The Angiography Suite
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The County Hospital has its own Angiography Suite where cardiac diagnostic tests, heart pacing and the fitting of pacemakers are carried out. The Suite has its own dedicated staff, which assists the doctor and takes care of patients during their visit. It is managed by the heart and lung department.
Coronary Angiography is a special x-ray of the coronary arteries. The coronary arteries do not show up on a plain x-ray. Coronary Angiography involves a dye being injected down the coronary arteries, which together with their smaller branches, then show up clearly on an x-ray “like a road map”. Dye is injected using a catheter (a thin, flexible, hollow tube).
Therefore, coronary angiography can show the exact site and severity of any narrowing of the coronary arteries. This helps the doctor to decide which treatment you may need. For example, if the narrowing is mild it may not need surgery, or, if the narrowing is severe, a coronary artery bypass graft or coronary angioplasty may have to be considered.
You lie on a couch in a catheterisation room. An x-ray machine is mounted above the couch. A catheter (tube) is inserted through a wide needle or small cut in the skin into a blood vessel in the groin or arm. Local anaesthetic is injected into the skin above the blood vessel. Therefore, it should not hurt when the catheter is passed into the blood vessel. The doctor gently pushes the catheter along the blood vessel towards the heart. Low dose x-rays are used to monitor the progress of the catheter tip which is gently manipulated into the correct position.
The tip of the catheter is pushed just inside a main coronary artery. Some dye is then injected down the catheter into the artery. Several x-ray films are rapidly taken as the dye is injected (the dye shows up clearly on x-ray films). The x-ray films are recorded as a moving picture and this is called an angiogram. The angiogram shows the vessels filling with blood and the sites of any narrowing can be seen.
The tip of the catheter is then put into the other main coronary artery and the test is repeated. So, an angiogram picture is built up of each of the coronary arteries and their branches. You cannot feel the catheter inside the blood vessels. You may feel an occasional ‘missed’ or ‘extra’ heartbeat during the procedure. This is normal and of little concern. During the procedure your heartbeat is monitored by electrodes placed on your chest which provide a tracing on an ECG machine (electrocardiograph). Sometimes a sedative is given before the test if you are anxious.
When the test is over, the catheter is gently pulled out and a firm dressing called Angio-Seal will be applied.
The Hospital will send you a leaflet explaining how you should prepare for your angiography.
The doctor will discuss with you what was found during the test. A letter is also sent to your GP giving details of the test results.
Other considerations after your test include:
- Ideally you should have someone with you during the first 24 hours following angiography
- When you reach home it is recommended that you rest and keep your affected leg or arm straight during the first 24 hours
Avoid moving around too much, especially up and down stairs
- Unless otherwise advised by your doctor you should resume your usual medications after the catheterization procedure
- If coughing, sneezing or straining occurs during the first 12 hours you should place a hand over the puncture site and support it
Modify activities for 48-72 hours – no straining, lifting greater than 5kg and avoid driving for 48 hours
- You can return to work between 48 hours and 5 days depending on the nature of your job. Strenuous physical work will require longer return
- A dressing should be left in place for 24 hours and the patient should only shower or strip wash for 3-4 days
- If you have to have an Angio-Seal fitted you will get an Angio-Seal Information Card before discharge. Ensure that your Angio-Seal Information Card is completed and stays in your possession for 90 days. An Angio-Seal is a device used to close the artery after the procedure.
- You may be able to feel a pea sized lump in your groin where you had the procedure. This will disappear in a couple of months and should not cause you alarm
- Contact a doctor if any of the following symptoms occur:
- Bleeding and/or fluid leakage from your wound
- Persistent tenderness or swelling in the groin
- Redness and/or warm to touch
- Numbness or pain in the extremity when walking
The following complications are rare but can occur within the first 24 hours and it is important that you know what action to take if a complication does arise:
- Bleeding – if this happens you or a companion should apply firm pressure using the finger directly over the puncture site. Bleeding should cease within 10-20 minutes. If bleeding persists after this it is advisable for you to seek medical attention. Call for your doctor, or if he/she is unavailable immediately call for an ambulance
- Bruising (also known as a Haematoma) – it is quite common to have bruises around the puncture site and on the thigh and buttock on the affected side, a day after the procedure. However if you think the swelling is increasing in size you should call your doctor
- Chest pain – if you experience any chest pain or extreme discomfort to the chest area and/or down your arms, you should contact your doctor immediately. If he/she is unavailable to attend immediately call for an ambulance.
Finally, we recommend that you do not return to work for 48 hours to 5 days depending on the physical nature of your job. Do not drive for two days and only then when you can do an emergency stop safely. During this time modify your activities to a minimum.
If you need further advice do not hesitate Day Case can be contacted on Tel: 01432 364185 before 8pm on the day of your procedure. Day Case is open from 8am to 8pm Monday to Friday for any advice. If absolutely necessary you can call the Cardiac Care Unit at the County Hospital on 01432 372996 at any time.
Are there any risks or side effects?
One problem is that a bruise may form under the skin where the catheter was inserted (usually the groin). This is not serious, but it may be sore for a few days.
The small wound where the catheter is inserted sometimes becomes infected.
Tell your GP if the wound becomes red and tender. A short course of antibiotics will usually deal with this if it occurs.
Some people get a brief angina-type pain during angiography. This soon goes.
