What is an angiogram?
An angiogram is not an operation; it’s an x-ray of blood vessels. In some cases, it’s a procedure to visualize the arteries on the surface of the heart to see if any of them are blocked. When blood flow to heart muscles is diminished, it often manifests as chest pain. The patient’s doctor is justifiably worried that problems with the coronary arteries are creating his new symptoms.
With the usual chest x-ray, you can’t see coronary arteries. They have to be made visible using a special dye. The dye is delivered through a catheter that is guided from a blood vessel in the upper thigh all the way up to the heart. Once the catheter is in position, a dye is injected and it goes right into the coronary arteries. The x-ray is taken at the precise time the dye flows through the arteries. Later, the dye is excreted with the urine.
The angiogram helps to answer these questions: Are there problems in the blood vessels supplying the heart muscle? How many vessels are affected? How bad is the problem?
The result of the angiogram gives your doctor an idea of what to do next. Treatment can range from adjustments in medication, to widening of that affected vessel, to creating another pathway to supply the heart (bypass surgery). The results are discussed with he patient and his family, and a decision regarding treatment is made later.
Before the angiogram. Ask your doctor to explain the procedure clearly. Coronary artery disease markedly diminishes a person’s functioning. If treated, the patient would likely be able to do more physical activity, and look forward to more years of healthy living. If not treated, he will experience chest pain with less exertion. Prepare the patient’s medical records. Health personnel will ask you about allergies and kidney disease as they guard against complications from injection of the dye.
During the angiogram. The patient will be awake during the entire procedure. It is done in an x-ray room. Usually a local anesthetic is applied in the area in his leg where a needle is inserted. The catheter is threaded through this needle. He will feel pain when the needle breaks through the skin — just like when an IV line is inserted into a vein in your arm. But the passage of the catheter through the blood vessels is painless.
When the dye is injected, patients sometimes report a brief, warm feeling as it spreads through the heart’s vessels. Several x-rays are taken to follow the flowing dye. He will be asked to hold his breath and be perfectly still so that the images will be sharp. The entire procedure usually takes about an hour. Afterwards, the catheter is removed and the insertion site is pressed firmly for up to 20 minutes to stop bleeding.
After the angiogram. There is usually no need for hospital confinement. But the patient should not be exerting himself for at least a day. Occasionally check the puncture site to make sure there is no bleeding. He will be asked to drink more liquids to flush out the dye through his kidneys. There are no food limitations. He should be back to his regular activities by the second day. Possible complications include bleeding or infection at the site of puncture, allergic reactions to the dye, or problems in exerting the dye among persons with kidney disease. Any invasive procedure entails risk.
New heart imaging technologies are being developed. A new generation of CT scans is able to visualize the heart’s vessels without the need to inject dyes. Ultrasound can visualize the heart to some extent. Ask whether such non-invasive options are available.
Keep an open line of communication with your doctor. Do not hesitate to ask for a second opinion to ensure the diagnoses are correct and the options being taken are helpful and necessary.
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