Getting an Angiogram

By Jim Rue

When treadmill tests, x-rays or other cardiac tests indicate a problem, you may be scheduled for an angiogram. An angiogram is a high-tech observation of the functioning of your blood vessels. While an angiogram might examine blood vessels to your lungs, kidneys, brain, arms or legs, if it follows a treadmill test the area of concern is probably the blood vessels in, on and leading to your heart.

The doctors, radiologists and nurses in the cardiac catheterization unit may take pains to inform you, as they did me, that the angiogram is not a surgical procedure. After all, nothing will be removed from you. Only one tiny incision will be done. But the procedure nonetheless calls for precise, specialized professional care.

Radiologists on the Side

It all takes place on an x-ray table. Several computer monitors are suspended above the x-ray table. An electrocardiogram (EKG), in which small electrodes are taped all over your abdomen, will monitor and record your heart and pulse functions throughout the test. A small clothespin-like device will be attached to one finger. This will monitor changes in the oxygen content of your blood. One small patch of your skin will be shaved just below your waist on one side of your groin, and the area will be thoroughly cleaned and sterilized. You will be covered with radiation shielding. Then your body will be covered with sterile sheets, leaving only a small window through which your groin can be seen. The staff may decide to use your upper arm instead of your groin if an artery there is determined to be larger or closer to the surface of the skin.

An intravenous drip of saline solution will be inserted to your arm, and through that you will be given a mild general anesthetic. Then you will receive a shot to deaden the skin around the site where the needle, or catheter, will be inserted. Everything that follows will be painless.

You can Watch if you Want To

First a very small incision is made into your artery. Then a tube called an introducer is inserted. This hollow device guides the catheter into your bloodstream. The catheter is itself a long hollow tube. The radiologist watches an x-ray monitor while he guides the end of the catheter through the artery until it reaches your aorta. From there the catheter can be guided into the arteries that nourish your heart, or into any of the chambers of the pumping muscle. A dye that appears as a different shade or color on the x-ray monitor is gradually injected into areas of the heart where signs of dysfunction or blockage may appear. The resulting movements of the dye are recorded. One unique sensation may be a feeling of sudden warmth spreading from your chest down.

While We Were in the Neighborhood

When everything has been seen that can be seen, further steps might be taken to actually resolve your cardiac problem. Angioplasty maybe performed. This is a procedure in which the end of the catheter is covered with a balloon, and the balloon is then inflated at the site of a problem. The balloon expands the inside diameter of the artery, allowing a more free flow of blood.

A stent is a metal cuff attached around the balloon, so that when the balloon is inflated the stent expands and reinforces the arterial wall. Then the balloon is deflated and the catheter and balloon are removed, leaving the stent permanently in place. If successful, a stent or angioplasty probably will make heart surgery unnecessary. Cardiologist and radiologist may very well have an update on your condition for you before you leave the examining room. Mine did.

Bring Reading Material

After the hardware has been removed from your artery, the docs may place a plug in your artery (which will eventually dissolve after the site has completely healed), or they may simply apply pressure to the site for six hours or so until the bleeding has stopped. In either case you will be placed in a hospital room to cool. Even if you drove yourself to the hospital, they will not let you drive yourself home, so be prepared. Several days of stiffness and weakness around the point of entry of the catheter will follow, and the procedure may leave some shockingly large bruises behind, but after a few days they will begin to fade.

The memory of the procedure though, and of the diagnosis, may not leave you so quickly. Good luck.