In-patient Cardiac Investigations

A coronary angiogram is a diagnostic test to visualise your coronary arteries. The procedure is performed in the cardiac catheterisation lab using specialised X-ray equipment. Coronary angiography is carried out using local anesthetic while the patient is awake. The test usually lasts 15-20 minutes.

Generally, the cardiologist uses a blood vessel in your right wrist (radial artery) and occasionally the left wrist to perform the examination. In some patients, it is not possible to use the arteries in either wrist. In such instances, the angiogram is performed using the femoral artery at the top of your leg.

An angiogram is performed to confirm and define the extent of coronary artery disease (blockages in your heart arteries). The test is performed in patients with risk factors for heart disease, those presenting with symptoms suspicious for heart disease and in patients with abnormal non-invasive test (exercise stress test and CT coronary angiograms).

At the end of the examination, the cardiologist will explain the results of the angiogram and recommend a treatment plan. There is a period of observation by the nursing staff for 2-3 hours after the test in the Angio day ward. This is to ensure there are no post procedural complications. You will not be able to drive home after the angiogram. You can resume normal activities 24 hours later.

Following a positive diagnostic coronary angiogram, a coronary angioplasty may be indicated. This is when the cardiologist passes a tiny wire down the artery past the coronary plaque using X-ray guidance. A balloon catheter is passed over the wire and placed across the obstructing plaque. The position of the balloon catheter is confirmed using X-ray. The balloon is then inflated for a period of 30-60 seconds, expanding the occluding artery.

The patient will usually experience some chest discomfort during balloon inflation as the balloon transiently occludes blood flow in the coronary artery. The balloon is then deflated, restoring normal blood flow in the coronary artery.

In some cases, coronary balloon angioplasty is sufficient to treat the occluding coronary plaque, however in most cases the cardiologist needs to place coronary stent(s) to complete safe and effective treatment of the plaque.

Following successful treatment of your coronary blockages, you will be observed overnight in a specialised cardiology ward. You will be reviewed the following morning by the cardiology team and will likely be discharged home. Following this procedure you will be seen in the office for an appointment 6-8 weeks after the angioplasty procedure to review your medications and discuss future management of your heart disease.

A coronary pressure wire study is used to determine if plaque (blockage) in your coronary artery is limiting blood flow to your heart muscle. This test is performed in a similar way to a coronary angiogram.

When the cardiologist identifies a plaque in your coronary artery he passes a tiny wire down your artery past the plaque using X-ray guidance. When the pressure wire is in position, the nursing staff will administer a medication (Adenosine) via a vein in your arm. This medication causes a drop in blood pressure and the patient may experience some chest discomfort for 1-2 minutes. The coronary pressure wire measures the blood flow in your artery while the medication is administered.

If the pressure wire measurement is positive, this indicates reduced blood flow to your heart muscle. The cardiologist will likely recommend the blockage be fixed with a stent or a heart bypass operation. If the test is negative, this indicates no significant blockage. The cardiologist may recommend a combination of medications, e.g. aspirin and a cholesterol drug. In this case, it is unlikely the patient will require coronary stenting or heart bypass surgery.

The post procedural care is similar to that after a coronary angiogram. There is a period of observation by the nursing staff for 2-3 hours after the test in the Angio day ward. This is to ensure there are no post procedural complications. You will not be able to drive home after the test. You can resume normal activities 24 hours later.

Coronary stents are tiny metallic scaffolds that are positioned inside the coronary artery using X-ray guidance. The function of the stent is to provide permanent scaffolding to keep the coronary artery open after performing balloon angioplasty. More than one stent may be required to successfully complete treatment of the blocked coronary artery. Stents may be placed in more than one of your coronary arteries during the procedure.

Most modern stents are referred to as drug eluting (coated) stents. This term indicates that the stent is covered externally by a drug that is released into the wall of your coronary artery over the next 3 months after the procedure. The rationale for using drug eluting stents is to minimise the risk of recurrence of the blockage in your coronary artery.

Following successful treatment of your coronary blockages with stenting you will be observed overnight in a specialised cardiology ward. You will be reviewed the following morning by the cardiology team and will likely be discharged home. Following this procedure you will be seen in the office for an appointment 6-8 weeks after the stenting procedure to review your medications and discuss future management of your heart disease.

An implantable device called a loop recorder may be indicated in patients with a diagnosis of “syncope” or unexplained collapse. This small device allows for remote monitoring of your heart rhythm and helps to diagnose the cause of collapses, blackouts and dangerous heart rhythms.

This is a day case procedure carried out in the catheterisation lab. The device is usually implanted under local anaesthetic in the region of the left breast or under the left collarbone (overlying the heart). The procedure only takes 10-15 minutes to complete. The patient will be fully reviewed by a member of the cardiology team prior to discharge to explain the procedures used to monitor the data from the loop recorder. The long battery life means the loop recorder stays in place for up to 2-3 years.

There is a period of observation by the nursing staff for 2-3 hours after the procedure in the Angio day ward. This is to ensure there are no post procedural complications. You will not be able to drive home after the implant of a loop recorder. You can resume normal activities 24 hours later.

A cardioversion may be recommended when a patient has Atrial Fibrillation. This day case procedure is performed in the Coronary Catheterisation Laboratory using sedation administered by an anaesthetist. While the patient is sedated, an electrical shock is delivered to the heart to reset the heart’s electrical rhythm. Following the Cardioversion, there is a period of observation. Please note that after this procedure, you will not be permitted to drive home.