Lancashire Teaching Hospitals

NHS Foundation Trust

Information for patients having Cardiac

Catheterisation (Angiography)
What to expect on the day of your test

Cardiology/Medical Directorate

Produced: Feb 2007

Review date: Feb 2010

After discussion with your doctor you have decided to undergo a cardiac
catheterisation procedure (angiogram). This is to obtain further information about
your heart and particularly your heart arteries. This information sheet describes the
procedure and how to prepare for it. The angiogram may show narrowing in your
heart arteries that can be treated by angioplasty. You will be referred to Blackpool
Victoria Hospital to have this done.

Before you come into hospital

Please tell us if you are allergic to anything, including X-ray dye or shellfish. Please
bring with you a dressing gown and slippers and a book. Please remove make up
and nail polish. All jewellery and valuables with the exception of wedding
rings/watches should be left at home. If you wear a hearing aid please leave it in for
the procedure.
Most angiograms are carried out as day case procedures. In order for this to happen
you must arrange transport to and from the hospital. Someone must be available to
escort you home and then stay with you overnight. Do not drive your own car to the
hospital. You are not allowed to drive again for 48 hours after an angiogram. You
may have a light breakfast of tea and toast four hours before your appointment time
but nothing else thereafter.

Medications Very Important!!

1. If you are diabetic and taking metformin please do not take this the morning
of the procedure. Do take all of your other medications as normal.
If you take insulin please take it when you eat four hours before procedure. If
you do not eat anything at this time please do not take your insulin but bring it
with you.
2. If you are taking Warfarin or Sinthrome you must stop taking this 3 days
before the procedure.
3. If you are not diabetic or not taking Warfarin/Sinthrome, take all of your
usual medications at the usual times.

If you are unsure what to do please contact the Cardiac Catheterisation Suite on
01772 524382.

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On arrival at the ward

You will be met by the nurse and shown to your bed or waiting area if your bed is not
ready. You will be given a hospital gown to wear and have your blood pressure and
pulse taken. You will have a venflon, a small plastic tube, placed in a vein in your
arm. The doctor will explain the procedure and answer any further questions you may
have prior to signing a consent form.

Cardiac Catheterisation
(Coronary angiography)
This is carried out in a special X-ray room called the Cath Lab. A team of staff
including doctors, nurses, radiographers and cardiology technicians will look after
you. The procedure involves placing a small tube (sheath) into the artery at the top of
your leg or at the wrist. The area where the sheath is inserted will be numbed with
local anaesthetic so you should only feel minimal discomfort. Specially shaped tubes
(catheters) are then passed through this sheath to the heart. Patients are awake
during the procedure but sedation is given if necessary.

After the procedure angiogram from the arm

The sheath will be removed immediately in the cath lab and pressure applied using a
plastic band inflated with air. You will return to recovery on your bed although you will
be able to walk about if no sedation has been given. When the artery has sealed up a
dressing will be applied to the area. You will be ready to go home 2-3 hours after the
procedure.

After the procedure angiogram from the leg

The sheath may be removed immediately and the small hole in the artery closed with
a special sealing device (angioseal). This dissolves in approximately 90 days. This
allows you to go home within an hour and a half.
Alternatively the sheath may be removed when you are back in the ward. The nurses
will press on the area until the bleeding stops (usually less than 15 minutes). In the
latter case you will need to spend one hour lying flat in bed. You will be ready to go
home after three hours.
During your recovery the nurses will carry out regular checks of your blood pressure,
pulse and wound. After any necessary bed rest you will be encouraged to walk
around the ward. This is to make sure you are well enough to go home. The doctor
will explain the results of the test before you leave. Any changes to medication or any
further plans will be discussed with you at this time.

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Risk of complications during cardiac catheterisation

This procedure cannot be performed without some element of risk. Significant
bleeding or bruising occurs in around 5% of patients and occasional patients may
develop an allergic reaction to the x-ray dye (less than 1%). Other more serious
complications can occur and the important ones are listed below for your information.
You should understand these before you sign the consent form.
1. Major bleeding requiring blood transfusion
This is rare (<1%) but serious and occasionally requires surgery to stop the
bleeding
2. Heart attack: 1 in 500 (0.2%)
If a heart artery blocks off during an angiogram this is usually treated by
immediate angioplasty and/or a combination of different medications. Very
rarely it may be necessary to consider emergency bypass surgery.
3. Stroke: 1 in 1000 (0.1%)
Heart disease itself can lead to stroke but the catheterisation procedure can
also cause strokes because the catheter has dislodged material from the main
blood vessel in the body (aorta) and this material has obstructed the blood
flow in one of the arteries supplying blood to the brain.
4. Death: 1 in 3000 (0.03%)
As you can see, death is very uncommon but can occur especially in patients
who are very unwell at the time of the procedure.
5. Kidney Damage
There is a possibility in a small number of patients that the dye used as part of
the procedure can cause damage to the kidneys. In these instances the
majority of patients recover well within a few days. For a very small minority
this kidney damage may require dialysis.
You are advised to drink plenty of water following the procedure, as this is a
very effective way of minimising the risk.
The incidence of all of these complications will to some extent depend on the
circumstances in which the procedure takes place and on the severity of the
underlying disease:

Problems are less common during elective planned procedures compared to

urgent or emergency procedures

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Problems are more common in patients with severe heart disease compared
to those with relatively mild or moderate disease.

The vast majority of procedures are performed without any major complications but it
is important you realise that these procedures are not risk free. Currently
angiography is the only available method of obtaining accurate pictures of the heart
arteries and in your case we are confident that the benefits of obtaining this
information outweigh the risks associated with the procedure.
If you have additional questions you would like to ask then please discuss these with
your doctor before signing the hospital consent form.

Sources of further information:

www.lancsteachinghospitals.nhs.uk
www.nhsdirect.nhs.uk
www.patient.co.uk
Cardiac catheterisation Suite 01772 52 4383

Lancashire Teaching Hospitals NHS Foundation Trust is not responsible for

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