Patient Information Guide to Cardiac Angiogramand Angioplasty
Croí works to improve the quality of life for
all through the prevention and control of
heart disease, stroke, diabetes and obesity.
Our specialist health team equip people
with lifesaving skills; provide rapid
access cardiac diagnostics; and develop
and deliver innovative cardiovascular
health care in the areas of prevention and
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throughout the region make measurable
improvements to their cardiovascular
health and wellbeing.
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Why am I having this investigation?
What is Cardiac Angiogram?
What happens in hospital?
What happens afterwards?
Aftercare of your catheter site
Your Cardiac Angiogram Results
What is Angioplasty
Preparing for your Angioplasty
What is a Coronary Stent?
Care after Angioplasty/Stent insertion
Advice on discharge
Why am I having this investigation?
Your doctor may consider doing a cardiac angiogram if you
have had any of the following:
• a heart attack
• irregular heart beats
• severe chest pain
• heart murmur (heart valve
• chest tightness or discomfort
• pains in the jaw, throat or
• abnormal preliminary
investigations (such as an exercise test)
• increased shortness of breath
What is Cardiac Angiogram?
Cardiac Angiogram or an ‘angiogram'
is the main investigation performed on people with suspected or symptomatic heart disease.
If there are indications that your
coronary arteries may have
become narrowed or blocked, the
exact position and severity of the
narrowing or blockage needs to
be known, in order that the most appropriate treatment for you can be
This investigation is also done to find any heart muscle abnormalities or defects; and to examine heart valves. Cardiac angiogram is performed under local anaesthetic. A thin tube (cardiac catheter) is inserted via one of the arteries shown on the diagram and positioned in the heart. The radial artery (1) is most commonly used however access can also be made via the femoral artery (2) or the brachial artery (3).
A special (radio-opaque) dye is then injected through the catheter into the three main coronary arteries; and the pictures recorded. As well as views of the coronary arteries, heart muscle function and heart valves can be viewed.
and put on I.V. Heparin to provide
satisfactory anticoagulation while your usual medication is stopped. If a blood test is required prior to
your angiogram it will be taken by the doctor who admits you
Should I take my tablets as
to the ward. Your anticoagulant
should be restarted on the night of
If you are on any medication,
the procedure, unless the doctor
you should take all your morning
advises you otherwise. If not, it
medication with a little water at
must be started on the following
approximately 6am. This includes
day at the latest.
Aspirin, diuretics and tablets for high blood pressure. Please note:
If you are concerned about taking diuretics (water tablets), due to
If you are a diabetic, it is important
having a long journey to hospital,
that you inform your doctor prior
these can be taken on arrival.
to your admission so that your
Please bring all your medication
procedure will be made a priority.
with you (including drops and
If you are instructed to fast from
lotions), as this helps doctors and
the night before, your procedure
nurses to establish exactly what
will be done early in the morning,
you are taking. You should take
following which you may take
your medication as normal during
your insulin or tablets. However,
the day while you are in hospital.
if you are taking metformin, it
should not be taken for 48 hours
Anticoagulants - Warfarin,
after the procedure. If you are
informed that your procedure will
be in the afternoon, you will be advised to have a light breakfast
If you are taking any of the above,
early that morning.
you will need to check with your Cardiologist (heart doctor) as to when you should stop taking it prior to admission. If you have a mechanical heart valve, you may need to be admitted earlier
If you are a patient with
Please bring a dressing gown/robe
renal failure who uses CAPD
and slippers with you. Please also
remove all nail varnish.
Peritoneal Dialysis), it is very
Ladies: You will be asked for the
important that you bring all
date of your last menstrual period.
the equipment needed for your
If there is any possibility that you
exchanges with you, including
may be pregnant, a pregnancy
connections. If this is not possible,
test will be done on admission
please ring the ward a few days
and only if this is negative will the
prior to your admission to inform
angiogram test be carried out.
the staff. If you are on dialysis,
please inform your dialysis unit of
your impending admission.
Please make your own
Eating and Drinking
arrangements for admission and discharge. You will not be able
You should have no food or drink
to drive yourself home or use
from midnight on the night prior to
public transport on the day of
your admission. However, if your
the procedure. If you live alone,
procedure is scheduled for later
arrange for a family member or a
in the day you may be advised to
friend to stay with you overnight;
have a light breakfast. This is to
this is for your own safety.
prevent any nausea or vomiting during the test. Refreshments will be provided after the procedure.
What happens in hospital?
Cash and Valuables
Please do not bring large amounts of cash/jewellery with you. You
Some people have a cardiac
will be allowed to keep spectacles
angiogram during a hospital stay,
and hearing aids with you during
others will come in overnight or
come in as a day-case patient for the procedure.
