A NOTE ABOUT PROCEDURE NAMES:

The terms angiogram and angioplasty will be used throughout the guide.

Angiogram is also known as “cardiac catheterization” and “coronary angiogram”.

Angioplasty is also known as “PCI” or “coronary angioplasty”.

Why Is an Angiogram Necessary?

Diagnostic tests provide important information, but they do not give all the answers. Sometimes an angiogram is also necessary for the doctor to make a correct diagnosis and determine the best treatment for your heart problem.

When your doctor orders an angiogram, the necessary information is sent to the Wait List Management Office at the Ottawa Heart Institute.

There may be unforeseen delays, changes in schedule or cancellations. Due to these possibilities there may also be a change in the doctor who will perform your procedure.

Should you have any questions or concerns or should you experience a change in symptoms while you are waiting at home for your angiogram,

do not hesitate to call the cardiology clinic.

 

What Is an Angiogram?

An angiogram is a dye test used to detect heart problems. The procedure involves the insertion of a thin flexible tube (catheter) into an artery in the groin area or in the arm. The catheter is guided to the heart. Once in position, a dye is injected into the coronary arteries so that X-ray pictures can be taken. The X-rays reveal any blockages or narrowing in the arteries. The test can also look at the functioning of the heart valves and heart muscle. Once the procedure is completed, your doctor can determine the best treatment for you.

Insertion Sites for Angiogram

What Is Angioplasty?

Angioplasty is also known as PCI:

• Percutaneous — through the skin

• Coronary — having to do with the heart

• Intervention — the type of procedure used to open a narrowed artery

Angioplasty is similar to an angiogram. Both are done in the catheterization lab. Angioplasty is a procedure used to widen narrowed arteries of your heart without surgery. The basic idea is to position a catheter with a small inflatable balloon in the narrowed section of the artery. Inflating the balloon catheter causes the balloon to push outward against the narrowing and surrounding wall of the artery. This process reduces the narrowing until it no longer interferes with blood flow. The balloon is then deflated and removed from the artery. In many patients a stent is placed within the artery once it has been opened.

A stent is a small metal mesh tube that is placed into your blood vessel using a balloon catheter. The stent expands against the blood vessel wall as the balloon is inflated. The balloon is then deflated and removed, leaving the stent in place permanently, holding the blood vessel open and improving blood flow. Stents lower the risk of this area narrowing again. There are several types of stents available. Your doctor will select the most appropriate type of stent for your medical condition.

Angioplasty is not for everyone. Your doctor will decide if angioplasty is suitable for you.

1. The balloon catheter and collapsed stent are inserted into the narrowed artery.

1. The balloon is inflated to expand the stent.

1. The balloon catheter is removed, leaving the stent in place.

 

Advantages of Angioplasty

Over 90% of angioplasties are successful immediately. Blood flow through the artery returns to normal or near normal. Some people may not have complete relief, but their symptoms are improved, allowing them to be more active and comfortable.

There is no incision as this is not surgery and you are not put to sleep (general anesthesia). Most people are up and walking on the same day. Some people go home the same day, but some patients are required to stay overnight and go home the following morning.

Disadvantages of Angioplasty

An artery may become narrow again after angioplasty. This is called restenosis. If the artery narrows enough, you may feel angina again. The use of stents has reduced the restenosis rate. Restenosis is usually treated with a second angioplasty but, occasionally, bypass surgery is needed or medical therapy is used.

Risks of Angiogram and Angioplasty

Angiogram and angioplasty (with or without stent implantation) are common procedures. Your physician has carefully considered your clinical condition and believes that the benefits of the procedure outweigh the risks. However, since these procedures are invasive, there are risks associated with them.

Common risks include:

• Bleeding at the catheter insertion site or other organs due to blood thinning medication (anticoagulants)

Less common but potentially more serious risks include:

• Heart attack

• Stroke

• Unknown dye allergy

• Kidney problems, including kidney failure requiring dialysis

• Emergency heart surgery

• Death

• Other rare and unpredictable complications

In 1% to 2% of angioplasty cases, the artery collapses or is damaged by the wire or balloon. A stent can often fix this, but sometimes patients need emergency coronary artery bypass surgery. At the Heart Institute, our operating rooms are close by if a patient needs surgery.

