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Heart failure

Angiograms and angioplasty

An angiogram is a test to find out which arteries supplying the heart have become narrowed. An angiogram uses X-rays to show 'route maps' of blood vessels and arteries in the heart. Angiograms also give detailed information about heart function as well as blood pressure, and oxygen levels in the blood as it passes through the heart. Angioplasty is a procedure to expand narrow arteries that may follow on from an angiogram. Both procedures are done in hospital under local anaesthetic. Many people we talked to had experienced angiograms and a few had had angioplasty.

Most people had been reassured by nurses during an angiogram and said that the dye gave them a warm sensation. Most were pleased to have had the test and one woman said she would have liked an angiogram earlier on in her treatment. Generally the test had not been worrying and people talked about the number of monitors and technicians required for the procedure; one man remarked that his doctors seemed excited about his angiogram and told him he was lucky to be alive. Occasionally people had found the procedure rather uncomfortable and said that keeping still for the length of time required had been tiring; one woman said that her angiogram had taken longer than she expected.

 

She explains what her angiogram felt like.

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Age at interview: 69
Sex: Female
Age at diagnosis: 64
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When you have an angiogram you're fully conscious and they put in a needle in the vein in your groin, here. And it's on a, it's like a wire and it goes up the body and it goes up into the arteries round your heart and then it squirts a blue dye, I think it is, and you lay on the table and you can watch it on a screen there. And then... where there is the blockage the dye doesn't go through, then that's the way they can see where the blockages are. And then, that's it really.

What do you feel, what's the effect of that test on you? What do you feel?

You just get a hot sensation, that's all. It doesn't hurt, but then I think they are fantastic, they're marvellous because they can show up the defect. Now I think, had I had one in 1991 then we'd have known better what was going on. I mean, maybe there wasn't a great blockage then but they could have seen how the arteries were furring up as they were. 
 
 

His doctors were surprised at the state of his heart.

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Age at interview: 46
Sex: Male
Age at diagnosis: 45
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The tissue or something under the heart itself, you know what I mean? That's why they were so, with the angiogram they were so amazed to see the heart in that condition for my age, or whatever it was, you know what I mean? Because they were saying 'well, you shouldn't be here' sort of thing, you know what I mean? Because that's the way I looked at it, anyway. You shouldn't be here because look at this, look at that, you know what I mean? And that's how they were going over this television screen. It's good though, to actually see your heart on the screen, honestly. You can see it pumping away there, you know and then he pointed out that that scar, that tissue needs to be repaired. And the only way they're going to repair it is to lessen the heart rate, which is the beta-blockers and things slowing down the rate of the heart so it's not working as fast. And like my nurse, she explained that hearts are supposed to be pumping like that [claps] - mine's like that - and it's better for it to kind of level because it's repairing the heart. So let's hope it sorts itself out.

 

She describes her angiogram and why she found it slightly uncomfortable.

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Age at interview: 69
Sex: Female
Age at diagnosis: 67
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When I went into the [hospital], that was four hour tests where they put a wire through you in the groin and the wire goes (which is not very pleasant), miles of it, into the heart, and those tests show the various areas where [cough] they can put the wires for the pacemaker. There is a kind of dye that goes in as well because I was able to look at a screen facing me, there were 7 screens in front of me (a whole bank of technicians who were, it was quite impressive, all working in different areas of their particular jobs of the screens), and the actual bed, it wasn't a bed actually, it was sort of table I was lying on 'cos the wiring job they called it (I don't know why) was very narrow and they had... cameras and screens above your body, below your body so you had pictures from both sides of you and you had to be still, I was still for about 4 and a half hours. So that was really not very nice at all. But I was able, I was conscious of it most of the time and able to see what was going on and there was things floating around and then when it came to taking the wires out, they had problems, because I had very curly veins [laughter] that took some time, not a very nice test at all, but it gave them the answers they were looking for.  
 
Angioplasty is a treatment performed by a doctor which involves inserting a small inflatable balloon into a narrowed artery. Sometimes angioplasty may also involve putting a stent (a short tube of expandable mesh) into a narrowed artery. Angioplasty may not be suitable for everyone.

 

A doctor demonstrates the equipment used in an angioplasty

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Sex: Male
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So a patient is having what we call an angioplasty we need to get to the arteries, which are the tubes that supply the blood to the body, and we are, essentially, going against the flow of blood to reach the heart and this is the sort of plastic tube that might be put into the wrist or the artery at the top of the leg in order for us to get into the blood supply.

 
This is a catheter, which is a tube with a hollow inside. Basically, that passes through the catheter that it’s in the either the wrist artery or the leg artery and it passes through back up and, essentially, we reach the heart with this catheter and by injecting dye we can look at the heart arteries and see where the blockage is. Through this we can then pass a very fine wire to open the artery and then use our balloons and stent treatments to keep the artery open.
 
