How angiogram is been done? - Online Doctor Chats
HI, how are you doing?
i am good how are you doing?
I am good, thank you
How can I help you?
i am trying to understand angiogram and how it is done...
i will give you the background
my mother is undergoing dialysis for the past 2 years 2 times per week....
We are exploring renal transplation option now
for which we did many tests like ecg,echo,blood and so on...
the doctor would like to rule out the possiblity of blocks n the heart based on which decsion has to be made wheteher or not to go in for transplanation
How old is your mother, XXXXXX?
she is 60 yrs
would like to know the procedure,consequences and precautions
Angiogram is actually a test which helps us look at the blood vessels which supply the heart
These vessels are called the coronary vessels
What we do is inject a XXXXXXX into a vein or a artery in the thigh or the elbow
actually what we do is pass a catheter through this artery or vein into the coronary vessels
Once the catheter is in the coronary vessels, we inject a XXXXXXX
A catheter is like a thin plastic tube
after we inject the XXXXXXX we take Xrays of this
the XXXXXXX would help identify the blocks if any ...
This helps us know about the narrowing of the blood vessels
how likely is the angiogram to be followed by angioplasty....keeping her age and medical condition in mind
But in your mother's case, is it being done for the vessels in the heart or the vessels in the kidney?
are both different ?
a coronary angiogram is done for the vessels of the heart
doctor said to rule out any heart disesase
then its a coronary angiogram
why is it done for the vessels of the kidney...? is it to identify blocks ?
actually, before a renal transplant, we do it to find out about the number, location and condition of the blood vessels
This is necessary so that we know that the transplanted kidney will be ok as far as the blood supply is concerned
As far as the angioplasty is concerned, it depends on how severe the block is
is it true if some block is identified they may not even consider transplantation?
These vessels are usually ok, XXXXXX
But we make sure that everything is ok as transplant is a major procedure
in her case will the angiogram be done for the kidney blood vessels too ?
I will not be able to comment on that, XXXXXX
It depends on case to case
ok...no issues doctor ....can the blocks be cured with medicines....?
The block in the heart vessels?
It depends on the extent of the block
If the block is such that it is not limiting the blood supply in times of exertion, then we will only give medication
However, if the narrowing is more than 75%-80%, we usually do a angioplasty or a bypass surgery
a lot of times, we do the angioplasty at the same time as the angiogram
In angioplasty, we just advance a stent into the blocked vessed
this opens up the vessel
is there anything else with respect to this procedure...any precautions....how to prepare the patient for this
As far as the complications of angiogram are concerned, the complications are more with increasing age and with kidney problems
is your mother diabetic?
she was diabetic which led to this
Is she currently recieving any aspirin or warfarin?
but now I dont think sh is under medication for diabetes
I dont think so...as her bp was high when we took her for the procedure lst week...doctor suggested to take her BP medicines 2 instead of one
I would suggest you check once aagain
and then come agin for it next week....
If she is getting it, you need to speak with your doctor about this
do yu want me to check with my mom if she is taking asprin ?
and also about warfarin
are both related to bp ?
she needs to stop this about 1 day before the procedure after speaking to her doctor
They affect the clotting of blood
Next, basically, she doesnt have to eat or drink anything 4-8 hours before angiogram
fasting....or any other prep is necessary?
also, is she allergic to anything?
after the procedure, she needs to take a lot of water to help flush out the XXXXXXX
Also, I would like to tell you that there is a chance of developing an allergy to a XXXXXXX
but it occurs rarely
as a physician, it is my duty to tell you about all the risks
I think thats it about the procedure
Is there anything else that you'd like to know?
also, apart from aspirin and warfarin, she needs to take all her medications, in the morning of the test
i checked with my dad on her medicines...she is not taking asprin or warfarin
Then there is no issue
On the day of the test, she needs to go fasting
since she is on dialysis she is not supposed to take more water
But do this only after you have spoken to your physician
But the XXXXXXX can damage the kindyes
I would suggest that you speak to her physician about this
They generally take some precautions in people with diabetes and in people with kidney disease
Otherwise, there is a small risk of allergy from the XXXXXXX
This is with everyone
But its something we can manage
No problems due to this one
how long will be the procedure?
