Most of the time coronary angiograms are outpatient procedures. It is usually performed that for an abnormal stress test or if you have symptoms that are truly convincing of obstructive coronary artery disease. Some of the time, coronary angiograms are performed emergency such as in a heart attack.
Coronary angiograms are performed in a catheterization laboratory. A catheterization laboratory appears like a mini surgical suite. You will most likely receive oral and/or written directions prior to an outpatient (scheduled angiogram). This includes knowing which medicines to hold prior to coronary angiogram, when you can last eat or drink, and what to expect the day of your procedure.
Your doctor will always and should always discuss the risks and the benefits of a coronary angiogram. This is very important, and should not be dismissed. You should ask your doctor his competency in performing such procedures and his complication rate.
In an outpatient basis, you will normally arrive to the catheterization holding room in the morning of the procedure. Certain medicines may be held by your doctor (such as diabetic medicines, blood pressure medicines, blood thinners). Typically, which medicines to take the night before or morning of your coronary angiogram should be explained to you during an outpatient visit. If you are unclear which medicines to take, ask your doctor. You will most likely have not eaten or drinking anything since midnight the night before. You will arrive to the catheterization laboratory by gurney by the Cath Lab staff or transporter. The doctor or the team will most likely visit you in the catheterization holding room and explain the procedure to you what to expect. Sometimes they will obtain consent for the procedure at that time, or may have received consent in the outpatient setting. You will arrive to the catheterization lab by gurney, transported to the catheterization table, and prepped.
Normally a “timeout” will be called prior to your procedure. This is a safety assurance to prevent errors. You may or may not receive sedation (most common combination of sedation is fentanyl and Versed). The doctor will anesthetize either your wrist or your groin region. This will most likely burn for about a minute. You’ll most likely feel pressure in some discomfort in the groin area or wrist depending on the access site that doctor has chosen. You will most likely not remember the procedure if you were sedated. . You should not feel significant pain during the procedure. After the procedure the doctor will most likely discuss your results with you and your family.
In an emergent basis (such as a large heart attack called STEMI or ST elevation myocardial infarction), you will most likely have the procedure briefly explained to reviewing the benefits and the risks associated with the procedure prior to urgently proceeding to catheterization. You will arrive to the catheterization laboratory in a hurried fashion, prepped, and perhaps receive sedation. The doctor will anesthetize the groin or the wrist depending on the access chosen. When receiving the anesthesia at the access site, it will most likely burn for a minute or so (feels like a wasp sting). You should not feel pain during the procedure. If you feel pain you should notify your doctor. The coronary artery that is blocked or causing problems will most undergo revascularization with a coronary stent (“fix the blockage”). After the procedure the doctor will discuss his findings and results with you and your family.
The Cath Lab team is usually composed of five people. A monitor (someone who is monitoring your heart rate, blood pressure, EKG, and records the minute to minute activity of the procedure), a circulator(someone who runs around gathering equipment needed for your procedure), a nurse (administers medications during coronary angiogram), scrub tech (assistant to the doctor during the procedure) and the doctor.
Before the coronary angiogram procedure begins the Cath Lab team will most likely have reviewed your allergies, medications, adverse reactions in the past, and concerns prior to the procedure. This is true for coronary angiograms and any medical procedure you undergo.
Please remember to go to the bathroom prior to getting prepped for your coronary angiogram. You may be asked to remove all jewelry and metal prior to the procedure.