This is a procedure to correct abnormal heart rhythms, the most common being atrial fibrillation. It sets out to restore the normal co-ordination between the top two chambers of the heart (atria) and the lower chambers (ventricles). While under anaesthetic, an electrical charge is passed through the heart. In more than 50% of patients, this is enough to restore normal heart rhythm. The procedure usually takes less than five minutes. You must be fasting from 12 midnight the night before. You should take your normal medication with a small amount of water on the morning of the test. Before the treatment can be performed, it is necessary to ensure there are no small blood clots lodged within the heart. This is done by administering a blood thinner called Warfarin or some other anticoagulant for a period of four weeks up to the treatment and for a minimum of four weeks after treatment.
A coronary angiogram is used to find out how well your heart is working and if any of the arteries feeding your heart muscle (coronary arteries) are narrowed or blocked and if gaps need tightening or opening.
Before the procedure: Don’t eat or drink anything for at least 6 – 8 hours before the test (or as your doctor tells you). If you take medicine (especially diabetes medicine), check with your doctor to see what you should do about taking it before the test. If you are taking Glucophage (Metformin), skip the last two doses before the angiogram. Find out when you should be at the hospital. Arrange for someone to take you and bring you home.
Tell your doctor if you:
- Are taking warfarin, aspirin or a blood thinner. You will be advised as to whether or not you need to stop taking these a couple of days before the procedure.
- Have any allergies to foods, medicines, x-ray dye or shellfish?
- Are pregnant? You will be asked to provide date of your last menstrual period.
How the test works:
A local anaesthetic is injected into the back of the wrist or upper leg (groin) to numb it. This may sting a little or be uncomfortable. A needle-like tube (introducer) is inserted into your blood vessel. A long thin tube (catheter) is inserted through it into the blood vessel. As your doctor watches it on the monitor, the catheter is guided through your blood vessel until it reaches your heart. You may feel a little pressure, but no pain, as this is done. Dye is injected into the catheter and x-ray pictures are taken of your heart and coronary arteries. You may feel warm or hot for about 30 seconds. You may be asked to take a deep breath, cough, and turn to one side or not to speak for a few minutes. Once the pictures are taken, your doctor will remove the catheter. The test takes about 20 minutes. If your wrist is used a metal clamp is applied for about two hours. If a blood vessel in your groin is used, firm pressure is applied to it for at least five minutes, and then a pressure bandage placed on top.
After the procedure:
You can eat and drink right after the test. If your arm was used, you may walk straight away. If your groin was used, bed rest is usually needed for an hour or two to allow a good seal to form. You should limit your movements while it seals. During this time, a nurse will monitor your blood pressure and check the insertion site to make sure it’s not bleeding. Tell your nurse if you have any chest pain or shortness of breath. Once a seal forms, all you’ll need is a plaster over the site. Unless other treatment is needed, you can most likely go home the same day. You may feel tired and have a bruise or lump where the catheter was put in. You should take it easy for a few days and avoid heavy lifting. You can return to full activity in a day or two. Ask your doctor when you can have a bath or shower. Please note you may not drive on the way to this procedure nor take alcohol. Therefore you will need someone to escort you home.
This is where the heart is scanned using a technique similar to having a gastroscopy. A probe is placed in the gullet. This is done under sedation and local anaesthetic. Because of the proximity of the gullet to the heart we can see the structures of the heart very clearly. It allows us to see the valve structures, identify holes in the heart, and check for clot formation and stroke risk.
A saline contrast or bubble study is carried out when a small hole or communication is suspected between the thin walls that separate the top two chambers of the heart. This fluid is injected into the vein. The bubbles travel to the right side of the heart where they can be clearly seen on the Echocardiogram. If a hole or communication is present the bubbles will be seen on the left side of the heart.
There are two types of imaging in use. CT Cardiac Scanning and CT Calcium Score are x-ray based tests which may give very early information as to whether you are developing condonary artery diease, many years in advance of actually developing real problems. The main benefit of this test is to help decide who requires routine follow-up and particular whether or not long term Cholesterol medication is needed. Cardiac MRI is useful to dertermine whether there is damage to the muscle of the heart as would be caused by previous heart attacks. It is also useful in assessing if there is an inherited heart muscle condition present (such as Hypertrophic Cardiomyopathy – HCM).
Cardiac computed tomography, or cardiac CT scan, is a painless test which uses an x-ray machine to take clear, detailed pictures of the heart. During a cardiac CT scan, an x-ray machine will move around your body in a circle. The machine will take a picture of your heart. A computer will then put the pictures together to make a three-dimensional (3D) picture of your whole heart. Sometimes, an iodine-based dye (contrast dye) is injected into one of your veins during the scan. The contrast dye highlights your coronary arteries on the x-rays. This type of CT scan is called a coronary CT angiography, or CTA.
Magnetic resonance imaging (MRI) is a safe, non-invasive test that creates detailed pictures of your organs and tissues. “Non-invasive” means that no surgery is involved and no instruments are inserted into your body. MRI uses radio waves, magnets and a computer to create pictures of your organs and tissues. Unlike other imaging tests, MRI doesn’t use ionising radiation or carry any risk of causing cancer. Cardiac MRI creates both still and moving pictures of your heart and major blood vessels. Doctors use cardiac MRI to get pictures of the beating heart and to look at its structure and function. These pictures can help them decide the best way to treat people who have heart problems. Cardiac MRI is a common test. It’s used to diagnose and assess many diseases and conditions, including coronary heart disease, damage caused by a heart attack, heart failure, heart valve problems, congenital heart defects, pericarditis and cardiac tumours. Cardiac MRI can also help to explain results from other tests such as x-rays and CT scans.
Percutaneous coronary intervention (PCI), commonly known as coronary stenting is a non-surgical procedure used to treat narrowed coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the build-up of the cholesterol-laden plaques that form due to atherosclerosis. These procedures are usually performed by an interventional cardiologist.
A Cardiologist feeds a small balloon through the arm or groin through to the blood vessels, to the heart, and into the blood vessels of the heart. At the site of the blockage the balloon is inflated thus restoring blood flow. A stent which is like a spring of a biro is left in position to keep blood vessel open.
A coronary artery bypass is an operation where new blood vessels outside the heart are used to bypass blocked vessels in your heart. As the Surgeons sometimes say it is like a ring road around a busy town. The blood vessels used are taken from somewhere else in your body (often the leg or the arm). This operation allows blood to be brought freely to some areas of heart muscle that had a low blood supply due to narrowing of the coronary arteries. The bypass involves taking a vein from the surface of the leg or an artery from the inner chest wall. The surgeon attaches one end of the vein to the aorta which is the main blood vessel leaving the heart. The other end of the vein is attached to the coronary artery beyond where it is narrowed. After the bypass operation, which can take 2 – 6 hours, you will be brought to a speciaslist Cardiac Unit. The normal hospital stay is between a week to two weeks. You can not drive for up to four weeks after your surgery and you start to feel pretty good after four weeks but full recovery takes up to three months.