Your coronary angiogram and coronary angioplasty

What is a coronary angiogram?

A coronary angiogram is a test used to look at coronary arteries, which are the blood vessels that supply the heart muscle with blood. This test shows your cardiologist the location and seriousness of any narrowed areas in your coronary arteries. The angiogram is a test and not a treatment.

What is a coronary angioplasty?

If a significant narrowing is found, a coronary angioplasty may be performed. This is where the narrowings are treated.

What happens before the procedure?

You will be seen in the pre-assessment clinic. This clinic may be held in the cardiac catheter suite or may be performed with your referring nurse. Once this is completed, arrangements are made for you to come in at a later date for your angiogram

Female patients

If you are pregnant or might be pregnant, please ring the catheter lab on 020 8321 2618. If you are 55 or younger, a pregnancy test will be carried out on the day of your procedure

Eating and drinking

It is important to follow the instructions in your confirmation letter about when to eat and drink before your appointment.

Medication

For your pre-assessment appointment you will be asked bring in a list of all your current medications. We will then advise you of any medications you need to stop before the procedure. This depends on the type of procedure planned and your specific medical history. The team will discuss this with you.

Preparing to come to hospital

On the day of your procedure, please take your usual medications, unless it was otherwise specified at your pre-assessment. Please bring all of your medication with you (including your tablets, inhalers and topical treatments).

Please do not shave or remove the hair from your chest, arms or legs before coming to hospital. If needed, this will be done for you in hospital.

Please have a shower or bath before coming in. Please avoid wearing false nails or nail polish.

Prepare to stay in hospital for at least 6 hours. Consider bringing something to read or listen to with headphones. You will need loose clothing to wear home. You will also need to bring an overnight bag in case you need to stay in hospital.

On the day of your procedure

Please arrive promptly at the time indicated on your letter. After you arrive, the nurse will perform a number of tests to prepare you for the procedure. You may also need to answer the same questions you were asked during the pre-assessment. You will be given a hospital gown. A cannula will be inserted in your arm.

After this, one of the specialist heart doctors will come discuss consent for the procedure. They will explain the risks and the benefits of the test and what it entails.

We will try not to keep you waiting, but sometimes this cannot be avoided. If there are any emergencies, your case may be delayed. We will do our best to keep you up to date and will be happy to discuss any concerns you may have.

During the procedure

You will be brought into the catheter lab by one of the members of the team. In the room you will meet the team looking after you. The team includes nurses, radiographers, physiologists and doctors.

You will be asked to lie on the x-ray table, and one of the team will put ECG stickers on you. A safety check will be carried out and you will hear the team discussing your case. We will then prepare to start.

We will clean the area where the catheter will be inserted (usually the wrist or the groin) and drape a large sterile sheet over you. It is important that you stay still once this is done.

Local anaesthetic is then injected in the area with a small needle. There will be some initial discomfort, but this area should quickly become numb. A small cut is then made and a sheath is placed, through which the catheter is inserted.

Once the catheter reaches the heart, a special dye is injected through the catheter, and pictures are taken by the X-ray machine. It will move around you and it may come very close to your head or chest. You are closely monitored by the team throughout the procedure.

After the pictures have been taken, the doctor may decide to proceed further by performing measurements in the coronary arteries, and it may be appropriate to perform an angioplasty (treatment). This part of the procedure involves passing a very fine wire and equipment into the coronary artery.

When the procedure is finished, we will remove the catheter and apply firm pressure to stop any bleeding in your groin or wrist. On your wrist, we will place a tight band. Sometimes a small plug is placed in the groin to stop bleeding.

After the procedure

After the test, we will take you back to the ward, where you will be able to have some food and drink. You will need to rest for at least one to two hours so we can monitor you.

You may be told one of the following::

• Your arteries do not have any significant narrowing.
• The stent has successfully treated the narrowing.
• You need an additional procedure on a different day.
• You may need to have surgery to redirect blood around the blocked arteries, by using another vein or artery. This is known as a coronary artery bypass graft (CABG). You will usually be allowed to go home to await your appointment for review for this procedure.

Going home

Most patients are able to go home on the day of the test. Before you go home, you will be asked to mobilise on the ward to make sure that the puncture in your wrist or groin is sealed.

You will have a dressing applied and the nurse will tell you when to remove this. You may have some bruising and tenderness

All patients need someone to take them home and stay with them overnight.

After sedation you need to be supervised by a responsible adult for 24 hours, you must not operate heavy machinery for 24 hours and you should avoid alcohol for 24-48 hours.

You may be given extra medication to take home with you.

If you have any questions once home, the Cardiac Catheter Lab staff will be available until 6pm on 020 8321 2618.

After 6pm please call the Coronary Care Unit on 020 8321 6945/5130.

However if you are experiencing concerning chest pain, palpitations or dizziness please go to your nearest Accident and Emergency Unit, or call 999.

Once home

Wound care
Keep the wound site clean and dry.
The dressing can be removed the day after the procedure. It is very unlikely you will bleed after you return home. If this occurs lie down, apply pressure and seek medical attention

Work
It is normal to take some time off work after this procedure. Please discuss this with the team, as it can differ according to the procedure and the nature of your work.

Driving after an elective (planned) procedure
Avoid driving for 48 hours. If you have had an angioplasty you must not drive for 7 days. If you have any further questions about driving after your procedure, please speak to our team

Medication changes
After your procedure there may be some changes in your medications. If you have had an angioplasty procedure, you will be prescribed additional medications to help reduce the risk of blood clots forming in the stent. This can happen if you stop taking these medicines too early. Please contact us if anyone advises you to stop taking them before the end of the period that we recommended to you.

Useful numbers:

CCU: 020 8321 6945/5130

Hospital address: West Middlesex University Hospital, Twickenham Road, Isleworth TW 7 6AF.

If you feel unhappy with any of the services you have received in hospital please speak to the staff responsible for your care or call PALS on 020 8321 6261 or email chelwest.wmpals@nhs.net. This is a confidential service.