CORONARY ANGIOGRAPHY

What is Coronary Angiography?

A coronary angiogram (also called Cardiac catheterization) is an invasive imaging procedure that allows your healthcare provider to evaluate your heart function. Your provider puts a catheter (tiny tube) into a blood vessel in your arm or groin and then into your coronary arteries. Providers can use a heart catheterization to find problems and use other procedures to fix them, sometimes during the same appointment. For example, your provider could fix a heart flaw you were born with or replace your heart valve without making a large incision and doing traditional surgery.

When would a cardiac catheterization be needed?

Cardiac catheterization is used to:

  • Find out why you’re having chest pain or an abnormal heart rhythm.
  • Take a tiny bit of muscle from your heart to examine (biopsy).
  • Evaluate or confirm the presence of coronary artery disease, valve disease or disease of the aorta. Your provider may do this as a scheduled procedure or shortly after a heart attack.
  • Evaluate heart muscle function.
  • Check your pulmonary arteries for issues.
  • Check on your blood flow, oxygen level and pressure in areas of your heart.
  • Get more information that other tests couldn’t provide.
  • Determine the need for further treatment (such as an interventional procedure or coronary artery bypass graft, or CABG, surgery).
  • Place a stent to open a blockage in an artery.
  • Diagnose cardiomyopathy, aortic stenosis, mitral valve regurgitation or pulmonary hypertension (high blood pressure in your lungs).
  • Help with planning a heart transplant.

Who performs this procedure?

A specially trained cardiologist and a team of cardiology fellows, nurses and technicians will perform your cardiac catheterization in the cardiac catheterization laboratory.

How does the test work?

Your provider uses a needle to place special equipment, including a catheter (which is a small specially shaped tube), into a blood vessel (artery or vein). This can be done in your arm, in the neck, or in your leg. Your provider then injects contrast material through the catheter and creates X-ray movies (coronary angiogram or coronary angiography) as the contrast material moves through your heart’s chambers, valves and major vessels. The digital photographs of the contrast material allow your provider to identify the site of the narrowing or blockage in the coronary artery, evaluate the size and shape of heart chambers and/or blood vessels and find abnormal leaks or holes.

Additional imaging procedures

In some cases, your healthcare provider may perform intravascular ultrasound (IVUS) and fractional flow reserve (FFR) along with cardiac catheterization to obtain more detailed images of your blood vessel walls. Only specialized hospitals and research centers have these imaging procedures.

  • Intravascular ultrasound: Your provider positions a miniature ultrasound probe (transducer) on the tip of a coronary catheter. They thread the catheter through your coronary arteries and, using high-frequency sound waves, produce detailed images of the inside walls of the arteries. IVUS produces an accurate picture of the location and extent of plaque (fat and cholesterol buildup). It can also identify other problems in blood vessels, such as calcium buildup, and it can help providers make sure any stents they put in the artery are positioned correctly.
  • Optical Coherence Tomography (OCT): This is another type of technology that can take pictures inside blood vessels. OCT uses a small laser instead of ultrasound. Depending on what type of imaging technology your provider is used to, and what problem they are looking for, they may choose either OCT or IVUS.
  • Fractional flow reserve: Your provider threads a small wire into the artery which can measure the pressure on both sides of a blockage. This can be done with a medication that simulates a stress test. The wire helps identify whether a blockage is bad enough to require treatment.

How do I prepare for the test?

You’ll need to make your provider aware of any medicines you’re taking and any allergies you have. Your provider will let you know how long before your procedure you should stop eating and drinking. Usually, you’ll need to stop eating and drinking six to eight hours before your heart catheterization.

Allergies

Discuss all of your allergies with your provider, especially these:

  • IVP dye/contrast agent allergy.
  • Iodine allergy.
  • Latex/rubber products allergy.

Medications

Discuss your medications with your provider, who may want to stop or adjust the doses several days before or on the day of the procedure, especially these:

  • Blood thinners (anticoagulants).
  • Aspirin.
  • Diabetes medications, especially metformin.

