Coronary
What is a coronary angiogram?
A coronary angiogram is a common procedure used to check your heart blood vessels using X-ray and a special dye called contrast. The test is usually recommended to see if there’s a narrowing affecting the blood flow to the heart.
A coronary angiogram can be used both to diagnose and to treat blocked blood vessel. The procedure to fix the artery is called percutaneous can be performed at the same time or planned as a future.
Coronary angiogram involves placing a long thin tube through your groin, or
wrist near the elbow into an artery. The tube is passed up inside the artery until
it reaches the hearts coronary arteries. A dye is injected and x-rays are taken.
Why do I need a coronary angiogram?
Your doctor may recommend that you have a coronary angiogram if you have:
⦁ Myocardial infarction or heart attack – NSTEMI or STEMI
⦁ Symptoms of coronary artery disease, such as chest pain (angina), jaw, neck or arm that can’t be explained by other tests
⦁ A heart defect you were born with (congenital heart disease)
⦁ Abnormal noninvasive heart stress test
⦁ Prior to your planned cardiac surgery to determine that status of your coronary arteries
Due to the small risk of complications, angiograms aren’t usually done other noninvasive heart tests have been performed. These tests include echocardiogram or a stress test.
What are the risks of a coronary angiogram?
Major complications are rare. Potential risks and complications include:
⦁ Myocardial infarction / heart attack
⦁ Stroke
⦁ Tamponade
⦁ Irregular heart rhythms (arrhythmias)
⦁ Allergic reactions to the dye
⦁ Allergy to medications used at the time of procedure
⦁ Kidney damage
⦁ Excessive bleeding
⦁ Infection
Your admission
On admission to the Cardiac Short Stay Unit, you will be greeted by members of a specialist cardiac healthcare team who will be caring for you before and after your procedure. It is expected that you will stay in hospital for the day or overnight, or until you have met the expected outcomes for your procedure. In preparation for your discharge, we will discuss what supports and potential needs you may have at home.
Your preparation
Please bring any medications you take (in Their original packets) and show them to
your admitting nurse. You will be given some paperwork to complete before admission if required. This information will help us to provide the right care for your specific needs.
You may receive a call from the pre- admission clinic if we need to clarify any other details.
You will be given an information pack prior to procedure (or on arrival) depending on the time of the procedure and when you see the doctor.
You must fast from food for six hours prior to your procedure.
You can have clear fluids up to two hours before your procedure. On the morning of your procedure, you should take any medications with a sip of water, unless you have been instructed to do otherwise.
You will be asked to change into a hospital gown – underwear and jewellery should be removed. You may continue to wear your spectacles and dentures and tape over your wedding ring. Nail polish should also he removed.
You will then be transferred to the Cardiac Catheter Laboratory with your nurse for your procedure
During the procedure:
You will be transferred to the Cardiac Catheter Laboratory (commonly called
the Cath Lab) and positioned onto an X-ray table, which is quite narrow and
firm.
The procedure site will be shaved, usually right wrist and in some cases – both depending on the specialist.
The angiogram procedure usually takes about 30-60 minutes to complete. The angioplasty (PCI) usually takes 45-60 minutes. The catheters and sheath
are then removed.
To avoid bleeding at the groin puncture site, either firm pressure will be applied to the skin, or, alternatively, a special plug (e.g. Angioseal, Starclose, Exoseal) will be
inserted. You may also have a special ‘clamp’ on your groin (femstop), which contains air under pressure. This air is gradually removed over a period of 1-2
hours and then removed. If your wrist was used, you will likely have a plastic strap around your wrist (TR Band), which also contains air (18mls) this air is gradually removed over a period of a few hours.
After the procedure
Your nurse will collect you from the catheter laboratory and return you to the Cardiac Short Stay Unit. You may feel drowsy for a few hours afterwards because of the sedation.
You may be connected to a heart monitor after your procedure. Your nurse will be checking your Blood pressure, pulse, operative site, foot pulses and circulation frequently after returning to the ward.
If you have had a PCl you may still have a thin tube (sheath) in the groin area this will remain until your nurse or cardiologist removes it
If there is a TR band around the wrist, then the nurse will be gradually removing air using a special syringe until the band is empty. The band may then be removed. If there is any further sign of bleeding, then this may be replaced for a period. Once the band is removed, the site is cleaned, and a small sterile dressing applied
Your nurse will ask you to report any chest or back discomfort as well as any swelling or discomfort from the puncture site
During the period of observation, you should minimise movement of the arm or leg used in the procedure. Keep the leg that was used straight or have the arm that was used resting on a pillow and remain flat in bed as instructed by the nurse or Cardiologist. This is to allow the puncture site time to heal and to help prevent bleeding. You may bend your other leg and use your other arm.
After about 2 hours, your nurse may allow you to sit up a little – DO NOT sit up until your nurse gives you the instruction
You will be allowed to eat and drink after the procedure but be aware when ordering that you will be lying flat. You will be offered sandwiches and other ‘finger food’ items after your return to the ward.
