what is an angiogram?
- an angiogram is a diagnostic procedure that provides detailed, x-ray pictures of the heart and its blood vessels performed by an interventional cardiologist.
what does an angiogram show?
- angiograms are very good at detecting problems with the blood vessels tumor, blockages and clots in the heart.
- an angiogram requires a visit to a hospital to a special room called the catheterization laboratory, or “cath lab.” the cath lab is equipped with an x-ray camera and a TV monitor (screen) on which the cardiologist views your heart and arteries.
how does an
- a catheter, or small, flexible tube, is inserted into a large vessel in the upper thigh or arm, then guided through the arteries to the heart.
- a special “contrast” dye is injected into the catheter and to the coronary arteries and heart.
this dye makes it possible for an x-ray camera to record a “movie” of your heart and its arteries.
- the movie, which you and your doctor may view on the TV screen, shows blood flow through the arteries of the heart – and the location of any blockages.
- the angiogram also provides details about the size and shape of any blockages.
- this information is critical as it helps the cardiologist plan the best approach for treating each blockage.
i should take before the
- if you take medications, such as blood-thinners, consult with your cardiologist about whether you should stop
taking them before the angiogram. aspirin should be continued
what are the
- bleeding, infection and irregular heart beat can also occur.
- more serious complications, such as heart attack, stroke and death can occur, but they are rare.
- the contrast dye typically used during the angiogram procedure contains iodine.
- some patients have a minor reaction to the x-ray dye, such as a skin rash or itching.
- those who have weakened kidney function, due to diabetes or high blood pressure, may face a greater risk of further deterioration in kidney function, often temporary.
- most people do not feel the dye injection. however, some feel minor discomfort, typically lasting only a few seconds, in the chest.
- few feel lightheaded or nauseous.
what precautions i should take before the angiogram?
- do not to eat or drink anything for several hours before the procedure.
- your blood count, kidney function and how quickly your blood clots may be tested through blood tests.
- you will receive medications to help you relax before the procedure begins.
- an angiogram typically takes 15 minutes and ispainless
- as the procedure begins, a nurse inserts an IV (intravenous line) into a vein in your arm. the IV allows you to receive fluids and medications easily.
- if you become anxious during the angiogram, you will receive more medications to help you relax.
- during the angiogram as you lie on the table, you are mildly sedated but awake throughout the procedure.
- the temperature in the cath lab is kept low to safeguard the computers that are critical to performing the angiogram.
- after you are relaxed, the doctor will use a small needle to inject lidocaine, a local anesthetic, to numb an area in the groin, or upper leg, or in the arm.
- this needle prick could be the only pain you will feel throughout the procedure.
- the femoral artery in the groin – near where your leg bends from the hip – is one of the vessels doctors most commonly use to insert a catheter and thread it through the arteries to the heart to perform the angiogram.
- instead of the femoral artery, your doctor may choose to insert the catheter in the brachial or radial artery in the inside of the elbow or wrist.
- from this “access” point in your leg or arm, the catheter is threaded through the arteries to your heart
what happens during the angiogram?
- since there are no nerves in your arteries, you will not feel the catheter or any pain during the catheterization procedure.
- the x-ray camera helps the physician guide the catheter to your heart.
- the catheter is properly positioned, the cardiologist injects a contrast dye (radiographic contrast agent) through the catheter into the heart and its arteries.
- when the x-ray beam passes through the dye, the arteries appear in black silhouette on a white background.
- if you have blockages, they appear as white areas.
- the x-ray camera records a “movie” of your heart's pumping chamber and arteries – a movie that can be recorded as a digital image or on 35mm film.
- this enables the cardiologist to see blood flow and the size, shape and length of any blockages.
- the angiogram provides vital information for planning the best approach to treating each one.
what happens after the angiogram?
- if the angiogram shows serious blockages, the interventional cardiologist may immediately perform acoronary intervention procedure, such as balloon angioplasty and stenting, to open them and restore blood flow to your heart. (or)
- the doctor may refer for a bypass surgery, a surgical method for restoring blood flow.
what care is taken in the hospital after the angiogram?
- when the procedure is complete, the catheter is removed.
- to stop any bleeding, a nurse applies pressure to the point on your leg or arm at which the catheter was inserted and holds it for about 20 minutes.
- after the wound is dressed, a weight (often a sandbag weighing about 4 kgs) may be placed on the wound to prevent bleeding.
- if the catheter was inserted in your leg, you will be asked to lie still and avoid bending your leg or lifting your head.
- you may need to be still for two to six hours after the catheter is removed.
- instead of using a weight to help the puncture wound stop bleeding and begin to heal properly, some physicians insert a small device at the site, that encourage a clot to form.
what care i should take at home after the angiogram?
- after you return to your home, you may notice a bruise in the area where the doctor inserted the catheter.
- it is caused by blood that has escaped from the vessel under the skin.
- a small – and sometimes larger – bruise is normal.
- it is not necessary to report bruising to your doctor, even if the area is large.
- usually, it clears up over a period of one to three weeks.
when shall i call a doctor?
- if its bleeding.
