Angiogram & angioplasty: what to expect

Angiogram & angioplasty: what to expect

I’m Dr. Eric Cohen and I want to talk about coronary angiogram for information of patients
who might undergo this procedure. First of all, coronary angiogram is a
type of x-ray picture of the arteries of the
heart. You can see on our model of the heart right here these these red lines are the arteries. They’re the tubes that take
blood to the heart muscle itself. As you probably know these are prone to
getting narrowed or blocked and the angiogram is about looking for those
narrowings or blockages. What we do in an angiogram is insert a tube through an artery in the wrist or
sometimes at the top of the leg thread it up to the heart and then inject x-ray dye into these
arteries here. The x-ray dye then outlines for us where the arteries
are blocked. Based on what we find on those pictures we then decide what – together with the patient of course – what the best
treatment might be. Various treatments include medications
alone, sometimes bypass surgery, and sometimes the balloon procedure with
the stent, which we called angioplasty or these days we call it PCI. On the day we do the procedure,
many patients come from home that morning. If we’re just doing the angiogram procedure, they usually go home the same day. It’s an
outpatient procedure, often home within a few hours. We usually ask you to not have
anything to eat in the morning if your procedure scheduled early in the
day. If it’s scheduled later you can have a light breakfast before showing up. Here you see Mr. Nezim coming into
the procedure room. He’s being led to the procedure table. The nurses will do some prep of
the skin on the hand and at the top of the leg. Then we usually insert some local anesthetic – a
very small amount. A little bit of discomfort with that but once it’s numbed up, you usually don’t feel anything else. You are awake during this
procedure. We often use a mild sedation so you’re a bit relaxed, but we do not need general anaesthetic. You don’t need to be
asleep for this. In fact, many patients can watch on the
monitor exactly what’s going on. Following this, we proceed to
insert what we call them introduce tube. The introducer tube is in place now. We advance the catheter towards the
heart and we are guided by the x-ray during this. You can see the people in the room
wear x-ray protection in the form of a lead apron and there are x-ray
shields. This is mainly to protect the staff who are exposed to the x-rays constantly in
their job. Here you can see how we are actually
injecting the x-ray dye and taking the pictures. The images are shown in real time on
the monitor. We are observing the monitor. We take multiple pictures from different
angles that’s why you see the camera being moved around to different projections. Once we’ve
seen the images sometimes we will proceed with the angioplasty procedure,
that’s the balloon and stent, right then and there at the same time. In other situations, it requires
further discussion, thinking about it and as I said before, possibly other
types of treatment. After the procedure you’re taken off the
procedure table, wheeled back to the room usually on
a stretcher, sometimes in a wheelchair. Then we usually keep an eye on
things and observe for three to four hours, sometimes a bit
less if it’s an uncomplicated procedure. As i said you go home the same day. We
always ask you to take it easy that evening when you go home, but one of the advantages of this kind
of procedure is that you can get back to your usual activities very quickly. If we do the angioplasty procedure
either at the same time or even if you come back on a separate day that takes a bit longer for the
procedure itself and that depends on how complex your particular arteries and
situation might be. We’ve completed taking the pictures and
we’re reviewing them now and discussing with Mr. Nezim what
the best treatment option would be. We’ll put at least one, maybe two stents there and that will probably make your chest discomfort feel better. In this case, we all felt that an
attempt to open that narrowed artery right away would be the best treatment option. So we’re getting set up at this point
to proceed with what we call angioplasty or a stent procedure. We started working on the angioplasty at this point. We use a very fine guidewire which is
threaded through the narrowed area of the artery and then we insert a small balloon. Everything is very small here. They are
only two or three millimeters in diameter We insert the balloon and then we inflate it
to stretch the artery a bit. That makes room to bring the stent in. In this
case, it requires more than one stent to fully open the narrow portion of the artery. At this point we’ve completed
the procedure, the stents are in place and it might be quite
obvious from the images that the arteries are now wide open where it was severely
narrowed before. At this point, we just have to
remove the tube – the introducer sheath – from the wrist. We apply pressure over the site
until the bleeding stops. You can see that there really is very little
blood loss and the only incision made is about a quarter of an inch in length. Do you wanna see the picture before and after? As you can see, it’s almost completely blocked. There’s no blood getting through. Afterwards it’s wide open. Lots of blood getting through. That’s called the right coronary artery. The whole bottom part of your heart was not getting very much blood supply. So I think your angina is going to feel better. Once we’re all done with removing all the equipment, the patient is
taken off the procedure table. He’s getting back onto a stretcher here and will be returned do
what we call the short stay unit. He may go home later in
the same day or in this case because it was later in the day already, he’ll
probably stay overnight and go home the following morning. We usually arrange or ask
that you arrange follow-up with your own cardiologist who might be someone here
at Sunnybrook or might be somewhere else. We make sure that you have all the
information about prescriptions because some of the medications after these
procedures are quite important.

