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Angiogram Information

The Angiogram

The angiogram is a diagnostic procedure involving the insertion of a catheter into the femoral or radial artery via a tiny incision approximately 2-3 mm under a local anaesthetic, to insert a dye which, under a fluoroscope (an x-ray showing the arteries on a screen), will show the coronary arteries and indicate any narrowings.  This will allow your Consultant to determine the best possible treatment, if any, to alleviate/manage your symptoms.  The procedure should take approximately 20 minutes.
Reference: Eido Healthcare

Angiography Pre-Assessment

Janet Raffel in the waiting list office will contact you to arrange an appointment.  Should you have any queries relating to an appointment, Janet can be contacted on 01245 514605.
The purpose of the pre-assessment is to meet our patients, gain important information to ensure we provide the best possible service, identify any special needs and give our patients the opportunity to ask any questions they may have.

The Pre-Assessment Clinic

You will need to bring your medication/list of medication to clinic with you.
The nurse will advise which medications to stop prior to the procedure.

You will be asked if you have any allergies or sensitivities and whether you are allergic to Contrast Dye, which is injected into the arteries.   Please inform the nurse if you are sensitive to, or have an allergy to shellfish, as this could indicate an allergy to the dye.

All patients will be given a blood form and will be required to take this directly to the phlebotomy department for bloods to be taken following their pre assessment.

All patients are routinely swabbed for MRSA prior to admission.

You will be asked various simple questions to give vital information to ascertain your previous medical history and current medical condition as well as questions relating to your social/home life to highlight any problems/special requirements.

During this assessment it may be detected that for a variety of reasons it may not be possible or beneficial to gain access via the preferred radial route (through the wrist)  In this instance it may be possible to gain access via a femoral artery (through the groin).  This is a common route.

It is a legal requirement to obtain written consent prior to carrying out an Angiogram.  The nurse will fully explain the procedure, the benefits and possible complications to you, prior to obtaining your signature on the consent form.

Consent

The Procedure: Coronary Angiogram
The Intended benefits: To examine the coronary arteries to determine further treatment
Serious or frequently occurring risks:
 a).  1 in 1000.  Infection, Allergic Reaction, Nerve Damage, Blood Vessel Damage,   Kidney Damage, Death, (a national statistic),Heart Attack, Stroke.
 b).  1 in 10. Bruising, Bleeding, Haematoma, Angina, Arrhythmia.
 c). Surgical Intervention : Coronary Artery Bypass Graft/Percutaneous    Transluminal Angioplasty
You will need to sign the consent form for the procedure to go ahead.
(Reference – British Heart Foundation 18/08/11 bhf.org.uk).

If the results show you need to be referred for balloon and stents (opening of a narrowed artery), or a coronary artery bypass graft you will be referred to a tertiary centre, possibly Basildon, at a later date.

If during the procedure it becomes necessary to refer you for a surgical procedure such as coronary artery bypass graft or stents as an emergency, you will be sent directly to the CTC at Basildon or you may, if deemed necessary, have the procedure carried out in the unit.

Please be assured that in the rare event of a complication or emergency, the staff in the Unit are fully trained and equipped to deal with all such events.

You will be required to consent to such procedures (should they become necessary) during your assessment. 
You will have your blood pressure, pulse and oxygen saturation (a small probe placed on a finger) taken.  Have your weight and height recorded, an ECG recorded, a swab taken (to help assist with infection control) and the pulses checked in your groin and feet (to ensure a good blood flow). Those undergoing a radial approach will have the blood flow to their hand checked by the nurse.

We will ask you your medical history (if you could come to your assessment equipped with this information, it will speed up the pre-assessment process). 

You will be asked to find your own transport to bring you to the hospital for your procedure and take you home again. If you are unable to make your own way there please advise the nurse.  We respectfully request that hospital transport is only requested where absolutely necessary.

You will be given a special liquid soap to use for seven days prior to your admission – full instructions will be given via a leaflet during your assessment*.  This is to help reduce the risk of any possible infections such as MRSA.  As you will see from the Infection Control details of the Unit, we have NO reported cases of MRSA.
*(Reference: Authors -Infection Prevention Team. Department - Infection Prevention (Mid-Essex Hospitals - Broomfield. Published 2010

You may be asked to shave your groin where you can feel the pulse.  A small area approximately 5cms diameter (2 inches), if it is thought a femoral artery route I preferred.

