Coronary Artery Disease: Should I Have an Angiogram?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Coronary Artery Disease: Should I Have an Angiogram?
Get the facts
Your options
- Have an angiogram to help decide how best to treat your coronary artery disease.
- Don't have an angiogram.
This decision aid is for people who have coronary artery disease and stable angina. This means that your angina symptoms, such as chest pain or pressure, happen at times you can predict. They happen when your heart is working hard, such as during exercise. Your symptoms go away when you rest or after you take nitroglycerin.
Key points to remember
- An angiogram can show if your coronary arteries are narrowed, where they are narrowed, and by how much. It can help your doctor see if a change in treatment—such as medicines, angioplasty, or coronary artery bypass surgery—can improve your angina or lower your risk of heart attack or death from heart problems.
- An angiogram can't show if narrowed places in your arteries will cause a heart attack.
- Other tests may give you and your doctor all the information you need to make treatment decisions. These other tests do not have the risks of an angiogram.
- If, during the test, your doctor sees that your arteries are narrowed, angioplasty could be done right away. So before you have the test, it's a good idea to talk with your doctor about this possible treatment. Ask what the test might show and what your choices are in each case.
- You may not want an angiogram if you already know that you don't want to have angioplasty or bypass surgery.
FAQs
A coronary angiogram is an X-ray test that takes pictures of the blood flow through your coronary arteries. It helps your doctor see if your arteries are narrowed. It can also show where they are narrowed and by how much.
During the test, a thin tube called a catheter is placed in an artery of your wrist or groin. It's then gently threaded up into your heart. A dye is put through the catheter. The dye helps your doctor see the arteries on the X-ray.
Before the test, you may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb. You may feel a brief sting or pinch from the numbing medicine. You may feel some pressure when the doctor puts in the catheter. You will probably feel some warmth when the dye is put in.
The procedure will take about 1 to 3 hours. You may be able to go home later the same day. Some people need to stay in the hospital overnight. You will need to avoid strenuous activity until your doctor says it is okay. This may be for several days.
Coronary artery disease occurs when fatty deposits called plaque (say "plak") build up inside the coronary arteries. These arteries wrap around the heart and supply it with blood and oxygen. When plaque builds up, it can narrow the arteries. This may limit how much blood can get to your heart muscle. If the plaque breaks apart, a blood clot could cause a heart attack.
Narrowing of the arteries can lead to symptoms of angina, such as chest pain or pressure and shortness of breath.
Treatment of coronary artery disease helps relieve symptoms. It also can slow how quickly the disease gets worse and can prevent a heart attack. Treatments include medicines, a heart-healthy lifestyle, angioplasty, and coronary artery bypass surgery. Everyone who has heart disease needs to take medicines and have a heart-healthy lifestyle—even if they have angioplasty or surgery.
An angiogram can help you and your doctor decide what treatment is best for you.
You may decide to have an angiogram because:footnote 2
- It can help your doctor see if a change in treatment might lower your risk of heart attack or death from heart problems. An angiogram can show your doctor where plaques have narrowed your arteries and if blood flow is slowed. But it can't show if these plaques will cause a heart attack.
- You want more relief from your angina. The test can show your doctor if a procedure or surgery could improve your symptoms.
It's important to talk with your doctor about your angina symptoms. Do your symptoms limit your daily activities and make it hard to enjoy your life? Do you have angina during light physical activity, such as walking a couple of blocks or up stairs? Also, if you are taking medicine for angina, let your doctor know if it doesn't control your symptoms enough. Your doctor may change your dose or suggest a different medicine.
Having the test doesn't mean that you will have an angioplasty or bypass surgery.
But, if during the angiogram the doctor sees that your arteries are narrowed, angioplasty could be done right away. So before you have an angiogram, talk with your doctor about a possible angioplasty. During the test, you may not be able to decide about more treatment, because you might be sleepy from medicines.
An angiogram isn't right for everyone.footnote 2
- Other tests may give you and your doctor all the information you need to make treatment decisions. These other tests do not have the risks of an angiogram.
- It's usually not suggested if you have a low risk of a heart attack or you don't have angina symptoms.
- If you can control your angina with medicines and a heart-healthy lifestyle, this test likely will not lead to changes in your treatment.
