StrokeSurvivorBlog

Steve is scheduled to have a coronary angiogram because he’s been having severe episodes of angina (chest pain) for the last two weeks. He’s feeling weaker, more fatigued and out of breath, and his heart races more often.

These episodes started when we were on vacation a few weeks ago and have become more frequent in the last week. He saw his cardiologist last Friday, and what happens so often when we go to the doctor, Steve felt pretty good that day. The doctor thought the angina could be a result of Steve’s overindulgence of food and salt while in Florida. So he made some adjustments to his medications. However, even with those changes, the angina continued. The worst episode was early this morning and lasted about 45-60  minutes. It subsided when he took several nitroglycerin tablets, but then after an hour, the angina returned creating pain in his chest and between his shoulder blades.

Against his objections, I called his cardiologist and talked with him directly. He recommended a coronary angiogram which is scheduled for this Thursday.

The angiogram will determine if there is a partial blockage, the location of it, and to see if it can be repaired with angioplasty (balloon and stent). If it can be repaired, it will be done at the same time.

During coronary angiography, Steve will be kept on his back and awake. That way, he can follow his doctor’s instructions during the test. He’ll be given medicine to help him relax, and it may make him sleepy.

The doctor will numb the area where the catheter (a small plastic tube) will enter the blood vessel through a small cut in the arm, groin (upper thigh), or neck.

The doctor then threads the catheter through the vessel up to the opening of the coronary arteries. Special x-ray movies are taken of the catheter as it’s moved up into the heart to help the doctor see where to position the tip of the catheter.

Then he will put a special dye into the catheter when it reaches the correct spot. This dye will flow through the coronary arteries and make them show up on an x-ray called an angiogram. If the angiogram reveals blocked arteries, the doctor may use angioplasty to restore blood flow to his heart.

After the doctor completes the procedure, he will remove the catheter from Steve’s body. The opening left in the blood vessel will then be closed up and bandaged.

The angiogram is an outpatient procedure and Steve can go home the same day if all goes well, but if an angioplasty is done, he will stay overnight.

To prevent the risk of bleeding, I’ve already withheld all of Steve’s blood thinners at his doctor’s orders.

The only way Steve would agree to this test is if the doctor would not do any surgical procedure on him if something went wrong that might cause another heart attack or stroke. Although these risks are rare, they do happen. He doesn’t want to be cut open and go through heart surgery again.

Back in 2000, Steve had quadruple by-pass surgery, but after 3 months the arteries became blocked above and below the grafted vessels, rendering the bypass ineffective. When a subsequent angiogram was done, it showed that the heart disease was very progressive. His doctor (a different one) told him to get his house in order because he had only a couple years left to live. Since that time, Steve suffered with a lot of pain in his upper stomach area and was never the same. He always regretted having the surgery. He made me promise that I wouldn’t allow them to do surgery, and I told his doctor Steve’s wishes.

What are the risks?

Coronary angiography is a common medical test that rarely causes serious problems. But complications can include:

• Bleeding, infection, and pain at the site where the catheter was inserted.
• Damage to blood vessels. This is a very rare complication. It may occur if the catheter scrapes or pokes a hole in a blood vessel as it’s threaded up to the heart.
• An allergic reaction to the dye used.

Other less common complications of the test include:

• An arrhythmia (irregular heartbeat) that often goes away on its own, but may need treatment if it persists.
• Damage to the kidneys caused by the dye used.
• Blood clots that can trigger stroke, heart attack, or other serious problems.
• Low blood pressure.
• A buildup of blood or fluid in the sac that surrounds the heart. This fluid can prevent the heart from beating properly.

As with any procedure involving the heart, complications can sometimes be fatal. However, this is rare with coronary angiography.

Please keep Steve in prayer. Even though he says he wants to die, the reality of it with this procedure is very real and scary to him because he can’t control the outcome.

Love, Kathy