You will be asked to have a light, early breakfast at 06.00hrs (6am) after which clear fluids should be taken until arrival at the unit. You will need to remain nil by mouth until after the procedure.

If you are hard of hearing and feel that a Personal Listener device would be of benefit to you (it is not necessary to have loop on your hearing aid), please advise the nurse during your pre assessment.

Please leave all jewellery at home (except wedding rings which can be taped) and do not bring any valuables into hospital with you.  It is Mid-Essex Hospitals Trust Policy that we cannot accept responsibility for valuable items.  Every effort is taken to ensure the safety of personal items.  However, once again, we cannot be responsible for the loss or damage to ANY belongings.

Mobile phones must be left on silent at all times and it is not possible to receive a signal in the unit due to the lead lining of the walls.

Make-up should not be worn and nail polish should be removed.

Please note it is not possible for friends/relatives to enter the Unit on your arrival. For infection control reasons entry into the unit is limited to strictly a `need only’ basis.

We are unable to discuss the procedure and/or results over the telephone with relatives due to confidentiality, but will be happy to answer any questions when you are being collected.  (Relatives are permitted to enter the unit when collecting their relatives as procedures are normally finished at this point).

Relatives/friends collecting are advised to turn left on the roundabout, (first exit) and continue passed the main hospital entrance.  After the multi storey car park there is a right turn.  Take this turning and park close to the Chemotherapy Day Unit and Assessment Unit.  LEAVE YOUR HAZARD LIGHTS ON.  Enter through this outer doorway, follow the corridor and turn left.  Follow the walk way until you reach 210 ‘The Cardiac Dept’.  Report to reception and a nurse will escort your relative out to you.

During your assessment you will be given an allocated time to arrive at the unit.  Please take a seat in the Cardiac Centre reception area where we will collect you.

In the case of radial approach angiograms it is strongly recommended you arrange to have a responsible adult with you at ALL times for the 24 hours following your procedure.  This includes overnight.  If this is deemed a problem please discuss this with the nurse during your pre-assessment.  In the case of femoral approach angiograms, you MUST have another person present to call for immediate assistance in case of an arterial bleed.  If it is not possible for you to have an adult with you at all times, it may be necessary for you to stay over-night in hospital.   However, for your own comfort and due to bed demand, we ask that you make every effort to avoid an overnight stay.  (Please note that if an overnight bed is required, it is possible, that on the day of your admission, your procedure may be cancelled if a bed is not available).

The Day of your procedure

When you arrive at the unit you will be shown to your allocated bed space.  You will remain dressed until just before entering the procedure room. (You will undress removing just the top half of your clothing in an allocated space opposite the room). A basket will be provided to store your belongings). You will be asked to wear a hospital gown which ties at the back.  You will be fully dressed prior to leaving the procedure room in the case of radial approach angiograms. In the event that you need to return to your bed space on a trolley, you will be covered at all times). Curtains are left around the bed when we have mixed gender on the ward.  We make every effort to ensure your dignity is maintained at all times.

When you are comfortable in the chair a nurse will take your observations (blood pressure, pulse, temperature, oxygen saturation) and ask various questions to prepare you for your procedure.  Small crosses will be put on your feet in the case of femoral approach angiograms.  This is to mark your pedal pulses which are used following the procedure to check you have a good blood flow to the feet.  Your groin will be checked to ensure it has been shaved sufficiently (this avoids infection).  In the case of radial approach angiograms, a very small area of your wrist may be shaved. 

A cannula (a small plastic tube), will be inserted into your hand/arm in order that any medication needed during the procedure can be given quickly and efficiently). 

We will ask contact details of the person taking you home.

The nurses will check your blood results.  This is an ideal opportunity to check on your cholesterol levels etc.
You will be seen by a doctor prior to your procedure.

Depending on your blood results you may be given fluids through the cannula prior to the procedure.  This is to protect your kidneys and is purely precautionary, and quite common.

If an allergy to Iodine is detected you will be given antihistamine cover.  Again this is purely precautionary.

The Procedure

The procedure room is adjacent to the recovery area.

You will be advised to visit the toilet just before you enter the procedure room as you could be unable to mobilise for up to approximately 4 hours.

