For a person who has never had an angiogram, the thought of making a hole in the groin, putting a tube through it into an artery, and then threading that tube all the way up to the heart, can be frightening. Not only can an angiogram sound terrifying, but the worry about what may be discovered is enough to raise anxiety levels even higher.

The procedure, called coronary angiography, is usually only ordered after other diagnostic tests show the possibility of heart disease. Although, as in all surgery, there is a risk of complication or even death, it has become more common and safer, in recent years. Over three-quarters of a million angiograms are done each year in the U.S. Complications are rare, and most people suffer no more than a sore groin and a bruise-like discoloration near the entrance site, which can last from a few days to a few weeks.

If you become a candidate for an angiogram, most likely you'll be given materials that explain the procedure and you may be offered to view a film or video of a person going through the whole procedure. It helps to watch these. A description of my experience may give you an idea of what having an angiogram is like. Since every hospital and each doctor may do things a little differently, other persons may have a different experience.

A few days before the angiogram, I went to get some lab tests that required drawing a small amount of blood. Some hospitals have patients come in the night before, but my appointment was for 7:30 am on the morning of the catheterization, scheduled to begin at 8:00. I was told not to eat anything except clear liquids, no caffeine or alcohol, after midnight. I was also advised which medications shouldn't be taken for 6 days before the procedure, others that shouldn't be taken the morning of the catheterization. I was also asked to bring any medications I regularly take, in their original containers, that I would need following the angiogram. I had to shave the hair around my right groin the night before the angiogram.

I was told I could leave about six hours after the procedure, if there were no complications, but just in case, to prepare an overnight bag and something to read or keep me busy. I was cautioned not to drive until the following day, so I had to arrange for someone to pick me up at the hospital and take me home.

As luck would have it, there was an accident on the freeway on the way to the hospital that caused traffic to be backed up for miles. That raised my anxiety level to an all time high. When I called in to report I'd be late, I found that most of the surgical team were also stuck in the same traffic jam, but that didn't help my anxiety. After arriving, I signed all the usual paperwork and went to the catheterization labs, where the procedure is done.

Putting on a gown backwards, open in the front, can be somewhat embarrassing, but I was the only person who was looking. I was placed on a narrow padded table with machines and monitors all around me. The room was quite cool, but I was covered with a warm blanket while being hooked up to enough wires to make a journey to outer space. The technicians were friendly, explained anything I wanted to know, but were busy getting everything ready. When I told them that I was scared to death, especially after being stuck in a traffic jam, they told me that they usually give patients a small dose of Valium to calm them down. On a monitor I could see my blood pressure was extremely high, but after they put the Valium into the IV tube, my pressure went down to low normal. No feeling of high or low, just a lot less anxiety.

The doctor told me that they didn't have to cut the skin to get into the artery, a small puncture device did that. He said that it might be the only discomfort I'd feel. As I gazed at all the electronic equipment and video monitors, I waited for the pain of the puncture to tell me that the procedure had started, but there was none. Soon I was told to look at the monitor to see the catheter going up the artery into my heart. I hadn't known until then they had begun.

I watched as different tests were performed on my heart's muscles and valves and felt a flush of warmth in my chest when they injected a contrast medium, which lets the x-rays display the flow in the smaller arteries of the heart. I could actually watch the blood pulsing through the arteries of my heart. I remember wishing I could save that amazing image, and later I was given some Polaroid photos of it to take home with me. A few minutes later I was being transferred to a gurney and wheeled into a recovery room. A firm and steady hand was pressing down heavily on my groin.

In the recovery room a sandbag was put on the puncture site. I got a drink of juice and a small sandwich. I was still hooked up to a number of monitors, including a clip on my toe to see how much oxygen was in my blood. About a half hour later, after at least a half-dozen careful evaluations by the recovery room nurses, I was moved into a private room to rest and recover and eat lunch. I recall that after it was over, my strongest feeling was hunger.

About three hours later the cardiologist came by to tell me what he had found in the angiogram and to tell me that I could go home in another hour. It was far less frightening after I'd been through it. The most difficult part was lying still on my back for four hours, not being able to raise my head or move to either side. When I think back about how scared and nervous I was, it is clear now that it was more a fear of the unknown. Even reading a booklet and watching a video wasn't enough to convince me how smooth and painless it would be. A year later, when I bravely suggested to my doctor that I ought to have another angiogram to show how much improved my coronary arteries are, he told me that it wasn't worth the risks. Although the odds are less than 1%, there is a slight chance of a heart attack, stroke, clotting, bleeding or perforation of the heart during an angiogram. The contrast medium also can cause hives, nausea or vomiting. About one out of twenty people have some complications after their angiograms, including infection and heart attack.

The small risks of angiography were worth it to me. Knowing the precise nature of my heart problem, I could learn from research studies about my type of blockage and compare it with others. I may have angiography sometime in the future to show how much I've improved by making the lifestyle changes and to demonstrate how effective they are. In the meantime I'll have to be satisfied knowing that I can do much more strenuous exercise now and enjoy life more, without angina or fatigue. My lifestyle changes have made it possible.

Next: Angioplasty

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