You will be welcomed to the ward,
• Throughout the procedure you
where your nurse will check your
will be attached to a heart monitor.
details, ask questions concerning
A local anaesthetic will be injected
your medical history; and check
into the area where the catheter
your blood pressure, pulse and
will be introduced. You may
weight. If you are allergic to iodine
experience a tingling sensation
or have any other allergies, please
for a few seconds. When the area
inform both your nurse and doctor.
of the skin becomes numb, the doctor will insert a catheter into
You will also be seen by a doctor,
the artery and guide it up to your
who will obtain a medical history
heart. The doctor uses X-ray to
from you, carry out a physical
see the catheter and moves it to
examination, explain the procedure
the opening of the coronary artery.
to you and answer any questions
You may experience pressure
you may have. You will be asked to
when the catheter is initially put
sign a consent form.
in, but nothing beyond that.
After changing into a gown, you
• If you wish, you will be able to
will be asked to remove any
view the catheter being guided
dentures before being escorted to
through the artery into your heart
the waiting area of the angiogram
on the equipment monitors. You
lab. There you will be greeted by
may feel your heart flutter, speed
a nurse, who will also check your
up or miss a beat; this is quite
details, before you are taken into
normal and will only last for a
the catheter lab. In the catheter lab
you will be introduced to the nurses
• When the catheter is in the correct
and doctors who will be present
position, a dye will be slowly
during your investigation.
injected. You may be asked by the doctor to cough, breathe deeply
or hold your breath from time to time. This helps the dye to move through the bloodstream
• The doctor will start the
of the heart. It is important that
procedure by cleaning the
you carry out these instructions.
area of your groin/arm with an
You may feel a warm-glowing,
antiseptic iodine solution and
flushing sensation when the dye
covering it with sterile sheets.
is injected, lasting a few seconds.
Some people experience a
• You will be instructed on the
metallic taste in the mouth or a
length of time of bed rest. This
feeling of wanting to go to the
is to prevent any bleeding
toilet. These sensations are not
occurring when you start
unusual. During the procedure
walking and allow the puncture
the lights in the lab may dim
site to seal fully. You must lie
from time to time; this is nothing
flat for at least one to two hours
to worry about.
after removal of the tube; and it
is important that you keep your
• If you feel sick or itchy, have any
leg or arm straight at all times
chest pain or discomfort, you
during the period of bed rest.
must tell the doctor. A series of
X-rays will be taken once the
• A nurse will check your pulse
dye has been injected. When the
and blood pressure; as well as
test is completed, the catheter is
check the wound at regular
intervals to ensure all is well. You must inform nursing staff if
• The catheter test takes
you feel unwell or peculiar after
approximately 20 to 30 minutes.
• Bedpans and urinals will be
provided as required, as it is
unsafe to get out of bed to use the toilet.
• It is very important that you
• If the catheter was inserted
drink plenty of fluids to ‘flush'
into your groin, the doctor
the dye out of your body. Light
will remove the tube once the
refreshments will be offered
procedure is over. Pressure will
following the procedure.
then be applied to your groin for at least 15 to 20 minutes to
• If you have heart or renal failure
ensure there is no bleeding from
you will not be expected to drink
the artery or the artery will be
more than your fluid allowance.
sealed with a suture. If the test
• Your doctors will inform you
was carried out by radial access,
of the results of your cardiac
manual pressure will be applied,
angiogram prior to your
or a band will be applied over the
discharge. The length of your
artery for approximately 2 hours.
stay in hospital may be affected
• If you notice a change in
by your results. You may wish
sensation or colour of your
to bring reading material,
leg or arm, contact your GP
newspapers, etc with you for
or Accident and Emergency
your time of bed rest.
Dept. Your leg or arm may be sore for a few days/weeks and Paracetamol can be taken to
Aftercare of your
alleviate this. It is common to
have some bruising, but if the bruising travels up towards your abdomen or round towards your
• Should the site begin to bleed
buttock, or extends further up
profusely or you notice a painful
your arm, get your GP to review
large swelling in the groin or
arm, apply pressure to the
• If you notice any signs of
site for 10 to 15 minutes. If the
allergy (e.g, rash, sore throat or
bleeding or swelling persists,
swelling) drink plenty of fluids
inform the doctors or nurses (if
and contact your GP or Accident
you are in hospital) or go to your
and Emergency Dept.
local Accident and Emergency Department (if you are at home).
