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1 Information for inpatients This leaflet is available in other formats including large print, audio tape, CD and braille, and in languages other than English, upon request. Med/304.1 (2012) Page 1 of 8 For Review Summer 2015 Your doctor has advised you to have a procedure called a coronary angiogram to find out more about your coronary arteries (blood vessels of the heart), heart valves and the pumping function of your heart. This leaflet tells you about a coronary angiogram and will help you to understand what will happen during and after your procedure. What is a coronary angiogram? A coronary angiogram is a special x-ray of your coronary arteries. It can also be called cardiac catheterisation. The coronary arteries do not show up on ordinary x-rays. During an angiogram a very fine, long, special catheter (tube) is passed through an artery in either your groin or wrist until it reaches your coronary artery. A special dye, called contrast medium, is injected through this catheter into your coronary arteries which then allows them to show up on an x-ray. See diagram below.

2 Med/304.1 (2012) Page 2 of 8 For Review Summer 2015 The procedure will also give your doctor vital information about the blood pressure inside your heart, how well your heart is pumping and the valves of your coronary arteries are working. An angiogram can show if you have any narrowing of your coronary arteries and exactly where the narrowing is. Narrowing of the arteries is usually caused by atheroma (a build up of fatty deposits in your blood vessels). See diagram below. Healthy blood vessel Diseased blood vessel cholesterol deposit Wall of the blood vessel Wall of the blood vessel The procedure will help your doctor to advise what further treatment will be best for you. If the narrowing is mild no further treatment may be needed. If it shows the narrowing is more severe your doctor may advise you to have a: coronary angioplasty (a special balloon used to widen the artery) stent (a short length of flexible tubing inserted to widen the vessel) coronary artery bypass graft (a piece of vein used to bypass the narrowed section). If you need to have any of these procedures: your doctor or nurse will explain it to you in more detail you will need to be referred to another hospital. If you have any worries or concerns please speak to your doctor or nurse.

3 Med/304.1 (2012) Page 3 of 8 For Review Summer 2015 What are the benefits of having a coronary angiogram? When your doctor has the results he or she will discuss these with you and, if needed, will explain the treatment choices available to help reduce your symptoms and improve your quality of life. What are the risks and possible side effects? Coronary angiogram is a safe procedure but does have some risks and possible complications. The risks must be compared to the benefits of having the procedure. The doctor who advised you to have this procedure will have considered these. Your doctor or nurse will discuss your risks with you. Steps will be taken to minimise (reduce) the chance of you developing these, for example, the procedure is carried out in a room, like an operating theatre, by an experienced doctor and you will be monitored (checked) throughout the procedure. Staff are trained to deal with these if needed. Some side effects are common; usually these are minor and easy to treat. Serious complications are rare. The risks and possible side effects include: reaction to the dye (contrast medium). About 1 person in every 1,000 may have a minor reaction to the dye used during the procedure. 1 This can cause mild nausea (feeling sick) or a minor skin rash. This usually settles on its own, but let your nurse or doctor know if this develops. About 1 person in every 40,000 may have a more severe reaction. 2 You will be monitored during and after the procedure and staff are ready to deal with any reaction, if needed. temporary renal dysfunction (your kidneys not working properly). About 5 people in every 100 may develop temporary renal dysfunction after this procedure. 1 You will not usually be aware if this was to develop and it should settle, without needing any treatment, within 7 days of having the procedure. You are asked to drink a lot of water for a few days after the procedure to help reduce the chance of this happening. This risk could be higher if you suffer from diabetes, existing renal problems, multiple myeloma (disease of the bone marrow) or are taking certain medications. problems with the circulation of blood which may cause you to have a fast, slow or an irregular heartbeat, a blockage in the artery in your arm or leg, a heart attack, stroke or death. This may affect about 1 patient in every 1, Your heart rate, rhythm and blood circulation will be monitored during and after the procedure. This risk may be higher if you were to have an angina or heart attack during the procedure, or if you have diabetes. You will be monitored throughout the procedure and staff are trained to deal with these problems, if needed. damage to an artery. 1 person in every 500 may suffer damage to the artery as the catheter is inserted. 2 Steps will be taken to treat this problem, if needed.