- You might choose not to have the test if you already know that you don't want to have angioplasty or bypass surgery.
Most people do not have problems during or after an angiogram.
Heart attack and stroke happen rarely, but they can be life-threatening. They are more likely to occur in older people or people who have health conditions that raise the risk of heart attack or stroke.
Other problems that can happen during or soon after an angiogram include:
- A tear or sudden closure in an artery.
- An allergic reaction to the dye used to see the arteries.
- Kidney damage related to the dye.
- Bleeding or bruising where the catheter was put in.
Conditions that can raise risk of problems
Certain health conditions can raise your risk of having problems after angioplasty. Conditions that can raise the risk of death from the procedure include heart failure, heart valve problems, and chronic kidney disease. The risk of heart attack may be higher if you have heart disease in the left main coronary artery.
Having these conditions doesn't mean that you will have a problem from the procedure. You and your doctor can talk about whether your risk of a problem is higher than average.
Radiation risk
There is always a slight risk of damage to cells or tissues from being exposed to any radiation. This includes the low levels of X-ray used for this test.
Ask your doctor about your risk of radiation from this test. Talk about whether you feel the benefits of the test might outweigh the risks.
Benefits
The benefits of an angiogram aren't the kinds of things that can be directly measured by numbers. The main reason to think about having the test is that it can help you and your doctor make better decisions about whether and how to treat your heart disease.
Risks
Fewer than 1 out of 100 people have a stroke, bleed heavily, or die soon after a coronary angiogram.footnote 1 This means that more than 99 out 100 people do not have these problems. These numbers are based on observed rates of complications from patients, not from studies.
Compare your options
| |
|---|
What is usually involved? |
| |
|---|
What are the benefits? |
| |
|---|
What are the risks and side effects? |
| |
|---|
Have an angiogramHave an angiogram- An angiogram takes about 1 to 3 hours. You will get a shot to numb the site where a catheter is placed in your blood vessel.
- After the test, you will stay in a recovery room for a few hours. You may go home the same day or the next day.
- You have a heart-healthy lifestyle. This includes quitting smoking, eating a heart-healthy diet, staying at a healthy weight, and getting regular exercise.
- You take medicines to lower your risk of a heart attack. You also may take medicines to help control angina.
- The test helps you and your doctor decide what treatment will improve your symptoms and lower your risk for a heart attack. Treatments include medicines and a heart-healthy lifestyle and maybe a procedure or surgery (along with medicines and a healthy lifestyle).
- An angiogram has some risks. They include:
- Allergic reaction to the dye used to see the coronary arteries.
- Bleeding at the site where the catheter is placed.
- Kidney damage related to the dye.
- Heart attack.
- Stroke.
- Death.
Don't have an angiogramDon't have an angiogram- You have a heart-healthy lifestyle. This includes quitting smoking, eating a heart-healthy diet, staying at a healthy weight, and getting regular exercise.
- You may take medicines to lower your chance of a heart attack. These include aspirin and medicines to control your cholesterol and blood pressure.
- You may take medicines to help control angina.
- You may have other tests that give you and your doctor the information you need.
- You avoid the risks of an angiogram.
- You may avoid treatments (angioplasty or surgery) that you don't want.
- You can decide later to have an angiogram.
- Medicines and a healthy lifestyle may not improve your angina as much as you would like.
My heart medicine just isn't working as well as it used to. Although my angina is stable, I am not feeling as well as I'd like to. I want to have the energy to play with my grandkids and the confidence to take the holidays my wife and I always planned. I've decided to have an angiogram so that my wife, my doctor, and I can make a decision about whether there may be something else that can help me.
I've been taking medicines for my angina, but my symptoms are still bothering me on my walks every day. My doctor said that an angiogram could show if an angioplasty could help me feel better. But she also said I could try a different angina medicine first and see if that helped. So I'm going to do that. I can still have the test later.
My chest pain is getting so bad that I can't do my gardening. And that's my favourite thing to do. So when my doctor recommended an angiogram, I was all for it. I decided I would rather have the test and then decide whether I want to get a stent.
