Your Coronary Angiogram: What Actually Happens

Why this test, specifically?

A coronary angiogram uses a thin catheter, X-ray imaging, and a contrast dye to produce a live picture of the arteries feeding your heart muscle. Unlike a CT scan, it can be combined with treatment in the same sitting if a significant narrowing is found, which is why it remains the definitive test when the diagnosis or treatment plan depends on seeing the arteries directly rather than inferring from other tests.

When it gets recommended

• Chest pain that hasn't been fully explained by non-invasive tests
• A CT coronary angiogram or stress test suggesting a narrowing that needs a closer look
• After a heart attack, to identify and treat the responsible artery
• Unexplained heart failure, where the cause needs to be clarified

On the day

Most angiograms in Australia are done as a day-only or overnight private hospital admission.

• You'll usually be asked to fast for a few hours beforehand, though your regular medications can normally continue with a small sip of water — your team will confirm this with you
• Blood tests check your kidney function and clotting before you go in
• A cannula is placed, usually in your wrist, and you'll change into a gown
• Someone will talk you through consent and answer any questions before you go to the catheterisation lab

In the catheterisation lab

You're awake for the whole procedure.

1. Local anaesthetic numbs the entry site, almost always the wrist (radial approach), which has a lower bleeding risk and lets you sit up and eat sooner than the older groin approach.
2. A fine catheter is threaded through the artery up to the heart. You won't feel this part.
3. Contrast dye is injected and the arteries are filmed from several angles. You may notice a brief warm flush when the dye goes in.
4. If a significant blockage shows up, it can often be assessed and treated in the same procedure, sometimes with the added help of intravascular imaging (a tiny camera or pressure sensor inside the artery) to guide exactly where and how a stent is placed.
5. Start to finish, the procedure is usually 15 to 45 minutes, longer if treatment is done at the same time.

Afterwards

• Pressure is applied at the wrist for a short time to seal the artery
• Most people rest for two to four hours before heading home the same day
• Heavy lifting and strenuous exercise are best avoided for a few days
• You'll be talked through the findings and next steps before you leave, and this is worth having a support person present for

How safe is it?

Serious complications are uncommon, occurring in well under 1 in 1,000 procedures. Bruising at the wrist is by far the most common issue, and it settles on its own.

The takeaway

A coronary angiogram gives the clearest possible view of the arteries supplying your heart, and for most people it's a same-day procedure done while fully awake. If a treatable narrowing is found, it can often be dealt with there and then.