At 8.30 in the morning I was wheeled to the catheter lab (cath lab). The doctor explained what angina is all about, and what he is about to do.
What is Angina
Angina (angina pectoris - Latin for squeezing of the chest) is chest discomfort that occurs when there is a decreased blood oxygen supply to an area of the heart muscle. In most cases, the lack of blood supply is due to a narrowing of the coronary arteries as a result of arteriosclerosis.
Angina is usually felt as pressure, heaviness, tightening, squeezing, or aching across the chest, particularly behind the breastbone. This pain often radiates to the neck, jaw, arms, back, or even the teeth.
Angina usually occurs during exertion, severe emotional stress, or after a heavy meal. During these periods, the heart muscle demands more blood oxygen than the narrowed coronary arteries can deliver. Angina typically lasts from 1 to 15 minutes and is relieved by rest or by placing a nitroglycerin tablet under the tongue. Nitroglycerin relaxes the blood vessels and lowers blood pressure. Both rest and nitroglycerin decrease the heart muscles demand for oxygen, thus relieving angina.
Up to 25% of patients with significant coronary artery disease have no symptoms at all, even though they clearly lack adequate blood and oxygen supply to the heart muscle. These patients have "silent" angina. They have the same risk of heart attack as those with symptoms of angina.
How is an angiogram carried out?
An Angiogram usually takes around 40 minutes to an hour.
A catheter (a thin, flexible, hollow plastic tube) is passed into the artery in the groin or occasionally the arm. You will have a local anaesthetic to numb the area where the catheter is inserted. Using X-ray screening the catheter is directed through the blood vessels and into the heart. You can’t feel the catheter going through the heart because there are not enough nerves in the blood vessels.
A special dye is injected into the catheter and a series of X-ray pictures are taken. The dye sometimes causes a hot, flushing sensation. The dye shows up all the coronary arteries on the X-rays, to see if there are any narrowings or blockages there. While you are having the angiogram you will be continually linked to a heart monitor that records your heart rate and rhythm.
The cardiologist explained the pictures on the monitor. You have 100 % blockages in at least three areas, he says. That makes insertion of balloons and stents out of question. So now the heart surgeon will have to take over.
And as if on cue, the surgeon appeared. I think you are very lucky, he said. We found your problem in time. You don’t have to worry, because your heart is still OK. I have done more than a thousand operations already. We can schedule yours tomorrow (Saturday, 18 October). Wowww, I thought. This is going too fast …
What happens after an angiogram?
After the angiogram, you can expect:
- A pressure dressing is placed on the test site for around four hours.
- Your blood pressure, pulse, breathing and wound site are regularly checked and recorded.
- Intravenous fluids may be given for a short time, although you are encouraged to eat and drink as soon as you feel able.
- You will have to lie on your back for three to four hours, keeping your legs as still as possible.
- You may be allowed to sit up after four hours.
- Often, you are not allowed out of bed until the next day.
- If you are not already on a special diet, a cholesterol-lowering diet is usually suggested.
I was wheeled back to the ward, to be prepared for the big day the following day.
On retrospect, I had undergone a stress test and ECG a year earlier at the panel clinic, and the doctor had suggested an angiogram. But the way he proposed made me suspicious of his intentions – was it in his interest or mine. Now that I have undergone the angiogram, I realize that maybe if I had done so earlier, I may have gone away with just angioplasty, and avoided the bypass operation. It would have been cheaper too. Then again, it could also already be out of question.
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