I have microvascular angina with normal large vessels. I have an appt to discuss whether to have CT cardiac angiography or invasive angiography (where a wire is put into your groin or arm and sent up to the heart), to check whether I have any blocked vessels.
Have you had this choice and what did you decide?
Did you have the invasive test and how was the experience? Did they go via the groin or the arm? Did you have any complications?
I had the CT test a few years ago, so I know what that is like.
Really interested to hear your experience.
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My surgeon much preferred having the invasive one done before my open heart double-valve surgery.
They went in through my arm. It's oddly uncomfortable, but not really painful. (I was partialy sedated, so I was awake. I believe you can also ask to be fully sedated. But then you'd miss the real-time pictures of your heart on the big screen, which are pretty dang cool.)
No complications. A bit groggy after, then tea and toast while they slowly reduce the air pressure in the wrist cuff over maybe 4 hours? Then home (though you need someone else to drive).
I initially had a CT which showed 70% blockage of my LAD but was told it was ok. After going privately I had an angiogram through my arm. They discovered the LAD nearly completely blocked so I had a stent inserted with great results. Following this I continued to have symptoms and ended up having two more angiograms in the NHS (through my arm) and they diagnosed microvascular and spasmodic angina which I'm learning to manage and live with. I also have atrial flutter and atrial Fib. I had the first ablation (privately as the NHS said I was ok) and this was done through the groin. Because for some reason I have an absent radial artery on my right arm, they had to use the left which isn't usual, but worked perfectly fine. It is a scary procedure but they know you're scared so are so good at explaining everything and everyone is really so positive and helpful. I'm now on another waiting list (9 months) for a second ablation. I think the initial CT highlighted the problem, but the angiogram can tell them so much more. Good luck
I'd have the Angiogram everytime, it's mildly uncomfortable but can't say that it hurts at all. I've had four Angiograms now and each time it's been through my arm (haven't known anyone who has had through groin). Beauty of Angiogram is that should they find any partial blockages of the main arteries then they will desl either it there and then. You will be home within 4 to 6 hours, your arm will ache a little for a few days but one thing to note is you are not supposed to drive for 7 days.
Hi. I've had what is called a coroventis procedure (private cardiologist) to check for microvascular disease/angina. The whole procedure went well, nothing like the initial angiogram I had with NHS a year previous when it was discovered i had heart disease and my LAD was partially blocked leaving me high risk for heart attack!
This was stented but my microvascular system still suffers which I think this invasive procedure is great if you can get it. It confirmed I do have coronary artery spasm as well which is managed with medications.
It was through my arm and I was partially sedated but awake to see the screens and pictures which is fascinating. I was looked after well and you do have to take it VERY easy for a few days/week at least!
Like many others here I have had both tests - both went smoothly with no complications (as they do for thousands of others)
The CT angiogram is the least risky, as it is non-invasive, only a canula (small needle) in the back of the hand, as you know - for the invasive angiogram I had a groin insertion, but I gather the radial (arm) insertion is more common these days, it is said to be safer, but you should discuss any concerns with the cardiologist.
as far as I know an invasive angiogram can trigger spasm of the heart vessels in some micro-vascular conditions.
But either way you need to discuss this with your cardiologist and be given the opportunity to ask questions so that you can make an informed decision before you consent
Hi … I had an angiogram in 2018; via my right arm (private hospital). Just a couple of things from my personal experience. My blood doesn’t clot very well, so the pressure cuff was needed for much longer (I bled more than a bit when they tried to release the pressure too soon!) wasn’t too much of a problem, but I did have to stay in overnight. So if you are on medication to thin your blood (I’m not) worth bearing in mind. Not sure from your bio, but if you are a woman ‘of a certain age’ you might want to bear this in mind too … I had a heated pad underneath me which I found super uncomfortable as I got very very hot as they administer various drugs during the procedure which affect your body temperature. Think I may be heading for another angiogram soon so will request not to have a heated blanket! You’ll be in very good hands so don’t worry too much, and as others have said the monitor images of your heart are super cool! Hope this is helpful … as the best
I don’t have MVD , I have CAS , if I had a choice I would go for a provocation angiography with the wire pressure resistance measurement, not every hospital is able to offer this but it does show what type of MVD you have so medication can be stratified for you
I've had both - groin and wrist - and can honestly say I was fine on both occasions. No real pain, for me, other than what was like a mild bee sting when injecting the contrast dye. The wrist was uncomfortable when they took the plug out and laying on your back for several hours after the groin insertion wasn't great as I don't like lying on my back for too long. I was given a dose of "gin and tonic", as one of the cardiologists described it, each time which helps to chill you out. Most painful bit was one having to endure my normal cardiologist's jokes the first time. He has an appalling sense of humour :-), he's the one who when deciding that I needed a second angiogram, via the groin, a few months after my initial one and several trips to A&E with changes to meds, came out with "we've marinated you long enough, time to get you back on the BBQ".
