Sheila is busy scanning the patient’s chart. She has always been keen about taking everything in nursing school seriously as she believes that even the smallest details can affect her future being a nurse. She studies almost every night and takes her classes as well as clinical duties seriously. She tries to relate everything she learns in the classroom with what she encounters in the clinical area. That way, she may be able to better understand the concept and remember it more easily.
Vital signs, medications due, Intravenous fluids, procedures, procedures. “Same old, same old,” she says to herself until she comes about the “for coronary angiogram today” order. What? Coronary angiogram? She’s sure she has read about it, but she just can’t bring herself to remember everything. What’s coronary angiogram again? How and why is it performed? Questions continue to swarm her mind as she approaches her Clinical Instructor to seek clarification with regards to the procedure.
Coronary Angiogram: an overview
A coronary angiogram is a procedure that uses X-ray imaging to see your heart’s blood vessels, and is a part of a general group of procedures known as heart (cardiac) catheterization which can both diagnose and treat heart and blood vessel conditions. Specifically, a coronary angiogram can help diagnose heart conditions, and is the most common type of heart catheterization procedure.
Before the test starts, the patient may be given a mild sedative to help him/her relax.
An area of the patient’s body, usually the arm or groin, is cleaned and numbed with a local anesthetic. Then, cardiologist passes a thin hollow tube, called a catheter, through an artery and carefully moves it up into the heart. X-ray images help the doctor position the catheter.
During this procedure, a type of dye that’s visible by an X-ray machine is injected into the blood vessels of your heart. The X-ray machine then speedily takes a series of images called angiograms, offering a detailed look at the inside of your blood vessels. It helps see how the dye moves through the artery.The dye helps highlight any blockages in blood flow. In some times and if necessary, the doctor can also perform procedures such as an angioplasty during your coronary angiogram.
Usually, this procedure may last from 30-60 minutes.
This procedure may be done if the patient has the following conditions:
- Angina for the first time
- Angina that is becoming worse, not going away as fast, occurring more often, or happening at rest (called unstable angina,)
- Aortic stenosis
- Atypical chest pain, when other tests are normal
- Had an abnormal heart stress test
- To have surgery on your heart and you are at high risk for coronary artery disease
- Heart failure
- Recent heart attack
The patient may be on NPO (Nothing per orem) for 8 hours prior to the procedure. The patient may either be admitted overnight prior to the test or in the morning before the test. The patient will be asked to sign a consent after a thorough explanation done by the physician.
The patient must also inform the doctor if he/she is allergic to seafood, if he/she has had a bad reaction to contrast material in the past, if he/she is taking certain medications such as Viagra, or if the patient might be pregnant.
A review of the patient’s medical history may be done, including allergies and medications he/she is taking. The health care team may perform a physical exam and check the patient’s vital signs especially the blood pressure and pulse. The patient will then be asked to empty his/her bladder and change into a hospital gown. Contact lenses, eyeglasses, jewelry and hairpins will be removed.
After the test, the catheter is removed and the patient might feel a firm pressure at the insertion site, used to prevent bleeding. If the catheter is placed in the patient’s groin, he/she will usually be asked to lie flat on his/her back for a few hours after the test to avoid bleeding. This may cause some mild back discomfort.
Like most procedures done on the heart and blood vessels, a coronary angiogram has some risks (major complications are rare) including:
- Heart attack
- Injury to the catheterized artery
- Irregular heart rhythms (arrhythmias)
- Allergic reactions to the dye or medications used during the procedure
- A tear in your heart or artery
- Kidney damage
- Excessive bleeding
- Radiation exposure from the X-rays
A normal result of the test must reveal normal blood supply to the heart with no blockages, while an abnormal result may mean you have a blocked artery. The test can show how many coronary arteries are blocked, where they are blocked, and the severity of the blockages.
If a blockage is found, the doctor may perform a percutaneous coronary intervention (PCI) to open the blockage during the same procedure, or may be delayed for various reasons.