Coronary Angiogram

What is a coronary angiogram?

A coronary angiogram is a test that uses X-rays and contrast dye to show how well your blood is moving in your coronary (heart) arteries. Your provider may also call this imaging test coronary angiography.

The test can show blockages in these arteries or if they’re narrowed — usually from atherosclerosis. Your coronary arteries are important because they get blood to your heart’s muscle. A blocked coronary artery can lead to a heart attack.

Your healthcare provider or cardiologist may recommend a coronary angiogram if:

• Your stress test or electrocardiogram (EKG) was abnormal
• You have heart valve disease, heart failure or a history of a heart attack
• You have heart surgery coming up, and your provider thinks you may have coronary artery disease
• You have chest pain (angina) that recently started or has changed in some way
• You have unusual chest discomfort or shortness of breath, but other tests don’t show anything wrong

Your provider will explain why they recommend this test. Don’t hesitate to ask questions.

How do I prepare for a coronary angiogram?

Your healthcare provider will give you specific instructions for preparing for the test. They’ll also go over your medications and health history. In general, your provider will likely:

• Tell you to not eat or drink anything except water (fast) for eight hours before the test
• Adjust your medications if you take anticoagulants, diabetes medications, diuretics or sildenafil (Viagra® or Revatio®)
• Ask if you’ve had an allergic reaction to contrast dye or anesthesia before
• Ask if you’re pregnant

For your safety, you won’t be allowed to drive yourself home on the same day of the procedure. You should figure out transportation from the hospital if you’re going home the same day.

What happens during a coronary angiogram?

In general, you can expect the following during a coronary angiogram:

1. You change into a medical gown and lie on your back for the procedure.
2. A healthcare provider gives you medicine that makes you feel relaxed (a sedative) through an IV. But you’ll still be awake enough to follow instructions. For example, they might have you cough or hold your breath for a couple of seconds.
3. An electrocardiogram (EKG) will monitor your heart rhythm during the procedure.
4. A provider gives you local anesthesia to numb the area where they’ll access an artery. This is usually in your groin or arm. You may feel pressure in this area during the procedure, but you shouldn’t feel pain.
5. A cardiologist accesses a blood vessel with a needle. They slide a sheath (or tube) over the needle and into a large artery.
6. The cardiologist passes wires and catheters through the tube to get to the coronary arteries on the surface of your heart. You won’t feel the tube going through your blood vessels.
7. An X-ray machine rotates around you (called fluoroscopy). It allows the cardiologist to see where the catheter is going from all angles.
8. Once your provider gets the catheter into your heart or aorta, they put a special dye into the tube. They look at X-rays to watch the dye go through your artery. For a few seconds, you might feel flushed or like you need to pee.
9. The cardiologist can see if anything (like cholesterol or plaque) is getting in the way of blood going through your coronary arteries.

If the cardiologist sees something blocking your blood flow, they may be able to clear the blockage right away with a balloon. This is called an angioplasty. They can then then place a stent to keep your artery open.

If this isn’t possible or the cardiologist thinks a different procedure later is best, they’ll end the coronary angiogram.

A coronary angiogram typically takes 30 to 50 minutes. But this can vary.

What to expect after a coronary angiogram

When the procedure is done, the cardiologist will take out the catheter. A healthcare provider will put pressure on the site to stop or prevent any bleeding.

Most people can go home the same day — two to four hours after the coronary angiogram.

If your procedure was complex or you had it in the afternoon, you should be prepared to stay the night at the hospital.

You may feel tired after your coronary angiogram. Your wound may be sensitive or bruised for a week or more. Your provider may tell you to limit your activities for a couple of days after you get home.

What are the risks of this test?

It’s a good idea to get a coronary angiogram from a healthcare provider who does them often (at a high-volume center). Most of the time, they’re safe procedures. But they’re more invasive than other imaging tests, like an ultrasound. Serious complications are rare.

The risks of a coronary angiogram include:

• Abnormal heartbeats (arrhythmia)
• Allergic reaction to the contrast dye or anesthetic
• An injured blood vessel
• Blood clots
• Cardiac tamponade (pressure on your heart from fluid building up around it)
• Heart attack
• Kidney damage, including the need for dialysis
• Low blood pressure
• Pain, bleeding or infection where a needle or catheter went into your skin
• Stroke

You’re more likely to have complications if you:

• Are over 65 years
• Have diabetes
• Have kidney disease

Talk to your healthcare provider if you have questions about these risks.

When should I know the results of the test?

You may be able to see your X-rays while the cardiologist does the test. Your provider will share what the results mean after your coronary angiogram is over.

Your cardiologist may describe your coronary angiogram results as normal or abnormal.

A normal result means nothing is blocking your coronary arteries. Your heart’s getting enough blood. If you still have symptoms, you may need other tests to get to the bottom of them.

With abnormal results, something may be blocking your coronary arteries. Your provider can tell you which arteries have a blockage and where. They can also explain the severity. They might use percentages to describe how blocked they are.

If the results are abnormal what are the next steps?

Your provider will explain what kind of treatment they recommend if the results are abnormal. This may include:

• Angioplasty or stenting
• Changes to your daily life, like more physical activity and different food options
• Coronary artery bypass surgery (CABG)
• Medication

When should I call my doctor?

Contact your healthcare provider if you have any of the following at the site of the catheter placement:

• Excessive bleeding
• Swelling
• Signs of infection, like skin discoloration or pus

You should also tell your provider if you have difficulty with circulation in your arms or legs.

How painful is a coronary angiogram?

Overall, a coronary angiogram should involve minimal pain. You may feel some temporary mild pain when:

• A provider inserts an IV line with a needle to give you a sedative
• A provider injects local anesthesia

You shouldn’t feel pain from the catheter during the procedure. You also won’t feel the provider threading the catheter through your blood vessels and arteries.

After the procedure, the sites where the IV and catheter went into your skin may be sore. But this should go away after a week or so.

Tell the provider immediately if you feel intense pain during any part of the procedure.