100 thoughts on “Angiogram & angioplasty: what to expect

  1. Doctor, Thank you sir for the expert explanation of this procedure. I am going to have an angiogram/angioplasty later this month. Thanks for alleviating some of the anxiety that I am having regarding this procedure. My cardiologist is a 4 hour flight from where I live as he is our dedicated physician for our union. As such, he is extremely busy and is somewhat difficult to just reach out to in light of our physical distance. An amazing procedure that can hopefully provide relief for my PVC's, (Premature Ventricular Contractions).

  2. It may seem a little trivial, but how safe is the X-ray dye that is injected into the patient's blood vessel and what is it composed of? I am assuming it should be safe otherwise it wouldn't have been injected into the patient in the first place but just out of curiosity I would want to know more.

  3. I had an angiogram recently. I went to ED for one issue & it was discovered that the heart palpitations I had been having, were of concern to the medical staff. So I had an echocardiogram & an angiogram. No issues were found thank goodness but I will be wearing a holter monitor for 48 hours to see if it can pickup any palpitations. The angiogram was a very unpleasant experience for me as my heart rate drop during the procedure & I felt very lightheaded & then vomitted during the procedure. However I recovered well & was about to go home that day. Few days on, my arm is still very tender & sore but otherwise I'm fine. I'm on a 25mg dose twice daily of beta blocker until they can discover the issue. Not a pleasant procedure & the local anaesthetic in the wrist stings but once the area is numb, you only feel the slightest movement of the catheter being inserted, without any pain so then, it's all over within 10 or so minutes, unless they insert stents. In saying that, I do hope I don't have to have this procedure ever again. Very unpleasant I'd say.

  4. have 13 stints after 7 heart attacks,has been 10 years since the last one.but going in the morning for another.

  5. i had 3 stress tests and failed them,am on a lot of medications and nitro patch as well, they are going to do this next,i am very nervous over this!!! does it hurt?

  6. I have a question. I'm 23 years old. I live a very athletic lifestyle however I had an anuerysm develop in my right subclavian artery. I got it fixed and had a bypass done where they replaced the damaged artery with a bypass graft. 7 months later I start having symptoms of my right arm, and right upper back/shoulder muscles starting to shrink in size. They also tire out much faster then my left side. I explained to the surgeon about the problem and he explained to me that the graft could be either blocked or narrowing and said its better to leave it like that as new arteries will grow back. I believe that theres not enough blood reaching my right side which leads to my arm tiring out. My question is would I need this procedure or will arteries actually grow back ,and how long would it take? I'm confused as this is the main subclavian artery.

  7. Thank you for posting this! My mom is having Angiogram & PCI tomorrow morning; this helped to ease my worry — very appreciated. You're a lovely speaker as well, thanks doctor! Edit: Also, thanks to Mr. Nazim for lending himself to YouTube for all of our education ๐Ÿ™‚

  8. I received a call from the cardiologists office today after having a stress test last week. I was informed that I there was evidence of an old heart attack. She wanted to know if I wanted to arrange for the angiogram then or wait until I spoke to the cardiologist at my next appointment. I chose to wait and speak with the cardiologist. I have to admit that this procedure scares me, but what scare me the most is her mentioning that there was evidence of an old heart attack. Any advice from anyone? Any concerns that I should have?

  9. Thank you for having this. I have to go in day after tomorrow for this and now I know what will happen I feel alot better about it.

  10. Just had this done 3 days ago, through the wrist, and it was not as bad as I had anticipated. The only surprise was an anti-spasm medication that was given while they inserted the stent and balloon. It sends a sharp burn up your arm that lasts about 3-5 seconds.

  11. I had an Angiogram to diagnose what ended up being Myocarditis. Had the heart pain and high Troponin levels so they thought heart attack. Angiogram was clear so they concluded Myocarditis after finding high level infection markers in blood tests. That was 3yrs ago, aged 33.

  12. I had one done and hey gave me the local to relax me during the procedure I felt like I could t breath. I heard the doctors say. Donโ€™t move donโ€™t move, then heard the doctor say stop the procedure. What do you think happened?

  13. I'm 55 years old and are scheduled to undergo an angiogram on February 15th, I'm terrified, watching this didn't help but thank you for posting it.

  14. I had this procedure on 22-11-2018 but through my groin which showed that I didnโ€™t have any blockages in my my heart and I had a cardio version on 12-01-2019 which fixed my wicked atrial fibrillation and Iโ€™m back into good health again with one cardio version shock.

  15. I just had this yesterday. It wasnโ€™t too bad, just a little pain in the wrist and the dye makes you feel like you peed yourself but you donโ€™t. Just a sensation with the dye. Your wrist will be sore after though.

  16. I had a heart attack March 16, was taken to a hospital, had the stent placed in one fully blocked artery. I was sent home the day after the procedure. It was incredible. I had no pain throughout the procedure, and I feel great immediately.

