CORONARY ANGIOGRAPHY

What is coronary angiography?

Coronary angiography (or cardiac catheterisation) is an X-ray procedure that allows your doctor to look at your coronary arteries (the vessels that supply blood to your heart muscle) to see if they are narrowed or blocked.

Why do I need to have coronary angiography?

Coronary angiography is performed when your doctor suspects that you may have coronary artery disease. It will help your doctor to make a diagnosis and plan future treatment to reduce your risk of angina or heart attack. Treatment following coronary angiography is designed to improve blood flow to your heart muscle. This might involve medications or procedures such as angioplasty (balloon dilation), stent or coronary artery bypass surgery.

Coronary angioplasty and/or stenting (to open narrowed arteries) can usually be done during your coronary angiogram, to avoid the need for you to have a second procedure.

A long, thin tube called a catheter is fed via the wrist or groin artery to your heart. A contrast dye that allows arteries to be visible on X-ray is then injected into your coronary arteries. The images allow your doctor to determine whether you have coronary artery disease and if so, how it can be treated. Occasionally the angiogram is supplemented by additional tests such as Fractional Flow Reserve (FFR), Intravascular Ultrasound (IVUS) or Optical Coherence Tomography (OCT) to confirm the extent of coronary artery blockage.

Can I eat or drink before my procedure?
You should refrain from eating for 6 hours before your procedure. You may drink water until 2 hours prior to your procedure.

Do I take my medications on the day of the procedure?
Unless advised by your doctor, you should continue to take your usual medications with water.

However, your doctor may advise you to stop taking or adjust your diabetic medications and/or to stop certain blood thinners 2 full days prior to your procedure.

Where do I go to have the procedure?
Peninsula Heart Centre will arrange your coronary angiogram to be performed at Peninsula Private Hospital in the cardiac catheterisation laboratory (‘cath lab’).

Most angiogram procedures are day procedures, meaning you will be admitted and discharged on the same day of the procedure. If you require treatment of coronary artery blockages with coronary angioplasty and stenting, this may be done at the time of the procedure, if it is amenable to do so. You will then be required to remain in hospital overnight.

What do I need to bring?
Your hospital admission paperwork with a signed consent form, health insurance details and Medicare /DVA card. Bring your usual medications in their original packaging and an overnight bag in case angioplasty and a stent is required.

What do I wear?
Wear clothing that is easy to remove as you will be asked to change into a hospital gown prior to the procedure.

How much will it cost?
Doctors at Peninsula Heart Centre do not charge any out of pocket fees for your procedures at Peninsula Private Hospital. Our doctors subscribe to the ‘No-Gap-Scheme’ and patients will not be charged any extra fees (your private health insurance covers the gap).

What happens during the procedure?
Exam and set up

Prior to commencing the procedure, the cath lab staff will review your medical history, blood tests, allergies and medications that you take.
They will check your vital signs (blood pressure and pulse).
You will be asked to change into a hospital gown. The groin and wrist will be prepped by clipping the hair in the area.
An IV line will be inserted into a vein in your arm to allow for administration of fluid and drugs if required. You will be given oral sedation consisting of Valium and Phenergan as well as intravenous sedation with Midazolam if required.

Local anaesthetic

You will be given a local anaesthetic to numb the area in your wrist or your groin.
A hollow sheath will then be inserted into the blood vessel (the femoral artery at the groin or the radial artery at the wrist) to allow the passage of the heart catheters.

Catheter insertion

A long, thin, flexible tube (catheter) is then passed through the sheath and into the artery, up the aorta (main blood vessel in the body) to the heart.
Our cardiologists routinely use a vascular ultrasound machine to guide the puncture of these arteries, to ensure correct insertion of the sheath, to reduce the likelihood of trauma or complications afterwards.

X-ray imaging

Dye will then be injected through the catheter into your arteries – you may feel a warm flush when this happens.
X-rays will be taken as the dye moves through the blood vessels, to see if your coronary arteries are narrowed or blocked. A series of X-Ray images are taken throughout the angiogram procedure.
To complete the angiogram assessment the doctor will pass a catheter into the ventricle and inject a small volume of contrast to check the heart muscle strength. During this time you may feel a warm flush.
FFR, IVUS or OCT may be required.

Catheter removal

The catheter and sheath will be removed and pressure applied to the access site either via a pressure device or by manual compression.

Will I feel any pain?
The coronary angiogram is not a painful procedure although at times you may feel uncomfortable. You will be awake for the procedure but you may be sedated.

Threading the catheter shouldn’t cause pain and you shouldn’t feel it moving through your body. Tell your doctor if you do experience any pain or feel unwell.

How long does the procedure take?
The procedure takes approx. 30-60 minutes from the time you are on the table to the completion of the imaging. The admission to discharge period takes about 4-6 hours.

If a blockage is found that can be treated with stenting, this is usually performed at the time. After a stent procedure, you will be observed overnight in the coronary care unit before being discharged the following day.

What are the risks?
While serious risks are unlikely, as with all medical procedures, there are some associated risks.

Most common risk:

bruising or swelling at the puncture site.
injury to the artery at the puncture site resulting in blockage or false channel. This may require vascular surgery to repair the artery.

Uncommon risks:

allergic reaction to the X-ray contrast dye. Medications are given to reduce this likelihood.

Rare but serious complications:

damage to one of the coronary arteries requiring a stent or urgent coronary bypass surgery.
heart attack caused by blocking off one of the coronary arteries.
a stroke caused by a plaque being displaced and travelling to the brain.

Please discuss concerns you may have regarding risks associated with the procedure.

Our cardiologists will give you the results of your angiogram after the procedure. You will be provided with images of your coronary arteries and a summary of the procedure and after-care instructions. Follow-up appointments will be made on discharge. A copy of your results will be provided to your referring doctor and a copy placed in your medical history.