• You may not drive for 24 hours
and will not be permitted to take
• It is advisable to rest the arm or
public transport home on the
leg as much as possible for the
evening of your angiogram.
first 24 hours. On the evening following your angiogram, you
• You may bath or shower on
should avoid climbing stairs as
the next evening. If you have a
much as possible.
plaster covering the site, this may be removed and it is not
• When you laugh, cough or
necessary to replace.
sneeze over the next 48 hours, you should support your
If you are worried about any
groin or arm (your nurse will
aspect of your recovery, please
contact your GP or the Cardiology team at your hospital.
Now that you have had your cardiac angiogram, perhaps it is a good time
to take a look at how you can keep your heart in better shape.
• Stop smoking
• Monitor your
Smoking cessation can
dramatically decrease the risk
It is important to have your
of heart attack.
cholesterol level measured
regularly. The doctor will
• Keep your blood
advise you on the appropriate
pressure under control
level for you depending on the
Reduce salt intake, watch your
results of your angiogram.
weight, exercise regularly, reduce stress, take medicines as pr
as p escribed.
• Eat well
Your Cardiac Angiogram
Try to eat less fatty foods,
eat more fresh fruit and vegetables.
The doctor will discuss with you the results of your cardiac
• Exercise regularly
angiogram. If your cardiac
Aim for a minimum of
angiogram (angiogram) shows
150 minutes of moderate
that there is disease in your
intensity aerobic activity
arteries, ask the nurse or doctor
per week. One way of
to show you the position of the
achieving this is a 30
narrowing on the diagram below.
minute brisk walk 5 days per week.
• Lose weight
Carrying extra weight
means that the heart has to work harder. Lose weight slowly by eating a balanced, varied diet and take more exercise.
• Try to manage stress
It's not easy, but put time
aside each day to relax.
• Drink alcohol in
Your doctor will then discuss
treatment options with you. Treatment for heart disease
Do not drink more than
involves using one or a
the recommended safe
combination of the following:
limits: for men 17 standard drinks a week, for women
11 standard drinks a week.
• Lifestyle changes
• Angioplasty or bypass surgery
The second section of this booklet is designed for people with coronary heart disease who have been advised by their Cardiologist (heart doctor) to have coronary angioplasty.
What is Angioplasty?
Angioplasty is a medical procedure
coronary angioplasty is usually
in which a balloon is used to open
planned in advance, in some
narrowed or blocked blood vessels
cases, it may be carried out as an
of the heart (coronary arteries),
emergency treatment. It may also
allowing the blood to flow more
be carried out at the same time
easily to the heart. The angioplasty
as the cardiac angiogram test if
procedure is similar to a cardiac
the person has consented to the
angiogram (angiogram). While the
A cross-section of a narrowed
Similar to the cardiac angiogram,
the doctor will numb the skin around the artery in your groin or radialartery with local anaesthetic.
Preparing for your
Next, a sheath (a thin plastic tube)
is inserted into the artery. A long, fine, hollow tube called a catheter is passed through the sheath and
Although angioplasty is not
guided up the blood vessel to the
surgery, your pre-admission
arteries in your heart.
preparation is important.
Once the doctor positions the
The preparation for angioplasty
catheter into the blocked artery,
is similar to the preparation for
the balloon at the end of the
cardiac angiogram so please see
catheter is inflated.
pages 3, 4 and 5 of this booklet.
This widens the artery by
The doctor will explain the
compressing the fatty matter into
procedure to you and discuss
the artery wall, thus increasing
any risks associated with the
blood flow to the heart.
You may feel some chest
Your angioplasty will take place in
discomfort while the balloon is
the Cardiac Angiogram Laboratory
inflated, but once the balloon is
and you will be awake throughout
deflated and removed this pain
the procedure. Medication to help
should disappear. Please inform
you relax will be given to you if
your doctor or nurse about this
required. The angioplasty may take
pain so that the balloon can be
up to two hours. Please ensure that
deflated and pain medication
you have made the appropriate
travel arrangements prior to your admission for your discharge
For most people, coronary balloon
angioplasty increases blood flow to the heart, diminishes chest pain and reduces the risk of heart
attack. However, for some people
• The stent will help hold the
the artery may become blocked
artery open and will improve
again. This can be treated with
blood flow to the heart, relieving
balloon angioplasty again or
symptoms of coronary heart
perhaps bypass surgery. However,
the risk of this artery becoming
blocked again is reduced if a
stent is also implanted during the
Coronary artery with stent
What is a Coronary
Care after Angioplasty/
A coronary stent is a small
stainless steel mesh tube that acts as a scaffold in keeping your artery open.
After angioplasty and/or stent insertion you will return to the
• It is introduced into your artery
Coronary Care Unit or transfer
by a balloon catheter and
back to the referring hospital after
positioned at the site of the
2 hours recovery in the Day Ward.
narrowing in the artery.
