I am told I need an angiogram but I saw on TV a new kind of angiogram using CT scanning. What's this?

It's known as 64-channel multi-detector computed tomography (MDCT). It is an outpatient specialised X-ray procedure which can take pictures of your arteries in less than half an hour. You have an injection in a vein (not an artery) and your heart is slowed, usually by taking a beta-blocker drug beforehand, as this leads to better pictures. It's an exciting new technique which does not replace an angiogram but can be used instead when the diagnosis of heart disease is unlikely but the doctor is not certain. It also is used when the person is at risk but has no symptoms - for example, someone with diabetes who has no chest pain but an abnormal ECG. It does involve X-rays so cannot be used casually in a check-up. New scanners are being introduced which are claimed to reduce X-ray exposure by 80% so this is going to be an exciting area of development with the possibility of repeated scans to monitor progress.

MRI does not involve X-rays so can I have an MRI instead of an angiogram?

Not yet. Magnetic resonance arteriography (MRA) can show up any problems in the aorta and renal (kidney) arteries but not yet in the coronary arteries. Magnetic resonance imaging (MRI) can tell us about the structure and pumping of the heart.

Is there any difference between an angiogram from the arm or the leg?

The leg approach does not involve stitches but pressure is needed for 10 minutes or so to stop the bleeding (a tiny hole is made in the artery by a fine needle). To prevent re-bleeding, you will be advised to rest in bed for 4-6 hours. This technique is 'percutaneous' which means 'through the skin' but no surgical cut is involved. Devices have been developed to 'plug' the hole in the artery and, if you are a suitable candidate, the artery will be closed and you will not need pressure on the groin. You will rest in bed for about an hour and then get up and about, going home sooner.

The arm approach is usually percutaneous at the wrist (radial artery) and does not need bed or chair rest for more than an hour.

The arm approach at the elbow can be percutaneous but often needs a cut and then stitches (the jargon we use is cut-down). Again, you are up and moving very soon. The wrist and leg techniques are the most common. The wrist approach is being used more frequently but is not suitable for everyone.

I have been on warfarin tablets for some time now, to prevent blood clots. Do I need to stop or reduce my warfarin before the angiogram?

Warfarin is a medication used to prevent blood clots from forming.

It is not always necessary to stop or reduce warfarin with an angiogram taken from the arm, but it is essential with the leg approach to prevent severe bruising. We usually advise four days of no therapy before an angiogram. Always remind the doctor that you are taking warfarin so your clotting can be checked before the procedure.

I'm taking aspirin every day - do I need to stop this for the angiogram?

No, this is not necessary. The mild blood-thinning action of aspirin

helps prevent clotting in the artery narrowings but it does not usually significantly increase the tendency to bruising or bleeding. The same applies if you are taking clopidogrel as an alternative to aspirin, or both together.

Is the angiogram at all painful?

The only discomfort should be the injection of local anaesthetic.

When the dye is injected into your muscle pump, you may feel hot and flushed with a strange warm feeling in your bottom. This passes quickly. Sometimes, when the catheter is in the pumping chamber, your heart may appear to miss a beat or flutter for a few seconds. Don't be afraid; this is all routine.

After the procedure, pressure will be applied to your groin to stop the bleeding (about 15 minutes) and you will be asked to rest in bed for 4-6 hours while the small hole in your artery closes. If your arm has been used, a pressure bandage will be applied to your wrist.

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