Angiogram

  • Angiography is a type of X-ray examination used for investigating the blood vessels and arteries in the body(1). An angiography may detect a stroke, aneurysm, malformation, tumor, blood clots, or artery stenosis(2). 
  • Angiography is performed to check for blockages in the heart’s blood vessels(3). These blockages may cause angina, shortness of breath, and other symptoms(4). Obstructions may also indicate cardiac disease, which may lead to a heart attack. 
  • Angiograms may not always indicate angioplasty or bypass surgery(5). If the angiography reveals severely constricted arteries, patients may need emergency angioplasty or bypass surgery.

What Is an Angiogram?

An angiogram is a type of X-ray imaging performed to look for signs of issues in the blood vessels in the body(6). 

The procedure can be done by using a catheter or a small tube. The doctor places the catheter into one of the arteries and injects a dye into the area(7).

The angiogram test can assist in the diagnosis of a stroke, arteriovenous malformation, aneurysm, tumor, blood clots, or arterial stenosis(8).

Alternative Names for Angiogram

Angiography, angiogram, and arteriogram are all words that refer to a procedure that examines blood vessels, typically arteries, in various locations across the body(9). 

Arteriograms of the kidney or renal arteries provide information on the kidney’s blood supply. Leg arteriograms are used to assess blood flow to the leg and groin. Aortic arteriograms depict the chest and abdomen’s primary blood vessels.

Cardiac arteriograms, alternatively referred to as a heart cath or cardiac cath, depict the heart’s arteries. Meanwhile, carotid arteriograms show the neck arteries that connect to the brain. 

Difference Between Angiogram and Angioplasty

A coronary angiography (coronary angiogram) is a diagnostic procedure that involves the examination of the blood arteries to rule out any potential heart problems(10). It is performed as part of a general procedure called cardiac catheterization.

On the other hand, angioplasty is a minimally invasive technique that involves widening the small arteries to treat coronary heart diseases and reduce the risk of heart attacks through procedures on the radial or femoral artery(11).

In the event of coronary artery disease, the blood arteries are narrowed due to plaque accumulation(12). Plaque is a gummy mass from a buildup of calcium, cholesterol, and other components. 

Over time, plaque may cause artery blockage, depriving some areas of the heart of getting sufficient blood(13). Thus, a healthcare expert may recommend angioplasty to remove plaque from the blood vessels.

Uses and Purpose of Angiogram

An angiogram is used to determine the presence of blockages in the blood arteries that provide blood to the heart muscle(14). 

These obstructions can result in chest pain (angina), shortness of breath, and other concerning symptoms(15). Additionally, the blocks may suggest that individuals have a heart disease, resulting in a heart attack.

An angiography will demonstrate to the interventional cardiologists whether or not blockages are restricting blood flow to the heart(16). 

Likewise, if blood flow is restricted, the angiography will enable the doctors to determine which arteries are narrowed or obstructed, the location of the blockages, and the severity of the blockages. 

Benefits, Risks, and Complications of Angiogram

An angiography can assist the patients, and the physician determines the best course of treatment for the patients.

Patients may choose to have an angiography for the following reasons(17): 

  • An angiography can assist the doctor in determining whether a change in therapy could reduce the risk of death from heart disease. 
  • An angiography can show the doctor where plaque has restricted the arteries and whether blood flow has been reduced. However, an angiogram cannot determine if these plaques will result in a heart attack. 
  • The patients may desire some relief in their angina (a form of chest pain due to blood flow restriction to the heart). Coronary artery disease is a symptom of angina. The test may inform the doctor whether a procedure or surgery would be beneficial in alleviating the medical condition.

Note that it is critical to discuss the angina symptoms with a doctor. Additionally, if patients receive medication for angina, they should notify the doctor if the medication does not control the symptoms adequately(18). 

Meanwhile, Mayo Clinic noted the possible risks of angiogram(19): 

  • Heart attack
  • Profuse bleeding
  • Injury to the catheterized artery
  • Stroke
  • Irregular heart rhythms (arrhythmias)
  • Allergic reactions to the dye or medications 
  • Kidney damage
  • Infection

Although angiography is a relatively safe technique, mild side effects are common, and a slight chance of serious complications exists(20).