Testing

Ask your provider if you’ve completed or scheduled all of the required tests before your cardiac catheterization procedure. These may include some of the following:

  • Blood work.
  • Electrocardiogram (EKG).
  • Chest X-ray.
  • Echocardiogram.
  • Cardiac CT scan.
  • Heart MRI.
  • Stress test.

What to bring

Wear comfortable, easy-to-fold clothing on the day of your procedure and bring:

  • A family member with you to wait with you before the procedure.
  • A robe to wear as you wait for the procedure.
  • Toiletries and any other items you would like to make your stay more comfortable if you stay in the hospital after your procedure. Your family member can retrieve these items from your car when you need them. Leave all valuables at home or with a family member.
  • A list of your medications (including over-the-counter drugs) and dosages. When you arrive for your appointment, tell your provider if you’re taking warfarin (Coumadin® or Jantoven®), clopidogrel, diuretics (water pill) or insulin. Also remind the staff if you’re allergic to anything, especially iodine, X-ray dye, penicillin-type medications, latex or rubber products (such as rubber gloves or balloons).

What to expect before the test

The cardiac catheterization room is cool and dimly lit. Your healthcare provider has to keep the air cool to prevent damage to the X-ray machinery they use during the procedure.

  • You’ll change into a hospital gown and your provider will offer you warm blankets to make you more comfortable.
  • Your provider will start an intravenous (IV) line in your arm so you can receive medications and fluids during the procedure.
  • You’ll lie on a special table. If you look above you, you’ll see a large X-ray camera and several TV monitors. You can watch your cardiac cath on the monitors, but you must keep your head down so that you don’t bump into the camera accidentally.
  • Your provider will clean (and possibly shave) your skin at the site (arm or groin) where they’ll insert the catheter (narrow plastic tube).
  • Sterile drapes will cover the site and help prevent infection. It’s important that you keep your arms and hands down at your sides, under the sterile drapes.
  • Your provider will place electrodes (small, flat, sticky patches) on your chest. The electrodes attach to an electrocardiograph monitor (ECG), which monitors your heart rate and rhythm.
  • You’ll receive a mild sedative to relax you, but you’ll be awake and conscious during the entire procedure. For some cases which are very short, you may not receive a sedative, especially if your provider wants to take certain kinds of measurements such as pressure inside your heart chambers.
  • In some cases, you may need a urinary catheter during the procedure.

What to expect during the test

Once you and your healthcare team are ready, your cardiac catheterization begins.

What to watch for during your procedure

During your procedure, tell your provider if you feel:

  • An allergic reaction (itching, tightness in the throat, shortness of breath).
  • Nausea.
  • Chest discomfort.
  • Any other symptoms.

Cardiac catheterization procedure

  1. Your provider will inject a numbing medicine underneath your skin with a small needle. They’ll insert a plastic introducer sheath (a short, hollow tube through which they place the catheter) in a blood vessel in your arm, neck or groin. Then they’ll insert a catheter through the sheath and thread it to your heart’s arteries. You may feel pressure when your provider puts in the introducer sheath or catheter, but you shouldn’t feel pain. Tell your provider if you do.
  2. To help position the catheter, your provider may ask you to turn your head or take a deep breath and hold it for a few seconds.
  3. When the catheter is in place, your provider will dim the lights and inject a small amount of contrast material through the catheters into your arteries and heart chambers. The contrast material outlines the vessels, valves and chambers.
  4. When the contrast material goes into your heart, you may feel hot or flushed for several seconds. This is normal and will go away in a few seconds.
  5. Your provider will use an X-ray camera to take photographs of your arteries and heart chambers while the contrast is flowing through them. You may need to hold your breath while your provider takes the X-rays. When all the photos are done, your provider will remove the catheter and turn the lights on.
  6. The sheath has to be removed very carefully because pulling it out incorrectly can cause you to bleed. Your provider will ask you to keep as still as you can while they remove the sheath.

Interventional procedures (percutaneous coronary intervention or PCI)

With the ability to put other devices at the end of the catheter, your healthcare provider may combine an interventional procedure with your cardiac catheterization. An interventional procedure (also called angioplasty) is a nonsurgical treatment that opens narrowed coronary arteries to improve blood flow to the heart. Your provider can perform an interventional procedure during a diagnostic cardiac catheterization when they find a blockage, or they may schedule it after a catheterization confirms the presence of coronary artery disease (narrowing or blockage of your heart’s arteries). An angioplasty opens your coronary artery, increasing blood flow to your heart.