So this is what a stent would appear like. There is a metal spring, if you like, just mounted on to a balloon.
 
So it’s a stent there. Okay there’d be a wire and a balloon going into the heart artery.
 

So that’s the balloon, which has now been expanded and that would be inside the artery and when we let the balloon down, and this is the stent, which would stay inside the artery and act as scaffolding to keep the artery open.

 

 

She describes what having angioplasty was like.

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Age at interview: 63
Sex: Female
Age at diagnosis: 63
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Well I wasn't scared about it. I did find out quite a lot about it before the procedure so and the nurses and the doctor did actually explain to me what was going on. Was a bit surprised to find it was just down in the x-ray department, as opposed in a theatre. So it seemed to be very low key and I think that kind of puts you in a low key mood. 

The doctors were there and they just explained that they were going to put the [stent] through the femoral artery. The [TV monitor] was there, so I spent my time watching the [screen]. 

Then they went in and when he showed me the heart, he said, 'you can see that the actual artery is blocked'. He told me which one it was but I can't remember at the moment and then he explained that he was looking at it and then they were going to push the stent up and blow it up. 

They did give me an injection just to calm me down a little. I wasn't particularly agitated but its impossible to be perfectly calm, when you know they're going in to your heart. If they're going in to a muscle or something its a different thought but there they are actually going in to one's heart. 

It is a thought so I had a bit of a tranquilising drug just to calm me down and I just watched them put in the stent and blow up the balloon and take it out.

I did have quite a lot of pain after the process had finished. I had a morphine injection because the pain was quite severe and that was it. I don't know how long it took, half an hour or maybe more or less I was back in the ward and felt good.
 
 

His hospital notes show that John's primary angioplasty and the fitting of a stent was done in...

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Age at interview: 67
Sex: Male
Age at diagnosis: 67
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As we got to the [Hospital name] they pulled up and as the doors opened a registrar got in, introduced himself to me and said, ‘Do you mind if I ask you a few questions as we are making our way to the Cath lab?’ And so he was running alongside the trolley. At the time it seemed like it was only seconds but in fact their log which I had a copy of, they sent me a copy of their log, showed it was 3 minutes to get me from the ambulance to the Cath lab [catherisation laboratory]. We went into the Cath lab which is like a really 21st Century, almost 22nd Century lot of robotic equipment in there, massive amount of people. I think there were probably 8 people in there or something like that' radiographers, surgeons and so on. I noticed this one guy who was already capped and gowned and he said, ‘Oh Mr. [Name] you’ve had a heart attack, my name is Professor [Name] which filled me full of confidence at being dealt with by a professor and he said, ‘We are going to go in through your groin and stent you.’ He said, ‘There are three arteries which are suspect but only one of them is, you know, urgent.’ He said, ‘So we are going to do that one which is the really urgent one and then you will have the option of either while you are here having them done or you could come back as an outpatient because they’re not urgent that we deal with the other two. They are mild in comparison.

 
So you had the angioplasty and the stent?
 
Yes
 
At the same time?
 
Yes, yes. So he went in and they blew up the artery with the balloon and then they put a stent in. The next thing, I mean it was slightly uncomfortable because I was still in my working clothes and they had sort of not even taken my shirt off. They’d sort of ripped open some of the button and I ended up being told, you know, ‘Keep your hands away from there because this is a sterile area but it was amazing. I have nothing but praise for the team.
 
There was no time to do anything.
 
No [laugh]. But anyway with, and again their log shows that within fourteen minutes of entering the Cath lab I was out again with a stent fitted which is phenomenal.
 

 

A year after heart by-pass surgery a woman was fitted with a special kind of stent that slowly releases a drug that can help prevent the artery from narrowing again. She said that it had made her feel much better, though she wondered with hindsight how long the stent would last. A man who had had a heart attack in the US underwent emergency angioplasty which he recalled in detail. He thought that there seemed to be a shortage of specialist staff and equipment in the UK which had delayed him getting treatment when he needed it.

 

She was given a special stent which has worked well.

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Age at interview: 59
Sex: Female
Age at diagnosis: 55
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But I was told that I could have this stent fitted, and it was a new American stent (quite expensive with VAT on) but it's a drug-secreting stent which is different to others in that it does secrete this drug which would hopefully prevent it blocking. So it was arranged for me to have this stent, again on my birthday, or the day after my birthday'

...it was '1500 plus VAT, so fairly expensive. My husband now says it's worth flogging me because I'm worth a bit! [laughs] More than I was anyway.

Yes, so I had the stent put in I think about, I was actually quite ill for two or three days again and I had the stent put in about three days after the angiogram when I'd actually, I'd stopped vomiting by then and actually feeling much better.  

