Coronary angiogram, also called cardiac catheteristion is increasingly performed now a days. It is done when people experience symptoms of coronary artery disease, such as — chest pain (called angina), pain in your jaw, neck or arm that cannot be explained by other tests; congenital heart diseases; heart failure and heart valve problem. A catheter in inserted into the coronary artery (blood vessels to the heart) through groin or artery in the elbow. It is done by using a contrast material or dye and X-rays to view how the blood flows around your heart or is there any block in the artery that carries blood to heart.
The procedure needs a short time but may be complicated if there is gap in the preparation. As a patient, you should know the facts to take a few precautions and your doctor must know certain information about you before the test performed.
Renowned Interventional Cardiologist of the country Professor Dr Md Afzalur Rahman, Head of the Department of Cardiology of Sir Salimullah Medical College and Mitford Hospital, Dhaka advised patients to take following necessary preparation prior to an intervention:
1. Test for kidney function: It is utmost importance to test your kidney function to check its condition. Kidney is the organ involved with excretion of unwanted substance like clearing the dye and other drugs. Otherwise dye can damage your kidney if you have kidney impairment. If anyone has kidney disease s/he should consult a specialist before the procedure.
2. Check for dye allergy: Dye is used to colour desired blood vessels and take the X-ray image during angiogram. Many people have dye allergy and it may seriously complicate with life threatening hypersensitivity reactions.
3. Medications to avoid: If you take regular medications, let your cardiologist know the list so that s/he can advise you properly. Usually morning doses are taken. The only exception to this might be if you take warfarin, in which case you should follow instructions provided for you.
4. Eating: you should not eat any solid food 6 hours prior to your procedure. You may have clear liquids (water, ice, chips but not fruit juice) at least 2 hours prior to the procedure.
5. Control your diabetes preferably with insulin: If you are diabetic and taking oral drugs, you should consult with your diabetologist for recommendation of drugs or insulin to lower blood sugar. It is recommended that some oral drugs (like metformin) to be temporarily discontinued before any radiographic iodinated contrast (such as a contrast-enhanced CT scan or angiogram). In that case, insulin is preferred option to lower blood sugar. Before switch to insulin you must consult a diabetologist.
6. Control blood pressure and check pumping capacity of the heart: if you have high blood pressure and taking medication, check your blood pressure before undergoing for the procedure. If your current medications cannot keep your blood pressure normal, consult your physician. It is also needed to evaluate the pumping capacity of heart, called Ejection Fraction (the fraction of blood pumped out of ventricles with each heart beat) by an echocardiogram.
7. Treat you specific conditions: If you have asthma, heart valve disease or a history of bleeding disorders, it is strongly recommended to consult the interventionist before the procedure.
Just after the procedure: If you are having your angiogram done as an outpatient service, you will stay in the hospital for four to six hours for observation after the procedure is completed. You can go home after the observation period. You should do the following things after the procedure:
* Drink plenty of fluids.
* Avoid caffeine and alcohol products.
* Do not smoke for 24 hours after the procedure. Smoking greatly increases the chances of a blood clot forming in the artery. Avoid all types of tobacco.
* Resume your regular diet.
* Do not wet the catheter insertion site and keep a bandage on for 24 hours for angiogram and 48 hours for angioplasty.
* Do not drive or run machinery for at least 24 hours.
* Do not do any strenuous exercise or lifting for at least two days.
Dr Md Rajib Hossain
Source: The Daily Star, March 27, 2010
Dr David Thomas
We are looking at ways of inproving ambulance delivery of patients who are having emergency angioplasty for myocardial infarction, if this is of any interest.
D. Thomas Tokyo Japan