I was getting chest pain after I walked a few blocks, or even less if it was cold out. I thought it was just my lungs, but when I saw my doctor, he said he thought it was my heart. So I took a treadmill test. Based on my results, my doctor thought I probably had some narrowing in my heart arteries. But he said it didn't seem too bad. We decided to try some medicine to see if that helps instead of having that test where they put dye in your arteries. I have been doing well and almost never get chest pain anymore.
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have an angiogram
Reasons not to have an angiogram
My angina is affecting my quality of life.
I'm able to control my angina with medicines.
More important
Equally important
More important
I want the choice of having angioplasty or surgery.
I already know that I don't want angioplasty or bypass surgery.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having an angiogram
NOT having an angiogram
Leaning toward
Undecided
Leaning toward
What else do you need to make your decision?
1. How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
3. Use the following space to list questions, concerns, and next steps.
Your Summary
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Next steps
Which way you're leaning
How sure you are
Your comments
Key concepts that you understood
Key concepts that may need review
Credits
| Author | Healthwise Staff |
|---|
| Clinical Review Board | Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
|---|
References
Citations
- Dehmer GJ, et al. (2012). A contemporary view of diagnostic cardiac catheterization and percutaneous coronary intervention in the United States. Journal of the American College of Cardiology, 60(20): 2017–2031. DOI: 10.1016/j.jacc.2012.08.966. Accessed June 4, 2021.
- Gulati M, et al. (2021). 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain. Journal of the American College of Cardiology, 78(22): e187–e285.. DOI: 10.1016/j.jacc.2021.07.053. Accessed December 2, 2021.
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Coronary Artery Disease: Should I Have an Angiogram?
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the Facts
Your options
- Have an angiogram to help decide how best to treat your coronary artery disease.
- Don't have an angiogram.
This decision aid is for people who have coronary artery disease and stable angina. This means that your angina symptoms, such as chest pain or pressure, happen at times you can predict. They happen when your heart is working hard, such as during exercise. Your symptoms go away when you rest or after you take nitroglycerin.
Key points to remember
- An angiogram can show if your coronary arteries are narrowed, where they are narrowed, and by how much. It can help your doctor see if a change in treatment—such as medicines, angioplasty, or coronary artery bypass surgery—can improve your angina or lower your risk of heart attack or death from heart problems.
- An angiogram can't show if narrowed places in your arteries will cause a heart attack.
- Other tests may give you and your doctor all the information you need to make treatment decisions. These other tests do not have the risks of an angiogram.
- If, during the test, your doctor sees that your arteries are narrowed, angioplasty could be done right away. So before you have the test, it's a good idea to talk with your doctor about this possible treatment. Ask what the test might show and what your choices are in each case.
- You may not want an angiogram if you already know that you don't want to have angioplasty or bypass surgery.
FAQs
What is a coronary angiogram?
A coronary angiogram is an X-ray test that takes pictures of the blood flow through your coronary arteries. It helps your doctor see if your arteries are narrowed. It can also show where they are narrowed and by how much.
During the test, a thin tube called a catheter is placed in an artery of your wrist or groin. It's then gently threaded up into your heart. A dye is put through the catheter. The dye helps your doctor see the arteries on the X-ray.
Before the test, you may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb. You may feel a brief sting or pinch from the numbing medicine. You may feel some pressure when the doctor puts in the catheter. You will probably feel some warmth when the dye is put in.
The procedure will take about 1 to 3 hours. You may be able to go home later the same day. Some people need to stay in the hospital overnight. You will need to avoid strenuous activity until your doctor says it is okay. This may be for several days.
What is coronary artery disease?
Coronary artery disease occurs when fatty deposits called plaque (say "plak") build up inside the coronary arteries. These arteries wrap around the heart and supply it with blood and oxygen. When plaque builds up, it can narrow the arteries. This may limit how much blood can get to your heart muscle. If the plaque breaks apart, a blood clot could cause a heart attack.
Narrowing of the arteries can lead to symptoms of angina, such as chest pain or pressure and shortness of breath.
Treatment of coronary artery disease helps relieve symptoms. It also can slow how quickly the disease gets worse and can prevent a heart attack. Treatments include medicines, a heart-healthy lifestyle, angioplasty, and coronary artery bypass surgery. Everyone who has heart disease needs to take medicines and have a heart-healthy lifestyle—even if they have angioplasty or surgery.
Why is an angiogram done?