The angiogram test does not necessarily imply that patients need angioplasty or bypass surgery(21). However, suppose the doctor discovers that the arteries are severely restricted during the angiography. In that case, patients may require immediate angioplasty or bypass surgery. 

Preparation and Considerations

Any medical procedure may be a source of anxiety. This health information will assist the patients in understanding what is to be expected in an angiogram. 

Coronary angiograms are sometimes conducted on an emergency basis(22). However, these procedures are more often arranged in advance, allowing patients time to prepare.

Angiograms are conducted at a hospital’s catheterization (cath) lab. The health care provider will provide precise instructions and discuss any drugs that patients will be taking with them. Among the general guidelines before the procedure are the following:

  • Before the angiography, avoid eating or drinking anything after midnight.
  • Bring all the medicines with the patients to the hospital in their original containers.
  • Consult the physician regarding the morning medications if needed to take.
  • Consult the doctor if the patients have diabetes and if they need to take insulin or other oral drugs before the angiography.

Who Performs the Test?

An interventional radiologist will perform the angiography test. The interventional radiologist inserts a short, thin tube or catheter into one of the arteries and injects contrast material (often referred to as contrast dye) into it while obtaining X-rays of the region(23).

Before the Procedure

Mayo Clinic briefly defines how the procedure takes place in angiograms(24). 

Before starting the angiography treatment, the health care team will evaluate the medical history, including any allergies or drugs the patients are currently taking. The team may do a physical examination and take the patient’s blood pressure and pulse.

Additionally, the patients need to empty their bladder and dress in a hospital gown. Patients may be required to remove contact lenses, eyeglasses, jewelry, and hairpins.

During the Procedure

As explained in Mayo Clinic, during the procedure, the patients will be placed on a tilted X-ray table so that the camera can move around and take X-ray pictures of the body(25). Safety straps will be attached to the legs and chest to prevent falls.

An IV line is placed in the arm to deliver fluids and medication to help the patients relax. During the angiogram procedure, doctors may put patients under sedation to help them feel better or give them other drugs and fluids to help them sleep.

Then, electrodes will be placed on the patient’s chest to monitor their heart. A blood pressure cuff will also be worn to keep track of the blood pressure.

After monitoring the heart, a catheter or flexible tube is placed in the shaved arm or groin. The shaved area is then thoroughly cleaned and injected with a local anesthetic.

A small incision is made in the arm to allow a catheter to be inserted into the blood vessel. The catheter is carefully placed through the sheath and into the heart or coronary arteries.

Although the procedure is simple, the patients should not feel the catheter moving inside their bodies.

During the angiogram procedure, a dye is injected into the catheter. Although the catheter may temporarily relieve some pain, the patients may tell their health care team about any discomfort they may feel.

Note that the dye used during the procedure is easy to see on X-ray images. The doctor can then monitor the catheter flow and identify areas of concern. 

Depending on the patient’s examination results, they may also have other procedures such as balloon angioplasty.

An angiogram is usually performed in about an hour. However, it can take longer depending on the procedure and the preparation needed.

After the Procedure

After the procedure, patients must stay on their backs for the next six hours(26). If a vascular closure device was used during this procedure, patients must remain flat on their back for two hours. Also, if patients experience any pain or swelling, immediately notify the nurse. Patients will be given specific instructions at home. 

Expected Results

Angiography may reveal problems with the blood arteries. Some possibilities may(27): 

  • Determine the location of blockages in the blood vessels
  • Indicate the number of coronary arteries in the body that are blocked or constricted by fatty plaques (atherosclerosis)
  • Examine the outcome of prior coronary bypass surgery
  • Demonstrate how much blood flow is being restricted in the blood vessels
  • Examine the circulation of blood via the heart and blood arteries

Note that the doctor may determine that patients might benefit from coronary angioplasty or stenting to assist in clearing blocked arteries. 

