An angiogram is an diagnostic test that we can perform to look at the coronary arteries
around the heart and angioplasty is the treatment that we can do to widen or unblock any coronary
artery that we might find to have a problem. I was really scared I was telling people I
was nervous but I wasn't I was really scared. I was frightened it was going to hurt. I was
frightened that I wouldn't like the feeling and I told them I was scared when I got there.
I think they could see it on my face, in fact I was quivering but they made me feel very
comfortable. Every single patient prior to going into the cardiac cath lab and having
either an angiogram or an angioplasty will be seen by the consultant or the registrar
who will go through the procedure fully and the patient will need to sign a consent form,
they have full opportunity to ask any questions at this time that may have been worrying them
before they have come here. When you come into the cardiac catheter lab you'll find
that there is a lot of equipment, the biggest bit of equipment you'll see when you first
come in is the X ray machine and that allows us to use X rays to obtain the pictures of
the coronary arteries. The cardiac cath labs are our X ray rooms, our imaging rooms where
we take any patient that's going to have any sort of intervention on their coronary
arteries. We carry out something called a coronary angiogram which is essentially a
picture of the coronary arteries which supply the muscle of the heart with blood. We work
as a team and I think that's very important that doctors as simply one member of the team
so we have nursing staff in the cardiac catheter lab and their role is to make sure that the
patient is comfortable and we also have what we call a scrub nurse who helps the doctors
doing the procedure by getting the equipment ready and handing the right equipment at the
right times, then we have the cardiac physiologist - sometimes called a cardiac technician they
are there to monitor the patient continuously before during and even after the procedure.
The final member of the team is the radiographer who is the person who is responsible for the
X ray machine and the amount of X rays that we use. The procedure itself isn't particularly
painful at all we give local anaesthetic into the groin or into the wrist depending on which
access route we are going to use, once that tube is in there should be no pain at all
for the patient. Well once I got in there and they'd calmed me down they were talking
to me the whole time they made a little cut in my wrist and they put a wire in. You
can't feel it. You only feel the cut, the wire goes into your heart and then they put
a little plastic tube over the wire, you can't feel that either and then they put dye in,
and then they have a look and see what the hearts doing and they can see if there's
any blockages or anything that is wrong in there. When we perform a coronary Angiogram
the first stage of the procedure is to anesthetise a small area of skin most commonly nowadays
we use the radial artery which is essentially where we feel for a pulse and that that then
allows us to feed a very fine wire into the radial artery and then feed a small tube into
the artery that gives us what we call access to the arterial system and from there we can
then pass long but very thin catheters up through the arm and around to the heart and
in fact you'd be very surprised at how quick that is to do. You might feel a little tickle
now and again like somebodies finger going like that inside the heart you know but otherwise,
no you don't feel no it's very good, everybodies nervous because you are going into the unknown
with some people, but nothing to be nervous about really. It is beneficial if the patient
can lie still as possible but just be nice and relaxed we can offer sedation and there
will be people in the room, people talking and chatting to the patient the whole time.
The team in the Cath lab are very used to dealing with nervous and anxious patients
in fact I would say that most patients have some anxiety regarding the procedure which
I think is entirely natural and we are fully expecting patients to be a little anxious,
we have an excellent team of medical professionals who are fantastically good at putting patients
at ease, even the most nervous of patients when we've completed the coronary angiogram
we are able to look up at the TV screens where the pictures are being displayed in the cardiac
catheter lab and we can then determine whether there are significant narrowings inside the
coronary arteries we then pass a very fine wire down inside the coronary artery that
goes through the narrowing and beyond the narrowing that's something we call an angioplasty
wire, we would then pass a coronary balloon over that wire so we use the wire as a rail
to pass the balloon up inside the coronary artery and then down the coronary artery so
we can position the balloon across the narrowing, we then inflate the balloon so that it squashes
the artery open again we will then most often want to insert a coronary stent which is a
metal mesh work which comes essentially flat packed and in it's flat packed form we then
pass that down the coronary artery and put it in the correct position when we're happy
that the stent is in the correct position we inflate the stent so that it expands, the
stent then expands up and braces the artery and in the open position, both the balloons
that we use and the stents that we use show up on the X rays that we take during the procedure
and that allows us to position the balloons and the stents with a great deal of accuracy
so that we can ensure that we are only treating the areas that require treatment, the final
part of the procedure is um removing the little tube from either the artery in your wrist
if that's where we inserted the tube or indeed the artery in the groin we put a wristband
on thats something that we call it TR band and which puts pressure over the artery in
the wrist and prevents the artery in the wrist from bleeding we would usually keep that wristband
on for somewhere in the region of about two hours the risk of serious complications during
or after the procedure is relatively low and I can reassure patients that as doctors we
are constantly looking at the risk of the procedure and comparing that to the potential
benefit of doing the procedure we want to see that the benefit is significant and that
the risks are lower before we go ahead and recommend that procedure to the patient. Well
just relax, relax you are in expert hands and you've got nothing to worry about at all.