All about the Coronary Angiogram

thanks for joining me it's peter barles here cardiologist and today we're going to talk all things coronary angiograms [Music] now you might have been asked to have a test called a coronary angiogram and this is a test that uses x-rays to scan the arteries around the heart now we're obviously going to be looking at whether there's a blockage or a buildup of cholesterol that develops around the arteries of the heart well the angiogram is the definitive test that we use with a gold standard test to look at these arteries and to assess whether there are blockages and what's the best way to fix these now an angiogram is a part of a test called a cardiac catheterization or cardiac cath and that involves an invasive test so it is an invasive test whereby we do place little tubes into an artery and then from there advance some tubes called catheters they're often 130 140 centimeters long and then using those catheters that are placed inside the arteries around the heart we inject dye or x-ray dye that takes a picture and it pacifies the arteries and we then visualize them using an x-ray that's on the outside now a coronary angiogram can help diagnose what might be causing your symptoms particularly when there are symptoms of chest pain and that chest pain can present in a number of ways it can be an insidious slowly developing progressive symptom that somebody might feel getting worse with exertion walking up inclines upstairs however it can also present rather acutely or abruptly in the form of what we call a heart attack and that's where an artery in fact blocks off very suddenly and that sudden reduction or loss of blood getting to the muscle starves the muscle of oxygen and thereby that is a medical emergency where often an ambulance is called and a patient is transferred to the cardiac cath lab and that's where we perform this procedure to visualize the arteries now in doing that we can also then look for the blockage and treat the blockage or open the artery up to restore blood flow now your doctor may recommend you have an angiogram if you are having symptoms and these symptoms may be chest pain pain down the arm pain in the jaw shortness of breath or you might have strong cardiac risk factors including diabetes high blood pressure high cholesterol smoking or a family history of heart disease and again it's all a matter of assessing your individual risk and your symptoms before we embark on these tests and there are several tests that can be done along the way before you have an angiogram and these tests can be simple as what we call an ecg or an electrocardiogram whereby we look at the electrical activity around the heart then you can also have scans of the heart using ultrasound or echocardiography to look at see how the heart muscle is actually contracting and functioning and then there are stress tests that you might be asked to have and these are non-invasive ways whereby we exercise you on a treadmill or sometimes give you a medicine in the drip to simulate exercise and it speeds up the heart rate and then we take a picture with some form of ultrasound or a nuclear scan to see whether there's any restriction of blood flow before and after exercise now an angiogram does carry some very small risks so it's not often the first test that we embark on when we're looking at assessing somebody who might have an underlying heart problem so these are risks that you have to engage with your cardiologist to make an informed decision about whether you need to have an angiogram now before you have an androgram or before any procedure your healthcare team will obviously assess you and take a history and find out what are some of the symptoms that you've been having what allergies you may have and which medication you might be on the team will also perform a physical examination and look at your vital signs including your heart rate your blood pressure your oxygen levels and then take a cardiogram or an ecg blood tests are often necessary as well to ensure that there's no abnormalities there particularly of the kidney function because we are using x-ray dye there is a small risk to the kidneys we want to make sure that your kidneys are safe to handle the contrast that we use during the procedure now we also suggest when you come to the cath lab and you're prepared by the the nursing team and then taken to the procedure that you do go to the toilet because often you might be lying flat for a few hours after the procedure so it's not a comfortable feeling to want to empty your bladder so we encourage that prior to the procedure and you will also have a cannula placed in the vein which allows us to give you some fluid some medicines to help support your blood pressure if necessary but also to give you some sedation now the angiogram is not performed under a full anesthetic it's actually just some local anesthetic that is provided but also some sedation and this sedation keeps you nice and relaxed and comfortable but it's interesting that the angiogram is not a very painful procedure you may have a little bit of discomfort as we introduce some local anesthetic in the area but short of that you won't feel too much traditionally an angiogram is performed via the femoral artery or you might have heard of people having an angiogram from the groin well specifically it's actually the artery or the femoral artery that we've accessed but more and more now most of our practice is converting to the radial artery or the artery in the wrist now there are several advantages in using the artery in the wrist particularly that it is far more comfortable for the patient you don't need to be lying flat for four or five hours often when we puncture the artery we really need to make sure that there's no bleeding there's no bruising and often getting up too soon can put a bit of stress and pressure on the area and thereby we get you to lie down for several hours so the angiogram via the wrist is far simpler studies have also shown that doing an angiogram from the wrist has been shown to have a lower risk of blood loss and bleeding particularly in the setting where we're introducing several blood thinning medicines for example somebody might come in acutely with a heart attack and they need to have a lot of clot