Your Coronory Angiogram Information for patients

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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format. Please contact: 01895 279973
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