Did you say you want to see your heart's arteries too? Let's talk about a coronary angiogram!

You've probably been told by a doctor that you need to have an angiogram to check your heart's arteries, right? It's normal to feel a little scared and nervous when you're told that. But once you know exactly what it is, how it's done, and why it's done, your fear and nervousness will be greatly reduced. So, let's talk about this in more detail today, shall we?

So, what is a coronary angiogram?

Simply put, a coronary angiogram is a special test that looks at the blood flow in your coronary arteries , the blood vessels that carry blood to your heart. It uses X-rays and a special liquid called a contrast dye . Sometimes doctors also call it coronary angiography , which is the same thing.

This test can clearly see if your heart arteries are blocked or narrowed . Most often, this is due to a condition called atherosclerosis . This means that things like cholesterol build up inside the arteries, causing the artery walls to thicken and narrow, narrowing the blood flow.

Do you know that the coronary arteries are a very important vascular system for our heart. Because these veins carry the blood that provides the oxygen and nutrients needed for the heart muscle to live and work. So, if one of these veins does not work properly or becomes blocked, then a dangerous situation like a heart attack can occur.

Why would a doctor order this angiogram?

There are several reasons why your doctor or cardiologist may recommend a coronary angiogram. Let's take a look at what they are:

• If there are any abnormalities in your stress test or ECG (Electrocardiogram) test.
• If you have heart valve disease, heart failure , or have had a heart attack in the past.
• If you are scheduled to have heart surgery, and your doctor suspects that you may have coronary artery disease .
• If you have chest pain (angina) , it may be new or the type of pain you have had may have changed.
• You have unusual chest discomfort or difficulty breathing, but other tests have not found anything.

This is why a doctor recommends this test. Never be afraid to ask questions about it. It is very important to ask your doctor anything you think or don't understand.

How do I prepare for this angiogram?

Your doctor will give you clear instructions on how to prepare for this test. He will also talk to you about the medications you are taking and your health history. Typically, a doctor will say things like:

• You will be asked not to eat or drink anything for eight hours before the test. You can only drink water. We call this 'fasting', or fasting.
• If you are taking anticoagulants , diabetes medications, diuretics (medicines that increase urination), or sildenafil (such as Viagra® or Revatio®), you will be given instructions on how to use them and whether to stop them in the days before the test.
• They will ask you if you have ever had an allergic reaction to the contrast dye or anesthesia mentioned earlier.
• If you are a pregnant woman, you should tell your doctor .

Another important thing is that, for your safety, you will not be allowed to drive yourself home on the day of the test. Therefore, it is best to arrange for someone to drive you home from the hospital that day.

What happens during an angiogram?

Okay, now let's see what usually happens during this coronary angiogram. Imagine, this is like a scene from a movie.

1. First, you will need to wear a special medical gown provided by the hospital. Then, you will need to lie down on the examination bed.

2. A medical staff member will give you a sedative through an IV (a type of saline solution given into a vein in your arm). This will make you feel relaxed, but you won't go completely to sleep. You will be awake and able to listen to the doctor's instructions. For example, you may be asked to cough or hold your breath for a few seconds.

3. Your heartbeat will be monitored with an ECG (Electrocardiogram) machine throughout the test.

4. The doctor will numb a large blood vessel (artery) in your groin or arm (local anesthesia) . This means that they will give you a numbing medicine to numb that area. You may feel a slight tingling sensation during this time, but you should not feel any pain.

5. The cardiologist then uses a small needle to enter the blood vessel through the puncture site. Then, a sheath , which is a small tube, is placed over the needle and into the large artery.

6. Next, the doctor will thread very fine wires and catheters (thin tubes) through this tube into the coronary arteries on the surface of your heart. You won't feel the tube moving through your blood vessels.

7. An X-ray machine rotates around you. This is called fluoroscopy . This allows the doctor to see the catheter's path from all sides.

8. Once the catheter is in your heart or aorta , the doctor will inject a special dye into the tube. Then, they will use X-rays to see how the dye flows through the artery. During this time, you may feel a warm sensation throughout your body for a few seconds, or you may feel like you need to urinate. This is normal.