Interventional procedures include:

  • Balloon angioplasty.
  • Stent placement.
  • Rotablation, a special procedure to treat calcium deposits in arteries.
  • Intravascular lithotripsy, where a special balloon uses pressure waves to break up calcium.

What to expect after the test

Your healthcare provider will remove the catheters and sheath after your procedure.

If you had a catheter in your arm

  • They’ll bandage your puncture site.
  • You’ll need to keep your arm straight for at least an hour, but you’ll be able to walk around.
  • They’ll observe you for a few hours to monitor any symptoms or side effects of the procedure.
  • You’ll get instructions regarding how to care for your arm when you return home.
  • Tell your provider if you think you’re bleeding (wet, warm sensation) or feel any numbness or tingling in your fingers.

If you had a catheter at your groin

  • Your provider will close your puncture site with applied pressure, and sometimes a suture device or a “plug.” A plug is a material that works with your body’s natural healing processes to form a clot in your artery. This reduces the risk of bleeding.
  • You’ll need to lie flat and keep your leg straight for two to six hours to prevent bleeding (less time if they used a plug). Don’t raise your head more than 30 degrees (two pillows high). Don’t try to sit or stand until your provider tells you it is safe to do so.
  • They’ll place a sterile dressing on your groin area to protect it from infection. They’ll check your bandage regularly, but call your provider if you think you’re bleeding (have a wet, warm sensation) or if your toes begin to tingle or feel numb.

Cardiac catheterization recovery

  • You’ll need to drink plenty of liquids to clear the contrast material from your body. You may feel the need to pee more frequently. This is normal. If you’re on bed rest, you’ll need to use a bedpan or urinal.
  • Your provider will tell you if you’re able to return home or will need to stay overnight. In either case, they’ll monitor you for several hours after the procedure.
  • Before you go home, they’ll talk with you about your treatment, including medications, diet and future procedures. They’ll also talk about caring for your wound site, activity and follow-up care.

Going home

A responsible driver must drive you home. Your provider won’t discharge you unless you have someone available to drive you home.

If you have more than a two-hour drive home, you should stay overnight in a hotel for your comfort. Some hospitals have a medical concierge to help you make arrangements. Then have your family member drive you home the next morning after you have rested.

During your drive home, stop every hour and walk for five to 10 minutes. If you’re traveling home by plane, stand up to stretch your legs and walk in the aisle at least every hour.

Ask your healthcare provider when you can resume driving and exercising.

Instructions for going home after Cardiac Catheterisation

Care for the Catheter Insertion Site

Procedures are routinely performed in the radial artery in your arm (wrist) and may be in the femoral artery in the groin (in the area at the top of your thigh). When you go home, there will be a bandage (dressing) over the catheter insertion site (also called the wound site).

  • The morning after your procedure, you may take the dressing off. The easiest way to do this is when you are showering, get the tape and dressing wet and remove it.
  • After the bandage is removed, cover the area with a small adhesive bandage. It is normal for the catheter insertion site to be black and blue for a couple of days. The site may also be slightly swollen and pink, and there may be a small lump (about the size of a quarter) at the site.
  • Wash the catheter insertion site at least once daily with soap and water. Place soapy water on your hand or washcloth and gently wash the insertion site; do not rub.
  • Keep the area clean and dry when you are not showering.
  • Do not use creams, lotions or ointment on the wound site.
  • Wear loose clothes and loose underwear.
  • Do not take a bath, tub soak, go in a Jacuzzi, or swim in a pool or lake for one week after the procedure.

Activity Guidelines

Dr Ubaid will tell you when you can resume activities. In general, you will need to take it easy for the first two days after you get home. You can expect to feel tired and weak the day after the procedure. Take walks around your house and plan to rest during the day.

For radial cardiac cath

  • Do not participate in strenuous activities for 2 days after the procedure. This includes most sports – jogging, golfing, play tennis, and bowling.
  • Gradually increase your activities until you reach your normal activity level within two days after the procedure.