You will walk into the procedure room with one of the nurses and asked to lie on the couch.  Arm rests will be put in place for your comfort.  We will make every effort to make you as comfortable as possible however please note it is necessary to keep the room at a certain temperature due to the equipment present which may prove to some patients to be rather cool.  It is also necessary for you to lie flat.

As mentioned previously, you will notice the staff will be wearing protective jackets and skirts.  This is purely for the protection of the staff as due to number of hours spent in the lab (procedure room) it is necessary to avoid radiation from the equipment).

There will be a number of staff present in the room.

The Consultant 
The Doctor performing the procedure
2 nurses
Radiographer
Cardiac Physiologist
Please note

There may be other members of staff in the room in a learning capacity.  You have every right to object to this if you wish.

The staff will introduce themselves to you and various checks will be carried out (such as name, date of birth etc).  These checks may seem repetitive but this is purely precautionary and for your protection.

You will be attached to a cardiac monitor in order that you can be monitored throughout the procedure.
The scrub nurse will commence by cleaning the area around the radial/femoral artery on your wrist/groin with iodine.  This is cold!  You will be asked to keep your hands and head down at all times to maintain the sterile area.  (If you have a problem i.e. itchy nose, need to cough etc, just let the nurse know).  A sterile drape will be placed over your entire body other than your face, head and wrist/groin.

The doctor will insert a local anaesthetic into the area.  As with all local anaesthetics, this will sting.
Once the anaesthetic has taken effect a very small incision (approximately half a centimetre – 1/8th of an inch) is made in the wrist/groin.  An introducer is inserted followed by a sheath into the area.  The catheters pass through this and sit just outside the heart where the dye is injected.  Images are taken of the left and right coronary arteries and sometimes a third catheter is inserted to check the pumping chamber (left ventricle) of the heart. (It is commonly necessary to use different catheters as every one of us is unique and different sizes and shapes of catheter may be necessary).

You will experience different sensations in the chest.  You should remain pain free.  However it is not uncommon for some discomfort in the chest.  This is purely the dye.  We ask you to let us know so that we can give you medication to relieve this if necessary.  Please be assured that you are very closely monitored throughout the procedure.  The last set of pictures taken may require a larger amount of dye than the previous two and for this reason you may experience a hot flush feeling with a strange sensation in the mouth and throat.  You may feel as though you have passed water but please be assured this is only a sensation – you will not pass urine.  This hot flush feeling only lasts a few seconds – it is simply the dye going around the body and you will be informed when/if it is likely to happen.

Some patients may be having graft studies.  This is simply taking the opportunity to check that any previous stents/grafts etc are still patent (the blood is free flowing through the artery).

Once all the images have been obtained, the nurse will remove the drape and clean the iodine off the area.  Again this will be cold.  You may/may not experience shivering at this stage.  This is simply due to the fact that you have experienced a hot flush and are then exposed to the cold air.  We make every effort to cover you up and keep you as comfortable as possible.  If a radial approach has been used, you will have a band fitted to your wrist into which approximately 10-15mls of air is inserted.  This is to prevent any bleeding.  The tabs from the cardiac monitoring are removed and you will be sat up, dressed and walked back to your bed space.  In the case of femoral approaches your bed will be brought in, and you will be slide over to the bed (we ask that you do nothing at all to help us, but just keep your head down and leg as straight as possible).  You are then taken back to your bed space.
You are given your results as quickly as possible.  The consultant will study the images and speak to you as soon as he/she is able.  This may be in the lab or when you are back in recovery.

The recovery period is usually 2-4 hours following the procedure depending on the route and how the puncture site was closed.
On return to recovery you will be attached to a monitor which will record your heart rhythm and observations (blood pressure, pulse etc.)
Radial approach angiograms
The monitor will be set to automatically record your observations every 15 minutes.  You will be given a call bell and asked to press it when the blood pressure cuff on your arm tightens.  This is to alert the nurse who will then remove 2mls of air in the band on your wrist and record your observations. 
Tea, coffee and refreshments will be offered. 

We will encourage you to drink plenty of fluids.  It is necessary for you to drink a litre of water before discharge.
During this time we will go through your post procedure care.  However, we find that some of our patients are inclined to forget, therefore you will also be given this information in written form on discharge. 

