Coronary Angiogram: What to Expect, Risks and Recovery

A coronary angiogram is the most detailed way to see the arteries that supply your heart. It is done through a small tube in your wrist or groin, usually while you are awake, and many people go home the same day.

Imagine being told your stress test shows your heart may not be getting enough blood. The next step is an angiogram. You are nervous about a tube going near your heart, but the next morning you are sitting up with tea, a small dressing on your wrist.

What a coronary angiogram is

A coronary angiogram is an X-ray test that uses a special dye (contrast) to show the coronary arteries. A thin, flexible tube called a catheter is passed through an artery in your wrist or groin up to your heart, and dye is injected while X-ray images are taken.,The images show whether any arteries are narrowed or blocked and how severely. If a significant narrowing is found, it can often be treated in the same procedure with angioplasty and a stent.

Why it is done

• Angina or chest pain that suggests narrowed arteries
• An abnormal stress test or CT coronary angiogram
• After a heart attack, often as an emergency
• Before some heart valve operations
• Investigating heart failure or abnormal heart rhythms in some cases

Before the procedure

• Follow instructions about fasting
• Ask whether to stop blood thinners or diabetes medicines such as metformin
• Tell the team about kidney problems and allergies, especially to contrast dye, iodine or shellfish
• Arrange someone to take you home and stay with you overnight
• Bring a list of your medicines

What happens on the day

You will be awake, but you may be given a mild sedative to help you relax. Local anaesthetic is injected into the wrist or groin, then a small tube is placed in the artery. You should not feel the catheter moving inside you.,When the dye is injected, some people feel a warm flushing sensation or feel as if they have passed urine, which passes quickly. The test usually takes 30 to 60 minutes, longer if a stent is placed.

Wrist or groin?

Many centres now use the radial artery in the wrist, which usually means less bleeding and a faster recovery. A tight band is placed on the wrist afterwards and gradually loosened. If the groin (femoral artery) is used, you may need to lie flat for a few hours afterwards, and a plug or stitch may be used to seal the artery.

Stents

If a narrowed artery is found, the cardiologist may perform angioplasty: a tiny balloon is inflated to widen the artery, and a stent (a small mesh tube) is left in place to keep it open. You will need to take blood-thinning medicines, often two antiplatelet medicines for a period, to prevent the stent from clotting. Never stop these without talking to your cardiology team.

Risks

Angiography is a common and generally safe procedure. Risks include bruising or bleeding at the access site, allergic reaction to the dye, kidney strain from the dye, and rarely damage to the artery, heart attack, stroke or abnormal heart rhythms. The team will explain your individual risks, which are usually small compared with the benefit.

Recovery at home

• Avoid heavy lifting and strenuous use of the arm or leg used for a few days
• Keep the wound clean and dry for 24 to 48 hours
• You can usually return to light activities within a few days
• Ask about driving; rules vary by country and depend on whether you had a stent or a heart attack
• Join cardiac rehabilitation if offered

Seek urgent help if

• The access site bleeds heavily or swells rapidly; press firmly and call for help
• Your hand or leg becomes cold, pale, numb or very painful
• You have chest pain, breathlessness or fainting
• You develop a fever or signs of infection at the wound

CT coronary angiogram vs invasive angiogram

A CT coronary angiogram is a different test that uses a CT scanner and contrast dye injected into a vein in the arm to create detailed images of the heart arteries. It does not involve a catheter in an artery and is often used as a first test for people with chest pain that might be angina.

If the CT scan shows significant narrowing, an invasive angiogram may follow, because it gives more precise information and allows treatment with stents at the same time.

Your feelings after the procedure

It is normal to feel tired, emotional or anxious after an angiogram, especially if a stent was placed or you have had a heart attack. Many people worry about chest twinges or wonder whether it is safe to exercise or have sex again.

Cardiac rehabilitation programmes are designed to help with exactly these questions. They combine safe, supervised exercise with advice on medicines, diet, stress and returning to work. Research shows they improve recovery and reduce the risk of further heart problems.

Protecting your heart afterwards

• Take all prescribed medicines, including blood thinners, statins and blood pressure medicines
• Stop smoking; this is one of the most powerful steps you can take
• Be active most days, building up gradually
• Eat a heart-healthy diet rich in vegetables, fruit, wholegrains, beans, nuts and fish
• Keep blood pressure, cholesterol and blood sugar under control

Frequently asked questions

Will I be put to sleep?

Usually not. Most angiograms are done awake with local anaesthetic.

How soon will I know the results?

The cardiologist often explains the findings straight after the procedure.

Can I fly after an angiogram?

Usually after a few days, but check with your team, especially after a stent or heart attack.

But what if they find a blockage?

Many blockages can be treated with a stent during the same procedure. Others are treated with medicines or bypass surgery. Knowing exactly what is happening allows the best treatment for you.

Related: Heart stress test · Angina

Sources: British Heart Foundation, British Cardiovascular Intervention Society, American Heart Association, European Society of Cardiology.