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How angiogram is been done? - Online Doctor Chats

Date : 26-Mar-2013
User rating for this question
Very Good Posted in: Hypertension and Heart Disease
Answered by

General & Family Physician
Practicing since : 2003
Answered : 1566 Questions
Doctor:HI, how are you doing?
User:i am good how are you doing?
Doctor:I am good, thank you
Doctor:How can I help you?
User:i am trying to understand angiogram and how it is done...
User:i will give you the background
User:my mother is undergoing dialysis for the past 2 years 2 times per week....
User:We are exploring renal transplation option now
User:for which we did many tests like ecg,echo,blood and so on...
User: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
Doctor:How old is your mother, XXXXXX?
User:she is 60 yrs
User:would like to know the procedure,consequences and precautions
Doctor:Angiogram is actually a test which helps us look at the blood vessels which supply the heart
Doctor:These vessels are called the coronary vessels
Doctor:What we do is inject a XXXXXXX into a vein or a artery in the thigh or the elbow
Doctor:actually what we do is pass a catheter through this artery or vein into the coronary vessels
Doctor:Once the catheter is in the coronary vessels, we inject a XXXXXXX
Doctor:A catheter is like a thin plastic tube
Doctor:after we inject the XXXXXXX we take Xrays of this
User:the XXXXXXX would help identify the blocks if any ...
Doctor:This helps us know about the narrowing of the blood vessels
Doctor:thats right
User:how likely is the angiogram to be followed by angioplasty....keeping her age and medical condition in mind
Doctor:But in your mother's case, is it being done for the vessels in the heart or the vessels in the kidney?
User:are both different ?
Doctor:a coronary angiogram is done for the vessels of the heart
User:doctor said to rule out any heart disesase
Doctor:then its a coronary angiogram
User:why is it done for the vessels of the kidney...? is it to identify blocks ?
Doctor:actually, before a renal transplant, we do it to find out about the number, location and condition of the blood vessels
Doctor:This is necessary so that we know that the transplanted kidney will be ok as far as the blood supply is concerned
Doctor:As far as the angioplasty is concerned, it depends on how severe the block is
User:is it true if some block is identified they may not even consider transplantation?
Doctor:These vessels are usually ok, XXXXXX
Doctor:But we make sure that everything is ok as transplant is a major procedure
User:in her case will the angiogram be done for the kidney blood vessels too ?
Doctor:I will not be able to comment on that, XXXXXX
Doctor:It depends on case to case issues doctor ....can the blocks be cured with medicines....?
Doctor:The block in the heart vessels?
Doctor:It depends on the extent of the block
Doctor:If the block is such that it is not limiting the blood supply in times of exertion, then we will only give medication
Doctor:However, if the narrowing is more than 75%-80%, we usually do a angioplasty or a bypass surgery
Doctor:a lot of times, we do the angioplasty at the same time as the angiogram
Doctor:In angioplasty, we just advance a stent into the blocked vessed
Doctor:this opens up the vessel
User:is there anything else with respect to this procedure...any to prepare the patient for this
Doctor:As far as the complications of angiogram are concerned, the complications are more with increasing age and with kidney problems
Doctor:is your mother diabetic?
User:she was diabetic which led to this
Doctor:Is she currently recieving any aspirin or warfarin?
User:but now I dont think sh is under medication for diabetes
User:I dont think her bp was high when we took her for the procedure lst suggested to take her BP medicines 2 instead of one
Doctor:I would suggest you check once aagain
User:and then come agin for it next week....
Doctor:If she is getting it, you need to speak with your doctor about this
User:do yu want me to check with my mom if she is taking asprin ?
Doctor:and also about warfarin
User:are both related to bp ?
Doctor:she needs to stop this about 1 day before the procedure after speaking to her doctor
Doctor:They affect the clotting of blood
User:oh ok...
Doctor:Next, basically, she doesnt have to eat or drink anything 4-8 hours before angiogram
User:fasting....or any other prep is necessary?
Doctor:yeah, fasting
Doctor:also, is she allergic to anything?
Doctor:after the procedure, she needs to take a lot of water to help flush out the XXXXXXX
Doctor:Also, I would like to tell you that there is a chance of developing an allergy to a XXXXXXX
Doctor:but it occurs rarely
Doctor:as a physician, it is my duty to tell you about all the risks
Doctor:I think thats it about the procedure
Doctor:Is there anything else that you'd like to know?
Doctor:also, apart from aspirin and warfarin, she needs to take all her medications, in the morning of the test
User:i checked with my dad on her medicines...she is not taking asprin or warfarin
Doctor:Then there is no issue
Doctor:On the day of the test, she needs to go fasting
User:since she is on dialysis she is not supposed to take more water
Doctor:But do this only after you have spoken to your physician
Doctor:I understand
Doctor:But the XXXXXXX can damage the kindyes
Doctor:I would suggest that you speak to her physician about this
Doctor:They generally take some precautions in people with diabetes and in people with kidney disease
Doctor:Otherwise, there is a small risk of allergy from the XXXXXXX
Doctor:This is with everyone
Doctor:But its something we can manage
Doctor:No problems due to this one
User:how long will be the procedure?
