Coronary Angiography

What is coronary angiography?

Your doctor will have explained to you that a coronary angiogram needs to be performed. This is a special diagnostic test that determines whether there is any build up of plaque and blockages in your heart coronary arteries. X-ray pictures of the coronary arteries are taken after the injection of a special dye. This is done through special small hollow tubes called catheters that are inserted into an artery in your wrist or groin.

How do I prepare for the procedure?

You will be admitted to the hospital either the same day or night before the procedure. Please bring all your normal medications and personal items for an overnight stay. You will need to fast (no food or drink) for 6 hours prior to the procedure. Our office staff will provide information on the scheduled time for the procedure and any other special instructions that may be required. You will also be required to complete a Cabrini registration form, and return it to the Admissions Desk on your arrival to the hospital.

If you don’t feel well on the day of the procedure, please inform our office.

How do I manage my normal medications?

In general, your regular mediations can be taken at their usual time with a sip of water, even if you are fasting. However, there are some special instructions for certain medications such as anticoagulants, insulin and other diabetic medications, and our office will provide you with these instructions prior to your admission. If you are in any doubt about what to do, please contact our office to enquire.

People on warfarin and other anticoagulants such as dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis) need to be aware that there is a risk of bleeding and haemorrhage if the procedure is performed while on these medications. They will generally need to be stopped 2-5 days before the procedure. Please ensure that you notify our staff at the time of your booking if you are taking one of these medications, especially if you have not yet received instructions about what to do with them yet.

Other blood thinners including aspirin and clopidogrel (Plavix, Iscover), prasugrel (Effient) and ticagrelor (Brilinta) should be continued and NOT stopped prior to your procedure.

Diabetics may require adjustments to their treatment on the day of the procedure. People on metformin (Diaformin, Diabex) are now advised not to take this medication on the day of the procedure. Please clarify this with your doctor if he/she has not already done so. People on insulin may need special instructions. Please ask your doctor about this if it has not already been dealt with.

Where do I go on the day of the procedure?

You need to present to the Cardiac Catheter Lab reception area, located in Area F, level 2. This can be reached via the Isabella St entrance, near Pathology and Day Oncology. Take the lifts just in from the entrance to level 2. You will need to bring your Medicare card, private health insurance details and a list of the medications you are currently on.

What is involved with the procedure?

A coronary angiogram normally takes 15-30 minutes. You will be awake but often under mild sedation. It is generally not painful. There is sometimes mild discomfort as the local anaesthetic is administered. The tube or sheath that is placed into the artery in the groin needs to be removed – usually immediately after the procedure. A moderate amount of pressure needs to applied the groin to do this to prevent bleeding from the artery. The duration of the pressure varies according to which technique is used to remove the sheath, and can range from a few minutes to 60 minutes or more.

Angioplasty and stent insertion may immediately follow the angiogram or be performed as a stand-alone procedure. It normally takes 30-60 minutes. There may be some chest discomfort (angina) during the procedure. If this becomes too uncomfortable, pain-relieving medicines such as morphine are given. Removal of the sheath is usually delayed for 3-6 hours to allow the blood-thinners used during the angioplasty to wear off

After the procedure

You will be required to stay in bed and keep relatively still for at least 6 hours after an angiogram. You will not be allowed to get up to the toilet during this period. If this may be a particular problem in your case eg. chronic back pain, unable to urinate lying down, restless legs, please discuss this with your doctor before the procedure. An alternative approach – eg. performing the angiogram through an arm artery – may be more suitable for you.

You will not be able to drive on the day after the procedure. Most people can drive on the second day, but your doctor will discuss recommendations in your particular situation before you are discharged. Active sport including tennis, golf and lawn bowls should be deferred for 1 week following the procedure.

What are the risks?

Coronary angiography is a safe procedure with an overall risk of a complication estimated at about 1 chance in every 1,000 cases. However, some of the complications are potentially very serious. These include -:

  • heart attack during or after the procedure
  • risk of stroke which may cause speech disturbance, difficulty swallowing, paralysis and blindness
  • blockage of other major body arteries such as the artery to the arm and hand, bowel, kidneys and legs. This may result in significant damage to any of these organs or limbs.
  • kidney damage caused by a toxic effect of the dye. There is an increased risk of this occurring if there is pre-existing kidney problems or if the person is diabetic allergic reactions to the dye which can be very severe in vulnerable individuals bleeding from the site of the artery puncture or internally related to the passage of the catheters other rare complications include thyroid problems precipitated by the iodine content in the dye, infection introduced into the body causing septicaemia, infection at the site of catheter insertion (wound infection).
  • death – people have died from coronary angiography, sometimes from one of the complications above, sometimes from a combination of factors