An angiogram can help you and your doctor decide what treatment is best for you.
You may decide to have an angiogram because:2
- It can help your doctor see if a change in treatment might lower your risk of heart attack or death from heart problems. An angiogram can show your doctor where plaques have narrowed your arteries and if blood flow is slowed. But it can't show if these plaques will cause a heart attack.
- You want more relief from your angina. The test can show your doctor if a procedure or surgery could improve your symptoms.
It's important to talk with your doctor about your angina symptoms. Do your symptoms limit your daily activities and make it hard to enjoy your life? Do you have angina during light physical activity, such as walking a couple of blocks or up stairs? Also, if you are taking medicine for angina, let your doctor know if it doesn't control your symptoms enough. Your doctor may change your dose or suggest a different medicine.
Having the test doesn't mean that you will have an angioplasty or bypass surgery.
But, if during the angiogram the doctor sees that your arteries are narrowed, angioplasty could be done right away. So before you have an angiogram, talk with your doctor about a possible angioplasty. During the test, you may not be able to decide about more treatment, because you might be sleepy from medicines.
Why might you choose not to have an angiogram?
An angiogram isn't right for everyone.2
- Other tests may give you and your doctor all the information you need to make treatment decisions. These other tests do not have the risks of an angiogram.
- It's usually not suggested if you have a low risk of a heart attack or you don't have angina symptoms.
- If you can control your angina with medicines and a heart-healthy lifestyle, this test likely will not lead to changes in your treatment.
- You might choose not to have the test if you already know that you don't want to have angioplasty or bypass surgery.
What are the risks of an angiogram?
Most people do not have problems during or after an angiogram.
Heart attack and stroke happen rarely, but they can be life-threatening. They are more likely to occur in older people or people who have health conditions that raise the risk of heart attack or stroke.
Other problems that can happen during or soon after an angiogram include:
- A tear or sudden closure in an artery.
- An allergic reaction to the dye used to see the arteries.
- Kidney damage related to the dye.
- Bleeding or bruising where the catheter was put in.
Conditions that can raise risk of problems
Certain health conditions can raise your risk of having problems after angioplasty. Conditions that can raise the risk of death from the procedure include heart failure, heart valve problems, and chronic kidney disease. The risk of heart attack may be higher if you have heart disease in the left main coronary artery.
Having these conditions doesn't mean that you will have a problem from the procedure. You and your doctor can talk about whether your risk of a problem is higher than average.
Radiation risk
There is always a slight risk of damage to cells or tissues from being exposed to any radiation. This includes the low levels of X-ray used for this test.
Ask your doctor about your risk of radiation from this test. Talk about whether you feel the benefits of the test might outweigh the risks.
What do numbers tell us about benefits and risks of an angiogram?
Benefits
The benefits of an angiogram aren't the kinds of things that can be directly measured by numbers. The main reason to think about having the test is that it can help you and your doctor make better decisions about whether and how to treat your heart disease.
Risks
Fewer than 1 out of 100 people have a stroke, bleed heavily, or die soon after a coronary angiogram.1 This means that more than 99 out 100 people do not have these problems. These numbers are based on observed rates of complications from patients, not from studies.
2. Compare your options
| Have an angiogram | Don't have an angiogram |
|---|
| What is usually involved? | - An angiogram takes about 1 to 3 hours. You will get a shot to numb the site where a catheter is placed in your blood vessel.
- After the test, you will stay in a recovery room for a few hours. You may go home the same day or the next day.
- You have a heart-healthy lifestyle. This includes quitting smoking, eating a heart-healthy diet, staying at a healthy weight, and getting regular exercise.
- You take medicines to lower your risk of a heart attack. You also may take medicines to help control angina.
| - You have a heart-healthy lifestyle. This includes quitting smoking, eating a heart-healthy diet, staying at a healthy weight, and getting regular exercise.
- You may take medicines to lower your chance of a heart attack. These include aspirin and medicines to control your cholesterol and blood pressure.
- You may take medicines to help control angina.
- You may have other tests that give you and your doctor the information you need.
|
|---|
| What are the benefits? | - The test helps you and your doctor decide what treatment will improve your symptoms and lower your risk for a heart attack. Treatments include medicines and a heart-healthy lifestyle and maybe a procedure or surgery (along with medicines and a healthy lifestyle).
| - You avoid the risks of an angiogram.
