Royal Sussex County Hospital. Princes Royal Hospital. Hove Polyclinic. Sussex Universities



Coronary Angioplasty

What is coronary angiography?
A coronary angiography is a test used to produce pictures of the blood vessels and chambers of the heart using X-rays (a type of radiation).A long, flexible, plastic tube called a catheter, which is about the width of the lead in a pencil, is inserted into a blood vessel in the groin or arm. The tip of the catheter is guided using X-ray images to the heart or the arteries (blood vessels) supplying blood to the heart. A special fluid (called a contrast medium or dye) is then injected into the catheter and X-ray images are taken. The pictures produced are called angiograms.
The fluid that is injected is visible on the X-rays, so the angiograms show up all the blood vessels that the fluid travels through. This reveals if any of the blood vessels are narrowed or blocked, and if the heart is working as it should be.

         Normal angiography                               Narrowed coronary arteries

    

When are coronary angiograms used?
Coronary angiograms are commonly used to diagnose a number of heart conditions and to guide treatment. For example, a coronary angiography may be used:

  • after a heart attack (when the heart’s blood supply is blocked)
  • to diagnose angina (when symptoms are caused by restricted blood supply to the heart) 
  • to plan surgical procedures, such as a coronary angioplasty (a procedure to widen blocked blood vessels).

Overview
An angiogram is normally carried out as a day case, so it is not necessary to stay in hospital overnight. However, if someone is having a coronary angiography because of a heart attack, they may be admitted to hospital.
A coronary angiography can cause some discomfort where the catheter is inserted, but it is a safe procedure with few risks. It is considered the best way to diagnose coronary artery disease (conditions that affect the arteries that surround the heart).

The heart
The heart has four chambers. There are two small chambers at the top of the heart called atria, and two larger chambers at the bottom called ventricles. Each ventricle has two one-way valves. These control the blood flowing into the ventricle and the blood flowing out of the ventricle.
A coronary angiogram can tell your cardiologist (heart specialist) how well your heart valves and the chambers of your heart are working. It can also provide important information about the blood pressure inside your heart.

Blood vessels
The arteries are the blood vessels that carry blood away from your heart to the rest of your body. The blood then returns to the heart through veins. A coronary angiogram can show any narrowing or blockages in the blood vessels that surround the heart. If there are any blockages, you may need further treatment.

Medical conditions and treatments
A coronary angiography can help diagnose conditions or guide treatment. It may be used if you have or need any of the following:

  • heart attack: a serious medical emergency where the supply of blood to the heart is suddenly blocked, usually by a blood clot
  • chest pain: caused when the blood supply to the heart is restricted
  • heart disease: when your heart's blood supply is blocked or interrupted by a build-up of fatty substances in the coronary arteries
  • coronary angioplasty: a surgical procedure used to widen blocked or narrowed coronary arteries
  • coronary artery bypass graft: a surgical procedure to divert blood around narrow or clogged arteries to improve blood flow to the heart
  • aortic valve replacement: surgery to treat problems affecting the aortic valve (the valve that controls the flow of blood out of the left ventricle of the heart to the body’s main artery, the aorta)


Preparing for a coronary angiography
When your coronary angiography is being planned, tell your cardiologist if you have any allergies and if you are taking any medication, either for a heart problem or for another medical condition. You will be told whether to continue taking this medication or if you need to stop. Never stop taking prescribed medication unless you are advised to do so. You may be advised not to eat or drink anything for six hours before the procedure.

Anaesthetic
The procedure is performed under conscious sedation. A sedative is a type of anaesthetic (painkilling medication) used for minor painful or unpleasant procedures. Sedation makes you feel sleepy and relaxed, but you will remain awake and aware enough to respond to instructions. For example, you may be asked to cough during the procedure. You will also be asked to take a deep breath and hold it at one or two points during the procedure.

Monitoring your heart
Throughout the procedure, you will be attached to an ECG (electrocardiogram) machine. An ECG records the rhythms and electrical activity of your heart. A number of electrodes (small, sticky patches) are put on your arms, legs and chest. The electrodes are connected to a machine that records the electrical signals of each heartbeat.

