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Invasive Coronary angiography

What is Cardiac Catheterisation?

Cardiac catheterisation, also known as a coronary angiogram, is a medical procedure used to assess the health of your heart. It examines the coronary arteries (the blood vessels supplying oxygen to the heart muscle) and evaluates how well the heart's pumping chambers and valves are functioning. This test is typically performed by a cardiologist (a heart specialist).

Your doctor has recommended a cardiac catheterisation, but it is your choice whether to proceed. This document provides detailed information about the benefits, risks, and alternatives to help you make an informed decision. If you have any unanswered questions, please consult your doctor or healthcare team.

Benefits of Cardiac Catheterisation

This procedure helps your doctor gather essential information about your heart that other tests may not provide. It is often recommended to investigate or address the following concerns:

Narrowed or blocked coronary arteries: These can lead to angina or a heart attack due to a condition called atherosclerosis, where fatty deposits build up inside the arteries. If necessary, your cardiologist might treat the narrowed or blocked artery during the procedure through a process called percutaneous coronary intervention (PCI). Additional information will be provided if a PCI is needed.
Damaged or faulty heart valves: Heart valves regulate blood flow through the heart. If they narrow or leak, it can strain the heart.
Weak heart muscle: This can result in breathlessness or swelling in the legs, often caused by problems with the heart's arteries, valves, or muscle itself.

By undergoing cardiac catheterisation, your doctor can better determine the most appropriate treatment for you.

Alternatives to Cardiac Catheterisation

While other tests, such as exercise tests and scans, carry fewer risks, they may not provide sufficient information for your doctor to determine the best course of treatment.

What Happens If You Choose Not to Have the Procedure?

If you decline the cardiac catheterisation, your doctor may suggest alternative tests to evaluate your heart. However, if your treatment plan involves procedures such as bypass surgery, valve repair, or coronary interventions like angioplasty or stenting, a cardiac catheterisation is usually required beforehand. It’s important to discuss this with your doctor to fully understand your options.

Procedure Overview

Before the Procedure:

You may need blood tests, an ECG (electrocardiogram), or a chest X-ray beforehand.
If you are a woman of childbearing age, a pregnancy test may be required, as X-rays can harm an unborn baby.
Inform your cardiologist if you take blood-thinning medications (e.g., warfarin or clopidogrel) or diabetes medication containing metformin.
Follow fasting instructions as directed. You may be allowed to drink water up to two hours before the procedure.

During the Procedure:

The procedure takes about 30 minutes, during which you'll lie on your back.
A local anaesthetic will numb the area where the catheter is inserted (typically the wrist or groin).
A long, narrow plastic tube (catheter) is guided through your artery to the heart using X-rays. A contrast dye is injected to highlight any narrowed or blocked arteries.

After the Procedure:

You'll rest in the recovery area for up to four hours.
Most patients can go home the same day but should have someone accompany them.
Avoid driving, operating machinery, or performing strenuous activities for at least 24 hours.

Risks and Complications

While the procedure is generally safe, there are potential risks, including:

Minor bleeding or bruising at the catheter site.
Rare risks such as heart attack, stroke, severe bleeding, or infection (less than 1 in 1,000).
Possible complications related to the contrast dye, such as allergic reactions or kidney damage.

Your healthcare team will take precautions to minimise these risks and will address any complications promptly.

Recovery and Lifestyle Considerations

Avoid heavy activities and hot baths for a few days after the procedure.
Maintain a healthy lifestyle by quitting smoking, eating a balanced diet, exercising regularly, and managing your weight.

Your doctor will provide the test results and discuss any necessary follow-up or treatment.

Summary

Cardiac catheterisation is a valuable tool for diagnosing and treating heart conditions. While complications are rare, understanding the benefits and risks is important in making an informed decision. If you have any concerns or need clarification, speak with your doctor or healthcare team.

Coronary Angioplasty (Stent Insertion) - August 2021

What is a Percutaneous Coronary Intervention (PCI)?