It generally lasts for a couple of hours
Its done both on an outpatient and inpatient basis
For her, I think they'll admit her
they have asked her to get admitted for a day
since they'd like to observe her
yes, thats right
doc has not recommended for treadmill test...does TMT has to precede angiogram?
All people are not able to do the TMT, XXXXXX
is your mother able to walk around quite a lot?
not a lot..she moves around in the house able to walk....
Its unlikely she'll be able to jog on the treadmill
thats why a TMT will be a useless test in her
she used t be heavy...but now hse is just 58-59kgs only
You can speak to her physician about a nuclear stress test
Its for people who cant jog on the treadmill
simulting the procedure of treadmill by creating stress to the heart when you jog or run..
we put the heart under stress
and check the blood supply
but its something which is not available at all centres
can i ask u few questions related to kidney ? transplanation and so on ?
We'll do it one by one
so it becomes easier for me to explain and for you to understand
i hear that dialysis is not a proper treatment as it only replicates the fucntion of a kidney...externally and in some cases people regain the fucntion of the kidney after some few sets are over....how is the permanent damage caused ?
Once the kidney function is lost and dialysis has been started, XXXXX, the function does not recover
You are talking about permanent damage by diabetes or by dialysis?
permanaent damage ....how it is caused..?If a person is able to pass urine and motion without any issues...then how is that they say kidney is damaged ? sorry this may be too immature..but just want to understand
You dont need to be sorry
Actually what has happened is that the diabetes has damaged your mother's kidneys
what happens is that the blood is filtered through a small network of blood vessels in the kidney. This network is called glomerulus and this has a thin membrane
when there is a lot of sugar in the blood ( as in diabetes), this damages the membrane of this glomerulus
ok...dialysis is done inorder to remove the pressure out of kidneys to work more...right ?
actually when the kidneys cant work anymore, thats when dialysis is started
It actually filters the waste the kidney is supposed to filter
and this waste is not urine or motion ?
Its stuff like urea, creatinine
Its called renal replacement therapy, XXXXXX
so you understand the basic use
to replace the kidneys
does it filter these and sents it out doctor?
It has a membrane
which selectively removes the toxic products
those come along with urine and motion? right ?
the stuff which is required in the body is retained in the body
Normally, the kidneys removes these toxic products
when they dont function, we use dialysis
how come the diabetes affects both the kidneys..they say for our sustenance one kidney itself is enough
Its a problem which affects the whole body XXXXXX
The sugar which is damaging the kidneys is in the blood
The blood is oing equally to both kidneys
It is true, we need only 1 kidney to survive
provided we dont have any other problem
now....coming to transplantation what is 3rd hour transplant ?
i hope it is not a sensitive question? not sure though
I am not sure about this, XXXXXX. a renal transplant will generally take 3-8 hours to do
where did you come across this term?
my dad was telling about this
I dont think there's such a term
Thats called a cadaveric transplant in medical terms
Like if you donate, its a living donor transplant
If you take a kidney from a dead person, its called a cadaveric transplant
The outcomes with living donors are better
But it depends on a lot of factors
is there anything else which should match ?
They do a HLA typing also
what is that ?
There are lots of tests that are done, XXXXXX
HLA stands for human leukocyte antigen. It is a group of genes which code for a protein on the cells
This protein helps white cells in our body recognize that this organ belongs to us
If for example, you give your kidney and your proteins are different from your mothers'
So the white cells in your mothers body recognize that this is not her own organ
So they mount a response against your kidney
to prevent this, we give drugs in the post transplant period
all the tests done on the donor matches
they have been done?
if in case?
is transplantion done live or preserved and done later
I dont understand XXXXXX
If the tests match, they'll do the transplant at the 1st available date
We dont want to delay it anyway
because renal transplants increase life expectancy which dialysis does not
is it removed from the donor and kept it on the patient as soon as it is remoed
Both the donor and the patient are taken in simulatenously
or the kidney preserved and done later?
No at the same time
is it a major surgery for both ?