Additionally, angioplasty or stent may be performed during the angiography to eliminate the need for additional treatment.

Recovery Process in Hospital or Home

After the surgery, the doctor may employ a device to seal the artery puncture or insertion site(28). Alternatively, the doctor or nurse exerts pressure for 20 minutes on the puncture site. If the catheterization procedure was implanted in the leg, the patients may need to rest for two to six hours.

After returning home, patients may see a bruise where the doctor put the catheter(29). The bruises may usually clear up in one to three weeks.

Call a nurse practitioner if patients experience the following(30):

  • Fever
  • Chronic chest discomfort, pressure, or tightness
  • Painful swelling or bleeding at the catheter insertion location
  • Swelling, weakness, or numbness in the catheterized leg or arm
  • Difficulty in speech, smiling, or weakness of the legs and arms

Note that the recovery period varies. Some patients may feel fine after a day or two of having the surgery(31). However, patients may feel somewhat exhausted, and the incision site may be sensitive for up to a week. Also, bruising may be visible for up to two weeks.

  1. Angiogram Test Prep
    https://www.uofmhealth.org/conditions-treatments/radiology-and-imaging/patient-resources/patient-instructions/angiogram-test-prep
  2. Angiogram
    https://mayfieldclinic.com/pe-angio.htm
  3. Your Angiogram: What to Expect
    http://www.secondscount.org/tests/test-detail-2/your-angiogram-what-to-expect#.YmcwmfMzY0o
  4. Ibid.
  5. Coronary Artery Disease: Should I Have an Angiogram?
    https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=hw267214
  6. Angiogram Test Prep
    https://www.uofmhealth.org/conditions-treatments/radiology-and-imaging/patient-resources/patient-instructions/angiogram-test-prep
  7. Ibid.
  8. Angiogram
    http://www.mayfieldclinic.com/pe-angio.htm
  9. Angiography, Angiogram, and Arteriogram
    https://www.johnmuirhealth.com/services/cardiovascular-services/intervention/angiography-angiogram-arteriogram.html
  10. What Is the Difference Between Angioplasty and Angiography?
    https://www.maxhealthcare.in/blogs/difference-between-angioplasty-and-angiography
  11. Ibid.
  12. Ibid.
  13. Ibid.
  14. Your Angiogram: What to Expect
    http://www.secondscount.org/tests/test-detail-2/your-angiogram-what-to-expect#.YmcwmfMzY0o
  15. Ibid.
  16. Ibid.
  17. Your Angiogram: What to Expect
    http://www.secondscount.org/tests/test-detail-2/your-angiogram-what-to-expect#.YmcwmfMzY0o
  18. Ibid.
  19. Coronary angiogram
    https://www.mayoclinic.org/tests-procedures/coronary-angiogram/about/pac-20384904
  20. Risks-Angiography
    https://www.nhs.uk/conditions/angiography/risks/
  21. Coronary Artery Disease: Should I Have an Angiogram?
    https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=hw267214
  22. Coronary angiogram
    https://www.mayoclinic.org/tests-procedures/coronary-angiogram/about/pac-20384904
  23. Angiogram Test Prep
    https://www.uofmhealth.org/conditions-treatments/radiology-and-imaging/patient-resources/patient-instructions/angiogram-test-prep
  24. Coronary angiogram
    https://www.mayoclinic.org/tests-procedures/coronary-angiogram/about/pac-20384904
  25. Ibid.
  26. Angiogram
    http://www.mayfieldclinic.com/pe-angio.htm
  27. Coronary angiogram
    https://www.mayoclinic.org/tests-procedures/coronary-angiogram/about/pac-20384904
  28. Your Angiogram: What to Expect
    http://www.secondscount.org/tests/test-detail-2/your-angiogram-what-to-expect#.YmcwmfMzY0o
  29. Ibid.
  30. Ibid.
  31. Recovery-Cardiac catheterisation and coronary angiography
    https://www.nhs.uk/conditions/coronary-angiography/recovery/
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