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Angiogram (cardiac catheterisation)

Published by Bupa's health information team, June 2008.

This factsheet is for people who are planning to have an angiogram (or cardiac catheterisation), or who would like information about it.

An angiogram (or cardiac catheterisation) is used to diagnose certain heart conditions.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your doctor's advice.

About angiogram
Diagnosis of heart conditions
Preparing for your procedure
About the procedure
What to expect afterwards
Recovering from an angiogram
What are the risks?
Further information
Questions and answers
Related topics
Sources

About angiogram

An angiogram (or cardiac catheterisation) is a procedure that involves putting a long, thin, flexible tube called a catheter into a blood vessel in your groin or wrist. The catheter is then guided to your heart. A special dye is injected through the catheter so that X-ray pictures show the heart more clearly. Angiogram helps to find out:

if your blood vessels to and from the heart are narrowed or blocked, and if so, where and how badly they are affected
how well your heart muscle is working
how well the heart valves are working

An angiogram can be done on adults, children and even newborn babies.

Diagnosis of heart conditions

Symptoms such as breathlessness, chest pains, dizziness, fainting, palpitations and a fluttering feeling in your chest can indicate a heart problem. Conditions of the heart and blood vessels are usually identified and treated by a specialist doctor called a cardiologist.

Preparing for your procedure

Your doctor will explain how to prepare for your angiogram. You may be asked to stop taking anti-clotting medicines (such as aspirin, heparin or warfarin) two or three days before the angiogram.

The angiogram is usually done as a day case under local anaesthesia. This completely blocks feeling where the catheter enters your blood vessel (in the groin or wrist) and you will stay awake during the procedure. You may be offered a sedative to help you relax during the procedure.

At the hospital you are likely to have the following tests in addition to an angiogram.

Blood and urine tests - to check your blood count, liver function and other markers of heart failure.
Electrocardiogram (ECG) - this measures the electrical activity in the heart.
Echocardiogram (heart ultrasound scan) - this shows the pumping action of the heart and valves.

You may also have your groin area shaved.

Your doctor will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the procedure

An angiogram usually takes 20 to 30 minutes. A nurse will usually stay with you throughout the procedure.

You will be connected to a heart monitor that records your heart rate and rhythm during the procedure. Tell your nurse if at any time you feel unwell or experience any discomfort.

You will lie on a table and an X-ray machine is positioned above your chest. Local anaesthetic is injected into your skin where the catheter enters your blood vessel (entry site).

Your doctor will use a needle to make a hole in your blood vessel and insert a fine plastic tube called a sheath into it. Next, your doctor will put a fine, flexible wire through the sheath and thread it through your blood vessel to your heart. The catheter is then put through the sheath over the wire to your heart.

Your doctor will take X-ray pictures of your heart and look at the images on a monitor to carefully guide the wire and catheter into your heart. When the catheter has reached the right spot, your doctor will remove the guide wire and inject a special dye into the catheter. More X-ray pictures are taken as the dye flows through your blood vessels and heart. Your doctor will look at these on the monitor to see if there is any narrowing in the blood vessels or problems in the heart.

The catheter and sheath are removed when the test is complete. Your nurse will either press firmly over the entry site for up to 10 minutes or insert a small collagen plug to help seal the blood vessel. The plug usually dissolves in 60 to 90 days. Your nurse may give you a card with information about the plug to carry with you for up to three months.

What to expect afterwards

You will need to lie flat on your bed for a few hours to allow the blood vessel to seal properly. Your nurse will regularly check your blood pressure, heart rate and the catheter-entry site.

You will be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Getting your results

Your results will usually be sent in a report to the doctor who recommended your angiogram. Other findings may be discussed before you leave the hospital. If you have sedation, it's a good idea to have someone with you if the results are being discussed immediately after the procedure, as you may not remember the details clearly.

Recovering from an angiogram

Take it easy for the rest of the day and don't do any vigorous walking or heavy lifting for the first few days.

Sedation temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you are in any doubt about driving always follow your doctor's advice and please contact your motor insurer so that you are aware of their recommendations.

What are the risks?

Angiograms are commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure.

As the dye reaches your heart, you may feel a warm, flushing sensation or a fluttery heartbeat. These symptoms are usually mild and disappear quickly.
During and immediately after an angiogram, you may feel mild chest pains or have a fluttery heartbeat for a short while.
The catheter entry site may be bruised, swollen and sore for a few days.

Complications

This is when problems occur during or after the procedure. Most people are not affected. The possible complications of an angiogram include bleeding during or very soon after the procedure, infection and an unexpected reaction to the anaesthetic or dye.

Other less common complications of an angiogram are listed here.

Arrhythmia (irregular heartbeat) - this often improves on its own but may need treatment if it persists.
Haematoma (build-up of blood under the skin) - this can happen if the blood vessel is damaged and may require surgery to drain the area.
Damage to blood vessels leading to the heart - this will require urgent surgery to repair the damage.
Heart attack or stroke - very rarely, the tip of the catheter can dislodge a blood clot or fatty plaque from the wall of a blood vessel. There is a risk these may block the blood supply to the heart or brain and trigger a heart attack or stroke.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your doctor to explain how these risks apply to you.

Further information

The British Heart Foundation
08450 70 80 70
www.bhf.org.uk