A Percutaneous Coronary Intervention (PCI) is a medical procedure used to alleviate symptoms of coronary artery disease, which occurs when the coronary arteries (blood vessels supplying oxygen to the heart) become narrowed.

PCI involves using a small inflatable balloon to widen or unblock an artery. Often, a stent (a metal mesh tube) is inserted to keep the artery open. This procedure is typically conducted following a cardiac catheterization, which diagnoses coronary artery issues.

A PCI is performed by a cardiologist, but the decision to undergo this procedure is ultimately yours. This document provides detailed information about the benefits, risks, and alternatives to help you make an informed choice. For further questions, consult your cardiologist or healthcare team.

Benefits of a PCI

Improved Blood Flow: PCI enhances blood circulation without the need for open-heart surgery.
Pain Relief: It often reduces or eliminates chest pain (angina) and can improve breathing in cases of blocked or narrowed arteries.
Emergency Use: During or after a heart attack, PCI can extend life expectancy and reduce the risk of subsequent heart attacks.
Medication Management: While effective alongside medication, PCI may allow for reduced reliance on some drugs.

Alternatives to a PCI

Coronary Bypass Surgery: Suitable for some cases, this surgical option has a longer recovery time but may offer lasting results and reduced need for future procedures, especially for patients with diabetes or multiple blockages.
Medication: Symptoms can be managed with medications designed to relieve discomfort and prevent disease progression.

What Happens If You Decline a PCI?

Your angina may remain stable for years with proper medication, but without a PCI:

Symptoms may worsen over time.
There is an increased risk of recurrent heart attacks, particularly after a recent heart attack or episode of unstable angina.

Procedure Overview

Pre-procedure Preparation:

You may need tests such as blood work, ECG, or chest X-ray.
Inform the healthcare team if you might be pregnant, as X-rays can harm unborn babies.
Notify your cardiologist if you take blood-thinning medications or diabetes treatments.
Avoid eating for six hours prior to the procedure; you may drink water up to three hours before.
A needle will be inserted in your arm or hand for administering medications.

During the Procedure:

Performed in an X-ray room, a PCI typically lasts 30 minutes to two hours.
You will lie on your back. A sedative or painkiller may be provided to help you relax.
Local anesthesia will numb the area where the sheath is inserted (radial or femoral artery).
Using X-ray guidance, a catheter is advanced to the coronary artery. Dye is injected to locate blockages.
A balloon and stent are used to open the artery.
After the procedure, the catheter and sheath are removed, and pressure is applied to the insertion site to minimize bleeding.

Post-procedure Recovery:

Rest in a recovery area for up to four hours.
Most patients can go home the same day or the next, provided they have someone to accompany them.

Potential Complications

During or Shortly After the Procedure:

Common: Bruising at the insertion site (fades in about three weeks), minor bleeding.
Less Common:
- Infection (1 in 100).
- Internal bleeding (1 in 200).
- Blood clots or nerve damage at the sheath site.
- Allergic reactions to dye or medications.
- Radiation exposure (minimal increased cancer risk).
- Heart rhythm changes, kidney damage, or stroke.

Late Complications:

Restenosis: Artery narrowing again (4 in 100 cases).
Stent Thrombosis: Blood clots in the stent (1 in 100 cases).

Recovery Guidelines

Avoid legal document signing, alcohol consumption, and strenuous activities for at least 24 hours.
Follow instructions for medication, particularly blood thinners.
Report persistent bleeding or swelling to your healthcare team immediately.

Lifestyle Recommendations:

Stop smoking to improve long-term health.
Maintain a healthy weight and exercise regularly (consult your doctor before starting).
Manage high blood pressure and cholesterol with prescribed medications.

Summary

PCI is a safe and effective treatment for coronary artery disease, improving symptoms and quality of life. Understanding the potential complications and benefits allows you to make an informed decision. Your healthcare team is available to support you throughout the process.

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