Once all the air has been removed from the band, we will contact your family/friend and give a time for your collection (We must point out that results cannot be given over the telephone).   There will be approximately a one hour notice for your collection.  However should it be necessary to obtain any medication from pharmacy, there may be a short delay).

Your lift will need to be available all day to collect you as it is extremely difficult for us to give an indication of what time you will be ready for discharge.  

Your comfort is important to us.  If you have any requirements, please let us know.
When all the air has been removed your family/friend will be contacted to arrange collection.

Femoral approach angiograms

The monitor will automatically record your blood pressure every two minutes until we are satisfied that we have prevented any arterial bleeding.  Your heart rate and rhythm will also be recorded.  Once satisfied your observations are within limits the nurse will remove the sheath in your groin.  This is a completely painless procedure.  However, you will feel the nurse pressing on your groin for approximately 10 minutes.  This is uncomfortable for some and not for others.  We do everything we can to cause as little discomfort as possible.
During this time we will go through your post procedure care.  However, we find that some of our patients are inclined to forget, therefore you will also be given this information in written form on discharge.                

Once we have managed to achieve haemostatis (stopped/prevented any bleeding) you will be given water to drink, the observations will be reduced to every 15 minutes for the next hour and you will be advised not to lift your head (this causes pressure on the groin and can cause bleeding), and instructed not to lift, move or bend the leg.  You will also be advised to rest and try to nap for the following hour during which time we will be returning to you every 15 minutes to check the site and record your observations. You will also feel us checking the pulses in your feet and offering sips of water.

Presuming there has been no bleeding after one hour you will be able to sit up and be offered tea, coffee, toast etc.  We will encourage you to drink plenty of fluids.  It is necessary for you to drink a litre of water before discharge.
You will need to be on bed rest for a further two hours.  Your observations being recorded half hourly for the next hour and once an hour thereafter.  (we suggest you bring in a book, I pod etc) after which time, presuming there has been no bleeding or complications, we will get you up and dressed and sat in a chair at which point we will contact your family/friend and give a time for your collection (We must point out that results cannot be given over the telephone).   There will be a one hour notice for your collection.  However should it be necessary to obtain any medication from pharmacy, there may be a short delay).

Your lift will need to be available all day to collect you as it is extremely difficult for us to give an indication of what time you will be ready for discharge.

All Patients

You will be seen by a specialist nurse before your discharge to discuss the angiogram and any recommended procedures.  If patients have any problems with regards to hearing and/or retaining information, you are welcome to have a relative present at the time you are seen.  Please advise the nurse on admission if you feel this is necessary.

Written information on your aftercare, any information given by the specialist nurses (also known as the cardiac rehabilitation team) any medication and the letter for your GP etc, will all be given to you on discharge.
Please note that booklets are available on a wide range of medical conditions/procedures/health education etc, produced by the British Heart Foundation.  These are free of charge so please feel free to take any you feel may be of interest. (available at reception).

You will receive any out-patient appointments in the post following the angiogram.

The Angio Team are fully aware that this is an anxious time for not only yourself, but also your family.  We are happy to discuss any concerns you or your family may have in the pre assessment clinic.

