Coronary Angiography

Pre-procedure preparation

Proper preparation for your coronary angiogram procedure begins several days before your scheduled appointment. Your healthcare team will provide specific fasting requirements, typically requiring you to avoid eating or drinking anything for 6-8 hours before the procedure. This fasting period is essential for your safety, particularly if sedation is needed.

Essential blood tests will be performed to assess kidney function, blood clotting, and overall health. These blood tests help your medical team identify any factors that might affect the procedure or your recovery. Your cardiologist will also order an electrocardiogram (ECG) to check your heart rhythm and identify any baseline abnormalities.

Transportation arrangements are crucial because you won’t be able to drive for around 24 hours after the procedure. Make sure someone can drive you home and stay with you for the first few hours following your discharge.

Your cardiologist will provide specific instructions on which medications to continue and which to stop temporarily before your coronary angiography. Blood-thinning medications like warfarin, clopidogrel, or other antiplatelet drugs may need adjustment to reduce bleeding risks while ensuring you remain protected from blood clots.

If you have diabetes, your medication schedule may need modification due to fasting requirements. Your healthcare team will provide detailed instructions about managing your blood sugar levels before and after the procedure.

Allergy considerations are particularly important, especially if you have known allergies to contrast dye, iodine, or previous dye reactions. Your medical team may prescribe preventive medicines if you have a history of allergic reactions.

Day of procedure preparations

When you arrive at the hospital, you’ll change into a hospital gown and remove all jewellery, contact lenses, and dentures. The nursing staff will insert an intravenous (IV) line, typically in your arm, to administer medications and fluids during and after the procedure.

The catheter insertion site (either your groin near the femoral artery or your wrist near the radial artery) will be shaved if necessary and thoroughly cleaned with an antiseptic solution to prevent infection. Your cardiologist will explain the procedure once more and obtain your final consent, allowing you to ask any remaining questions.

You’ll also be connected to a heart monitor to continuously monitor your heart rhythm and oxygen levels throughout the procedure and recovery.

Initial setup and monitoring

Once you’re positioned on the examination table in the cath lab, your medical team will secure you with safety straps and position you comfortably for the procedure. Multiple monitoring devices will be attached: ECG electrodes on your chest to continuously monitor your heart rhythm, a blood pressure cuff on your arm, and a pulse oximeter on your finger to track your oxygen levels.

The procedure area will be covered with sterile drapes, and your cardiologist will administer a local anaesthetic at the chosen insertion site. This numbing medication ensures you won’t feel pain during the catheter insertion, though you may feel some pressure. Many patients receive mild sedation to help them feel relaxed while remaining conscious and able to follow instructions throughout the procedure.

Catheter insertion and navigation

Your cardiologist will make a small puncture in either your femoral artery (in the groin) or radial artery (in the wrist). The choice of access site depends on several factors, including your anatomy and the planned procedure. A small sheath is inserted through this puncture to provide access for the catheter.

The tube, called a catheter, is then carefully advanced through your arterial system under continuous X-ray guidance. You won’t feel the catheter moving through your blood vessels, as the arteries don’t have sensation for this type of contact. The cardiologist uses real-time imaging to navigate the catheter tip to the openings of your coronary arteries at the base of your aorta.

Imaging and assessment

Once correctly positioned, the contrast dye is injected through the catheter into your coronary arteries. As the dye is injected, you may experience a brief sensation of warmth spreading through your chest; this is entirely normal and indicates that the contrast medium is flowing through your heart arteries.

The cardiologist takes X-ray images from multiple angles as the contrast agent flows through your coronary arteries, creating detailed angiograms that reveal the internal structure of these blood vessels. You may be asked to hold your breath briefly during image acquisition to ensure the clearest possible pictures.

If the contrast dye moves freely through your arteries, it indicates good blood flow. However, if the flow is slow or stops at certain points, this suggests narrowed coronary arteries or complete blockages that may require immediate attention.

The typical procedure lasts 30-60 minutes, though it may extend if therapeutic interventions are needed. Throughout the process, your medical team continuously monitors your vital signs and comfort level to ensure your safety at all times.

If significant blockages are identified, your cardiologist may immediately proceed with percutaneous coronary intervention, using balloon angioplasty to open narrowed areas and placing stents to keep the artery open for improved blood supply to your heart muscle.

Immediate post-procedure care

Following completion of your coronary angiography procedure, your cardiologist will carefully remove the catheter from the insertion site. The puncture site requires immediate attention to prevent procedure bleeding – your medical team will apply direct pressure for approximately 15 minutes to ensure proper closure of the artery.

If the procedure was performed via your femoral artery, you’ll need to lie flat for several hours (typically 2-6 hours) to minimise the risk of bleeding at the wound site. A closure device may be used to seal the artery, potentially reducing the time you need to spend in bed. If your radial artery was used for access, you can typically sit up and move around much sooner, though a pressure bracelet will remain on your wrist for a few hours.

Your nursing staff will regularly check your blood pressure, heart rate, and circulation to ensure you remain stable. They’ll also monitor the puncture site for any signs of excessive bleeding, swelling, or circulation problems. Most patients experience only mild discomfort at the insertion site during this recovery period.

Recovery timeline and discharge

Most coronary angiogram procedures are performed on an outpatient basis, meaning you can typically go home the same day after a few hours of observation. Your total hospital stay is usually 4-8 hours, including the procedure and recovery.

Before discharge, you’ll receive detailed instructions about wound care, activity restrictions, and medications, if any were prescribed. Your cardiologist will schedule a follow-up appointment to discuss the results in detail and plan any necessary treatments.

You’ll need someone to drive you home, as you cannot drive for around 24 hours after the procedure due to both the sedation effects and the need to avoid straining the insertion site.

Post-procedure restrictions and care

Activity restrictions are important for proper healing and the prevention of serious complications. Avoid heavy lifting (anything heavier than a kettle or small bag) for 3-5 days after the procedure. You should also avoid strenuous physical activity for about a week, though light walking is encouraged and beneficial for your circulation.

Wound care involves keeping the insertion site clean and dry for the first 24 hours. You can shower after this period, but avoid baths, swimming, or soaking the wound site for several days. Watch for signs that require immediate medical attention: excessive bleeding that doesn’t stop with direct pressure, increasing swelling, numbness or tingling in the affected limb, or severe chest pain.

Medication compliance is crucial if you received any stents during the procedure. You may be prescribed dual antiplatelet therapy (aspirin plus another blood thinner) that must be taken exactly as directed to prevent blood clots from forming in your stents.

Gradually return to your normal activities over 3-7 days, listening to your body and avoiding activities that cause discomfort at the insertion site. Contact your healthcare provider if you experience any concerning symptoms or have questions about your recovery.