Angioplasty is not a cure for coronary artery disease. Coronary disease needs lifelong management.

You can control your condition with a healthy lifestyle:

• Get enough exercise

• Maintain a healthy weight and reduce your waist size

• Quit smoking

You can control your risk factors by taking the medication that your doctor prescribes. Your doctor may prescribe medication for:

• High blood pressure

• High cholesterol

• High blood sugar

Discuss the risks and benefits of your procedure with your doctor.

 

 

PREPARING FOR YOUR PROCEDURE

As a patient coming to the Heart Institute for a procedure, you will be in one of the following categories:

• A day patient or outpatient coming from home

• A referred patient sent from another hospital for a day procedure

• An admitted patient coming to the Heart Institute the day prior to your procedure

The patient categories are described below, because the process for each is slightly different.

SAME-DAY ANGIOPLASTY

Same-day angioplasty occurs when the angioplasty is done immediately following the angiogram. This decision is made by your doctor at the time of you procedure.

Day Patients or Outpatients

You are considered a day patient or outpatient if you are coming to the Heart Institute from home on the same day as your angiogram. A pre-procedure visit may be arranged by the office of the cardiologist performing the procedure. This visit includes:

• Cardiac assessment

• A session to teach you about the procedure

• Review and signing of the consent form

• Pre-catheterization tests (blood tests, ECG)

• Specific instructions about your medications

Note: Please bring your health card and all your medications.

 

Many of our patients also find it helpful to bring:

• A family member or friend to take notes or ask questions

• A list of your own questions to ensure that you have all the information you need

If you are coming to the Hospital for blood work and ECGs, please report to the Day Unit. If you have been given an information package from your doctor, please give this to the ward clerk in the Day Unit. You will then be directed to the Laboratory for your tests.

Things to do before the day of your procedure:

• Please make arrangements for transportation home on discharge. You are not allowed to drive yourself. Discharge will take place approximately five to six hours after your procedure.

• If you live a considerable distance from the Hospital, check with the doctor to see if you should stay close to the hospital on the night of discharge. Arrangements for accommodations should be made in advance (see Accommodations insert).

Relatives and visitors may accompany patients to the Hospital. One or two person may stay with thepatient at any time. This person may be asked to wait in the lounge area for short periods of time. If the contact person is not present, the staff will phone them after the procedure.

 

For All Patients

Please use the Patient Responsibility Checklist to help prepare for your admission to the Heart Institute.

Prior to your procedure:

• A nurse will do an assessment and take your blood pressure and other vital signs.

• A saline lock (intravenous catheter) may be inserted, and blood tests and an ECG may be done.

• Pre-procedure teaching will be done and a video will be available for your viewing.

• You will see the cardiologist performing your procedure.

• Informed consent will be obtained.

• You may eat up to four hours before and drink fluids up to two hours before your procedure.

• A small area on both sides of your groin or on your wrist will be prepped.

In the Cardiac Catheterization Lab

You will be escorted to the waiting area of the Catheterization Lab on foot, in a wheelchair, on a stretcher or in a bed.

BEFORE YOUR PROCEDURE

After a brief discussion with the nurse, you will be taken into the Catheterization Lab and asked to lie on a special X-ray table. The temperature in the room will be very cold. You will be attached to a heart monitor.

As this is a teaching hospital, there may be other physicians, nurses and lab technologists involved in your procedure. All staff will be wearing gowns, masks and special aprons.

Your groin or wrist will be washed with a cold solution and sterile sheets will be placed over you. It is important that you neither move nor touch the top of the sheets once they are in place. You may be asked to lie with your arms above your head for a period of time. A nurse will be available to assist you.

