Coronary Angiogram

Okay, so you've been referred for a coronary angiogram, and it's probably a good idea to know what that's all about. What it can give us is information about whether the arteries in your heart are narrowed. We have to gain that information by actually putting dye into those arteries, and the only way we can do that is to actually puncture one of those arteries that lead to the heart. So we're either going to go from the leg, a femoral angiogram, or we're going to go from the right wrist, a radial angiogram. Both of those take around about the same amount of time, but there are pros and cons to each of those approaches. Both of them have a small complication rate, but your doctor would not have referred you for the procedure unless they felt that the risk was worth taking. So what is the risk? The risk is about one in a thousand of having some sort of complication. Of course, the puncture itself can be slightly painful but we give you some local anesthetic. At the puncture site there can be some bleeding and bruising so we have to be aware of this. When we pass pipes all the way to the heart we're going close to the brain blood vessels before we get to the heart blood vessels. So there's a small risk of setting off a stroke, there's a small risk of setting off a heart attack and of course if any of those are calamitous there is a very small risk of dying. All of that is wrapped up in the one in a thousand risk of complications. You have to balance that against the fact that if you do have narrowings in your blood vessels, there's about a three in a hundred risk that you might have a serious heart problem this year. So it's not as though we're exposing to that one in a thousand risk for no good reason. Your doctors feel that it's important to have that information so the right treatment can be decided. So are there alternatives? Well, there are, and I'm sure that would have been discussed with you in the clinic, but you could have a CT scan, which gives you about the same amount of radiation and the same amount of dye, but uses only a vein puncture, which has a lower risk of complications from that site, than an arterial puncture, which is what we would have to do today. What else is available? Well, there's an exercise test, there are some non-invasive tests, which would not give you the anatomy of your heart, but would tell you whether it's causing a functional problem. If you're unkeen on having an angiogram, then of course you can tell the doctors on the day and we won't proceed. This is an elective procedure that you're having and you can always have more discussion about it. The consent form that you sign on the day is the end part of the consent process where you've been given the information, the information sheet and you've had time to read it, digest it and agree that this procedure is for you. What would you expect afterwards? Well, we'll keep you in hospital for about two hours after the procedure. You'll You'll obviously be a little uncomfortable either in the leg after we've done a puncture there or in the wrist where we've done a puncture there. Both mobilize fairly much about the same amount of time. Two hours later you should be able to get home. I favor the wrist approach, my colleagues sometimes favor the leg approach. It's whatever you prefer and what the doctor prefers in getting the information that we need to get about your arteries. And sometimes we have to switch between the two if we can't get the images that we need. You'll go home the same day, and there should be someone to look after you that evening just in case there's a problem. It's unlikely, but there should be someone to look after you. We don't like doing it if you're going to be completely on your own at home. Within three days or so, you should be completely back to normal and you should be able to undertake all activities. Where that little puncture is, because it is a very tiny puncture point, you want to keep that dry probably for a week, so put a Band-Aid on it. Don't dive into a swimming pool or have a bath. showers are absolutely no problem. The information about the results should be given to you on the day and that should be an open discussion with you about what happens next. Sometimes it's not clear cut and that discussion may be deferred to a more important meeting where lots of doctors are involved to decide what the right treatment for you is.