Coronary angiography
What is coronary angiography?
Coronary angiography is an X-ray procedure used to examine the coronary arteries. These are the arteries that bring fresh blood carrying oxygen and nutrients to your heart muscle. The purpose of the test is to obtain vital information about the severity and position of any narrowing in the coronary arteries.
Coronary angiograms are performed using a technique called cardiac catheterisation, which involves using a tube called a catheter (a long, flexible, plastic tube) to reach your heart. The same procedure may be used to measure the blood pressure within the heart chambers, and to check the functioning of the heart valves.
Will I be admitted to hospital for coronary angiography?
If you are not already a patient in the hospital, you will usually be admitted as a day patient on the day you are scheduled to have your catheterisation and then go home the same day or the day after.
How will I be prepared for the angiography?
You may have blood tests, an electrocardiogram (ECG), chest X-ray and possibly an exercise test. Your doctor or cardiologist will decide what food and drink you may have the night before and on the day of the test.
If you have been taking medication, your doctor will decide whether you should continue this before your test, so it is a good idea to have a list of all your medications, including those you take only occasionally, and any complementary or alternative medicines. If in doubt ask your doctor or cardiologist. You should bring all your medications with you into hospital in their original bottles.
It is very important to tell the doctors and nurses looking after you if you have diabetes, asthma, any allergies or any problems with your kidneys, as special precautions may be necessary.
Where is the procedure carried out?
Coronary angiography is done in a cardiac catheterisation laboratory. A number of nurses, X-ray staff and cardiac technicians will be present. You will be taken there from the ward on a wheelchair or a movable bed. Once you are in the laboratory you will be moved onto an examination table. This is directly under an X-ray camera through which the angiography procedure can be viewed.
Depending on the way the room is designed, you may be able to see parts of the procedure on a TV monitor.
What does coronary angiography involve?
An area of your arm or groin, depending on the technique used, will be cleaned, shaved and draped with sterile towels and you will be given local anaesthetic into the area. A thin, plastic tube called a cardiac catheter is inserted into an artery in your arm or groin and threaded to the part of the aorta (the big main artery through which the heart pumps blood to the body) near to where the aorta comes out from the heart. This is where the coronary arteries arise. A special fluid called contrast medium or dye, which may contain iodine, is passed through the catheter into the blood in the coronary arteries. This is to make the blood within the heart and coronary arteries visible on X-ray.
As the blood with the contrast medium flows through the arteries and the chambers of the heart, the doctor can see how these areas look and how they are working. A series of X-ray pictures is recorded digitally or on film. The doctor will need to make several injections of contrast medium so the coronary arteries can be filmed from different angles. This involves rotating the camera or moving you.
Throughout the procedures you will be secure on the table. By connecting the catheter to a gauge, the pressure in the chambers of your heart and blood vessels can also be measured. Blood samples from those chambers may be withdrawn for tests. Your heart function and blood pressure will be continuously monitored throughout the procedure.
Is angiography painful?
You will be given a local anaesthetic, similar to that used by a dentist, to numb the area in your arm or groin into which the catheter is inserted. This stings a little before the numbness sets in. Only a small nick in the skin with a special needle is needed so the catheter can be inserted into the artery. You will not feel the catheter being moved to the heart.
There is no pain when the contrast fluid is injected but it does cause a sensation of warmth, flushing or tingling which lasts about 20 or 30 seconds. You will be warned when to expect this.
Very occasionally, people have an allergic reaction to the contrast fluid and develop hives, itching or other reactions, which will be treated immediately. If you have a history of allergies or asthma, or if you have had an allergic reaction to dye used in X-rays of the kidneys or other arteries or veins, tell the doctor before the test.
You may experience slight angina, but it should subside rapidly.
Will I be awake during the procedure?
You will need to be awake to assist your doctor during the test. About an hour before the procedure you may be given a sedative to help you relax. It will not put you to sleep.
While the films are being taken you will usually be told to take a deep breath and hold it for about 10 seconds. After this you may be asked to cough and then resume normal breathing.
When will the catheter be inserted?
You may not even realise that the catheter has been introduced because the area of insertion has been numbed and there are no nerves in the arteries. You may feel some minor discomfort when the catheter is inserted through the skin. The doctor will tell you when to expect this.
How long will the procedure take?
The time required for each catheterisation is different. Coronary angiography usually takes less than an hour. Other types of catheterisation procedures may take up to 2 hours depending on the information required.
Is there any risk?
Like any medical procedure, coronary angiography occasionally causes complications. However, in skilled hands these are rare. The doctor performing the investigation will discuss this with you before the test. Feel free to bring up any concerns or questions you have.
Will I feel any pain after the angiography?
You may feel some pain where the catheter was inserted. If you feel uncomfortable, ask the nurse or doctor for some pain relief. There may be some bruising around the groin that will gradually disappear. However, if the discolouration spreads, you see blood coming through the dressing or you have undue discomfort in the groin, leg or arm, tell a nurse or doctor immediately.
What will the doctor discover about my coronary arteries?
The angiogram will show exactly where your coronary arteries are narrowed or blocked. At these points, blood does not flow through the arteries freely and this is the cause of chest pain known as angina.
When angina is severe and an angiogram has shown significant narrowing or blockage of one or more arteries, your doctor may recommend surgery or other alternatives to relieve the condition. Sometimes the angiogram may show that there are no serious problems.
Cardiac catheterisation is also used to show how the valves and muscular walls of the heart function. It may also be used to diagnose an aneurysm (a bulging of the heart wall) or a birth defect of the heart such as a hole in one of the walls between the chambers of the heart.
The technique of cardiac catheterisation can also be used for therapeutic procedures, such as angioplasty, where blockages in the coronary arteries are dilated by inflating a tiny balloon on the tip of the catheter, sometimes followed by the placement of a stent.
Last Reviewed: 30 August 2009
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