 

DURING YOUR PROCEDURE

You will be given medication to help you relax, but you will be awake during the procedure so that you can follow instructions from the doctor and nurses. The doctor will administer freezing to your groin or wrist. A small catheter will be threaded through a blood vessel up to the heart. A contrast dye will be injected through this catheter to highlight the coronary arteries. Most patients experience a sensation of body warmth as the dye is injected or the urge to empty their bladder.

X-ray pictures will be taken throughout the procedure. The X-ray machine will move over you very close to your body.

During the procedure, you may be asked to take a deep breath and hold it for a few seconds, or to cough. It is not unusual to experience some chest pain. Inform the nurse if you experience any discomfort or have concerns.

The time for the procedure in the lab is usually from 30 to 90 minutes. If your condition is complex, the procedure will be longer.

Due to unforeseen circumstances there may be a lengthy wait in the lab waiting area or you may be returned to your room until the lab is available.

FOLLOWING YOUR PROCEDURE

After the Procedure

You will leave the Catheterization Lab on a stretcher and one of the following will happen:

• After an angiogram: The catheter will be removed and a special clamp or manual pressure will be A sand bag will then be placed over your groin to continue pressure on the puncture site.

• After an angioplasty: You will be transferred to a unit which specializes in catheter (sheath) removal if a groin insertion was used, or back to the sending unit if the wrist was used.

The nurse will frequently check your pulse, blood pressure, pulses in your feet or wrist, and the puncture site.

1. Following a groin insertion:

• If the doctor used your groin (femoral artery), you must remain on bed rest for up to six hours after the procedure.

• It is important to keep your head on the pillow and your affected leg straight. You will be reminded frequently to do these two things to avoid bleeding from the puncture site.

• If you experience back discomfort, you can be repositioned with the help of a nurse, keeping your affected leg straight. The head of your bed may be elevated slightly.

• During this time you may sleep, read or rest. You will be given a snack.

2. Following a wrist insertion:

• If the doctor used your arm (radial artery) you will have a clamp applied to your arm in the lab to prevent bleeding.

• You will be on bed rest for approximately one hour after the procedure.

• It is important to keep your arm on the pillow and refrain from twisting your wrist. You may move your fingers. Your nurse will be available to assist you while the clamp is in place.

• During this time you may sleep, read or rest. You will be given a snack.

You will be encouraged to drink fluids so the dye will flush out through your kidneys. Ask your nurse for assistance as soon as you need to empty your bladder. It is important not to sit up. The nurse will assist you in getting up once your bed rest is complete. You will be encouraged to walk around during the hour before discharge.

You must have someone pick you up at the hospital and drive you home. Someone should stay with you overnight on the day you go home. If this is a problem, tell your cardiologist .

 

Results of Your Procedure

Sometime following the procedure, prior to your discharge, the doctor will review your results and treatment options. In general, there are three treatment options for coronary artery disease: medical therapy, angioplasty or coronary artery bypass surgery. The most appropriate treatment will be discussed with you by your physician. A copy of the results of the angiogram will be made available to your referring cardiologist or your family doctor.

Your doctor will use this picture of a heart to show you what was done during your procedure.

Discharge Instructions for Angioplasty or Angiogram

(Femoral (Groin) and Radial (Wrist) Insertion)

Procedure: Date:

Insertion site:

Day of Procedure

Please note any bruising or discoloration at the insertion site. A certain amount of bruising, stiffness or soreness is expected. A small bruise or lump at the procedure site is normal and will likely go away on its own. Some numbness or tingling in the affected limb immediately after the test is normal. Such numbness and tingling should disappear by the time you are ready for discharge.

Discharge Procedure

Prior to discharge please report to the nursing station. You may need:

• A saline lock removed

• A return appointment

• A prescription

Returning to Another Hospital

If you have been transferred from another hospital, the clerks will make return arrangements for you. Transfer times depend on your recovery period as well as the availability of ambulances. It is not unusual to encounter delays.

Going Home

YOU MUST NOT DRIVE HOME YOURSELF. You should make arrangements to be driven home by a relative or friend. If such an arrangement is not possible, a taxi may be acceptable if approved by your physician.