For femoral cardiac cath

  • Do not strain during bowel movements for the first 3 to 4 days after the procedure to prevent bleeding from the catheter insertion site.
  • Avoid heavy lifting (more than 10 pounds) and pushing or pulling heavy objects for the first 5 to 7 days after the procedure.
  • Do not participate in strenuous activities for 5 days after the procedure. This includes most sports – jogging, golfing, play tennis, and bowling.
  • You may climb stairs if needed, but walk up and down the stairs more slowly than usual.
  • Gradually increase your activities until you reach your normal activity level within one week after the procedure.

Ask your doctor when it is safe to

  • Return to work.
  • Resume sexual activity.
  • Resume driving. Most people are able to resume driving within 24 hours after going home.

Medications

  • Please review your medications with your doctor before you go home. Ask your doctor if you should continue taking the medications you were taking before the procedure.
  • If you have diabetes, your doctor may adjust your diabetes medications for one to two days after your procedure. Please be sure to ask for specific directions about taking your diabetes medication after the procedure.
  • Depending on the results of your procedure, your doctor may prescribe new medication. Please make sure you understand what medications you should be taking after the procedure and how often to take them.

Fluid Guidelines

Be sure to drink eight to ten glasses of clear fluids (water is preferred) to flush the contrast material from your system.

What type of results do you get and what do the results mean?

After completing your cardiac catheterization, your healthcare provider will have a lot of information they can use to figure out your next step in treatment. Depending on the reason for your heart catheterization, your results can vary.

Your provider may:

  • Find and fix a blockage in your coronary artery.
  • Diagnose you with a condition that requires surgery.
  • Send a tissue sample of your heart muscle to the lab for a biopsy.
  • Get the information they need to plan your heart transplant.
  • Find and repair a heart problem you’ve had since birth.
  • Find that your heart is working well after previous treatment and you don’t need additional treatment.

When should I know the results of the test?

Your healthcare provider may discuss your results with you right away. For something that takes more time, like a lab analysis of a tissue sample, it might take a few days to get results.

When should I call my healthcare provider?

Contact your healthcare provider if you have:

  • Fever.
  • Dizziness.
  • Pain, swelling, bleeding or discharge (yellow or green) from where the catheter went into your skin.
  • Chest pain.
  • Shortness of breath.
  • Abnormal heart rhythm.

If you feel you’re having a heart attack or stroke, get help right away.

Your kindness and good humour were very much appreciated and certainly put me at ease throughout the procedure, which on other ocassions has been quite daunting, your relaxed approach to my problem was very calm and professional.

What I valued as much as his erudition was his people skills, he related to everyone as an individual, his understanding, communications, interactions and personable nature were exceptional. Dr Ubaid was quite simply staggering, he is somebody that has had a significant impact on me, not just for giving me my life back and for his medical genius but for being the person that he is.

His presence radiates a warmth, he instils confidence in all those around him, he sets an example for others to follow and is a role model for others to aspire to be like. He was kind, courteous, professional, understanding, caring and highly approachable and relatable as well as the medical guru we all benefit from and rely on to give us our lives back.

In life we all need role models, if I was in training to be a doctor you would certainly fit that role for me. I thank you so much for what you have done to allow me to continue with my fitness regime and wish you well in the life ahead of you.

A great team player, all of the nursing staff are very happy to work with Salahaddin as he is polite, efficient, and has a great aura of calmness and competence and appreciates the time to be light-hearted.

In Dr Salahaddin Ubaid I had a medical genius who also contributed significantly to aiding me overcome all of the negative worries and emotions I was feeling. The care he provided to me, his attention to detail, his personal knowledge, expertise, experience and skills was outstanding.

Dr Ubaid works well with all the staff. His approach to his fellow workers is both patient and respectful. His easy going manner makes him very approachable to ask advice and he accommodates any delays graciously. I personally look forward to working with him.

Meet Dr Salahaddin Ubaid

General & Interventional Cardiology

Risk Assessment & Prevention Clinic

Sports Cardiology Clinic

Cardiac Rehabilitation Clinic