of the Coronary Angiography / Percutaneous Coronary Intervention (PCI)?
The Cardiologist will come and visit you on the same day and explain the results of the procedure and any further treatment you may require. If you need further advice please do not hesitate to contact us.
PCI is an important treatment option for patients with coronary artery disease and is performed in large numbers around the world.
Some patients undergoing this procedure will have previously had a coronary angiogram to examine the condition of the coronary arteries. In other patients a PCI may be undertaken immediately after the coronary angiogram
Instructions for coming in for Coronary Angiography / Percutaneous Coronary Intervention (PCI)
Arrangements have been made for you to come to The Heart Centre at The Cumberland Infirmary.
You will be contacted by letter from your Cardiology Consultants secretary confirming a date of your procedure.
Please follow these instructions for you admission
- Please bring an overnight bag in case you need to stay in hospital post procedure. A little money may be useful, but try and not bring other valuables or jewellery. Please bring slippers and a dressing down.
- Please wear loose fitting clothing (t-shift / shirt/ jumper / blouse) if possible without any metal attachments or buttons. You will be asked to remove your bra (if wearing). You maybe asked to change into a hospital gown.
- DO NOT EAT in the three hours before arriving at hospital for your procedure, however clear fluids such as black tea, black coffee or water may be taken.
- If you take blood thinning medication (e,g Apixaban, Rivaroxaban, Edoxaban, Dabigatran or Warfarin) you will need to follow the instructions given to you by the doctor or nurse arranging your procedure. You may need to stop the medication a few days beforehand – if you are unsure please contact the secretary of the clinician who referred you.
- METFORMIN – if you are taking Metformin you should take your last dose the day before the procedure, and not take any further Metformin tablets for TWO DAYS following the procedure. Please take all your other medicines as normal on the morning of your procedure, including aspirin and clopidogrel if prescribed.
- It is important that you bring all of the tablets you are currently taking with you on the day. Please note: it may be up to 9 hours after your admission before you are ready to go home, depending on what time your procedure is carried out.
- DO NOT DRIVE or use public transport on the day of your procedure.
- Please make sure that you have someone with you during the first 24 hours following your angiogram.
Additional information
The British Heart Foundation has numerous guides on Angiography and other Heart related Tests which can be found on their website. www.bhf.org.uk
Many patients say at the end of the procedure that they would not have worried about it had they realised how straightforward it was going to be. If you feel at all worried or uncomfortable during the procedure, please do not hesitate to say so.
What will happen after the procedure?
You will return to the radial lounge / ward area. The nurses will be regularly monitoring your blood pressure and puncture site and once the bleeding has stopped will remove the tight band (wrist approach) or allow gentle mobilising around the ward (femoral approach).
Normally you will be able to travel home later on the same evening, Rarely you may be required to stay overnight.
Please DO NOT consider driving yourself home, as the continual leg/arm movement could cause problems at the puncture site, such as severe bleeding.
You will be given an advice sheet on discharge. You should rest for 24 hours after the procedure and avoid any heavy or strenuous activities for at least 48 hours. If all is well normal activities may be resumed.
What to do when you get home
After your PCI (coronary angioplasty) procedure you will be give an advice sheet on discharge.
You should have a quiet evening, resting your arm or leg, which has the insertion site (wound) following the procedure.
You may eat and drink as normal and sleep in your usual position at night time.
You should have someone with you during the first 24hours following your procedure.
The following day you can shower or have a bath as normal.
Unless otherwise advised by your doctor, you should resume your usual medications after the procedure.
You should avoid driving for a minimum of one week, longer if you are an HGV driver, in which case you should contact the DVLA for advice.
Very important
If you have had a stent inserted into one or more of your heart arteries, you MUST continue to take a tablet called Clopidorgel or Ticagrelor or Prasugrel.
You will be advised on how long to take these medications for (usually 12 months, sometimes shorter). These tablets are usually taken together with aspirin unless you take additional blood thinning tablets such as warfarin.
Are there any risks related to the procedure?
Like many other medical procedures, there are small risks and every effort is made to minimise these. The test is generally very safe and the risk of serious complication is less than 0.5% (1 in every 200 patients).
Risks are greater under certain circumstances (e.g as an emergency procedure). For patients with advanced heart/vascular disease or other significant medical problems, complications may arise even when the most experienced and skilled specialist performs the procedure.
The risks of complications varies from patient to patient depending on their condition(s).
The following figures quoted represent an average:
- Damage to the artery in the leg or arm where the catheters are inserted.
Although a bruise commonly occurs, there is less than 0.2% (1 in 500 patients) of a major complication.
This could include excessive bleeding or blockage of the artery requiring blood transfusion or surgical treatment. If a large swelling develops (haematoma) you should firmly apply ice to the area and contact your GP.
- Development of abnormal heart rhythm occurs in less than 0.2% (1 in 500 patients).
In rare circumstances this may lead to loss of consciousness requiring treatment with drugs or an electric shock.
- Reduction in kidney function.
The contrast dye used can, in rare circumstances, cause kidney function to deteriorate. This is more likely on patients with abnormal kidney function before the procedure. It is usually reversible and resolves with time.
- An allergic reaction to the contrast dye.
This may cause you to feel sick and / or develop a skin rash, which usually resolves. Very rarely it can cause breathing difficulties or your blood pressure to fall requiring supportive treatment.
- Damage to a major coronary artery causing it to suddenly narrow or block < 0.2% (< 1 in 500 patients).
This could cause an onset of a heart attack and may require treatment with a coronary angioplasty (balloon) or stent insertion or an emergency transfer for a coronary bypass operation.
- Radiation Risk.
Occasionally, with a prolonged or high radiation dose examination, there may be a small risk of skin redness (erythema) at the time of/or following the procedure. Other risks related to excessive radiation exposure are very rare.
- Stroke – less than 0.2% (1 in 500 patients).
- Death – less than 0.1% (1 in 1000 patients) during a routine angiogram.
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