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A coronary angiogram, also known as a coronary arteriogram, is a special X-ray test where radio-opaque dye is injected through the coronary arteries of the heart. The test is used to detect any blockages in the coronary arteries, which may occur due to plaque (fatty deposits).
The procedure can help to determine:
How badly blocked the artery is.
If you need further treatment such as angioplasty, heart bypass surgery or medical therapy.
How it works
A coronary angiogram is one of the most basic catheterisation procedures for the heart. The structure of the heart vessels and arteries is usually not visible through X-ray.
During an angiogram, a catheter is threaded through an artery in the wrist or groin to reach the coronary arteries of your heart. A special X-ray visible dye is then injected into the catheter. The dye allows your doctor to take an X-ray image of the heart structure to find the existence and extent of blockages within your coronary arteries.
Why do you need a coronary angiogram?
Your doctor may request a coronary angiogram to:
Decide the most appropriate treatment for you by identifying any narrowing (stenosis) or blockage in the coronary arteries (coronary artery disease) or other heart diseases.
Plan a path before your scheduled coronary angioplasty (ballooning) to guide the procedure.
Check if your grafts are still open after coronary bypass surgery (open heart surgery).
What are the risks and complications of a coronary angiogram?
There are some risks involved in any invasive or minimally invasive procedure. Coronary angiograms are widely used and complications are low, occurring in less than 3% of patients.
Potential complications include:
Infection
Allergic reaction to the dye
Bleeding in the area of the catheter insertion
Air embolism (when air gets into the bloodstream, where it could cause damage)
Who have conditions such as diabetes, hardening of the arteries and kidney failure
How do you prepare for a coronary angiogram?
Your doctor will discuss your medical history with you before the procedure. Inform your doctor if you:
Are taking any medications. Certain medications may need to be stopped or reduced.
Havediabetes. Your doctor will advise you on your food and insulin intake before the procedure. Generally, on the day before the test, you should not consume anything after midnight.
Have a blood-clotting disorder or an allergic reaction to any of the following: iodine, shellfish (e.g. crab or shrimp) or X-ray contrast media.
What can you expect in a coronary angiogram?
A coronary angiogram or arteriogram is an effective way to accurately detect any narrowing or blockage in the coronary arteries as well as other abnormalities that may be present. Your doctor will use your results to determine the treatment that will best suit you.
Before the procedure
You will be admitted to the hospital on the day of the procedure. Once you are admitted:
Your doctor or nurse will explain what is going to happen.
You will have to sign a written consent for the procedure.
You will have a small needle or plastic tube inserted into the vein of your arm. This is done to allow you to receive fluids and medications during the procedure.
During the procedure
You may be given medicine to help you relax. You will be asked to lie on a firm, padded table near an X-ray camera and other equipment.
Your doctor will:
Numb a spot on your groin or arm
Insert a thin tube (catheter) into an artery and up to the heart. The catheter will pass through the aorta into the blood vessels located on the surface of the heart, known as the coronary arteries. Your doctor may also pass the catheter inside the heart to assess the function of the heart valves, and finally into the cavity of the heart where the muscle pumping action of the heart can be evaluated.
Inject a special fluid (contrast media) through the catheter so that your arteries show up well on the X-ray. Any reduction in blood supply would show up as a narrowing or constriction of the blood vessel.
Take multiple X-rays as the fluid goes through the artery. You can watch the X-ray on the screen if you wish.
Ask you to hold your breath or cough
Study the X-rays to identify any problems within your coronary arteries.
During the procedure, you may experience the following sensations:
Slight pressure as the catheter is inserted
Some chest pain or discomfort as the fluid goes in
A warm, tingly feeling when the fluid goes in
An urge to go to the bathroom
Shortness of breath
Nausea
After the procedure
Your catheter will be removed. To make sure there is no internal bleeding, our staff may apply direct pressure on the catheter insertion site or use a special pressure device on your wrist. This should last for about 15 – 30 minutes. After that, they will apply a dressing.
You will be brought back to your hospital room. During this time, you may feel sore at the site where the catheter was inserted or from lying on your back. You will be asked to lie quietly on your back for several hours.
Note:
If you need to cough or sneeze, use your fingers to apply light pressure on the insertion site.
If you notice bright red blood on your dressing, notify the nurse immediately. You should also inform the nurse if your arm or leg feels cold, numb or painful.
Care and recovery after a coronary angiogram
After you return home, you may experience the following sensations around your catheter insertion site:
Bleeding, swelling, numbness or tingling
Slight bruising and a lump
Tenderness
These are common and usually go away in 2 – 3 weeks. During this period, you are advised to:
Bathe and carry out other activities as usual.
Refrain from lifting heavy objects or engaging in strenuous exercise for several days after the procedure.
Frequently asked questions
A: A radiologist or cardiologist, who is specially trained to interpret radiology reports, will analyse your images and send an official report to your doctor.
Your doctor will go through the report with you during your consultation. Do not hesitate to ask your doctor if you have any queries about the test and its findings.
A: No, the CT angiogram procedure should be painless.
When the contrast media is injected, you may feel a warm sensation.
A: Although a coronary angiogram is generally safe, the risk of complications is higher in older patients.
However, the benefits of an angiogram outweigh the risks. By testing and finding out if the heart’s arteries are blocked or narrowed, your doctor can advise appropriate treatment and improve clinical outcomes.
A: Your doctor may recommend an angiogram if you have symptoms of coronary artery disease. An angiogram can help your doctor to see if any of your blood vessels are blocked, damaged or abnormal.
By identifying the source of the problem and the extent of damage, your doctor can determine the best treatment for you.
A: Yes, an angiogram and angioplasty can be done at the same time. Where appropriate, your doctor will:
Conduct an angiogram first, to look inside your arteries and check where the blockages are.
Continue to perform the angioplasty as part of the same procedure.
A: If you do not have severe disease, a CT coronary angiogram can deliver results that are detailed enough for doctors to make decisions that are 95 – 99% accurate.
A: About 1 – 3% of people who undergo an angiogram might develop changes in their kidney function. This is generally caused by the contrast dye used in an angiogram, which helps doctors to see blockages in the blood vessels clearly.
This kidney condition is known as contrast-induced nephropathy (CIN). Patients most at risk for this condition include those who:
Are elderly
Have chronic kidney disease (CKD)
Have diabetes (particularly in those who have CKD)
