Cardiac catheterisation is sometimes referred to as “Coronary Angiography”; “an Angiogiogram” or simply “a catheter”. It is a test that clearly shows the heart (coronary) arteries and confirms whether or not there are any narrowings or blockages in these arteries. The test can also assess the pumping function of the heart and also the function of the valves that control the flow of blood through the heart.  If there are problems with the arteries it confirms their nature and extent. Knowing this I can decide on the most appropriate treatment for the individual patient.  If the arteries are in good condition then medical treatment (with tablets) will usually be recommended. If there are a number of narrowings present and they look suitable, then angioplasty with a balloon and stents may be advised. Finally if the narrowings are not suitable for angioplasty then coronary artery bypass grafting may be advised.

The test is usually done as a day case. This means that patients are at the hospital for the day but in most cases will not need to stay overnight. After the test you are not allowed to drive for 24 hours. You should also not use mechanical machinery or climb ladders. You will need a friend or relative to take you home in the evening after the test.

Before the test you will be told not have anything to eat or drink for four hours before the time of your arrival at the hospital. In most cases you will be told to take your heart tablets (including aspirin) as usual on the day of the test. If you are diabetic then you should discuss this with the cardiologist. Often diabetic treatment may be stopped or reduced on the morning of the test.

It is helpful to bring all the tablets and medicines that you may be taking, with you when attending for the test.  This makes it much easier to discuss with you, any adjustments in your treatment.

The test is done in a specially equipped room with x-ray equipment. During the test you have to lie on an x-ray table. You are surrounded by a lot of equipment that will come close to you but will not actually touch you. The test is usually done though an artery at the top of the right leg. At the start of the test the area is cleaned and your body and legs are covered by sterile towels. A local anaesthetic is given and once this has worked a small cut is made in the skin and a fine tube is put up through an artery into the heart. It is not possible to feel the tube inside you.

Once the tube is in place a special dye is injected into the main pumping chamber of the heart and also down the arteries supplying the heart with blood. At the end of the test the tube is removed and any bleeding is stopped. Often I use a collagen plug or other device to do this. In other cases pressure is applied at the top of the leg. You then return to your bed where you have to stay for up to 4 hours. Patients often experience some bruising around the procedure site: this generally fades over 2 - 3 weeks. If a closure devise has been used there is often some temporary swelling. There may also be some discomfort that generally responds to paracetamol.
            
The test is safe but does carry a small degree of risk. On average this is about 1 per 1000 (0.1%) for death, a heart attack or stroke. The test is therefore 99.9% but not 100% safe. The staff are trained to treat promptly any unexpected problems and have the necessary equipment to hand.

For many patients undergoing this test the worst part is the worry beforehand. In my practice I do everything possible to look after patients during their admission and encourage them to discuss any concerns.