- if its drainage or painful swelling at the site where the catheter was inserted.
- if its swelling or weakness and/or numbness in the leg or arm in which the catheter was inserte
how is an angioplasty performed?
- angioplasty performed in a cath lab by an interventional cardiologist.
- you will lie on a table and be mildly sedated to help you relax, but you will remain awake throughout the procedure.
- the doctor will use a small needle to inject
- idocaine, a local anesthetic, to numb an area in the groin, or upper leg, or in the arm.
- the femoral artery in the groin – near where your leg bends from the hip – is one of the vessels doctors most commonly use to insert a catheter (a flexible tube that is smaller than the vessels) and thread it through the arteries to the heart to perform the angioplasty.
- instead of the femoral artery, your doctor may choose to insert inside the elbow or wrist.
- from this “access” point in your leg or arm, a “guiding” catheter is threaded through the arteries to your heart.
- an x-ray camera and images of your arteries on a TV screen help the physician guide the catheter to the blockage.
- when the guiding catheter is properly positioned, the cardiologist injects a contrast dye (radiographic contrast agent) through the catheter into the heart and its arteries.
- most people do not feel the dye injection. however, some feel minor discomfort, typically lasting only a few seconds, in their chest.
- next, a balloon catheter – a long, thin flexible tube with a small uninflated balloon at its tip – is threaded through the guiding catheter to where the artery is narrowed.
- a guidewire – a tiny, thin wire of about .014 inches' diameter – is then passed across the narrowed segment. it serves as a guide for positioning the tiny balloon across the blockage.
- once in position, the balloon is inflated with water and x-ray dye. (it may be inflated several times.)
- when fully inflated, the balloon pushes the plaque against the wall of the artery. some patients feel minor discomfort when it is inflated. as the balloon inflates, plaque that extends into the wall of the artery may tear or crack. this is normal and necessary.
- once the balloon is deflated, x-ray pictures are taken ensure the blockage is gone.
- when the balloon catheter is removed, final x-ray pictures are made.
what are stents?
- arteries opened with angioplasty can become blocked again if the artery collapses.
- to reduce the risk of collapse, many angioplasties (at least 80 percent) are accompanied – or followed – by the insertion of a stent, a small stainless
- steel mesh tube that helps prop open the artery at the point where the blockage was opened.
- some arteries that can be treated successfully with angioplasty are not well suited to also receive a stent.
- these include arteries that are hardened or calcified and those in which blockages occur at points where arteries form a branch.
what are the different types of stents?
- bare metal and
- drug-coated (or drug-eluting).
1) what is a bare metal stent?
- arteries held open with bare metal stents may re-narrow, a condition called restenosis.
- the re-narrowing occurs when scar tissue grows inside the stent, reducing or blocking blood flow and causing a recurrence of chest pain.
- with a bare metal stent, the risk of scar tissue growing to re-block the flow of blood is approximately one in three.
2) what is a drug-coated or drug-eluting, stent?
- drug-coated, or drug-eluting, stents were developed to prevent or slow the growth of scar tissue at the site where the stent was placed.
- coated with medications that are slowly released, the stents help block the body's ability to form scar tissue.
- compared with bare metal stents, drug-coated stents dramatically reduce the likelihood that an artery will re-narrow - and that a repeat procedure will be needed to re-open an artery.
what care is taken at the hospital after the angioplasty and stenting?
- you will be moved to your hospital room or a recovery area.
- before the catheter is removed, you will receive medications to reduce any discomfort.
- once the catheter is removed, steps will be taken to close the opening in your leg or arm into which the catheter was inserted.
- heavy pressure, applied by a nurse or the weight of a 4 kg sand bag, may be used to stop any bleeding.
- if the puncture wound is at the top of your leg, you will be asked to lie still and avoid bending your leg or raising your head for several hours.
- if the wound is in your arm, the length of time you will be asked to lie still is typically less.
when should i call the doctor or go to the hospital, in emergency?
- chest pain like you felt before the procedure or during it when the balloon catheter was inflated in your artery.
- chest pain lasting one to two seconds. typically, they say it feels different from the pain they felt before the procedure. these brief pains are often muscular and are not related to the heart.
- if the puncture wound in your leg or arm gets bigger, turns red, drains a thick yellow/brown material or is painful, even when no pressure is applied. a larger, painful lump may be a sign that the puncture hole is not healing properly or is leaking blood.
- if you have fever.
- if you experience swelling – with or without pain – anywhere in the leg in which the catheter was inserted.
- if you have chest pain that lasts 15 to 20 minutes, resuming normal activities after your procedure.
what care should be taken at home after the angioplasty and stenting?
- for the first five days, do only light activities.
- walking, climbing stairs and taking care of routine activities are fine.
- after five days resume moderate activities, but you should avoid over exertion that leads to shortness of breath, tiredness or chest pain.
- wait until three to four weeks before lifting heavy objects or doing strenuous exercise.
- get clearance from your doctor before very strenuous activity or manual labor.
- occasionally, your doctor may ask you to take a stress (treadmill) test three to six weeks after your procedure.