Getting an angiogram was more emotional than I expected it to be. I cannot tell you how incredible it is to find out you have a healthy heart!
Dr Mehmood Butt, a Consultant Interventional Cardiologist and the Director of Cardiac Catheter Laboratory at King’s College Hospital, Dubai, was the specialist in charge of the angiography I had earlier this year.
My results, he said, were “boringly normal” – which is ironically a good thing! In this blog, I take you through the process of what going deep into your heart (literally) constitutes and signals about your health.
Very simply, an angiogram tells you the state of your arteries.
The procedure is done under local anaesthetic and typically doesn’t last more than 15-20 minutes. Mine took about 10 minutes. A fine needle is inserted into the wrist, through which runs a catheter all the way through the arm and to the chest. Dye is injected from the outside to inspect whether the arteries are properly functional, pictures of both sides of the heart are taken, and that’s it!
If all goes well, the apparatus is taken out and a band is applied to your wrist, where the needle went in. In a couple of hours when the wristband comes off, the area is dressed and you’re free to go.
What if there’s a problem? There’s a monitor by the bedside and standard protocol calls for the doctor to show the patient (and their companion) the internal issue on the screen. And if the parties agree, then the doctor would proceed to fix it through the same conduit.
“Most of the time, the process to fix an artery takes 15-20 minutes but it all depends on how complex someone’s anatomy is,” Dr Butt says. It could even take an hour in some cases. “The cutoff for treatment is 50%. If it’s less than that, then we advise to treat medically or conservatively – that the medicines or lifestyles change, or cholesterol reduced.”
In any case, it is recommended that you avoid strenuous activities like weight-lifting or driving for at least 24 hours after you undergo an angiogram, since the medication administered could make you feel drowsy for some time.
Now, the crucial question: Is the procedure painful?
The short answer: Not really and not always.
Dr. Butt explains, “You can feel the traffic going through your arm but shouldn’t feel the pain. It’s just used as a conduit – it’s a tunnel for us. That’s why we give a bit of the ‘happy juice’ to help relax people.”
The results for my angiogram were shown to me a couple of days after the exam. On a monitor, where images appear foreshortened (or magnified), Dr. Butt showed me the insides of my heart. I could see it actually beating!
The arteries as shown on the screen resemble “black worms,” per Dr Butt, and are essentially wrapped around your heart. The catheter (appearing as a hockey stick-like structure) that went from my wrist all the way to my heart was parked at and attached to one of my arteries. Using that as a conduit, a dye was injected. The dye shows up on the extra imaging as a black fluid and helps in detecting irregularities.
“Arteries come from different parts of the aorta and then we carefully engage them with these catheters. It’s like landing on a space station – only once it’s engaged safely, we inject the dye,” Dr Butt elaborates. The catheter is steered to whichever side of the heart is being examined.
“We see the arteries from different angles to see if there are any eccentric lesions or if there are any blockages, how bad they are and how we can treat them.”
All arteries, big and small, are supplying some muscles. Therefore, “any blockage of them would mean that the muscle that a particular artery is supplying is at stake,” says Dr Butt. He recalls a case he managed wherein the patient had zero symptoms of a heart health issue but a 90% blockage was found in his arteries.
“While I was about to treat him, his heart stopped. Had it happened outside the hospital, you can imagine the chances of him surviving. But he was in the hospital and we stented him. Today he’s going home.”
While modern equipment and technology have greatly enhanced the scope of treatment for heart patients, Dr Butt notes that even today, 40% of the people who have a heart attack don’t make it to hospital.
“If you do the [angiography] and find a problem and you end up stenting that patient, then the risk escalates. The risk of death is less than 1 in 1000 for them. But then, if someone has a 90% or 100% blockage, then the risk of dying is way higher than the risk of not doing it. On the balance of probabilities, it’s better to have it done.”
If your arteries are fine, you can consider yourself safe for at least a decade and more. There’s one (important) reason to think of getting an angiogram!
Finally, are there are risks associated with angiography? Dr Butt says the risks, if any, are linked to other factors that adjudge the reason behind someone getting an angiogram or the profile of said person.
“Most of the time, the risk is associated with bleeding and infection from the side that you perform the procedure on. In some cases, we have to give people extra blood thinners and they can also have a bit of a bruise on the wrist [where the needle went in]. Chances are less than 1%.”
The procedure itself is quite safe – especially if in the reliable hands of specialists as accomplished as Dr Butt!
Caroline Labouchere
Mother of two grown-up children and wife, for nearly thirty years of a now retired, senior British Army officer. Modelling for the first time at the age of 53 she led a full-page campaign in eight editions of British Vogue, and in Tatler, Hello and White Magazines.