Information to ensure a good recovery following a RADIAL approach

Following  the Angiogram (usually during the period the nurse is removing the sheath and  preventing bleeding), we will give you all the necessary information to ensure a good recovery.  The following points will be made.
a). Do not use the arm for 48 hours. No bending, no lifting, no carrying any bags with the affected arm. You will need assistance to put on shoes, socks, pants etc.  When you get home you need to rest.
b). You will be required to drink plenty of water (preferably in addition to tea and coffee) before leaving  the Angio Suite and a plenty of water before going to bed that night and a few days after.  This is due to the fact that the dye is not very kind to the kidneys and you need to flush it out of your system as quickly as possible. Frequent sips are better than gulping the water down.  It is also important that you ensure you are passing out the same amount you are taking in).  The dye is clear and will not be seen in urine.  Headaches and visual disturbances are common side effects of the dye and will be alleviated by taking more fluids.  A patient with Diabetes may need to have a blood test following their procedure. (To ensure their kidneys are working efficiently). 
c). Baths and showers should be avoided for 48 hrs following the procedure as the site needs to be kept dry for this time and when taking the first bath or shower you should ensure the water is tepid (not too hot and not too cold).
d). You will not be able to drive for 48 hours following the angiogram.
e). You should not have any problems following the angiogram but the following may occur.
i).  Bruising.  This can be very black but is nothing to worry about.
ii).  Haematoma.  You may experience a lump or swelling in the wrist.  This is likely to be a haematoma which is a build up of blood underneath the skin.  It is not dangerous.  It is simply blood escaping from a blood vessel and building up underneath the skin.  However, if not dealt with quickly it can be very painful and take a very long time to resolve.  If a swelling is noticed whilst in hospital inform the staff immediately.  If at home, press very firmly on the area for 10 minutes gently massaging the area towards the end of that time and the blood should disperse into the tissue and be absorbed.  If you are unable to disperse the haematoma or are at all concerned, please contact your GP or give the Angio Suite a ring and we will be happy to advise you.
iii).  Bleeding.  Spotting is quite normal.  It is just capillary blood from the tiny incision.  However, should there be heavy bleeding, especially if the blood is pumping from the incision site, the likelihood is that the artery has unsealed itself.  Should this happen, do not panic!  Simply press as firmly as you can on the pulse in the wrist.  If you cannot stop the bleeding ask the person with you to call 999.  (This is the reason we recommend you have a person with you).
f). A copy of your results will be given to you to drop off at your GP’s surgery in order to ensure that the inform is received.  A detailed letter is sent in the days following.
g). Whether the results are negative or you require any procedures to be undertaken, you will be seen by Anne Karabardak or Louise Cohen, our Cardiac Specialist Nurses, who go through the results with you once you have had time to recover.  This is a very thorough explanation giving full details of any procedures recommended as well as giving health education.  If you would like a member of your family/friend to be present when this information is given, please notify your nurse after the procedure.  However, they will need to park the car in the car park as this can take some time.  This can be arranged when given a time for collection.

The nursing staff will contact your relative/friend an hour before you are ready for discharge.

Collection Directions/Instructions

Turn left on the roundabout, (first exit) and continue passed the main hospital entrance.  After the multi storey car park there is a right turn.  Take this turning and park close to the Chemotherapy Day Unit and Assessment Unit.  LEAVE YOUR HAZARD LIGHTS ON.  Enter through this outer doorway, follow the corridor and turn left.  Follow the walk way until you reach A210 ‘The Cardiac Dept’.  Report to reception and a nurse will escort your relative out to you.

Instructions for recovery/Discharge information
Precise Information given on a leaflet on discharge

After your recovery you will be ready to go home.  You must be collected by car.  Do not use public transport.
On reaching home, lie on a couch or bed and remember not to use your arm. 
• Keep the puncture site dry.
• Ask someone to remove your shoes and socks etc when undressing/dressing. 
• You will need to have someone to stay with you for the first 24 hours and you should not have a hot bath/shower for 24 hours.  You must not drive for 48 hours.
• You should not return to work or do any heavy lifting or strenuous exercise for 48 hours.
You will be informed of any changes to your medication before discharge and you will be told how to care for your wound site prior to discharge.
If you have any concerns following your discharge, please contact the cardiac angiography suite on 01245 514418 from 08.00 hrs to 19.00 hrs.  If you have any concerns after this time please contact your GP.
The Cardiac Rehabilitation team are happy to answer any concerns post angiogram on 01245 516376.
If any bleeding occurs at home, apply 3 fingers to the wound site.  If severe bleeding occurs do not hesitate to dial 999.