9. When the dye passes through the coronary arteries, the doctor can clearly see if there is cholesterol or plaque buildup somewhere inside the coronary arteries, obstructing the flow of blood.

Imagine this, it's like using a drone camera to see if there is traffic jam on a road and where it is.

Sometimes, if the doctor sees that the blood vessel is blocked, he can inflate a balloon to open up the blocked area. This is called angioplasty . Then, a stent , a small mesh-like device, can be placed in the vein to keep it from collapsing again.

However, if that is not possible, or if the doctor thinks it would be better to do another treatment method later, then the coronary angiogram will be completed there.

The entire test usually takes between 30 and 50 minutes , but sometimes it can be longer or shorter.

What happens after the angiogram?

After the examination is complete, the doctor removes the catheter. Then one of the medical staff holds the needle in place tightly to stop the bleeding.

Most people can go home the same day the test is done, two to four hours later.

However, if your test is a bit more complicated, or if the test was performed during the day, it's best to expect to stay in the hospital that night.

You may feel a little tired after the angiogram. The area where the needle was inserted (the wound) may be tender and blue for about a week. Your doctor may also ask you to limit your activities for a few days after you go home.

Are there any risks to this test?

It is best to have this test done at a high-volume center where an experienced doctor performs it regularly. Most of the time, these tests are safe. However, compared to other tests, such as ultrasound, this is a somewhat invasive test. Serious complications are rare.

However, it's good to know what the possible risks of an angiogram are:

• Irregular heartbeat (arrhythmia) .
• An allergy to either the dye or the anesthetic.
• Damage to a blood vessel.
• Formation of blood clots.
• Fluid accumulates around the heart and puts pressure on the heart (cardiac tamponade) .
• Heart attack .
• Kidney damage, possibly requiring dialysis to purify the blood.
• Low blood pressure.
• Pain, bleeding, or infection at the site of insertion of the needle or catheter.
• Stroke .

The following people may be at increased risk of developing these complications:

• For those over 65 years of age.
• For those with diabetes .
• For those with kidney disease .

If you have any further questions about these risks, talk to your doctor.

When will I know the results of the test?

Sometimes the doctor may show you X-ray images during the test. However, after the angiogram is finished, the doctor will explain to you what the results mean.

Your doctor may say your angiogram results are 'normal' or 'abnormal'.

• A normal result means that there are no blockages in your coronary arteries and that your heart is getting enough blood. However, if you still have symptoms, further tests may be needed to find the cause.
• With abnormal results , there may be a blockage somewhere in your coronary arteries. Your doctor will tell you which arteries are blocked and where. They will also explain how severe it is. They may also tell you how much of the blockage is.

If the results are abnormal, what do you do next?

If your results are abnormal, your doctor will also explain what treatments are recommended for you. Some of these include:

• Angioplasty or stenting (inserting the aforementioned balloon and placing a stent).
• Making changes to your daily life, for example , exercising more or changing your eating habits.
• Coronary artery bypass surgery (CABG) .
• Using medications.

When do you need to talk to the doctor ?

After the test, if you notice any of the following at the site where the catheter was inserted, call your doctor immediately:

• If there is excessive bleeding that does not stop.
• If that area is swollen .
• If there are signs of infection (e.g., skin discoloration, pus).

Also, if you have any discomfort related to blood circulation in your arms or legs, tell your doctor about that as well.

Is an angiogram painful?

Typically, a coronary angiogram is not very painful. You may experience temporary, minor pain during:

• When they put in the IV line to give you that light sleep medicine.
• When injecting local anesthesia.

You won't feel any pain during the test because of the catheter. Also, you won't feel it as it moves through your veins and arteries.

After the test, you may feel some pain where the IV was placed and the catheter was inserted. This will subside after about a week.

If you experience unbearable pain during the test, tell the doctor right away.

Finally...

It's normal to feel a little nervous and anxious when you're told you need to have a coronary angiogram. You may even wonder if the results will be abnormal. But remember, the information your doctor gets from this test will help him or her diagnose your condition and develop a treatment plan that's right for you. So, talk to your doctor about anything you don't understand or have any questions about. He or she is there to help you.

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