Doctor:It generally lasts for a couple of hours
Doctor:Its done both on an outpatient and inpatient basis
Doctor:For her, I think they'll admit her
User:they have asked her to get admitted for a day
Doctor:since they'd like to observe her
Doctor:yes, thats right
User:doc has not recommended for treadmill test...does TMT has to precede angiogram?
Doctor:All people are not able to do the TMT, XXXXXX
Doctor:is your mother able to walk around quite a lot?
User:not a lot..she moves around in the house able to walk....
User:she is under physiotherapy for her leg ache
Doctor:Its unlikely she'll be able to jog on the treadmill
Doctor:thats why a TMT will be a useless test in her
User:she used t be heavy...but now hse is just 58-59kgs only
Doctor:You can speak to her physician about a nuclear stress test
Doctor:Its for people who cant jog on the treadmill
User:simulting the procedure of treadmill by creating stress to the heart when you jog or run..
Doctor:using drugs
Doctor:we put the heart under stress
Doctor:and check the blood supply
Doctor:but its something which is not available at all centres
User:can i ask u few questions related to kidney ? transplanation and so on ?
Doctor:go ahead
Doctor:We'll do it one by one
Doctor:so it becomes easier for me to explain and for you to understand
User: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 is the permanent damage caused ?
Doctor:Once the kidney function is lost and dialysis has been started, XXXXX, the function does not recover
Doctor:You are talking about permanent damage by diabetes or by dialysis?
User:permanaent damage 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
Doctor:I understand
Doctor:You dont need to be sorry
Doctor:Actually what has happened is that the diabetes has damaged your mother's kidneys
Doctor: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
Doctor:when there is a lot of sugar in the blood ( as in diabetes), this damages the membrane of this glomerulus
User:ok...dialysis is done inorder to remove the pressure out of kidneys to work more...right ?
Doctor:actually when the kidneys cant work anymore, thats when dialysis is started
Doctor:It actually filters the waste the kidney is supposed to filter
User:and this waste is not urine or motion ?
Doctor:Its stuff like urea, creatinine
Doctor:Its called renal replacement therapy, XXXXXX
Doctor:so you understand the basic use
Doctor:to replace the kidneys
User:does it filter these and sents it out doctor?
Doctor:It has a membrane
Doctor:which selectively removes the toxic products
User:those come along with urine and motion? right ?
Doctor:the stuff which is required in the body is retained in the body
Doctor:Normally, the kidneys removes these toxic products
Doctor:when they dont function, we use dialysis
User:how come the diabetes affects both the kidneys..they say for our sustenance one kidney itself is enough
Doctor:Its a problem which affects the whole body XXXXXX
Doctor:The sugar which is damaging the kidneys is in the blood
Doctor:The blood is oing equally to both kidneys
Doctor:It is true, we need only 1 kidney to survive
Doctor:provided we dont have any other problem
User:now....coming to transplantation what is 3rd hour transplant ?
User:i hope it is not a sensitive question? not sure though
Doctor:I am not sure about this, XXXXXX. a renal transplant will generally take 3-8 hours to do
Doctor:It is definitely not a medical term. But I can confirm with a nephrologist and let you know
User:no issues...
Doctor:where did you come across this term?
User:my dad was telling about this
Doctor:I dont think there's such a term
User:i guess it is concerned with the person who donates the kidneys...who is brain dead...
Doctor:Thats called a cadaveric transplant in medical terms
Doctor:Like if you donate, its a living donor transplant
Doctor:If you take a kidney from a dead person, its called a cadaveric transplant
Doctor:The outcomes with living donors are better
Doctor:generally speaking
Doctor:But it depends on a lot of factors
User:the blood group should match
User:right ?
User:is there anything else which should match ?
Doctor:They do a HLA typing also
User:what is that ?
Doctor:There are lots of tests that are done, XXXXXX
Doctor:HLA stands for human leukocyte antigen. It is a group of genes which code for a protein on the cells
Doctor:This protein helps white cells in our body recognize that this organ belongs to us
Doctor:If for example, you give your kidney and your proteins are different from your mothers'
Doctor:So the white cells in your mothers body recognize that this is not her own organ
Doctor:So they mount a response against your kidney
Doctor:to prevent this, we give drugs in the post transplant period
User:all the tests done on the donor matches
Doctor:they have been done?
User:if in case?
User:no ....
User:is transplantion done live or preserved and done later
Doctor:I dont understand XXXXXX
Doctor:If the tests match, they'll do the transplant at the 1st available date
Doctor:We dont want to delay it anyway
Doctor:because renal transplants increase life expectancy which dialysis does not
User:is it removed from the donor and kept it on the patient as soon as it is remoed
Doctor:Both the donor and the patient are taken in simulatenously
User:or the kidney preserved and done later?
Doctor:No at the same time
User:is it a major surgery for both ?