There will be some who have difficulties, inevitable as we are all different, but I wouldn't hesitate. In my case I was well looked after before, during and afterwards, and was chatting with those attending throughout.
I suggest that you discuss this with your Cadiologist, particularly focusing on what the objective is. I have had 5 invasive angiograms now. Two to insert stents after initial heart attack. Third one to check all clear a couple of years later when I started having angina. A fourth one to do pressure study, this had to be stopped when a clot was pushed into my left artery. A fifth ( at a different hospital) to full studies and actylcholine provocation. This revealed Vasospastic and MVA which had not been revealed by earlier CT angiogram and nuclear perfusion scanning.
I understand that an invasive angio is the gold standard form Vasospastic and Microvascular Angina diagnosis.
Sometimes what confuses me is all the different names are given to procedures.Last October 16th I had a "coronary angiogram ". Was performed via the wrist.
I was very worried about it and asked for sedation.
It was all over in about 20 mins or so.
Then back to area where my comfortable armchair was for tea and biscuits.
Stayed there for a couple of hours whilst I was monitored and inflated wrist band gradually removed and a dressing to replace it.
I was told my results will go to a "panel" who set up the TAVI that I will need.
Just waiting for that procedure to be arranged now.
I had no choice. After a heart attack I had an angiogram and two stents fitted to open up the blocked artery.They went through my wrist. I felt nothing except the cannula. Unfortunately they wouldn't let me watch the screens. Then into the recovery ward where eventually the pressure bandage was released. I had another a few weeks later to c heck on another blockage they'd seen. That time the pressure bandage was taken off too early and my entire arm from wrist to elbow was black. It didn't hurt at all but took a few weeks to clear. I wasn't at all worried about the first one but strangely I was terribly anxious about the second one. I had sedation both times. The cath lab was really cold. LOL.
A CT angiogram and rountine invasive angiogram is good for detecting structural problems in your arteries, such a pernament blockages.
However these types of angiograms cannot detect functional disorders of the arteries causing microvascular and vasospastic angina
A functional angiogram ( the term being adopted rather than provocative angiogram) uses techniques to measure how the blood flows through the small vessels.
This is how microvascular dysfunction can be diagnosed.
Another chemical acetylcholine can then be injected into the coronary arteries. Normal functioning coronary arteries should dilate in response to acetylcholine. If the coronary arteries constrict, then coronary vasospasms are diagnosed.
I have had two invasive angiograms. The second one a functional angiogram, 10 years ago.
I had spontaneous and acetylcholine induced coronary vasospasms, significant ECG changes and lots of chestpain. I was given morphine.
Most people don't usually experience as much pain as I did.
The adenosine which is used with guidewires to measure the blood flow in the small blood vessels can give a temporary chest pressure with a feeling of not bring able to breath in.
My groin was used, because using the wrist was less common back then. It is now been shown that it is safer to use the wrist artery to perform an angiogram.
My diagnosis is severe vasospastic angina. I have vasospasms in my small and large coronary blood vessels.
I suggest you discuss with the Cardiologist whether you can have an angiogram that assesses for microvascular dysfunction and coronary vasospasms, to confirm your diagnosis.
The symptoms of microvascular and vasospastic angina can overlap, the treatment options are different though.
Functional angiograms are being more widely offered than in the past.
The number should further increase now that the latest European Society of Cardiology's 2024 Management of chronic coronary syndromes, recommend the use of functional angiograms to diagnose microvascular and vasospastic angina.
Forgot to mention: the x-ray emitter is robotic (not like a normal x-ray where they position the doo-hickey by hand). It knows where your head is, so for some particular angles it will zoom in like it's going to hit you and then stop dead 1 inch from your face, pointed down toward your heart. The nurse warned me about this beforehand; just something to be aware of.
I'd like to thank everyone who replied and shared their experiences and advice. I'll be able to have a much better informed discussion with the cardiologist at my appt next month.
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