Coronary angiogram (invasive)

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Learn More…
About the risks involved?
About the Preparation
About What to Expect
After the Procedure…

 

General information

What: A coronary angiogram is a minimally invasive procedure performed in the cardiac catheterisation laboratory using x-ray dye or contrast injected into the coronary arteries. It can identify narrowed or blocked coronary arteries and abnormalities of the heart muscle and heart valves.

Why do I need a coronary angiogram?

  • Your cardiologist must have decided that you will benefit from this procedure (after weighing risks and benefits of not proceeding) in order to determine whether you have coronary artery disease.
  • Your cardiologist may have recommended this procedure if you have the following:
    • The previous investigations may have suggested that you might have coronary artery disease
    • Chest pain symptoms or heart conditions that may be suggestive of coronary artery disease.
    • To check for progression of coronary artery disease or the outcome of your previous coronary procedure.
    • Heart valve disease that require surgery.

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Risks

What are the risks involved?

It is generally a very safe procedure. However there are few risks involved:

  • Bleeding and bruise around puncture site (<5%)
  • Allergic reaction to contrast (minimal risk)
  • Major bleeding and bruising (<1%)
  • Injuries to blood vessels at puncture site (pseudo-aneurysm, dissection etc)<1%
  • Major bleeding into abdominal cavity (very rare)
  • Heart attack or need for emergency bypass surgery (very rare)
  • Stroke or mini-stroke(very rare)

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Preparation

How do I prepare for the procedure?

  • You must fast (nothing to eat or drink) for at least 6hours prior to the procedure.
  • For diabetics:
    • Please do not take your diabetic medications in the morning of your procedure.
    • Please do not take metformin for 48hrs after the procedure.

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What to Expect

What can I expect when I am transferred to the cardiac catheterization laboratory (cath lab) for the procedure?

  • The cath lab is a specialised X-ray suite where your coronary angiogram is performed by your Interventional Cardiologist, assisted by specialized cardiac scrub nurses.
  • You may occasionally be given a sedative, either orally or through an intravenous line just before the procedure to help you relax. You will, however, still be awake during your procedure.
  • The puncture site (your wrist and/or groin) will be cleaned with an antiseptic solution and thereafter, a sterile drape will be used to cover you.

What do I expect during the procedure?

  • Your Interventional Cardiologist will inject local anaesthetic around the puncture site (wrist or groin). This puncture site is where catheters (long tube) will be inserted via a small tubing (sheath) after a small cut in the skin.
  • The catheter will be passed to the coronaries in your heart via arteries in the arm, or via the aorta if the groin approach is taken.
  • If your artery in your arm is considered to be small or tortuous, there is a chance that the groin approach will be taken rather than using the wrist as an access. In this situation, groin approach would be then converted from radial approach.
  • It is generally a painless procedure but you may feel some discomfort in your arm while the catheters pass through.
  • You will also notice that the X-ray machines be rotating around you during the procedure. This is to ensure the appropriate coronary images are taken during the study.
  • When your Interventional Cardiologist positions the catheter at the origin of your coronary arteries, contrast (dye) will be injected into your arteries. Occasionally, due to differences in body sizes and shapes, different sized catheters have to be used (and exchanged at the sheath) to be able to position the catheter accurately at the origin of your coronaries.
  • Moving images of Xray will then be taken as the dye “colours” your arteries. Your Interventional Cardiologist will then be able to identify the significant blockages affecting your coronary arteries.
  • The whole procedure usually takes up to 30mins, but may be prolonged due to complexity of locating your coronary arteries.
  • Following the completion of the procedure, the sheath will be removed from your wrist or groin, and firm constant pressure at the puncture site will be applied to avoid bleeding. Occasionally, your Interventional Cardiologist may deploy a special device that will stop the bleeding.

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After the procedure

What can I expect after the procedure?

  • The nurse caring for you will instruct you to rest in bed for up to 4hrs depending on whether the wrist or the groin is used as the puncture site.
  • Your nurse will also monitor your blood pressure, heart rate and puncture site for bleeding closely.
  • You can normally be discharged after 2 to 6 hours, after being observed in the recovery room.
  • You are encouraged to make prior arrangements for someone to send you home, especially if you have been given sedatives. Please do not drive for the next 24hrs post procedure if you have been given sedatives.

What should I look out for when I reach home?

  • On the night after the procedure, please rest with minimal walking if the groin procedure was done. Use your arm minimally with minimum wrist flexion for the next 24-48hrs if you have a wrist puncture.
  • You are discouraged from lifting heavy weights for 7 days after the procedure.
  • You can remove the plastic bandage dressing the day after the procedure.
  • Drink lots of fluids.
  • Please make an appointment to see either your Cardiologist or General Practitioner 1 week after your procedure to check on your puncture site.
  • Please take note:
    • If you notice that your puncture site (groin or wrist) becomes painful and develops a large lump, you are advised to lie down immediately and apply pressure on the puncture site with the help of someone.
    • Please seek medical attention (calling an ambulance or proceed to nearest hospital) immediately as this could be due to bleeding from your artery.

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