4 Med/304.1 (2012) Page 4 of 8 For Review Summer 2015 bleeding, bruising or infection after the procedure, especially at the catheter entry site. Any bleeding can be stopped by applying firm pressure over the wound site. Some bruising may develop 1-2 days after the procedure but should then slowly settle over time. Steps are taken during the procedure to prevent an infection developing, for example, your skin will be cleaned and sterile instruments are used. radiation. Radiation risks from x-rays are small with the dosages used in this examination. The benefits of this examination outweigh any small radiation risk. If you think you may be pregnant you must let staff know as soon as possible before the examination. conscious light sedation (a drug which should make you feel comfortable and relaxed). This can occasionally cause problems with your breathing, heart rate and blood pressure. Careful monitoring (checking) by a fully trained healthcare professional will make sure they are identified and treated quickly. How long does the procedure take? You will be taken to the Cardiology Day Unit. The procedure usually takes minutes but you may be in the Cardiology Day Unit for 3-4 hours before you are transferred back to your ward. Who will be involved in my procedure? A team of qualified and experienced healthcare professionals including a cardiologist (a doctor who specialises in conditions of the heart), nurse, cardiac physiologist (someone trained to perform and record special tests on the heart) and a radiographer (someone trained to take x-rays and scans) will be involved in your procedure. However, qualified staff, who are learning this procedure, may also be involved. This would only be done under the supervision of qualified and experienced staff. Can I be sedated for the examination? Sedation can be given before and during the procedure, if needed or specially requested. This may be a light sedation given as a tablet about 1 /2 hour before your procedure, to make you feel more relaxed. Stronger intravenous sedation and/or strong painkillers may be given just before or during the procedure if needed. This is called conscious sedation. You will still be awake but should feel more comfortable and relaxed. This involves injecting medication (drugs) through a cannula (a fine tube) inserted into a vein in the back of your hand or arm using a small fine needle. This is not a general anaesthetic.

5 Med/304.1 (2012) Page 5 of 8 For Review Summer 2015 What will happen during my coronary angiogram? If you are an inpatient at the University Hospital of North Tees, arrangements will be made by the hospital to transfer you by ambulance to the University Hospital of Hartlepool on the day of your coronary angiogram, and return you to the University Hospital of North Tees after you have had your coronary angiogram. If, for any reason you are not able to travel the same day after your coronary angiogram, arrangements will be made for you to be transferred to a ward at the University Hospital of Hartlepool, and later transferred back to the University Hospital of North Tees. A nurse will check your blood pressure and pulse and insert a cannula (a fine tube) into a vein in the back of your hand or arm using a small fine needle. This is in case you need to be given any medication during the procedure. You will be shown to a screened area and asked to undress, put on a theatre gown and a dressing gown. We operate a list system; this means you will be seen when it is your turn. A doctor or nurse will confirm your consent to having the procedure. When it is your turn you will be taken into the procedure room. Your heart rate will be monitored throughout the angiogram by placing sticky pads on your chest. These are attached to leads linked to an ECG machine to record your heart rate and rhythm. A small plastic clip will be placed on one of your fingers or toes to check your pulse and the oxygen levels in your blood throughout the procedure. Do not worry, this does not hurt and is all routine. You will be asked to lie on your back on a special trolley which has an x-ray machine above it. A nurse will be with you throughout the procedure to make sure you are comfortable. A local anaesthetic is injected into your groin (top of your leg) or wrist to numb the area. When the area is numb your doctor will make a small incision (cut) in the skin above an artery. He or she will then pass a very fine, long, special catheter (tube) into the artery and up towards your heart. You will not feel the catheter moving around in your chest but you may be aware of a missed or extra heart beat occasionally. Contrast medium is then injected through the catheter into your coronary artery. The catheter may then be passed into the main pumping chamber of your heart, as this happens you may feel a warm flushing feeling and may feel you have wet yourself, even though you have not. This is normal and will wear off very quickly. You will be warned when to expect this. X-rays are used to check the progress of the catheter as it is gently guided into the correct position. A number of x-rays are taken and recorded as a moving picture. This is called an angiogram. It shows your vessels filling with blood and whether there is any narrowing of any of the blood vessels.