Advance arrangements should be made to have someone with you at home throughout the evening and night after you are discharged from the hospital.

If this is not possible, you must discuss this with your doctor in advance of your procedure.

 

Daily Activity Guidelines

ACTIVITY

Discuss individual questions about specific activities with your doctor.

Generally, if you are discharged on the same day as your test, once home, you should take it easy and rest. On the day following the test, you may gradually begin to resume normal activities.

1. Groin (femoral) insertion

• Limit the amount of stair climbing as much as possible. Try to climb stairs only once on the day of your procedure.

• Do not lift anything heavier than 10 lbs. (4.5 kg) within 48 hours of your procedure.

• Apply pressure to your groin if you have to sneeze or cough hard within 48 hours of your procedure. The easiest way to apply pressure is to make a fist and place it firmly on the groin area over the dressing.

2. Wrist (radial) insertion

• Do not use the affected arm to lift anything heavier than 10 lbs. (4.5 kg) within 48 hours of your procedure. Avoid vigorous wrist movements of the affected arm.

• You may elevate your arm on a pillow to help prevent swelling.

RETURNING TO WORK

You must discuss your return to work with your doctor. If you have a job that involves mostly sitting, you may be able to return to work a few days following discharge. If your work is active, involving a great deal of movement, you may be advised to stay off work for a longer period.

DRIVING

Before discharge, be sure to talk to your doctor about when you may start driving again.

Do not drive or operate any motorized vehicle within two days of your procedure. Additional driving restrictions (two days to one week) may apply following such procedures. The restrictions may be extended if you have had a heart attack.

Care of Insertion Site

DRESSING

• You may remove the clear dressing or bandage on the day after the procedure and replace it with a new dressing.

• A small amount of dried blood on the old dressing and insertion site is normal.

• You may take a shower on the day after your test, but do not allow the dressing to stay wet.

• Do not take a tub bath or cleanse the insertion site within 48 hours of your test.

• You may reapply a dry dressing for a few more days in order to keep the skin clean and reduce the risk of trauma or infection. The dressing may be removed 72 hours after the procedure.

• Try to avoid wearing tight or restrictive clothing over the insertion site.

INSERTION SITE

Examine the insertion site each day and notify your physician if any of the following develops:

• An expanding lump or persistent area of redness and warmth

• Yellow drainage from the insertion site

• Increasing numbness in the leg, hand, wrist or arm

• Severe discomfort at the insertion site

Mild discomfort at the insertion site or in the forearm is normal and may be treated with Tylenol or the application of a warm, dry towel.

DIET

• You should try to drink more fluid than usual in the 48 hours after your procedure. This will help your kidneys flush the dye from your system.

• You may resume your usual diet after discharge.

 

BLEEDING

If there is a small amount of bleeding at the puncture site:

• For a wrist site, sit down immediately and apply firm pressure to your wrist with your fingers for 10 minutes.

• For a groin site, lie down and apply pressure to your groin using a fist placed firmly on the groin area over the bandage.

If the bleeding stops, stay still and keep the affected leg or wrist immobile for two hours.

If recurrent bleeding occurs, notify your physician as soon as possible.

• If you are unsure as to what action you should take, phone112 and ask to speak with the cardiology nursing co-coordinator.

If the bleeding does not stop or if there is a large amount of bleeding:

• CALL 112 IMMEDIATELY. DO NOT DRIVE YOURSELF TO THE HOSPITAL.

• Lie down and place firm pressure on the insertion site until help arrives.

Medications

MEDICATIONS AFTER YOUR ANGIOPLASTY

If your cardiologist has placed a stent in your artery, you will need to stay on the medication Plavix®. These stents are very effective in reducing the risk of artery renarrowing. It is very important that you take the two blood thinners, aspirin and Plavix®, as prescribed by your doctor to reduce the risk of blood clots forming on these stents. You must not stop these medications without consulting your cardiologist.

Discuss any medication issues with your doctor prior to discharge.

