This involves the introduction of a catheter into the heart.  A catheter is a narrow, floppy plastic tube, about 3 mm in diameter, which is passed through one of the arteries (+/- veins) in the right leg (or arm) and gently pushed through the body to the heart.

An x-ray dye can be injected through the catheter to make the heart chambers or arteries visible on x-ray pictures.

     

What will happen to me?

Most patients will have pictures taken of the arteries which run on the surface of the heart (the coronary arteries).  This is called ‘coronary angiography’. It is used to see if there are any narrowings or blockages which could restrict the flow of blood to the heart muscle. A picture is usually taken of the main pumping chamber of the heart (left ventricle). The test can also give information about the heart valves.  These normally ensure the blood flows only in one direction, but can sometimes become narrowed or leaky.

In some patients a catheter is also passed through a vein into the right side of the heart especially to measure pressures in the right side of the heart. This is useful if there are leaky valves, holes in the heart or weak heart muscle (heart failure). The doctor will explain the details of what will be done in your own case.

How will it help me?

The information gained from cardiac catheterisation and angiography will help the doctor in deciding the best treatment for you. This might include heart surgery (for example coronary artery bypass grafting or heart valve replacement) or balloon treatment (angioplasty).

Where is the procedure carried out?

In hospital in a cardiac catheter lab. This is usually a day case procedure enabling you to go home the same day.

Who will carry out the procedure?

The procedure will usually be performed by one of the Cardiology doctors. This will normally be your own consultant or one of the trainee cardiologists supervised by your consultant.  They will be assisted by nurses, physiologists (ECG technicians) and radiographers (X-ray technicians).

What will I have to do to prepare for the procedure?

If you are a hospital outpatient you will be asked to attend the hospital a few days before the investigation to check how you are. A blood sample will be taken and the doctor will be there for you to talk to and ensure that you understand the procedure. You will be asked to sign a consent form. As the 'dye' contains iodine, it is important to that you let us know in advance if you are allergic to iodine or have had an allergic reaction to shellfish.

If you do not have a means of transport to get you to hospital you will need to let your GP know in advance so that transport can be arranged. Some patients may need to be admitted to hospital the day before the procedure. We will let you know if this is the case.

You will need to shave your right groin area where access to your vein or artery is necessary unless the doctor has decided to use your arm. You should have a bath or shower on the morning of the test. It is important that you bring all of your medication with you.  Please also bring overnight things just in case you need to stay in hospital after the procedure.

If you are an inpatient in hospital arrangements will be made to transport you to the catheter laboratory on the day of the test.

Can I eat and drink?

If your test is planned for the morning, you can have a light breakfast before 7am and you can drink fluids until you are admitted.

If your test is in the afternoon you may have breakfast before 11am in the morning and then nothing to eat until after your test is completed.  Fluids may be consumed up to admission.

Can I take my regular tablets?

If you are taking 'water tablets' (diuretics) and you think this might cause problems for you on the morning of the procedure, then it may be possible for you to omit that medication. Please discuss this with the doctor or nurse before the procedure.

If you are taking warfarin tablets you will usually be asked to take the last dose 5 days before the test. You will be given instructions on restarting the drug after the test.  If you are taking metformin tablets for diabetes you may be asked to omit these on the day of the test. You may require a kidney blood test 48 hours after the catheter test before the metformin is restarted.  If this is necessary in your case this will be explained to you.

Please take all your other tablets and medicines as usual – do not stop them unless instructed to do so.

What happens when I arrive at the hospital to have the procedure?

On arrival at hospital a nurse will carry out a few checks. If you wish you may be given a small dose of a sedative (Diazepam) to help you relax, but it is not necessary to have a full general anaesthetic for the procedure.  You will be given a gown to wear.

How is the test carried out?

The test will take place in an x-ray room which we call a 'Cardiac Catheter Laboratory'. You will be asked to lie fairly flat on a mattress. There will normally just be one pillow. If that might cause you a problem please let us know in advance. Once in the laboratory the doctor will ask you to relax and let your arms rest by your sides on the mattress. A Cardiac Physiologist will attach some heart monitoring leads to your chest using sticky discs.

In most patients the catheter is inserted into an artery in the groin. The area will be cleaned with antiseptic. The doctor or nurse will then cover you with a sterile paper sheet that reaches from your chin to below your feet.