6 Med/304.1 (2012) Page 6 of 8 For Review Summer 2015 This gives your doctor the vital information he or she needs to advise the best treatments for you, if needed. Some people may have a short mild angina pain during the procedure. This does not mean anything is wrong, but you should tell your doctor if it happens. When the procedure is over, the catheter is removed and the artery will be sealed using a plug or pressure. The small wound does not usually need any stitches or dressing. What happens after the procedure? You will be taken back to the ward area for further monitoring. You must not try to get off the trolley until your nurse says you can. You will be given a "nurse call buzzer" to use if you need anything. If you have had your angiogram through the radial artery in your wrist you will be able to sit in a chair or walk around the unit. Your nurse will regularly check your blood pressure, pulses in your feet or wrist, and your wound site. You will be offered a drink and a snack. You will then be transferred back to your ward. How will I feel after the procedure? The place where the catheter was inserted may feel a little tender for a few days. Most people get back to normal activities 1-2 days after the procedure. When will I be told the results of my coronary angiogram? Before you are discharged your doctor will discuss what he or she found during the procedure and discuss any further treatment choices, if needed. A letter will be sent to your GP giving details of the results. Will I need a follow-up outpatient appointment? Your doctor will tell you if you need to be seen again or if you are going to be referred to another hospital.

7 Med/304.1 (2012) Page 7 fo 8 For Review Summer 2015 Contact numbers If you have any worries or concerns when you have been discharged from hospital you should contact your GP during normal surgery hours. Outside surgery hours you should contact the GP Out of Hours Service, telephone: Further information is available from: NHS Direct 24 hour helpline or via the website at References 1 Bain D S, Simon D I, (2005) Complications and the optimal use of adjunctive pharmacology, Grossman's Cardiac Catheterization, Angiography, and Intervention, 7th ed. (pp.36-75). Lippincott/Williams & Wilkins, Brinker J (2003) What every cardiologist should know about intravascular contrast, Reviews in cardiovascular medicine, Volume 4, Supplement 5, 2003.

8 Med/304.1 (2012) Page 8 of 8 For Review Summer 2015 This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to Quality Assurance Team, University Hospital of North Tees, or telephone: or patientinformation@nth.nhs.uk. Comments or complaints We are continually trying to improve the services we provide. Please let us know about things we are doing well, or if you have any suggestions about how services can be improved. Our Patient Advisory Liaison Service (PALS) is here to try to deal with any problems on the spot and give information about local services. If you would like to contact or request a copy of our PALS leaflet please contact: University Hospital of North Tees telephone: or University Hospital of Hartlepool telephone: or If you are unhappy with any aspect of your care, please speak to any member of staff, PALS, the Patient Relations Department or write to the Chief Executive. If you would like a copy of our complaints leaflet please contact the Trust Patient Relations Department on: telephone: Data Protection and use of patient information The Trust has developed a Data Protection Policy in accordance with the Data Protection Act 1998 and the Freedom of Information Act All of our staff respect this policy, and confidentiality is adhered to at all times. If you require further information please contact the Head of Patient and Public Involvement. telephone: or University Hospital of North Tees, Hardwick, Stockton-on-Tees TS19 8PE Telephone: Fax: University Hospital of Hartlepool, Holdforth Road, Hartlepool TS24 9AH Telephone: Fax: