Text for the Angiography Brochure

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What is an Angiography?

An angiography is a remarkable type of procedure that allows doctors to use an X-ray camera outside your body to see how blood circulates within the walls of your heart. This is accomplished with only one small incision, typically at the very top of your leg. Through this incision, a very small tube - a catheter -- is threaded to your heart. When the tube is exactly in place, at the openings to each of the coronary arteries, X-ray dye is released. The X-ray camera outside of your body will show exactly where the dye reaches, and where it doesn't. If the dye doesn't make it to part of the heart wall, it indicates that there's a blockage in the vessel feeding that portion of the heart wall muscle.

Heart Anatomy

Your heart is your body's hardest-working muscle - a hollow shape about the size of your fist, pumping blood throughout your body, day after day. Like any muscle, the heart needs a constant supply of oxygen and nutrients. These reach the heart walls via the three coronary arteries - the two

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branches you see on the drawing above, plus one on the back side. In spite of all the blood passing through your heart every minute, your heart muscle can starve when any of the three coronary arteries become too clogged. Unfortunately, partially blocked coronary arteries are not uncommon - over 7 million Americans have this condition, known as coronary heart disease (CHD).

Coronary Heart Disease

CHD is caused by a thickening of the inside walls of the coronary arteries. This thickening, called atherosclerosis (ath a row skle row sis), narrows the space through which blood can flow, decreasing and sometimes completely cutting off the supply of oxygen and nutrients to the heart.

Atherosclerosis usually occurs when a person has high levels of cholesterol, a fat-like substance, in the blood. Cholesterol and fat, circulating in the blood, build up on the walls of the arteries. The buildup narrows the arteries and can slow or block the flow of blood. When the level of cholesterol in the blood is high, there is a greater chance that it will be deposited onto the artery walls. This process begins in most people during childhood and the teenage years, and worsens as they get older.

Right now your symptoms suggest that you have coronary heart disease. If that is the case, your doctor will recommend changes in your lifestyle, possibly medications, and possibly procedures to reestablish blood flow to the heart muscle that needs it. But first it's important to confirm that your symptoms are caused by blockages in your coronary arteries. If there are blockages, it's important to see just how serious the blockages are. All this can be done with an angiography.

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Before Your Angiography:

Although an angiography is not surgery, there are a few guidelines that need to be followed.

Please do not eat or drink anything after midnight the night before your procedure. If you need to take medications in the morning, wash them down with just a sip or two of water. If you smoke, be sure not to smoke the morning of your procedure, since nicotine will distort the results of some tests.

Since you will not be allowed to drive yourself home after the procedure, arrange for transportation to and from our facility.

Please be on time for your appointment, since there's lots to do. After completing a few last-minute forms, it will be time to change into a hospital gown. We will draw a small sample of your blood, for lab work, and we will place an IV in your arm. As we're about to go to the lab, we'll add a medication to your IV that will help you to relax.

During the Procedure:

Dr. Welby will join us in the lab. Although you'll feel groggy, you will be awake, and able to speak with him.

The large machine hanging from the ceiling is the X-ray camera. What makes this machine unique is that, instead of a single snapshot, like a traditional X-ray, this machine takes pictures continuously. These pictures are displayed on the monitors next to you, and they are also filmed, for later review.

The procedure begins with a very small incision, where your leg joins your torso. Through this small cut a hollow tube, called a catheter, is threaded into your artery system. Soon the catheter is at the heart. Although blood is constantly circulating through the heart; the heart itself is nourished just by the blood that makes it through the three coronary arteries. Watching on the TV monitor, Dr. Welby will carefully guide the catheter until it is exactly at the entrance to the first of the coronary arteries. At the right moment Dr. Welby will release X-ray dye through the tube. Through this careful timing, and by placing the catheter in exactly the right place, the dye will be pulled into the coronary artery, and not simply flushed through the heart. On the monitor, the delicate vessels that feed the heart wall will stand out, much like a river with many small streams leading from it. Partial blockages will show as unusually narrow sections of the river; complete blockages will look like dams, with X-ray dye unable to pass.

Since there are three different coronary arteries, Dr. Welby will repeat the procedure as necessary. He might ask for your help, for example by asking you to cough, to help flush the heart. While the catheter is in place, other tests may be run as well. Common tests include measuring how much blood your heart pumps in a beat, and how well your heart valves work.

Correcting Blockages:

Your angiography is a procedure to help identify the problem - it is not a treatment. Sometimes your treatment will be as simple as feeding special medications through the tube, while it's in place. Other times the treatment is what's called an angioplasty. During an angioplasty a very small uninflated balloon is fed through the tube. The balloon is positioned where the blockage is, then inflated. When the balloon is inflated, it pushes the build-up in your vessel back against the walls, widening the vessel once again. Sometimes the balloon is used to push miniature wire scaffolds, called stents, into place against the walls of the vessel, to help keep it open. Whether one or more of these treatments is used depends on exactly what we learn during your angiography. While sometimes blockages will be treated at the same time as your angiography, often times it is better to review the results of the angiography before deciding on the best treatment.

After Your Procedure:

When your angiography is done, a piece of tape will be placed over the cut. Although the incision is very small, the area needs to begin healing before you go home. Consequently, you'll be our guest for the rest of the day, lying flat. Although you'll need to lie still, you'll be able to eat and drink, and visitors are allowed. Expect that you'll be released in the late afternoon. You will not be allowed to drive home yourself, and you shouldn't drive for the rest of the day.

Your Recovery:

Take it easy at first. Although you should be fine to return to desk-work the day after your angiography, avoid lifting or straining for at least a week. If you're uncomfortable, take Tylenol (Acetaminophen).

For the first few days, if you feel that you're about to cough or sneeze, put gentle pressure where the incision was, to keep the wound from reopening.

During the healing process, if something happens, and you do begin bleeding from your wound, put pressure on it, and call us. If we're not available, be safe, and get to an emergency room.