busting medications then of course there is a slightly higher risk when we go through the artery in the groin which is obviously a larger artery and does carry a higher risk of complications such as bleeding and thereby the approach from the wrist is certainly far more preferable now during the angiogram procedure you are monitored continuously we have staff both inside the laboratory but also outside continually measuring your oxygen levels measuring your blood pressure your ecg or your cardiogram with some leads on the chest and also the heart rate in addition to the cardiologist we often have a nurse and the nurse there essentially is there to assist the cardiologist to inject the contrast or the dye as we advance the catheter up into the artery and they are a critical part of the team to keep you safe during the procedure outside the laboratory we equally have a very very important team including a cardiac technologist who can continually monitor the heart rate and the blood pressure record all the medicines and everything that goes on during the procedure and also a radiographer which is a critical part of the team to actually help delivering proper imaging or x-ray so we actually get all the information we need in as little time as possible now in preparation for the angiogram if we do go from the wrist you often have your your wrist supinated or opened up this way and we go through the artery here called the radial artery we place a catheter or a little tube called a sheath and that's about two millimeters in diameter so a very fine and flexible sheath done under some local anesthetic so you don't really feel anything there and that allows us passage of our catheter from the artery here in the wrist all the way up across into the aorta and into the arteries around the heart or the coronary artery when we thread the catheter into the artery this should cause no pain no pain whatsoever and it often takes only a few minutes to be able to do this and the cardiologist manipulates the catheter whilst visualizing the tip of the catheter on the x-ray with the x-ray passing along you in top of you and going above your head and then going onto the left and the right side really taking pictures from various angles to look at the arteries in great detail to determine whether there might be a narrowing or a blockage so the angiogram takes about half an hour or so and that's the first part of the angiogram whereby we take the picture of the arteries often take a picture of inside the heart muscle called the left ventricle to get an assessment of how strong the heart muscle is and then from there we've got all the information in front of us we also have a discussion with the patient to outline what we have found and then what the next step should be now that can vary as to how the patient might may have presented whether they're presented rather acutely with a heart attack the next steps are often using the similar catheters that we've got say from the wrist up into the heart whereby we can advance our equipment or a wire or a balloon or a stent to actually open an artery or open a blockage up if we find that there's no significant problem no significant blockage or narrowing then we may just recommend some medic medication they might be useful some lifestyle changes optimizing diabetes risk factors such as blood pressure cholesterol stopping smoking improving the amount of exercise we're doing so these are the lifestyle changes and again it's all determined by the severity of any blockage if there is a blockage that we identify and often we say a blockage of more than about 60 or 70 percent narrowing then that often is enough to cause symptoms and then we need to treat that and there are a couple of ways we have of treating blockages depending on which arteries are involved how many of the arteries where in the artery is the blockage these are critical factors that we consider when we look at what is the best treatment for you and again the treatments may be medication alone and that might be enough to help improve symptoms or secondly there might be a need to consider placing a device called a stent to help open up an artery if there are multiple blockages or there are blockages in the main artery of the heart then sometimes it is necessary to undergo a bypass operation they will have a separate video and an interview with a colleague of mine who specializes in cardiac surgery to go through what's involved with bypass surgery that is a very useful way to actually treat patients who might have blockages involving multiple parts of an artery or multiple arteries or branches following an angiogram if it's decided that an angiogram is the only test that needs to be done and no further treatment needs to be offered you may be discharged the same day you may go home the same day but we do ask that you take some precautions and have somebody at home with you particularly keeping an eye on the puncture side or the entry site that we've gone in and to make sure there's no bleeding there's no bruising developing and there's no pain often after two or three days that settles down but we usually say during that three day period after an angiogram we advise no heavy lifting we advise no driving as well that's an important consideration so we ask that you have somebody who can pick you up if you do go home the same day so what i've done is gone through essentially what an angiogram is what information it might give us and i'll have a series of videos coming up to focus on how we go about treating arteries that have problems or treating arteries that have blockages or cholesterol build up and as i said we'll go through various medications we'll go through stints and what stints are and how they might be useful but also go through bypass surgery and having an operation to treat the arteries and blockages so hopefully you found this video useful and i look forward to seeing you again on the next video thanks very much for joining me

Channel: Heart Matters

Views: 134,475

Keywords: Professor Peter Barlis, angiogram, blockages, blood pressure, bypass surgery, cardiologist, cholesterol, coronary artery disease, diabetes, heart disease, heart tests, stents

Id: 8Bcwq_X2ySQ

Length: 14min 19sec (859 seconds)

Published: Tue Sep 07 2021