The procedure
Your coronary angiography should last around half an hour. Below is a step-by-step guide to what you can expect during your coronary angiography. The healthcare professionals with you will explain what is happening throughout the procedure.

  • You will go into the catheterisation laboratory and lie on a special table. If the catheter is being inserted into your groin, your groin will be shaved and cleansed with antiseptic fluid.
  • You will be covered with a sterile sheet.
  • You will be given an injection of local anaesthetic to numb the skin of your groin or your arm, so the procedure should not be painful.
  • The catheter will then be inserted through a fine tube called a sheath.
  • The catheter will be guided through your blood vessels to your heart using X-ray guidance. X-rays are a type of radiation that can pass through your body and create images.
  • A small amount of special dye is injected through the catheter and the pressure within your heart is measured.
  • When the dye is injected, you may feel a hot flushing sensation that passes quickly. You may experience a warm feeling in your groin and imagine that you have wet yourself, but this is only a feeling. You may also experience a metallic taste in your mouth, which is nothing to worry about. You will be warned when to expect this. 
  • You will not feel the catheter being guided through your blood vessels. However, you may be aware of the odd ‘missed’ or ‘extra’ heartbeat.
  • A series of X-ray images will be taken of your heart and the blood vessels around it. These are called angiograms and will be stored digitally (on a computer).
  • In certain circumstances, for example if you have blockages in your arteries, your cardiologist may decide to do a balloon angioplasty (a type of surgical procedure to widen blocked arteries) immediately. This will add about an extra hour to the procedure.
  • Once the procedure is complete, the catheter will be removed.
  • If the catheter was inserted into your groin, the nurse or cardiologist may apply pressure to the entry site for around 10 minutes to stop any bleeding.
  • Alternatively, a number of different plugs or clips can be used to seal or close up the wound.
  • If the catheter was inserted through your arm, a tight dressing will be applied for two or three hours. 

Risks of a coronary angiography 
Coronary angiograms are generally considered safe procedures. However, as with any procedure, there are some risks, including:

  • allergy to the contrast dye used. This is rare. Discuss any allergies you have with your cardiologist (heart specialist) before the procedure is done
  • bleeding under the skin at the wound site (haematoma). This should go down after a few days. If you have any worries, contact your GP
  • bruising. It is common to have a bruise in your groin or arm afterwards

Serious complications
In very rare cases, a more serious complication can occur. These include:

  • death
  • heart attack: a serious medical emergency where the supply of blood to the heart is suddenly blocked, usually by a blood clot
  • stroke: a serious medical condition that occurs when the blood supply to the brain is disturbed

The risk of one of these serious complications occurring is estimated to be around 2 in 1,000. It is usually the result of a serious underlying heart disease. Your cardiologist should discuss these risks with you before the procedure.

After a coronary angiography
After the procedure, your pulse and blood pressure will be recorded. A nurse will check for any bleeding from where the catheter (thin plastic tube) was inserted. You will be asked to sit up after the test. If all is well, you should be able to get up and walk around after a couple of hours' rest. Tell the healthcare professionals treating you if you feel unwell at any time.
About four hours after your coronary angiography, one of your friends or a family member will be contacted to take you home.
Most people feel fine a day or so after the coronary angiography, although this can vary from person to person. Some people feel a bit tired after the test and the wound site is likely to be tender (painful) for up to a week. Bruising may last for two weeks.

Self-help advice 
The following advice may help your recovery:

  • Avoid hot baths for three or four days until the wound site has healed. You can still take a shower.
  • Remove the plaster from your groin the day after the procedure. Gently clean the site with mild soap and water and dry before applying a new plaster. Change this daily until the skin heals.
  • Contact your GP if you experience any redness at the wound site that is warm to touch, or if you have a high temperature (fever), rash, numbness or a pain in your leg when walking.
  • Do not drive for 24 hours.
  • Avoid any sport, excessive activity or lifting anything heavier than 5kg (11lb) for two or three days.


 
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