Again a scary time for us because you're not quite sure whether you know they're going to proceed, if the stent's going to work or whether they're actually going to need to proceed with bypass surgery. So I remember going down for it thinking, oh I hope this works, I don't really want to be opened up again, to go through that again. But luckily it was fine, it was put in and in a good place, evidently, and all seemed to be working well. And I was just in, I think, for a couple of days after that and then home to recover.  

 

He describes his experience of angioplasty in the US.

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Age at interview: 49
Sex: Male
Age at diagnosis: 46
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Stenting or angioplasty is as they term it, basically a very very fine tube of wire mesh. And this very fine tube of wire mesh is sat over the end of a balloon, a very thin balloon, on the end of a long introductory tube. You are taken to a theatre, day theatre, a local anaesthetic is put into your groin and then they, via the artery in your thigh, the femoral artery, they insert this catheter with it's a little fine tube with mesh on the end, and feed it all the way through your body, into the arterial track they're after, one of the main the three round your heart, whichever one is blocked up. Once it's in place and they've got to the obstruction, they push this into the obstruction, and then they inflate the balloon. This in itself expands the mesh making it much wider they then deflate the balloon and withdraw it. The mesh remains in place and opens up the artery so its in force from the inside. And then obviously the blood is no longer restricted and passes through to the part of the heart it should be going through to. That's basically what stenting is.

The following day... after some rest, well later that day actually, the difference was phenomenal obviously because they had opened up the obstructive artery and I felt like I had been hit by a bus, but I was still in a fairly good condition. Well enough to phone my wife and break the news to her myself, sort of 'don't panic, I'm in hospital'-  in fact I'm in the coronary care unit in a hospital, but don't worry! [laughs]. 
 
Heart failure patients with “hibernating myocardium’ (where the heart muscle stops working temporarily because of reduced oxygen supply) are often offered angioplasty. People with unexplained heart failure or heart failure which worsens without reason should be investigated and they may benefit from angioplasty and stenting or best of all from coronary artery bypass grafting (CABG). The effect can be dramatic and life–prolonging.
 

The angiogram showed that Sab wouldn’t benefit from angioplasty and stenting and doctors concluded that he needed a triple bypass instead.

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Age at interview: 65
Sex: Male
Age at diagnosis: 64
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So he found phoned up and we had that done and it was showing a little blip and then from then on he sent me for more tests so for the next six, seven months I did all the tests, treadmill and so on and finally I went for an angiogram and then they found out that is was much worse than it actually showed and the doctor agreed that they couldn't put the stent in because that would be more dangerous, it would be more than one stent so they decided they wanted to do a triple bypass so then asked me to wait for a date and then they give me a date on December 1st, Thursday and do the operation at 1.30 and, and that's when the operation took place and instead of doing triple bypass then I was told it was a five grafting that they had to do because it was, artery was so bad.
 

He asked the surgeon how many bypass operations he had done before he consented to surgery.

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Age at interview: 77
Sex: Male
Age at diagnosis: 69
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I'm telling you this because one of the things that the surgeon told us was that the, one of the things that I wanted to know from the surgeon was how many of these things had he done. Was he, sort of, did he know what he was doing and he told me, this was September, he told me by that time he had done about 140 bypass operations that year. 

So that was you know, quite reassuring. And I also asked him what the prognosis was and he told me that 95% of all cases of, who have bypass surgery are successful, and 5% are not. So you've got a 1 in 20, is it? yes 1 in 20 chance that something might go wrong and I said what can go wrong. 

He said mostly what can go wrong is that you get some kind of sepsis and we can fix that. So I thought the odds were pretty good, bearing in mind that my cardiologist said I've got to have this done, not much choice.

 

He felt positive after seeing ex-bypass patients exercising in the gym before he left hospital.

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Age at interview: 77
Sex: Male
Age at diagnosis: 69
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Before I was discharged the physiotherapist took me to the gym down stairs and in the gym there were a number of people doing various exercises and she said they were all ex-patients who had bypass operations and I was, you know, I was pretty impressed. You know, they were doing, they were jumping up and down and they were doing skipping, and they were doing a mild form of press-ups. 

A number of fairly strenuous looking things and I thought, oh well it must have been two or three years since they've had their bypass and I asked her about that and she said, turned to one of the chaps and she said 'How long ago have you had your bypass?' and he said, 'Oh, just six weeks ago now.' 

So that was, that was a real eye opener and again something very positive. And really from that moment on I felt, and my wife, we both felt very positive about the whole thing.  

For more information on angiograms and angioplasty see the British Heart Foundation website: What happens during an angioplasty?  



Last reviewed April 2016.
Last updated April 2016.

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