The dye may give you a hot, flushing feeling when it is injected. Many people also describe a warm feeling in the groin when the dye is injected – as if they have “wet themselves”. These feelings last just a few seconds (and the operator will say when they are about to inject the dye).
An allergic reaction to the dye may occur, however, this is rare.
Serious complications are rare, but do sometimes occur. The risk is mainly in people who already have serious heart disease. A doctor will only recommend coronary angiography if he/she feels that the benefits outweigh the small risk.
Potential serious complications are:
- A heart attack occurring during the procedure
- The catheter may damage a coronary artery. If this occurs, the artery may be repaired by emergency heart surgery
- A stroke
There are a number of reasons why a person may need a pacemaker;
- A heartbeat that is very slow or pauses intermittently, causing blackouts, falls or dizzy spells
- A catheter ablation (excision of heart tissue) that results in either deliberate or accidental damage to the heart’s natural electrical system.
The heart has its own pacemaker called the sinus node, which produces electrical impulses. This keeps the heart beating in a regular pattern throughout life. An artificial pacemaker is a small electronic pulse generator (smaller than a matchbox) connected to one or two leads, that stimulates the heart to beat in a regular pattern. It is powered by a battery that sits within the pacemaker.
Nearly all pacemakers are implanted under local anaesthetic by the transvenous method (using a vein). If you agree to have a pacemaker fitted you will be given an appointment to come into hospital. It is usually a day-case procedure but an overnight stay may be required.
If you are on Warfarin, and/or If you have Diabetes controlled by either insulin injections or metformin tablets, please contact the Cardiology Secretaries on Tel: 01432 364071, for further advice about adjustments to your medication.
- When you arrive you may have some or all of the following checks before the implantation: blood pressure, pulse, blood tests, chest x-ray and heart tracing (ECG)
- You should inform the nurse if you have any allergies (drugs, elastoplast, latex) and what medications you are taking
- You will be given a gown, and taken to the Angiography Suite
- A doctor/nurse will explain the implantation to you and ask you to sign a consent form to confirm that you understand the procedure and agree to go ahead with it. This is often done during a previous outpatient appointment.
- The procedure usually takes about an hour.
- You will be lying on a table which can be moved around. Mounted above it is an x-ray machine
- You will have an injection of local anesthetic and may also be given a sedative, to make you feel relaxed and sleepy
- The pacemaker is implanted just under the skin in a ‘pocket’ below your left collar bone. If you are left handed the right side may be used instead. You will feel pressure as it is inserted
- The doctor feeds the wire(s) through a vein into the heart using x-ray guidance. They are then attached to the pacemaker
- Stitches are used just under the skin to hold the pocket edges together. The scar is about 2” long – stitches are dissolvable in most cases
- A technician will check and programme the pacemaker before you go home. This is not painful but you may be aware of your heart beating slower or slightly faster than normal during the checking procedure
- You may have a chest x-ray, depending on the technique used to fit your pacemaker
- Painkillers such as paracetamol, may be taken if needed.
- You may start on a short course of antibiotics just before the procedure
- You may have to stay in hospital overnight, or go home the same day.
- Please make sure that you arrange for a friend or relative to collect you and take you home
- You are not allowed to drive a car for one week after the operation and must also inform the DVLA that you have had a pacemaker fitted. It is a legal requirement that the DVLA are informed. Those who drive larger vehicles may have to cease driving for 6-weeks. Please check this with the DVLA prior to driving.
You will be given more detailed information about this procedure and the risks involved by the Pacing Team. Pacing Implantation is done every Thursday and Pacing Clinics are held to check your pacemaker at 1 month post implant, three months post implant and then annually.
Cardioversion - As a Day Case
Twice a month, a Cardioversion list is conducted, where patients with fast and irregular heart rhythms, such as atrial fibrillation or atrial flutter, are treated by a controlled electrical shock to restore the normal heart rhythm.
This treatment will have been discussed with you as an in-patient or in Cardiology Clinic and the cardiology secretaries will provide the information needed to prepare you for the procedure and, once your blood tests are satisfactory, will book a date for you to come in for the day.
On the day, the procedure will be supported by a senior anaesthetist and will be performed by a clinical nurse specialist with a cardiac background. They will ensure you have not eaten for 6 hours before the procedure, that your blood tests are satisfactory, and review your electrocardiogram. They will answer any questions/queries and confirm that you are happy to consent to the procedure. You will then meet the anaesthetist and a small cannula (a flexible tube) will be sited on the back of your hand for you to have a light anaesthetic. You will be asleep for 5 to 10 minutes while the treatment is given and will wake up quite quickly.
The clinical nurse specialist will review the procedure with you once you are fully awake and you will know immediately if the treatment has been successful.
You will be given a drink and a sandwich. Advice will be given on continuing medications and a follow-up cardiology clinic appointment will be arranged prior to discharge home.
As you will have had a short general anaesthetic, you must not drive, drink alcohol or be alone for 12 hours following the procedure. You will be discharged home into the care of a responsible adult. Occasionally, arrangements may be made for you to be admitted to a ward overnight if you live alone and do not have someone to stay with you at home.
Cardiac Resynchronisation Therapy (CRT) and Implantable Cardioverter Defibrillator (ICD)
Cardiac Services now offers a CRT service and management of ICDs to improve the co-ordination of the heart. For further information please click on the information sheets below.