Alternatives to angiogram

I have an angiogram on Thursday which I am dreading. I am wondering why they have not proposed an MRI or CT scan which would be far less invasive. Does anyone know why they are so keen to do angiograms? Like ablations, some clinicians seem to be obsessed with angiograms. I know these are more accurate, but how much accuracy is really required? The death rate is apparently 1 in 1000 which doesn't sound that low to me.

[etheral]

The main reason to do an angiogram vs. a less invasive study is if you are contemplating a bypass or stent placement if a potentially dangerous lesion is found. Don't think a cardiothoracic surgeon would attempt a bypass based on any other srudies..etheral

[Hidden in reply to etheral]

Apparently this is just investigational- they said any stenting would be done at a later date.

[Rubymurray25]

The best tip I had before mine was to drink plenty of water the day before and on the day as it really makes it the veins more flexible. I too was extremely anxious and was given a little dose of a relaxing drug during and it was over in my mind in 3 seconds.

[Hidden in reply to Rubymurray25]

Good tip. Thanks.

[McIvor]

They should explain in detail why. If not absolutely necessary a CCT would be better because of less radiation and the other risks. I had an angiogram before heart surgery and got a dose of 10mSv (one single chest x-ray is 0.02 - 0.1mSv).

A CCT can be done with far less radiation exposure, sometimes as low as 1mSv.

As I remember MRI is not accurate enough yet.

[Hidden in reply to McIvor]

I didn't know the CT involved less radiation. That makes it even more concerning that they have opted for an angiogram.

[DevonHubby1]

There is such a thing as a CT Angiogram. My wife had it done at an NHS hospital to rule out her pains in chest being angina. She suffers from PAF so there was a risk standard angiogram could have started an episode.

[Hidden in reply to DevonHubby1]

This is one of the very concerns I have as I have PAF. When I raised this question at the pre-procedural appointment there was no clear answer. Thanks for the reply.

[BobD Volunteer]

It is really the only way to judge the condition of the cardiac arteries properly.

[ILowe]

It is also used to exclude/include clogged arteries as a reason for any problems you may have.

[Mike11]

I've just had a cardiac CT scan which showed everything in great detail. But they are very expensive so and only a few machines around whereas everywhere can do an angiogram

[Hidden in reply to Mike11]

Aha! Yes, that is possibly the reason. Given the risk from an angiogram it's inexcusable. Thanks for the reply.

[Mike11 in reply to Hidden]

Yes I had one back in 2010 before my bypass when the new CT scanners didn't exist. Had an MRI in 2015 and it said one of the bypasses had died, but the CT scan showed it in perfect health in 2022. You could ask for a CT scan but it's a long wait or you pay the £1600 yourself.

[Hidden in reply to Mike11]

Thanks for this very useful information.

[BrotherThomas]

I wouldn't worry about it at all, I had one last year and all went very smoothly with only slight discomfort when they looked at one particular artery. Fortunately, my arteries were considered to be in excellent condition despite my being significantly overweight and 67 years old. You never know, you might get similar good news about yours.

[Hidden in reply to BrotherThomas]

True-or I might not!

[JOY2THEWORLD49 in reply to Hidden]

HiThey gave me a CAROTID ultra scan. Which showed perfectly clear arteries.

After Embollic Stroke affecting Left Frontal Lobe. They thought it would be at the back of my head.

CAROTID scan showed a shadow on my THYROID.

So AF caused stroke but thyroid problems caused AF.

I had rapid persistent AF. Day but 47 h/b at night.

At 70 I was given PRADAXA 110mg x twice day.

In NZ I guess they will look at Thyroids. Tests were fine!

Cheri JOY 73 NZ

[Hidden in reply to JOY2THEWORLD49]

I have had an underactive thyroid (corrected with thyroxin) for about 20 years. I wonder if this caused AF? Thanks for your reply

[Buffafly]

An angiogram is quite interesting if you are allowed to watch the screen. I have had two, terrified before the first one but there was nothing to it really, only downside was that the cardiologist liked to keep the catheter lab at below freezing 🥶 or so it seemed to me as I wasn’t well at all and couldn’t warm myself …..

[BobD Volunteer in reply to Buffafly]

The hospital where I go they use a hot mat under one for just that reason. LOVLEY!

[JOY2THEWORLD49 in reply to BobD]

Hi

Good thinking.

In any op I tell them I get cold and blood pressure gets so low.

Since 1987 op and freezing I am lovely and warm! No more hot water bottles.

My night h/rate is 47! An answer why I get cold shoulders summer/winter.

cheers JOY. 73. NZ

[Hidden]

True. But I've read that if a bit of plaque breaks off when they are passing the catheter through the vein that that spells curtains! I don't know how they know that won't happen.

[Ppiman]

The stress MRI was said to me to be the gold standard but I think it demands on what your doctor wants to find out as each imaging technique (CT, MRI, etc) shows different things up better than others.

I would stick in there and think of the positives - better treatment!

Steve

[Ducky2003]

Hi. I have to have an angiogram next month as I'm on the list for mitral valve repair surgery. Surgeon said they have to check for Coronary Artery Disease before operating. I had a feeling he was going to say that so I did a bit of research and asked him for the less invasive CT scan version. He seemed a bit taken aback that I'd looked it up and asked why I wanted the CT.I told him that after an ablation, 2 cardioversions, a TOE without sedation and now facing open heart surgery, I just wanted to have a simple procedure. I was fed up with things being shoved in me from all angles.

He sympathised and ordered the CT one. He did explain, if it showed the slightest anomaly or ambiguity, I would have to have the invasive one as a second opinion as its supposed to be more accurate.

Worth asking if you could have the CT version instead.

[Hidden in reply to Ducky2003]

Good idea. I will mention it when I go on Thursday.

[Ducky2003 in reply to Hidden]

I think that there are different preparations for each procedure so if your having it done tomorrow, it may be too late to change.

[Buffafly]

Just thinking that as CT scans are very often done as emergency investigations - head injury, bowel obstructions, suspected acute cancer, pneomothorax etc the queue might be quite long?

[Hidden in reply to Buffafly]

Thats certainly possible. They didn't even mention such a scan during my appointment. They originally wanted to do a test which involves injecting a substance to constrict the blood vessels-this can be used to determine whether someone has angina. Even the doctor admitted it wasn't very pleasant. Not sure what this test is called.

[Ducky2003 in reply to Hidden]

My appointment for the CT was 2 months from the date of referral.