- You may avoid treatments (angioplasty or surgery) that you don't want.
- You can decide later to have an angiogram.
|
|---|
| What are the risks and side effects? | - An angiogram has some risks. They include:
- Allergic reaction to the dye used to see the coronary arteries.
- Bleeding at the site where the catheter is placed.
- Kidney damage related to the dye.
- Heart attack.
- Stroke.
- Death.
| - Medicines and a healthy lifestyle may not improve your angina as much as you would like.
|
|---|
Personal stories
Personal stories about deciding whether to have an angiogram
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
"My heart medicine just isn't working as well as it used to. Although my angina is stable, I am not feeling as well as I'd like to. I want to have the energy to play with my grandkids and the confidence to take the holidays my wife and I always planned. I've decided to have an angiogram so that my wife, my doctor, and I can make a decision about whether there may be something else that can help me."
"I've been taking medicines for my angina, but my symptoms are still bothering me on my walks every day. My doctor said that an angiogram could show if an angioplasty could help me feel better. But she also said I could try a different angina medicine first and see if that helped. So I'm going to do that. I can still have the test later."
"My chest pain is getting so bad that I can't do my gardening. And that's my favourite thing to do. So when my doctor recommended an angiogram, I was all for it. I decided I would rather have the test and then decide whether I want to get a stent."
"I was getting chest pain after I walked a few blocks, or even less if it was cold out. I thought it was just my lungs, but when I saw my doctor, he said he thought it was my heart. So I took a treadmill test. Based on my results, my doctor thought I probably had some narrowing in my heart arteries. But he said it didn't seem too bad. We decided to try some medicine to see if that helps instead of having that test where they put dye in your arteries. I have been doing well and almost never get chest pain anymore."
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have an angiogram
Reasons not to have an angiogram
My angina is affecting my quality of life.
I'm able to control my angina with medicines.
More important
Equally important
More important
I want the choice of having angioplasty or surgery.
I already know that I don't want angioplasty or bypass surgery.
More important
Equally important
More important
My other important reasons:
My other important reasons:
More important
Equally important
More important
4. Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Having an angiogram
NOT having an angiogram
Leaning toward
Undecided
Leaning toward
5. What else do you need to make your decision?
Check the facts
1. An angiogram can help me and my doctor decide which treatment is best for my heart disease.
You're right. An angiogram may help you and your doctor decide whether you want to take other medicines or have an angioplasty or coronary artery bypass surgery.
2. I may not need an angiogram if I can control my angina symptoms with medicines and I'm otherwise healthy.
You're right. Some people will do well just by taking medicines to control their symptoms.
3. An angiogram can tell if I'm going to have a heart attack.
You're right. An angiogram can show your doctor where plaques have narrowed your arteries and if blood flow is slowed. But it can't show if these plaques will cause a heart attack.
Decide what's next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
Not sure at all
Somewhat sure
Very sure
2. Check what you need to do before you make this decision.
3. Use the following space to list questions, concerns, and next steps.
Credits
| By | Healthwise Staff |
|---|
| Clinical Review Board | Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
|---|
References
Citations
- Dehmer GJ, et al. (2012). A contemporary view of diagnostic cardiac catheterization and percutaneous coronary intervention in the United States. Journal of the American College of Cardiology, 60(20): 2017–2031. DOI: 10.1016/j.jacc.2012.08.966. Accessed June 4, 2021.
- Gulati M, et al. (2021). 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain. Journal of the American College of Cardiology, 78(22): e187–e285.. DOI: 10.1016/j.jacc.2021.07.053. Accessed December 2, 2021.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.Current as of: June 24, 2023
Author: Healthwise Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
Dehmer GJ, et al. (2012). A contemporary view of diagnostic cardiac catheterization and percutaneous coronary intervention in the United States. Journal of the American College of Cardiology, 60(20): 2017–2031. DOI: 10.1016/j.jacc.2012.08.966. Accessed June 4, 2021.
Gulati M, et al. (2021). 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain. Journal of the American College of Cardiology, 78(22): e187–e285.. DOI: 10.1016/j.jacc.2021.07.053. Accessed December 2, 2021.