Information to ensure a good recovery following a FEMORAL approach

Following the Angiogram (usually during the period the nurse is removing the sheath and preventing bleeding), we will give you all the necessary information to ensure a good recovery.  The following points will be made.
a). Keep the leg straight. No bending, no lifting, no carrying any bags. You will need assistance to put on shoes, socks, pants etc.  When going home ensure the car seat is pushed back and the leg kept straight out in front.  When you get home you need to be on bed rest – this means you put the leg up on the sofa (or go to bed) and stay there for the rest of the day, only getting up to go to the toilet.  If you laugh, cough or sneeze, place your hand on your groin and press firmly where you can feel the pulse.  This is to support the artery and prevent a haematoma/bleeding, (a collection of blood underneath the skin).
b). You will be required to drink plenty of water (preferably in addition to tea and coffee) before leaving  the Angio Suite and before going to bed that night and a few days following.  This is due to the fact that the dye is not very kind to the kidneys and you need to flush it out of your system as quickly as possible. Frequent sips are better than gulping the water down.  It is also important that you ensure you are passing out the same amount you are taking in).  The dye is clear and will not be seen in urine.  Headaches and visual disturbances are common side effects of the dye and will be alleviated by taking more fluids.  A patient with Diabetes may need to have a blood test following their procedure. (To ensure their kidneys are working efficiently). 
c). Baths and showers should be avoided for 24hrs following the procedure and when taking the first bath or shower you should ensure the water is tepid (not too hot and not too cold).
d). You will not be able to drive for 48 hours following the angiogram.
e). You should not have any problems following the angiogram but the following may occur.
i).  Bruising.  This can be very black, up to the hip and down to the knee but is nothing to worry about.
ii).  Haematoma.  You may experience a lump or swelling in the groin.  This is likely to be a haematoma which is a build up of blood underneath the skin.  It is not dangerous.  It is simply blood escaping from a blood vessel and building up underneath the skin.  However, if not dealt with quickly it can be very painful and take a very long time to resolve.  If a swelling is noticed whilst in hospital inform the staff immediately.  If at home, press very firmly on the area for 10 minutes gently massaging the area towards the end of that time and the blood should disperse into the tissue and be absorbed.  If you are unable to disperse the haematoma or are at all concerned, please contact your GP or give the Angio Suite a ring and we will be happy to advise you.
iii).  Bleeding.  Spotting on the pants is quite normal.  It is just capillary blood from the tiny incision.  We do not use dressings as research has shown that this can encourage infection, (due to the nature of the site). However, should there be very heavy bleeding, especially if the blood is pumping from the incision site, the likelihood is that the artery has unsealed itself.  Should this happen, do not panic!  Lie on the floor and press as firmly as you can on the pulse in the groin whilst the person with you calls 999 after which they need  take over pressing as it is unlikely you will be able to put enough pressure on lying down to stop an artery bleeding.  It is EXTREMELY unlikely this will happen, but if it did you would not get to the telephone in time to get assistance yourself.  (This is the reason we insist you have a person with you).
f). A copy of the results of your angiogram will be given to you for you to drop off at your GP’s surgery in order to ensure that the information is received. A detailed letter will be sent in the days following.
g). Whether the results are negative or you require any procedures to be undertaken, you will be seen by Anne Karabardak or Louise Cohen, our Cardiac Specialist Nurses, who go through the results with you once you have had time to recover.  This is a very thorough explanation giving full details of any procedures recommended as well as giving health education.  If you would like a member of your family/friend to be present when this information is given, please notify your nurse after the procedure.  However, they will need to park the car in the car park as this can take some time.  This can be arranged when given a time for collection.
The nursing staff will contact your relative/friend an hour before you are ready for discharge.

Collection Directions/Instructions
Turn left on the roundabout, (first exit) and continue passed the main hospital entrance.  After the multi storey car park there is a right turn.  Take this turning and park close to the Chemotherapy Day Unit and Assessment Unit.  LEAVE YOUR HAZARD LIGHTS ON.  Enter through this outer doorway, follow the corridor and turn left.  Follow the walk way until you reach A210 ‘The Cardiac Dept’.  Report to reception and a nurse will escort your relative out to you.
Instructions for recovery/Discharge information
Precise Information given on a leaflet on discharge

After your recovery you will be ready to go home.  You must be collected by car.  Do not use public transport.  Sit in the front passenger seat in a reclining position or alternatively in the back with your leg raised.
• On reaching home, lie on a couch or bed, keeping your leg as straight as possible. 
• Keep the puncture site dry.
• Do not bend down. Ask someone to remove your shoes and socks. 
• When going up and down stairs keep your leg as straight as possible and keep your hand firmly on the puncture site.
• You will need to have someone to stay with you for the first 24 hours and you should not have a hot bath/shower for 24 hours.  You must not drive for 48 hours.
• You should not return to work or do any heavy lifting or strenuous exercise for 48 hours.
You will be informed of any changes to your medication before discharge and you will be told how to care for your wound site prior to discharge.
If you have any concerns following your discharge, please contact the cardiac angiography suite on 01245 514418 from 08.00 hrs to 19.00 hrs.  If you have any concerns after this time please contact your GP.
The Cardiac Rehabilitation team are happy to answer any concerns post angiogram on 01245 516376.
If any bleeding occurs at home, apply flat hand pressure to the wound site and lie flat.  Make arrangements to go to your local A & E as soon as possible.  If severe bleeding occurs do not hesitate to dial 999.

