Explaining coronary angiography

Explaining coronary angiography to patient with angina

Candidate Instructions 🧒

You are an FY1 working in Cardio.

Mr Sam Smith is a 67 year old gentleman who is calling in to ask about an investigation he's been scheduled for. He is due to have a coronary angiography done next week to investigate his angina and he was wondering if he could ask some questions about the procedure. Please answer all of Mr Currie's questions and address his concerns.

Recommended time: 5 mins


Station Material (ONLY OPEN WHEN PROMPTED)

There are no station materials for this station

Actor Instructions 🤒

Name: Mr Sam Smith
DOB: DD/MM/YYYY
Age: 67

Agenda:

  • You're worried that because you have angina, it means you will likely have a heart attack
  • You're worried that this procedure could trigger a heart attack.
  • You're a very precise man, always wanting to understand exactly what to expect.
  • You currently take metformin for diabetes.

Questions: (ask if not already addressed)

  • Why am I having this test done?
  • How does this test work?
  • Do I have to do anything on my part before the procedure?
  • What happens during the procedure? Can you run through the whole thing for me so I know exactly what to expect?
  • How will you know you won't poke this 'catheter tube' into brain instead of my heart?
  • How long does the procedure take?
  • When can I go back to work? (I'm an engineer.)
  • Are there any risks or side effects involved with this procedure? Will I get a heart attack from this?

Mark Scheme ✍️

Introduction

Washes hands
Full name and role
Checks patient's name and DOB
Explains purpose of consultation
Gather information - obtain a recap of what happened from patient
all-markschemes.introduction

Ideas, concerns and expectations

Uncovering concerns

Elicit concerns regarding the procedure
Elicit concerns regarding the diagnosis
history-markschemes.ideas-concerns-expectations

Why

The chest pain you're experiencing is due to lack of blood to heart tissue
This lack of blood is likely due to narrowing of the vessel
This test can show us narrowing of the vessels so we can decide on the treatment
explanation-markscheme.why

Description

A special X-ray of the heart's blood vessels
Heart blood vessels don't usually show up on X-ray
We inject dye into arteries using a catheter (thin flexible tube)
explanation-markscheme.description

Before

Blood test and ECG done day before
Warfarin stopped 5 days in advance
DOACs stopped 2 days in advance
Diuretics stopped for the day
Diabetes medication altered - metformin needs to be stopped day before (to prevent lactic acidosis)
No food or drink 6 hours before
Both groins will need to be shaved
explanation-markscheme.before

During

Preparation

Lie on couch in catheterisation room
X-ray is positioned above the couch
Local anaesthetics given at site of injection
explanation-markscheme.during

Imaging

Catheter is inserted through a wide needle into blood vessel in the groin
Catheter tunnels all the way to the blood vessels of the heart
Catheter manoeuvre is guided by low dose X-ray
Once tip is pushed into main arteries - dye injected and X-ray is taken
ECG will be monitored throughout
Won't feel catheter moving through the blood vessel
Can be normal to feel the odd heartbeat (palpitation)
explanation-markscheme.during

Post-imaging

Catheter is gently pulled out
Insertion site may need few stitches if a cut was made
May require nurse to apply pressure to injection site for a while
Whole procedure takes 30 mins
explanation-markscheme.during

After

Stay put and rest for a few hours
Can go home on same day, but must be accompanied by someone
Can return to work the following day
If stitches used, they will need to be taken out after a week
Eat and drink plenty to flush out the dye
explanation-markscheme.after

Risks

Side effects

Site of injection may be bruised and painful after anaesthetic wears off - use paracetamol
Wound site infection
Anginal pain may present during procedure - usually wears off
Hot flushing feeling due to dye
Rare allergic reaction to contrast dye
Very rare risk of stroke/MI during procedure
Very rare risk of artery damage
explanation-markscheme.risks

Conclusion

Invites questions
Checks understanding, offering to repeat any section
Addresses concerns calmly
Avoids use of jargon throughout
Offer additional resources for further reading (online or leaflet)
all-markschemes.conclusion

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