I'm Stephen Brecker. I'm a consultant cardiologist
at St George's Hospital in London and an honorary senior lecturer
at St George's Medical School, University of London,
and I'm the director of the cardiac catheterisation laboratories
here at St George's.
An angiogram is an invasive cardiac procedure
used to identify the coronary arteries
and any narrowings within the coronary arteries.
It's a very common procedure and very safe,
with a risk that is below one in a thousand of serious complications.
An angiogram is the standard procedure to investigate coronary heart disease
in anyone presenting with chest pain that is thought to be of cardiac origin.
If I were the patient, I would want to know
what the different types of investigation were
that could be done in addition to the angiogram or as an alternative.
There are non-invasive tests.
They're not quite as good as an angiogram,
but I would want to be able to discuss the indication for the angiogram
as opposed to one of the non-invasive tests.
The reason it's the procedure of choice
is that it has a very high rate of picking up the problem.
It's very rare for a problem that is there
to be missed on an angiogram,
and that's different to non-invasive tests,
where either a problem can be identified which isn't really there
or, more importantly, one that is there is missed.
With an angiogram, you pick up the problem
and you don't identify irrelevant things.
The procedure's usually done as a day case procedure.
A patient will be asked not to have anything to eat or drink
prior to the procedure for some hours.
They'll come into a catheterisation laboratory
and then have the procedure done under a local anaesthetic.
Following the procedure, pressure will be applied
to the point that the artery was entered,
and then they will usually be able to go home the same day.
This is an angiogram of a patient
who had the procedure done this morning.
What we can see is the catheter tube in the left coronary artery,
and these black lines are the arteries themselves.
This is the left coronary artery.
These two arteries, branches of the left,
have mild disease at most,
just a minimal area of narrowing at this point.
The rest of them look pretty good.
The first group of patients that have angiograms
are those who've had abnormal tests before that are non-invasive,
such as an exercise test or a myocardial perfusion scan.
If those tests are abnormal, then they need an angiogram.
Some patients go straight for an angiogram,
and those are the patients who are at higher risk
who have been admitted to hospital as an emergency with chest pain at rest.
There are risks with any invasive procedure,
but with angiography, they're fairly low.
They include heart attack and stroke, but this occurs very rarely.
It's very important that, as a patient,
you discuss the options of investigation for chest pain
with your cardiologist, and that you discuss whether the angiogram
is the most appropriate form of investigation,
but if an angiogram is needed,
it's important that the patient understands why.