Invasive means that we have to put something into your body.
Invasive Testing for people with heart problems is when we put some dye into your blood and then take an x-ray. The dye makes the x-ray clearer and helps us to get a good picture of what is happening inside your heart.
We provide a diagnostic coronary angiogram service to patients who are having symptoms of chest pain or who are suspected of having coronary heart disease.
We provide monitoring of various clinic measurements during a coronary angiogram procedure, supporting the Cardiac Consultant who is performing the procedure.
Patients are referred to us from a wide range of departments throughout the hospital, although predominantly via our Cardiology service. Patients often undergo tests previous to a coronary angiogram which suggest that they may have coronary artery disease, and it is after this when they will be referred for a coronary angiogram.
You will be brought from the ward to the X-ray room, which contains a lot of X-ray and video equipment. You will lie on a firm X-ray table whilst ECG (heart monitor) wires are attached to you. Throughout the procedure the doctors and nurses will be wearing surgical gowns and possibly hats and masks.
This test is now frequently performed through the right radial artery, which is the blood vessel in your right wrist where the pulse is usually taken, although in some cases the left wrist or the groin will need to be used. The skin of the area selected will be cleaned with a cold solution, and if your groin is going to be used, this will have been previously shaved. Apart from your head, you will be covered with sterile towels or sheets. Some local anaesthetic will be injected into this area to 'freeze' it.
A needle will then be used to make a small hole in your artery, into which a short, soft ‘sheath’ will be placed. A three foot long, thin, flexible tube (called a catheter) will then be passed through the sheath and up to the heart, but since the arteries do not have nerves on their inside, most people do not feel this.
Contrast agent (dye) will be injected through the catheter into the heart and several pictures taken with the X-ray equipment that will be rotated around you as you lie still on the bed.
Please note that the catheter goes through the blood vessel to the heart, so you do not feel this. It is only this fine tube that goes into your artery and the cameras travel around the outside of the body.
You will be asked to control your breathing at different times during the recording of the pictures. At the end of the first set of pictures, the catheter will be changed (through the sheath) for a different shaped one and the procedure repeated. No further needles are used.
Usually, two different sets of pictures are obtained using two different catheters, although in some cases a third picture is taken to look at the main pump (ventricle) of the heart. If this is the case, you will usually feel a hot flush when the dye is injected and may even feel as if you are passing urine, although this is not actually the case.
When all the pictures have been taken, the sheath and catheter are removed and the hole in the blood vessel is sealed, either with pressure, or more usually with a device that plugs the vessel or presses on it. You will then be returned on a trolley to the ward.
The test usually takes about 30 to 40 minutes in all but this can change, depending upon what information is required. It is important that you keep as still as possible during this period.
Mild sedative tablets are sometimes given about an hour beforehand to make this easier and also to reduce any anxiety you may have. Each procedure is tailored for a particular patient.
Once you arrive back in the ward, you will be asked to lie flat and still in bed for two to four hours. If the catheter has been inserted into your arm, there is no need to lie in bed afterwards, though you will need to keep your arm as straight as possible for the next 24 hours.
A nurse will check your pulse, blood pressure, breathing rate and wound. After this time, you will be allowed to sit up in bed for a similar period of time.
During this time you should try and avoid strains such as talking a lot, coughing, laughing or passing water, as these increase the chances of a late bleed from the arterial puncture site. You will be able to eat and drink normally.
Our Cath Lab Co-ordinator will arrange all the dates and times of the procedure with you to suit your convenience. We have a team of Cardiac Physiologists who who perform the relevant tasks required during an coronary angiogram, in support of the Consultant Cardiologist who will be performing the procedure. There will aslo be 1-2 nurses present and a radiographer to take the x-ray images during the procedure.
Patients who are referred for a coronary angiogram will attend a pre-assessment clinic appointment with a specialist nurse who will discuss the procedure and answer any questions you may have. This usually takes place in the outpatient clinics on the ground floor of The Royal Liverpool hospital
On the day of the procedure you will attend the cardiac day ward (3C) before being transferred to the interventional theatre where you will have the procedure performed.
After the procedure you will be transferred back to the ward where you will be able to have something toe at and drink.
Cardio-Respiratory Department
The Royal Liverpool and Broadgreen University Hospital Trust,
Prescot Street,
Liverpool, L7 8XP
Tel - 0151 706 3855
Fax - 0151 706 5855
Loop hearing services available at reception.
The outpatient clinics where you will attend for you pre-assessment appointment are located on the ground floor of The Royal Liverpool Hospital and your appointment letter will describe the exact clinic and its location.
The cardiac day ward (3C) can be found on the 3rd floor of The Royal Liverpool Hospital on the A,B,C side. Lifts and stairs are available.