If you normally take antacids, discuss this with your doctor. Antacids may interfere with some medications.

See the following chart for general information about some common heart medications. For more detailed information about your specific medications, ask your pharmacist.

TYPE	NAMES	ACTION	POTENTIAL SIDE
			EFFECTS

Antiplatelet ASA = aspirin

agents (ECASA = coated

aspirin)

Plavix® =

Clopidogrel

• Stop platelets (cells in the blood that help promote clotting) from clumping together

• ASA is a mild antiplatelet agent for lifelong prevention

• Plavix® is a stronger antiplatelet agent needed for a minimum of one year after a stent

• Increased risk of bleeding

• Stomach upset (nausea, diarrhea, heartburn); may need Pantaloc® to reduce these side effects

Angiotensin	Altace® =	•	Relax blood vessels	•	Cough
converting	Ramipril	•	Lower blood pressure	•	Headache
enzyme (ACE)	Vasotec® =	•	Strengthen the heart	•	Dizziness,
inhibitors
	Enalopril		muscle		lightheadedness
	Coversyl® =				(may need dose
					adjustment)
	Perindopril
				•	Increased potassium
					in blood
				• Swelling of lips, face
					or throat (rare) Call
					112
Beta blockers	Lopressor® =	•	Lower blood pressure	•	Fatigue or tiredness
	Metoprolol		and heart rate		(improves with daily
	Tenormin® =	• Reduce the work of			exercise)
			the heart	•	Dizziness,
	Atenolol
		•	Protect against heart		lightheadedness
	Monocor® =
					(may need dose
			rhythm problems
	Bisoprolol				adjustment)
			after heart attack
				•	Insomnia or
		•	Improve heart
					nightmares
			function
					(improves over time)

 

Cholesterol-	Lipitor® =
lowering drugs	Atorvastatin
(statins)	Zocor® =
	Simvastatin
	Crstor® =
	Rosuvastatin
	Provachol® =
	Pravastatin

• Reduce the amount of cholesterol in your body

• Prevent further heart disease

• Constipation, gas

• Nausea

• Muscle pain: Notify doctor (may need dose adjustment)

Nitroglycerin Nitro spray

Nitro patch

•	Improves blood	•	Nitro spray may
	flow to the heart by		still be needed
	relaxing the blood		occasionally; use if
	vessels		required
•	Reduces angina	•	Nitro patch may
	symptoms		not be required
			after angioplasty or
			stent and is often
			discontinued before
			discharge from
			hospital

Angiotensin	Cozar® =	•	Relax blood vessels	•	Dizziness
II receptor	Losartan	•	Lower blood pressure	•	Headache
blockers	Diovan® =	•	Strengthen the heart	•	Fatigue
(ARBs)
	Valsartan		muscle
	Avapro® =	•	Prescribed instead of
			ACE inhibitors
	Irbesartan
	Atacand® =
	Candesartan

WHAT TO DO IF YOU EXPERIENCE ANY CHEST DISCOMFORT (SIMILAR TO YOUR PREVIOUS SYMPTOMS) THAT:

• Travels to your shoulder, arm, neck or jaw

• Feels vice-like, constricting, like a crushing weight or pressure or indigestion

• Is accompanied by sweating, shortness of breath, nausea, fear or denial

At the first sign of discomfort Stop immediately and rest

If no relief with rest Take 1st nitroglycerine tablet/spray

If no relief within five minutes Take 2nd nitroglycerin tablet/spray

If no relief within five minutes Take 3rd nitroglycerin tablet/spray

IF NO RELIEF AFTER THE 3RD NITROGLYCERIN, CALL 112 OR HAVE SOMEONE ELSE DRIVE YOU TO THE NEAREST EMERGENCY DEPARTMENT.

Before you go home, did you discuss the following with your doctor?

Medications:………………………………………….	☐ Yes	☐ No
Activity guidelines:…………………………………	☐ Yes	☐ No
Driving:………………………………………………….	☐ Yes	☐ No
Return to work (if applicable):…………………	☐ Yes	☐ No