Possible Treatment Options

Depending on the result of your angiogram there are 3 main treatment options:
1). Medication
 The problem in your arteries does not require intervention or surgery, therefore it can be treated with tablets.
National Institute for Health and Clinical  Excellence. Mid City Place, 71 High Holborn, London, WC1V 6NA: www.nice.org.uk. 2011.
NICE Clinical guidelines 126 Issue date July 2011

2). Angioplasty or stent
The narrowing in your arteries can be treated by a balloon procedure (PCI).  This is also known as an angioplasty.  This is similar to the angiography procedure.  However, instead of just passing dye; a fine balloon is inserted into the catheter and passed into the arteries.  The balloon is inflated to widen the narrowing.  Usually a small metal mesh (called a stent) is placed inside the artery to keep the artery open after it has been widened.  Some patients experience angina pains through this procedure, but it should not last long.
Are there any risks?
During the angioplasty procedure there is a small risk of a heart attack occurring (1-2 patients per 1000 cases) – Nowadays, less than 1 in every thousand patients require emergency heart surgery as a result of this procedure.

References:

British Heart Foundation. A registered Charity No 225971. Registered as a Company limited by guarantee in England and Wales. Registered office at Greater London House, 180 Road, London NW1 7AW. Registered as a Charity in Scotland.
Eido Healthcare 
National Institute for Health and Clinical  Excellence. Mid City Place, 71 High Holborn, London, WC1V 6NA: www.nice.org.uk. 2011.

3). Coronary Artery Bypass Graft
 Some patients may require heart surgery.  This is known as a coronary artery bypass graft.  If surgery is required your consultant will refer you to a cardiac surgeon who will be able to discuss this procedure and any risks involved in detail.
The PCI and coronary artery bypass grafts cannot be carried out at Broomfield Hospital.  Hospital Choice will be discussed with you on the day.

References

British Heart Foundation. A registered Charity No 225971. Registered as a Company limited by guarantee in England and Wales. Registered office at Greater London House, 180 Road, London NW1 7AW. Registered as a Charity in Scotland.
Eido Healthcare 
National Institute for Health and Clinical  Excellence. Mid City Place, 71 High Holborn, London, WC1V 6NA: www.nice.org.uk. 2011.

 

4). Thallium Scan
   A Thallium Scan is a method of examining the heart to obtain information about the blood supply to the heart.  In the scan special cameras take a series of pictures of the heart.  Radioactive Thallium is injected into the bloodstream and serves as a tracer.  The tracer attaches to certain cells and makes them visible to the special camera.  If an area of the heart does not receive an adequate flow of blood, it appears as a darker area on the picture.
It will be necessary to exercise on a treadmill or alternatively receive medication to stimulate the heart.
References
British Heart Foundation. A registered Charity No 225971. Registered as a Company limited by guarantee in England and Wales. Registered office at Greater London House, 180 Road, London NW1 7AW. Registered as a Charity in Scotland.
Eido Healthcare 
National Institute for Health and Clinical  Excellence. Mid City Place, 71 High Holborn, London, WC1V 6NA: www.nice.org.uk. 2011.

Rehabilitation following your Intervention

Following your cardiac surgery or stent insertion, the cardiac rehabilitation teams at your local hospital will offer you the opportunity to attend a rehabilitation course to support you through the rehabilitation phases of your recovery and meet both your physical and psychological needs.
For patients under the care of Dr Turner, Dr Clesham and Dr Gamma there are currently three courses available consisting of 12 sessions over a 6 week period.  These are held at Broomfield and St Peter’s in Maldon (days and times will be confirmed if and when required).
Contact the rehabilitation office to attend the rehab course on 01245 516376.  If no one is in the office, please leave a message on the answer phone and your call will be returned.

We look forward to welcoming you/your relative to the Angio Suite and hope this information has given you sufficient insight into the procedure you/your relative will be undertaking in the near future.  (This electronic information is in addition to the written and verbal instructions/information our patients are given).  However if you have ANY queries regarding the procedure, please do not hesitate to contact us on 01245 514418