Having an angiogram

 When 'bad engineering' means you need to fix a heart problem it is important to know if the rest of your heart is performing well. Mine has probably never performed well due to a mitral valve that never closes properly so the blood leaks out as the chamber never closes. No wonder I got tired playing sport at school. The only strenuous exercise I could tolerate was dancing. For most of my life the leakage was mild. Then, just before I left NZ in 2010 it had climbed to mild-moderate. This year doctors informed me my condition is severe and will require a valve replacement but I could feel myself deteriorating and wanted more detailed info on what was going on. Were increasing symptoms just the failing valve?

I've always been an active person; out and about, dancing in its many forms, gardening, running around after my daughter and working full time, not always office-bound. Keeping my weight down has been a priority since I was 26, when I realised I could no longer just eat what I wanted and get away with it. I've had to endure a lot of criticism and snarky comments from people who did not approve of my careful life-style. No matter, it always seemed the right thing to do to give myself quality of life as long as possible. Yesterday I discovered I was being rewarded for my efforts.

I checked into the day clinic cath lab in the cardiology section of Christchurch Hospital bright and early for an angiogram to look at the state of my coronary arteries, was allocated a bed, signed the forms the nurse had filled out from my answers to her questions and disrobed in favour of the hospital top and bottoms. Hospital nurses had varying degrees of friendliness and thoughfulness but all made sure I was informed and all necessary attention given.

Being admitted to a hospital usually means you have to have a luer inserted into a vein for IV support. I really hate those painful things. A nurse said a young anaesthetist was passing through and could do it for me with a local anaesthetic. Great. He was fast and competent and it really helped. I'd recommend insisting on a local to help the pain of the insertion.

Just in case the doctors have a problem with accessing your wrist for the catheter you get a groin shave on the right side in case they have to insert the catheter there. Fortunately that was not necessary as the groin route is more risky. I was informed that the angiogram would be diagnostic only; in other words if problems were found requiring stents or angioplasty  they would not be performing that.

You then walk to the operating theatre and climb onto the bed. It was a very chilly room with just a sheet on top. A green plastic sheet is then popped on top of you so you can become the team's table for their instruments. A heavy 'apron' is placed on your lower half to stop radiation to that part of your body. Numerous electrodes are placed on you for the heart monitor. This is important because for an unlucky few, 'rust' (highly technical term used by my cardiologist) can get dislodged from your arteries and cause a heart attack or stroke.

Sedation is introduced via the IV and local is injected into your right wrist. That's the painful bit out of the way. Then a liquid is put in that relaxes the artery so it doesn't spasm. They then open an artery in your wrist, insert a catheter and then feed a wire through all the way up your arm , across your chest and into your heart to introduce a marker dye that is shown as a contrast seen by the Xray machine. This machine moves across your chest and effectively killed my field of vision so I couldn't see what was happening on the TV screen. They do the front two coronary arteries, then back out a bit and go around to the back one. Then everything is withdrawn from your artery and pressure is applied to stop the bleeding. They put a clear plastic sort of bracelet, a TR Band, on your wrist which has a pocket of air in it to put pressure on the incision. It stays on for about an hour or two. Gradually, at 15 minute intervals, back in the day ward, a syringe is used to remove small amounts of the air so gradually there is less pressure. 

I was given a sandwich, piece of fruit and as many cups of tea and water as I wanted, to help flush out the dye which is a bit nephrotoxic. In other words, you need to flush out the dye to help your kidneys.

My wrist and lower arm swelled up so a cold pack was popped on top. This helped. It's reuseable so I took it home for use in case of later first aid needs. Better than using a pack of frozen peas. After all the air had been taken off the bracelet was removed and the incision cleaned. A waterproof bandage remains on my wrist for 5 days as it takes time for the incisions (artery and skin) to close.

While this procedure is not pleasant, it is very useful to see if anything major needs to be done in conjunction with my valve replacement. The cardiologist informed me my arteries are great. I was a bit surprised given I have familial hyperlipidemia; an inherited condition where the body makes too much cholesterol. My mother's readings were nearly off the charts and mine are frowned on but I try to follow a somewhat mediterranean diet as a consequence of my years living in France. It has all paid off. Advice? Keep your weight down and avoid alcohol where possible, stay away from drugs and smoking. Be active.  I will continue to ignore pressure from my GP to go on statins. In my case they would pose a risk rather than any benefit. High cholesterol doesn't mean your arteries are clogged. If you need to know for sure, get an angiogram.

I had not received any written instructions before the procedure on what to do beforehand so I had not eaten or drunk anything beforehand. It appears you should take your usual medicine beforehand. They weren't keen on letting me check out when they discovered I live alone. You are supposed to have someone stay with you overnight in case arterial bleeding breaks out. Fortunately I had my procedure early in the day so I stayed a few hours in recovery and then left. You cannot drive yourself home as you are still under sedation effects so a kind neighbour provided transportation. I was told not to make any important decisions or sign any important papers that day, for the same brain-fog reason.

The wound isn't very painful if you don't use it so I tried to avoid using my right hand and arm for the rest of my first day. Sleeping is not a problem and I have managed to avoid painkillers. The day after I am still being extremely careful as the riskiest time is the first 48 hours but I'm clearly back at my laptop.  After a few days I can start to take back my usual activities such as showering and maybe bass playing though bruising will continue for a couple of weeks and I'm currently not allowed to lift, push or pull anything more than 5kg for several days. By two weeks I should be back to normal.

Here's a NZ video on the procedure. Skip the first 2 minutes as it relates to Waikato. https://www.healthnavigator.org.nz/videos/a/angiography-procedure/

The cardio team will decide when and what to do with me as I am in a grey area. Too healthy to need immediate attention but not healthy enough to leave too long. Surgery is needed but we don't know when.

Photo source https://www.southvalleyvascular.com/treatments/angiogram