You will receive a local anaesthetic injection through a very fine needle in the groin area. It may sting a little at first but within a couple of minutes the area should become numb. After this a short plastic tube is inserted into the artery in the groin through a small nick in the skin.

While this is done you may feel a slight pushing sensation but it should not be painful. Through this tube the catheter is then passed up via the main artery to the heart. You will not be aware of the tube passing up the artery and it should not be painful. At this point you may be asked to put your hands up under your head on top of the pillow. If you have any arthritic problem in your shoulders or arms that could make this difficult please discuss this with us beforehand.

Before the catheter is inserted, the radiographer will move an x-ray camera into position in front of your chest. When a picture is taken you may be asked to take a breath in and hold it while dye is injected. The x-ray camera will be moved to different positions to take pictures from different angles.

             

When pictures are taken of the coronary arteries you should not be aware of the dye being injected. Larger volumes of dye are used to take pictures of the main pumping chamber and occasionally of the main artery out of the heart. Following this you may be aware of a brief warm, flushed feeling. This will spread from the your head down to your toes. It is quite common at this point for patients to feel that they have " wet themselves ". Please try not to worry as this will not have happened.  Occasionally, you may feel some extra heart beats or "palpitations". These are very common and should not worry you as your heart is being closely monitored at all times.

How long will the test take?

The procedure usually takes no more than ½ to 1 hour.

What happens after the procedure?

Once all the information has been obtained you will be taken on a trolley through to an adjacent room or back to your ward. A doctor or nurse will pull out the short plastic tube from the artery and firm pressure will be applied over the groin for at least 10 minutes to make sure that there is no bleeding from the artery. You will not need any stitches. You will then be asked to lie flat for two hours following which you will be able to sit up. This is important in order to make sure that there is no bleeding from the groin.If any bleeding or bruising does subsequently occur a pressure bag may be applied over the groin area.

The nurse caring for you will check your blood pressure and pulse and observe the catheter puncture site at regular intervals. You will be asked to keep your leg as still as possible. You will be able to eat and drink.

In some patients a very small plug will be inserted through the nick in the skin while they are still in the laboratory.  This seals the hole in the artery so that pressure may not need to be applied to the leg.

In some patients an artery on the front of the elbow or wrist is used instead of the groin artery for the catheter test. The procedure is very similar but you will be able to sit up straight away and may have a special pressure dressing put over the nick in the skin.

It is normally possible to go home later on the same day.

It rarely happens, but if there is any concern that the artery in the groin might start bleeding again or we have any other concerns we might ask you to stay overnight.  If you are an inpatient, your doctor will explain if it will be necessary to stay in hospital to have further treatment.  If you need urgent balloon treatment (angioplasty) or surgery you may be transferred to the local Cardiothoracic Hospital.

When will I get the results?

Your doctor will review your angiogram pictures in detail, then will explain the results of the test to you soon afterwards on the same day before you go home.

                                                            

                                                           

How long will I be at the hospital?

From your admission till discharge can take between 6 – 8 hours. You will not be able to drive for 24 hours after the procedure and will need to make arrangements for someone to collect you and drive you home. We prefer patients not to be on their own after returning home following the test so if you normally live alone please discuss this with us in advance.

Does the procedure carry any risks?

Most patients have no problem at all with the procedure and a common reaction afterwards is ‘I don't know what I was worried about’.  However all procedures carry some risk. You are having this test to determine the best treatment for you. This decision can only be made following the catheter test when we know much more about the condition of your heart.  The main complications which can occur during or after the catheter test and their approximate frequencies are:

Chest pain - 1 per hundred cases

Haematoma (big bruise) - 1 per hundred cases

Kidney damage (usually temporary) - 1 per hundred cases

Damage to leg artery (needing treatment) - 4 per thousand cases
Cardiac Arrest - 3 per thousand cases

Bleeding requiring treatment -  per thousand cases

Heart attack - 1 per thousand cases

Stroke - 1 per thousand cases

Severe allergic reaction to dye used - 1 per thousand cases

Death - 1 per thousand cases

But remember your Cardiologist has deemed it necessary for you to undergo this test. He therefore feels that the benefits outweigh the small risks.

Written in conjunction with Peter Reid

Home       Investigation and Management        Dr John Somauroo

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