Nursing staff will monitor your
• Once in place, the balloon tip is
heart rhythm and blood pressure;
inflated and the stent expands to
and will check your puncture site
the size of the artery and holds it
for bleeding. If the femoral artery
was used, your foot pulses will
• The balloon is then deflated and
also be checked regularly. As the
removed and the stent stays
numbing sensation wears off from
in place permanently. One or
the groin site or wrist you may
more stents may be used in the
feel some pain or discomfort. This
vessel to span the length of the
is normal and can be resolved if
you ask your nurse for pain relief medication.
After the required length of bed
Advice on discharge
rest you may mobilize. If a closure device was used to help close the site incision, this period of bed rest
may be shorter. Your nurse will let
If a stent was inserted during the
you know if this is the case.
angioplasty procedure, you will need to take anti-platelet drugs. These drugs thin the blood,
reducing the risk of clots forming
If you feel sudden pain at
around the new stent and allowing
the groin site or wrist, or
the stent to be incorporated into
suspect that it is bleeding,
the artery wall. Examples of these
it is very important that you
drugs include Aspirin, Plavix,
inform the nursing staff
Brilique, and Efient.
Your doctor will give you a prescription for your tablets before you are discharged and
When can I eat and drink?
will explain to you any new medications that you may be
When you return to the ward you
required to take.
may eat and drink. It is important to drink plenty of fluids to clear
It is important that you follow
the contrast dye through your
your medication regimen exactly.
kidneys and out of your body. You
Do not stop taking any of the
may feel the need to urinate more
prescribed medications unless you
frequently, but this is normal.
are instructed to do so by your doctor. If you experience any side effects from the medications, such as headaches, nausea, vomiting or rash, please.
NOTIFY YOUR DOCTOR
Most activities can be resumed
gradually within two weeks.
If you experience chest pain
It is advisable to avoid any heavy
similar to the type of pain
lifting or vigorous activity for
you experienced prior to your angioplasty stop what you are
several days to allow for the
doing and sit down. If the pain is
wound to heal properly.
still there after two minutes and
If you have had a heart attack
you have the nitrolingual spray,
just prior to your angioplasty,
place one to two puffs under your
the advice will be a little different
tongue. Continue to rest and relax.
and your nurse will discuss this
If the pain becomes more severe
with you before your discharge.
or does not ease after 15 minutes,
Please ask for a copy of the Croí
then you or a family member
‘Recovering from a Heart Attack'
should call 999 or 112.
booklet. For the first few days after you get home, it is important
to check your puncture site. If pain,
Your doctor will see you before
redness or tenderness develops,
you go home; he will discuss
contact your GP immediately
the results of your angioplasty/
as this may indicate infection or
stent with you. You will receive a
bleeding. It is also important, if
follow-up appointment with the
you feel that you're about to cough
cardiologist (heart doctor) about
or sneeze, to put gentle pressure
six weeks after you go home.
on the wound site, to keep the wound from re-opening.
Returning to normal
The advice you receive on
discharge depends on how successful the procedure was
Cardiac rehabilitation classes
and whether or not you have
are provided to give continued
blockages in any other coronary
support to patients following
angioplasty, heart attack and cardiac surgery. The cardiac
Your doctor will advise you as
to what extent you can resume
aims to help you to return to
normal activity and return to work.
normal life and health following
Looking to the future
your angioplasty. It involves a
While the procedures performed
supervised exercise programme,
during your coronary angioplasty
advice on relaxation and
will open a blocked/narrowed
management of stress, as well as
artery, they will not cure coronary
educational sessions in relation
artery disease. Lifestyle
to risk factors for heart disease.
modifications will need to be
It is best to enquire about cardiac
made to reduce the risk of further
rehabilitation classes before you
cardiac problems occurring.
are discharged. Croí offer a range
Please see page 8.
of specialised cardiac health and lifestyle programmes, for further
A nurse will complete the
information please contact Croí on
following page for you as a
summary, after the doctor has seen you and discussed with you the results of your cardiac
angiogram and angioplasty.
You should not drive for the first week after having angioplasty. However, if you hold a truck or bus driving licence, this period may be longer and you will need to seek medical advice prior to resuming driving.
For further information visit
Any Change in Medication
Before you leave hospital it is important that you are clear about which medicines
you need to take and which you no longer require. Do not stop taking any medicines
without seeking medical advice.
Outpatients Appointment or Referrals
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This booklet is designed to help you understand more about the
procedure of Cardiac Angiogram and Angioplasty and is not intended to
replace the medical advice of your doctor.
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