  17. Sir possible stent remove in future and i can leave normal life.i don't need stent.bcoz i want to live without stent normal life

  18. Plx pray for my father ..he is having blockage in 3 arteries..angioplasty was done but it was not success…now the drs have asked about other kinds of stents or bypass surgery…

  19. My stress test was abnormal so they want to do a heart catheterization I'm scard! Never in my life have been on medication either.

  20. Thank you so much for the brief explanations. really appreciate it. i cried so hard ths few days thinking abt my mum who has a heart blockage and she is going to undergo angio procedure at National Heart Institute Kuala Lumpur this week.Anyone who is reading ths, please keep my mum in yr prayer.May God Bless all of us. Always <3

  21. I work in a lab. We make stents. I always wanted to know how they use it during the procedure. So cool

  22. Thanks a lot for the Medical info…God willing i could have this kind procedures very soon, i need 2-stents for my heart…

    Thanks a lot

  23. Thank you Dr. This was actually scarry and one has to do with such precision and carefulness.Goshhhhh and I am planning to be a Dr. Theory seems cool and fascinating but practically performing it is always difficult (got to be dam focus and perfect)

  24. Pleae reply.. today itself.. my friends dad .. after its noticed water in his heart..n my friends dad is on ventilator now..plese please advise what to do are saying.. we need to wait for 24 hrs

  25. Sept 10, 2019.. In a few hours I'll be going for my angiagram.. I'm kinda freaked out and I just don't know how to feel.. I've been in the hospital for 5 days since my heart attack.. Hoping and pray for the best is all I can do now.. Reading positive experiences gives the strength I need.. Take care y'all..

  26. Thank you for sharing. I am now stress and sad as my older brother in this situation, we need cash around 5,000 USD to proceed with the procedure. :(. Please pray for my older brother.

  27. Much thanx for this informative video Dr. Cohen. I had my angiogram/angioplasty procedure done yesterday at Brampton Civic Hospital (Ontario Canada) by one Saint of a cardiologist Dr. F Hussain. I'm glad i didn't watch any videos prior to the procedure, as it would have heightened my anxiety even more…….but now, it's very interesting to see exactly what went on. They went through my artery in my wrist, and the procedure itself was a cake-walk!! ๐Ÿ™‚ The only difficulty we had was afterwards……a pressurized plastic "bubble" was clamped around my wrist to help the wound heal and eventually clot. Every half hour or so, the nurse would release a small amount of air-pressure from the "plastic bubble bandage". But even 2 hours after the procedure, the wound still bled quite a bit and refused to clot. After almost 8 hrs in recovery, my patience started wearing thin……i was dying to get home and was going to discharge myself!! Dr. Hussain approached me with tears in his eyes, and BEGGED me not to leave, as if i got home and turned my wrist the wrong way, i would 100% bleed out (it's a major artery….not a vein!). I relented, and over the next 2 hours they were able to stop the bleeding with different techniques and it started clotting :). It was a long stay for me, but i'm soooo grateful for modern medicine and these true hero's (cardiologists) that save and prolong our lives every single day!! ๐Ÿ™‚

  28. This is the test for Billy Skonsky! This is a second one in two months! They are checking for blockages in my legs! My first one went very well and no problems whatsoever! I would have it done for varies reasons again! It is a very good test!

  29. What a wonderful description of the procedure. Dr Cohen is obviously a very skilled surgeon and explains this so well in simple to understand terminology. Thank you. There should be no fear in having this done now that you have seen this.

  30. I have had 6 stents put and 5 procedures since 2002 Having another angiogram to be done on the 13 of November. If not for this procedure I would have probably died long ago. My brother was supposed to have one done in 96 but waited too long and passed away after another heart attack.

  31. Magnesium chloride cleans blood vessels and therefore prevents and prevents heart attack, stroke, and many other blood circulatory problems, such as arrhythmia as well. For it removes the fats from the blood vessels and impurities inside them that clog them, unclogging them, causing the blood to flow freely through the body. And so you don't even have to do angioplasty, catheterization or ablation. But you can't take it forever, you have to take it for a while and then stop. Hope it helps everyone and hugs!

  32. Spent xmas eve having an angiogram. I was told it wouldn't hurt once I had the Lidocaine shot. OMG. It was horrendously painful as my arteries are narrow for the tube. Every time he moved it it hurt like h*ll (in your arm). Then your arm hurts badly for around 2 hours and you feel like s**t for around 4. Then you start to feel better. However you are NOT fit to drive until around 8 to 12 hours after the procedure. They also have to slowly let out the air on your wrist cuff. But it's not a nice experience at all.

  33. having mine tomorrow.. I have a bleeding disorder and I am allergic to contrast they use… Been told they will give me something to try to stop the reaction of the contrast… wish me luck.

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