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The Angiography Suite

The County Hospital has its own Angiography Suite where cardiac diagnostic tests, heart pacing, and the fitting of pacemakers are carried out. The Suite has its own dedicated staff, which assists the doctor and takes care of patients during their visit. It is managed by the heart and lung department.

Coronary Angiography

Coronary Angiography is a special x-ray of the coronary arteries. The coronary arteries do not show up on a plain x-ray. Coronary Angiography involves a dye being injected down the coronary arteries, which together with their smaller branches, then show up clearly on an x-ray “like a road map”. Dye is injected using a catheter (a thin, flexible, hollow tube).

Therefore, coronary angiography can show the exact site and severity of any narrowing of the coronary arteries. This helps the doctor to decide which treatment you may need. For example, if the narrowing is mild it may not need surgery, or, if the narrowing is severe, a coronary artery bypass graft or coronary angioplasty may have to be considered.

What should I expect?

You lie on a couch in a catheterisation room. An x-ray machine is mounted above the couch. A catheter (tube) is inserted through a wide needle or small cut in the skin into a blood vessel in the groin or arm. Local anaesthetic is injected into the skin above the blood vessel. Therefore, it should not hurt when the catheter is passed into the blood vessel. The doctor gently pushes the catheter along the blood vessel towards the heart. Low dose x-rays are used to monitor the progress of the catheter tip, which is gently manipulated into the correct position.

The tip of the catheter is pushed just inside a main coronary artery. Some dye is then injected down the catheter into the artery. Several x-ray films are rapidly taken as the dye is injected (the dye shows up clearly on x-ray films). The x-ray films are recorded as a moving picture and this is called an angiogram. The angiogram shows the vessels filling with blood, and the sites of any narrowing can be seen.

The tip of the catheter is then put into the other main coronary artery and the test is repeated. So, an angiogram picture is built up of each of the coronary arteries and their branches. You cannot feel the catheter inside the blood vessels. You may feel an occasional ‘missed’ or ‘extra’ heartbeat during the procedure. This is normal and of little concern. During the procedure, your heartbeat is monitored by electrodes placed on your chest, which provide a tracing on an ECG machine (electrocardiograph). Sometimes a sedative is given before the test if you are anxious.

When the test is over, the catheter is gently pulled out and a firm dressing called Angio-Seal will be applied.

How do I prepare for a coronary angiography?

The Hospital will send you a leaflet explaining how you should prepare for your angiography.

How long does a coronary angiography take?

It usually takes about 30 minutes. In most cases, it is done as a day-case procedure.

After the test

The doctor will discuss with you what was found during the test. A letter is also sent to your GP giving details of the test results.

Other considerations after your test include:

• Ideally, you should have someone with you during the first 24 hours following angiography.
• When you reach home, it is recommended that you rest and keep your affected leg or arm straight during the first 24 hours. Avoid moving around too much, especially up and down stairs.
• Unless otherwise advised by your doctor, you should resume your usual medications after the catheterization procedure.
• If coughing, sneezing, or straining occurs during the first 12 hours, you should place a hand over the puncture site and support it. Modify activities for 48-72 hours – no straining, lifting greater than 5kg, and avoid driving for 48 hours.
• You can return to work between 48 hours and 5 days depending on the nature of your job. Strenuous physical work will require a longer return.
• A dressing should be left in place for 24 hours, and the patient should only shower or strip wash for 3-4 days.
• If you have to have an Angio-Seal fitted, you will get an Angio-Seal Information Card before discharge. Ensure that your Angio-Seal Information Card is completed and stays in your possession for 90 days. An Angio-Seal is a device used to close the artery after the procedure.
• You may be able to feel a pea-sized lump in your groin where you had the procedure. This will disappear in a couple of months and should not cause you alarm.
• Contact a doctor if any of the following symptoms occur:
  • Fever
  • Bleeding and/or fluid leakage from your wound
  • Persistent tenderness or swelling in the groin
  • Redness and/or warm to touch
  • Numbness or pain in the extremity when walking
  • Rash

The following complications are rare but can occur within the first 24 hours, and it is important that you know what action to take if a complication does arise:

• Bleeding – if this happens, you or a companion should apply firm pressure using the finger directly over the puncture site. Bleeding should cease within 10-20 minutes. If bleeding persists, call for your doctor, or if unavailable, call for an ambulance.
• Bruising (also known as a Haematoma) – it is quite common to have bruises around the puncture site and on the thigh and buttock on the affected side, a day after the procedure. However, if you think the swelling is increasing in size, call your doctor.
• Chest pain – if you experience chest pain or extreme discomfort in the chest area and/or down your arms, contact your doctor immediately. If unavailable, call for an ambulance.

Finally, we recommend that you do not return to work for 48 hours to 5 days depending on the physical nature of your job. Do not drive for two days and only then when you can do an emergency stop safely. During this time, modify your activities to a minimum.

If you need further advice, Day Case can be contacted on Tel: 01432 364185 before 8pm on the day of your procedure. Day Case is open from 8am to 8pm Monday to Friday for any advice. If absolutely necessary, you can call the Cardiac Care Unit at the County Hospital on 01432 372996 at any time.

Are there any risks or side effects?

One problem is that a bruise may form under the skin where the catheter was inserted (usually the groin). This is not serious, but it may be sore for a few days.

The small wound where the catheter is inserted sometimes becomes infected. Tell your GP if the wound becomes red and tender. A short course of antibiotics will usually deal with this if it occurs.

Some people get a brief angina-type pain during angiography. This soon goes.

The dye may give you a hot, flushing feeling when it is injected. Many people also describe a warm feeling in the groin when the dye is injected – as if they have “wet themselves”. These feelings last just a few seconds (and the operator will say when they are about to inject the dye).

An allergic reaction to the dye may occur, however, this is rare.

Serious complications are rare but do sometimes occur. The risk is mainly in people who already have serious heart disease. A doctor will only recommend coronary angiography if he/she feels that the benefits outweigh the small risk.

Potential serious complications are:

• A heart attack occurring during the procedure
• The catheter may damage a coronary artery. If this occurs, the artery may be repaired by emergency heart surgery.
• A stroke

Pacemakers

There are a number of reasons why a person may need a pacemaker:

• A heartbeat that is very slow or pauses intermittently, causing blackouts, falls, or dizzy spells.
• A catheter ablation (excision of heart tissue) that results in either deliberate or accidental damage to the heart's natural pacemaker.

These problems are usually due to issues with the electrical system of the heart. Most people who need pacemakers have an abnormally slow heartbeat. An artificial pacemaker is a small, battery-powered device, and it is inserted just under the skin in the upper chest.

What is a Pacemaker?

A pacemaker is a device used to control abnormal heart rhythms. It works by sending electrical signals to the heart to keep it beating at the right pace. It may be used to treat conditions such as bradycardia (slow heartbeat) or other abnormal heart rhythms.

How is a pacemaker fitted?