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 rehabilitation, helping thousands of people throughout the region make measurable improvements to their cardiovascular health and wellbeing.
Publication kindly supported by
Croí 2014. All Rights Reserved. No part of this document may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic or otherwise, without prior permission.
Section 1
Why am I having this investigation? What is Cardiac Angiogram? Pre-admission preparation What happens in hospital? What happens afterwards? Aftercare of your catheter site Your Cardiac Angiogram Results Section 2
What is Angioplasty Preparing for your Angioplasty What is a Coronary Stent? Care after Angioplasty/Stent insertion Advice on discharge

Section 1
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. Section 1
and put on I.V. Heparin to provide satisfactory anticoagulation while your usual medication is stopped. If a blood test is required prior to Medication
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
Rivaroxaban (Xarelto),
informed that your procedure will Dabigatran (Pradaxa)
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 (Continuous Ambulatory 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 the procedure.
come in as a day-case patient for the procedure. Section 1
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 short while.
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.
the investigation.
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.
Section 1
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 demonstrate this).
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.
Section 1
• 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

Section 2
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.
Section 2
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.
Chest pain
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
Cardiac Rehabilitation
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 rehabilitation programme to what extent you can resume aims to help you to return to normal activity and return to work.

Section 2
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.
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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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