It is a major surgery, XXXXXX
There are no 2 ways about that
how long will it take for the donor to recuperate ....?
and the patient to recuperate
after 1-2 days, the donor is discharges
after 2-3 weeks, they can usually resume work
for patient ?
they can feel tired and would want frequent naps
but exercising, especially walking should be continued when they are recovering at home
doe the patient,
the recivery time is around 6 months
they will be discharged in 3-7 days and will need close follow up for 1-2 months
for the entire six months ?
only for the immediate period after surgery
ok...can they do regular household work ofcourse assisted y others after a month or so ?
after that, gradually, they can resume activity
Provided she doesnt have any complications
the kidney is accepted and all goes well
ok...what are the likely complications...doctor?
plus no outside food, not going out much, is also going to be required
most important is rejection
that the kidney is not taken up and it fails
although the rates of this are coming down
we have very good drugs now
% of chance of rejection?
will depend on case to case
there is no specified percentage as such
as it depends on a large number of factors
but the drugs we use to prevent rejection suppress the immune system
so it leads to an increased chance of infections
will the acceptance rate depend on the relation of the donor with the patient
closer the relation, better is the chance of HLA matching
like identical twins, they have 100% HLA matching
then there are cardiovascular complications
from yesterday i am suffering from this urinary infection...i am not sure if that is the reason...i am unable to hold the urine until i reach the toilet...is that the reason ?
Yes, it can cause such symptom
Have you taken any treatment for the urinary infection?
One simple cause is we do not give it time to pass urine frequently
We hold urine for long time though
which makes it difficult to control the urge while passing urine
doctor suggested simple antibiotic norflox...i havent taken it yet...
Norflox is an effective antibiotic but it is not a simple one
You can take it,if it is proven that there is an urinary infection
If not, try other simple measures first
i will get it today and have it from tonight..
one more thing....
Like, Try syrup Citralka 1 teaspoons full in half glass of water
Three times a day for 2 days
Take lot of cranberry juice
and plenty of fluids orally
oh...she suggested tender coconut water
There is no need to take Norflox on the first basis
Yes, you can take that too
It helps in a great way
ok....wanted to check with you o smething else too...
i have some sort of pain on my left breast....no fluid discharge or anything....
This is normal
May I know your last menstrual period?
and it started on 9th march
Is this the first time you are facing this pain?
this is not only PMS but....even inbetween
inthe sense not only before or after periods....
Yes, you are right
first time...the pain started 2 weeks ago
DO you feel any lump in your breast?
not exactly lump...but i could feel the pain when i touch
this is not on my right one
May I know your age?
Are you married?
5year and 3 year old
XXXXXX, Are you sure this is the first time you are having the pain in your breast?
Just get it examined as a routine from your gynecologist as and when you XXXXXXX her
previously i fell down from my bike and the hadlebar hit my left breast and got a clot there that was a year and half ago
There may be some residual damage left in your left breast
There is no harm in getting it physically examined
which i took
That is good
Please get a routine breast examination done
and the clot is no more there nor the reddish look
what is it called
And if required, the doctor may advise a Mammogram
You can just request the doctor to conduct a breast examination
Is there anything else I may help you with XXXXXX?
will they use an instrument or with hands..?
It is done with hands manually
ok....from a gyneac...right ?
yes, that is right XXXXXX
ii was checking with Dr XXXXXX on a pain onmy left breast ..she suggested that i do a regular breast examination with gyneac..
Thats always advisable, XXXXXX
How old are you?
A regular breast examination is always something we should be doing
I think the clot would have gone away by now
You still have pain?
the clot had gone...and the pain was not there after that for a ery long time..
Not you have the pain again?
i am not sure if it is the same thing which is causing the pain...
i have pain...but intense only when i touch
Did you have a child recently, XXXXXX?
and i was feding her for 2 years
Where is the pain exactly, if you'll let me know?
sure...it is from the rightside to the bottom of the left breast
is there a pain while breathing?
have you noticed a swelling or a lump or anything?
i could not feel any swelling...but when i touch i feel the pain
that is not same with right breast
when you actually press on the sternum, a bone which is right there, it hurts
But I would suggest you see a physician
I want 2 things
oh...why is it not on my right breast?
You got injured there right?
i got injured on my left
There is a lot of the normal elastic tissue
Yes, thats what
You got injured, it led to a loss of elastic tissue and you can press the sternum here more easily
a general physician would e able to find out...or a gyneac
A gynaecologist would be better
Actually, I want you to have a Pap smear
oh...do u suspect something ?
form the symptoms
No, its normal preventive screening
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