Angiogram

An angiogram is a diagnostic method that uses X-ray images to detect potential blockages within your blood vessels, whether Arteries or Veins. This test enables healthcare providers to observe the blood circulation at specific locations in your body. In cases of artery or vein issues, such as those in the Heart, Neck, Kidneys, or legs, this procedure is conducted to pinpoint the source of the problem.

Coronary Angiogram fall under the broader category of cardiac catheterization, which are the procedures employed for both diagnosis and treatment of heart and blood vessel conditions. Among these procedures, the Coronary Angiogram, primarily used to diagnose heart conditions, stands out as the most commonly performed type of cardiac catheterization.

Why Is Angiogram Needed?

Your healthcare provider might recommend an Angiogram procedure if you exhibit signs of obstructed, damaged, or irregular blood vessels. This diagnostic test aids your provider in identifying the source of the issue and assessing the extent of damage to your blood vessels. It may be suggested in cases where you experience symptoms of Coronary Artery Disease, such as:

• Chest Pain (Angina)
• Unexplained Pain in Chest, Jaw, Neck, or Arm Pain, new
• Escalating Chest Pain (Unstable Angina)
• Congenital Heart Disease
• Abnormal results on a noninvasive heart stress test
• Other blood vessel issues
• Chest Injury
• Heart Valve Problem requiring surgery

Due to the slight risk of complications, angiograms are typically conducted after non-invasive heart tests like Electrocardiograms, Echocardiograms, or stress tests. This procedure allows your provider to diagnose and plan treatment for conditions like:

• Coronary Artery Disease
• Peripheral Artery Disease
• Atherosclerosis
• Blood Clots
• Aneurysms

Before undergoing your Angiogram test, your healthcare provider may will review your medical history, do a thorough examination, and conduct a blood test to assess your blood clotting function and ensure proper kidney function. Always consult your provider before discontinuing any medication, especially antiplatelet agents and anticoagulants. Adhere to the following guidelines from midnight the night before your test if approved by your provider:

• Avoid taking aspirin or any aspirin-containing products
• Refrain from using blood thinners like dipyridamole or warfarin (Coumadin® or Jantoven®) within 72 hours before and 24 hours after the test
• Abstain from taking clopidogrel for five days before the procedure
• Continue taking all other medications as usual
• For individuals with diabetes, seek instructions from your provider regarding the administration of insulin and/or other medications
• Refrain from eating after midnight the night before the angiogram. If undergoing general anesthesia, avoid consuming any food or drink after midnight
• On the day of your procedure, limit your breakfast to clear liquids, including clear broth, tea, black coffee, and ginger ale

You may expect following during the procedure:

1. During the procedure, you lie on your back on an X-ray table, and safety straps may secure your chest and legs due to potential table tilting. X-ray cameras maneuver around your head and chest for capturing images from various angles.
2. An IV line is placed in your arm for administering a sedative, along with other medications and fluids to induce relaxation. Though you may become very sleepy and possibly drift off, you remain easily awakenable to follow instructions.
3. Electrodes are placed on your chest monitor your heart, while a blood pressure cuff and a pulse oximeter track your blood pressure and oxygen levels, respectively.
4. A minor amount of hair may be removed from the groin or arm, the designated site for catheter insertion. After cleansing and disinfecting, a local anesthetic injection numbs the area.
5. A small incision is made, and a plastic tube (sheath) is inserted into your artery. The catheter is then threaded through the sheath into your blood vessel and carefully guided to your heart or coronary arteries.
6. Catheter threading should be painless, and you shouldn't feel its movement. Inform your healthcare team if any discomfort arises.
7. Contrast dye is injected through the catheter, potentially causing a fleeting sensation of warmth or flushing. Report any pain or discomfort to your healthcare team.
8. The dye, visible on X-ray images, allows your doctor to observe blood flow and detect blockages or narrowed areas. Depending on findings, additional catheter procedures like balloon angioplasty or stent placement may be performed concurrently. Other noninvasive tests, such as ultrasound, may aid in evaluating identified blockages.
9. The angiogram typically lasts about an hour, potentially longer if combined with other cardiac catheterization procedures. Time for preparation and post-procedure care may extend the overall duration.

Following are the potential risks associated with Cardiac Catheterization and Angiograms:

• Allergic reactions to the local anesthetic, contrast dye, or sedative
• Bleeding, bruising, or soreness at the insertion site
• Blood clots
• Injury to an artery or vein
• Damage to the hearts walls
• Acute kidney failure
• Infection
• Irregular heartbeat
• Although highly unlikely, there's a remote possibility of a heart attack or stroke

Individuals with a history of allergic reactions to contrast dye may need preventive medication taken at least 24 hours before the procedure. To mitigate the risk of an allergic reaction entirely, doctors may opt for an alternative method instead of the traditional Angiogram.

Your healthcare provider will remove the catheter and apply a bandage to the puncture site on your skin. They will apply pressure to the bandaged area for a minimum of 15 minutes to halt or prevent bleeding. If the catheter was inserted through your leg, it's advisable to rest in bed for four to six hours, reducing the likelihood of bleeding from the incision.

Before you leave, your provider will assess your condition and provide you with instructions for at-home care.

You may expect following after undergoing Angiogram:

• You should be able to return home on the same day, even if angioplasty and stenting were performed.
• As anesthesia was administered, it's necessary to have someone drive you home.
• Upon returning home, refrain from lifting anything heavier than 10 pounds or engaging in stooping or bending for the next two days to prevent incision bleeding.
• It is advisable to have a responsible adult stay with you overnight after the procedure.
• While many individuals can recover at home, some may need to spend the night in the hospital following the angiogram.
• For individuals with diabetes, it's recommended to abstain from taking metformin (Glucophage or Foramet) for 48 hours post-test to minimize the risk of kidney complications.

Angiogram risks are minimal, with complications typically occurring in less than 1% of cases, primarily in the area where your healthcare provider accessed your artery through the skin. According to National Heart, Lung, and Blood Institute, the older adults and individuals with specific medical conditions, such as chronic kidney disease or diabetes, may have a slightly higher risk of complications following an angiogram. A study conducted from August 2012 to July 2013 aimed to evaluate the effectiveness and safety of angiography in 2845 patients. The results revealed an impressive success rate of 97.6% for coronary angiography. Notably, only a minimal number of patients experienced minor hematoma (0.25%), and a small percentage (1.7%) encountered reduced radial pulse 3-4 hours post-procedure.

The cost of Angiogram in India is generally more affordable than Western nations, while still maintaining world-class quality. The average price for such procedures in India is INR 25,000 (USD 313).

The comparative cost of Angiogram in India with respect to other countries:

Following are the factors affecting cost of Angiogram in India:

• Out of pocket expense
• Health insurance coverage
• Consultation fees
• Pre Surgical expenses
• Surgery cost
• Hospital fees
• Doctor fees
• Patients age
• Severity of vessel blockage
• Type of angiogram
• Overall health status of the patients
• Complications involved after the surgery
• City where hospital is located

The expenses associated with the preliminary assessments and examinations conducted prior to the angiogram might cover various diagnostic procedures. These additional charges encompass tests such as blood tests, ECG, and other diagnostic evaluations. The total expenses for these tests can vary between INR 1000 and INR 1500.

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