Having an Angiogram

by Nicky Phillips

On the plane home from his Algarve holiday, Stuart had time to reflect. He'd had a great time with his mates - a bit of golf, a lot of sun, more than enough food and drink, along with huge helpings of banter and catching up - but something wasn't quite right. A couple of times he'd been out of breath for no apparent reason, and there had been that occasion in the swimming pool. Not realising it was unheated, he'd jumped in first and was surprised - not at how cold it was (it was!) but more at the tightness he felt across his chest as he swam to warm up. And he never did manage to warm up properly but rather got out and lay back in the hot sunshine.

Stuart's dad had died suddenly of a heart attack in his early 60s, since when Stuart had always taken care to get regular health checks. He'd been on statins for a number of years, tablets taken to reduce his cholesterol as a preventative measure, because high cholesterol levels are associated with blocked arteries. He also knew that his blood pressure reading was fine when he'd had it checked last month. The annual ECGs he had were always fine, too, so there couldn't be that much wrong with him. Nonetheless, he decided to get checked out by the doctor when he got home.

Three days later, the doctor listened as Stuart explained his concerns. He knew Stuart's family background and saw him regularly to monitor the amount of statin he was taking.

"So I'm just wondering whether I'm imagining things, Doctor," Stuart concluded.

"Well, there could be a couple of things going on here," said the doctor.

"It may be nothing, but given your family history, I think the best way to check would be to refer you for a treadmill test at the local hospital."

He explained that the test involved Stuart being wired up to an ECG machine to monitor his heart responses while he was subjected to increasing levels of exercise on a treadmill.

An appointment came through quickly. Stuart wasn't unduly worried; he felt quite fit apart from the odd twinge in his chest and was still sure that anything untoward would have shown up on his ECGs. He'd played a couple of rounds of golf in the meantime and was quite proud of his final score. He'd taken a bit longer to get round than he normally did, and his legs felt heavy and ached more than usual, but he just put that down to not being as fit as he was when he was younger.

The staff in the Cardiac Unit were very friendly and seemed optimistic that he would soon be on his way, having been reassured that all was well. But it was not to be: after a few minutes on the treadmill, the doctor in attendance said to him "Stuart, you have evidence of angina coming through on the ECG trace, so I would like you to step off now and come and sit down."

"Angina, isn't that what old people get?"

"Yes, it can be. The usual cause of angina is narrowing of one or more of your coronary arteries. This reduces the blood supply to a part or parts of your heart muscle. The blood supply may be enough when you are resting, but your heart muscle needs more blood and oxygen when it works harder. If the extra blood that your heart needs during exertion cannot get pass the narrowed arteries, the heart 'complains' with pain."

"What's caused that then?"

"It could be from a number of factors: smoking is one of the biggest risk factors, others are too much fat in the diet, high cholesterol levels in the blood, lack of exercise. In your case, Stuart, as you're fairly fit and a non-smoker, it's most likely to be hereditary."

"So what happens now?"

"I recommend you come in for an angiogram, which is an x-ray of the coronary arteries. A special dye is injected into your arteries through a small cut in your groin (although it can be done through the arm in some cases), which outlines narrow spots and blockages on the x-ray images."

"Do I need a general anaesthetic for that?"

"No, but we will give you a local anaesthetic for the cut in your groin. We need you to be awake so that you can follow instructions."

"Do I have to stay in hospital?"

"No, you will be allowed to go home after a few hours. We will write to you in a few days; I would expect to see you within about a month. Try not to worry; it is important to avoid as much stress as you can. By doing this test we will be able to find out the cause of your angina and treat it. Lucy, our cardiac nurse, will bring you some information booklets to take home for reference. She'll also give you the telephone numbers for the cardiac unit so that you can call at any time if you have concerns."

Despite what the doctor had said, Stuart did worry. Why was he getting angina? What was going on? He wasn't even as old as his dad had been when he'd got angina. Sometimes life didn't feel too fair. Then he remembered how lucky he was to have the chances his dad never had, and determined to put his faith in the doctors.

After a pint in the local with his mates that night, Stuart went home and took a look at the booklets he had been given. He found them very informative and quite reassuring. Living alone, he also felt reassured by the knowledge that he could call any time.

The day of the angiogram soon came round.

Stuart checked in at the cardiac unit at the given time for his appointment. He was told to get undressed, put on a hospital gown and wait on a bed. During the wait, the risks were explained to him by a doctor and then he was asked to sign the consent form.

After a while, Lucy came and took him to an air conditioned room which looked like something out of Star Trek. There was a hi-tech device in the middle of the room that looked vaguely like a bed, but it was surrounded by computer screens, lights and electronic equipment. There was also what looked like a control room at one end, behind which were more computers.

Stuart was helped on to the bed and told to lie down and relax. The nurse confirmed with him that he had managed to shave his groin, as requested in the pre-admission letter. Some local anaesthetic was applied to his groin, and he felt a slight pain.

After this, it was twenty minutes of watching screens, lights and x-ray equipment being moved around with Stuart also being asked to move his arms or his head or to breathe in and out. He wasn't really aware of the catheter moving around or any other feelings until, near the end, he was warned that he might feel a warm sensation inside, which may make him feel like he was wetting himself, and he did, but it was only briefly and nothing untoward happened.

At the end of the procedure, with Stuart still on the bed, the doctor in charge showed him on screen an x-ray print of his heart, explaining that he had two blockages in the coronary arteries, one 60% and one 70% blocked.

"That accounts for your symptoms," he explained, "Your heart isn't getting enough blood. We may be able to help you with drugs, which can thin the blood, open up the vessels and slow down the heartbeat. We could put in stents which are little steel cylinders that hold open the arteries at the point of blockage. Your consultant will discuss the various options with you."

Stuart was wheeled back to the waiting area, where a nurse explained to him that their concern for the next few hours was the cut in his groin.

"The wound has been sealed but you need to lie still for about an hour, and then we will gradually get you up," she explained. "We want to make sure that the seal has not cut off the blood supply to your leg, and as the cut is in a major artery, we need to ensure that it is properly closed. That's also the main reason you aren't allowed to drive for 48 hours."

She continued, "In about four hours, you will be allowed to go home. If you have no-one coming to collect you, we can arrange a taxi. If you have any problems over the next few days, come back in or call."

After a while, Stuart looked across to the man on the next bed and smiled.

"Are you just in for the day, as well?" he asked.

"No, unfortunately I had a heart attack and I've come down from the cardiac ward for an angiogram to find out what caused it and what the damage is," the other chap replied.

"Oh, I just had angina," said Stuart. "Did you have that too, before your heart attack?"

"No, I had no idea anything was wrong. Still, they've told me what I need to have done and I should be okay. I'll be back on that golf course in no time. It's all a bit scary, isn't it? I'll know more after I've seen the consultant, but apparently there are so many things they can do to help these days - medication, stents, or even heart bypass, which itself is far more common than it used to be. At least we're in the right hands. Now, golf, you said? Which course is that then?"

"St George's, down at Hartwick. You play?"

"Certainly do, I'm a member there too. We'll have to have a game together."

"Yes, that would be great, good exercise too."