Your nurse will assist you with any hygiene and toileting needs whilst you are in bed
Once you can get up, it is important that for the first time, you do so with your nurse, so that the puncture site can be monitored during and afterwards
Discharge home
After 4-6 hours (once your nurse and/ or cardiologist is happy with your recovery), you should be able to get up and move around gently.
NOTE: If your cardiologist is happy with your progress, you will be discharged
home on the day of your procedure (angiogram only)
Discharge time is early on morning after your procedure and following your doctor’s review. You should expect to be leaving the hospital by 08:30am. Please ensure your relative/friend is prepared to collect you and escort you home at this time.
Your nurse will present you with a discharge package containing information tailored to your needs, including care of the groin incision wound, about resuming normal activities, a list of any medications you may be on, and information on any new medications you may be starting.
Your regular medications will be returned to you on discharge, and you should receive an initial supply of any new medications
You may be given the drug Glyceryl Trinitrate to take home with you. This comes as tablets – Anginine, or a spray – Nitrolingual. If you are given these it is important that you always carry a supply of fresh tablets or a spray with you (mark on the container the date you open a bottle of anginine, as those tablets remain effective for 90 days/3 months)
If you had a coronary stent inserted, you are normally prescribed an extra medication called Clopidogrel (commonly known as Plavix or Iscover)
or Prasugrel or Ticagrelor (commonly known as Brilinta) – these are anti-clotting medications which help your stent settle in position by modifying the body’s natural reaction to a foreign object (the metal stent)
If you had a coronary angioplasty you will probably be referred for Cardiac Rehabilitation either at Cabrini or at a facility closer to your home. You would normally be expected to see your cardiologist in 4-6 weeks. Before you are discharged an appointment may be made for you, or you may be given a card and asked to phone to make an appointment at a convenient time for you.
Recovery: information for you and your family
Following an angiogram, you may be allowed home after the recovery period. You will be given discharge instructions regarding care of the puncture site and a medication summary, along with a supply of any new medications.
You would normally be given an appointment or given a number to telephone to arrange a follow up appointment with your cardiologist. It Is Important that someone drive you home because of the effects of the sedation may persist for several hours you should not drive for 24 hours after the procedure.
There should be someone staying with you overnight if you go home the night of the procedure.
Following an angioplasty (PCI), or on the advice of the cardiologist after an angiogram, you would normally be discharged the following day
With a groin puncture you should only walk a little and plan to rest at home the
following day. With a wrist puncture, you should use your arm sparingly for the next one-two days and avoid flexing the wrist for a minimum of 24 hours. Do not lift heavy weights for at least a week following the procedure. Your doctor will advise you about when
you can drive
You should be able to have a shower. When bathing or showering, do not rub soap or talcum powder over the puncture site. Allow water to run over it and pat dry. The plastic dressing over the puncture can normally be removed in the shower
the day after the procedure. You should be able to eat normally.
Depending upon the results of the angiogram, or PCI, you may be commenced on a cardiac diet – essentially a low fat, low cholesterol, and low salt diet
You should drink plenty of fluids over the next eight hours as this helps to flush out the contrast used during the procedure. You should be passing urine normally
and your usual bowel patterns will have returned. Avoid straining when you have
your bowels open, but if you must strain, then place a free hand over any groin puncture site and press gently to support the wound. Please also support any groin wound if you need to cough or sneeze. You should continue to take your usual
medications, and if any anti-coagulant medications were ceased for this procedure, these may be recommenced.
You are encouraged to see your local doctor one week after your procedure to have the puncture site checked. Observe the groin puncture site and note if there is any further swelling, bruising, redness, or discharge. Minor bruising may occur around the puncture site and can last 2 weeks. Do not worry about this. But if pain occurs over the puncture site or it becomes tender to touch, contact your doctor sooner.
Information to manage any bleeding:
1. Lie down
2. Apply continuous firm pressure with a clenched fist over the groin puncture site, or two fingers over a wrist puncture
3. Maintain this pressure for 10-15 minutes or until bleeding stops
4. Notify your doctor
If you develop further chest pain/ angina, take anginine spray/tablets as per the instructions below:
⦁ Always carry your fresh Anginine tablets or Nitrolingual spray with you
⦁ If angina occurs stop what you are doing. Stay calm!
⦁ Sit or lie down and rest for 2-3 minutes
⦁ If the pain is still there take one dose of tablet or spray under the tongue. Remember DO NOT Swallow the tablet
⦁ Wait S minutes (it is important to wait to allow the medication to go into the bloodstream)
⦁ If you still have any discomfort after 5 minutes, take a second dose
⦁ Wait 5 minutes
⦁ If you still have any discomfort after 5 minutes, take a third dose IF you do not feel dizzy
⦁ IF THE DISCOMFORT CONTINUES CALL AN AMBULANCE PHONE 000
⦁ Wait for the ambulance. Do not allow family or friends to drive you to hospital
⦁ If the discomfort has been relieved by the medication rest awhile before resuming activity. Report to your doctor if this episode is more severe, or if the attacks are becoming more frequent.