Doctor:It is a major surgery, XXXXXX
Doctor:There are no 2 ways about that
User:how long will it take for the donor to recuperate ....?
User:and the patient to recuperate
Doctor:after 1-2 days, the donor is discharges
Doctor:after 2-3 weeks, they can usually resume work
User:for patient ?
Doctor:they can feel tired and would want frequent naps
Doctor:but exercising, especially walking should be continued when they are recovering at home
Doctor:doe the patient,
Doctor:the recivery time is around 6 months
Doctor:they will be discharged in 3-7 days and will need close follow up for 1-2 months
User:complete bed rest ?
User:for the entire six months ?
Doctor:only for the immediate period after surgery
User:ok...can they do regular household work ofcourse assisted y others after a month or so ?
Doctor:after that, gradually, they can resume activity
Doctor:Provided she doesnt have any complications
Doctor:the kidney is accepted and all goes well
User:ok...what are the likely
Doctor:plus no outside food, not going out much, is also going to be required
Doctor:most important is rejection
Doctor:that the kidney is not taken up and it fails
Doctor:although the rates of this are coming down
Doctor:we have very good drugs now
User:% of chance of rejection?
Doctor:will depend on case to case
Doctor:there is no specified percentage as such
Doctor:as it depends on a large number of factors
Doctor:but the drugs we use to prevent rejection suppress the immune system
Doctor:so it leads to an increased chance of infections
User:will the acceptance rate depend on the relation of the donor with the patient
Doctor:closer the relation, better is the chance of HLA matching
Doctor:like identical twins, they have 100% HLA matching
Doctor:then there are cardiovascular complications
User: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 that the reason ?
Doctor:Yes, it can cause such symptom
Doctor:Have you taken any treatment for the urinary infection?
Doctor:One simple cause is we do not give it time to pass urine frequently
Doctor:We hold urine for long time though
Doctor:which makes it difficult to control the urge while passing urine
User:doctor suggested simple antibiotic norflox...i havent taken it yet...
Doctor:Norflox is an effective antibiotic but it is not a simple one
Doctor:You can take it,if it is proven that there is an urinary infection
Doctor:If not, try other simple measures first
User:i will get it today and have it from tonight..
User:one more thing....
Doctor:Like, Try syrup Citralka 1 teaspoons full in half glass of water
Doctor:Three times a day for 2 days
Doctor:Take lot of cranberry juice
Doctor:and plenty of fluids orally
User:oh...she suggested tender coconut water
Doctor:There is no need to take Norflox on the first basis
Doctor:Yes, you can take that too
Doctor:It helps in a great way
User:ok....wanted to check with you o smething else too...
User:i have some sort of pain on my left fluid discharge or anything....
Doctor:This is normal
Doctor:May I know your last menstrual period?
User:28 days
User:and it started on 9th march
Doctor:Is this the first time you are facing this pain?
User:this is not only PMS but....even inbetween
User:inthe sense not only before or after periods....
Doctor:Yes, you are right
User:first time...the pain started 2 weeks ago
Doctor:but hormonal levels keep changing in our body
Doctor:DO you feel any lump in your breast?
User:not exactly lump...but i could feel the pain when i touch
User:this is not on my right one
Doctor:I understand
Doctor:Try simple pain killers like Paracetamol 500mg twice a day for 2 days
Doctor:May I know your age?
Doctor:Are you married?
User:yes...2 kids...
User:5year and 3 year old
User:i took dolo 650 one yesterday night and one today morning...
Doctor:XXXXXX, Are you sure this is the first time you are having the pain in your breast?
Doctor:Just get it examined as a routine from your gynecologist as and when you XXXXXXX her
User: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
Doctor:There may be some residual damage left in your left breast
User:doc sugested chymoral forte and some oral application
Doctor:There is no harm in getting it physically examined
User:which i took
Doctor:That is good
Doctor:Please get a routine breast examination done
User:and the clot is no more there nor the reddish look
User:what is it called
Doctor:And if required, the doctor may advise a Mammogram
Doctor:You can just request the doctor to conduct a breast examination
Doctor:Is there anything else I may help you with XXXXXX?
User:will they use an instrument or with hands..?
Doctor:It is done with hands manually
User:ok....from a gyneac...right ?
Doctor:yes, that is right XXXXXX
User:ii was checking with Dr XXXXXX on a pain onmy left breast ..she suggested that i do a regular breast examination with gyneac..
Doctor:Thats always advisable, XXXXXX
Doctor:How old are you?
User:33...married...2 kids
Doctor:A regular breast examination is always something we should be doing
Doctor:I think the clot would have gone away by now
Doctor:You still have pain?
User:the clot had gone...and the pain was not there after that for a ery long time..
Doctor:Not you have the pain again?
User:i am not sure if it is the same thing which is causing the pain...
Doctor:Its unlikely
User:i have pain...but intense only when i touch
Doctor:Did you have a child recently, XXXXXX?
User:3years ago
User:and i was feding her for 2 years
Doctor:Where is the pain exactly, if you'll let me know?
User:feeding is from the rightside to the bottom of the left breast
Doctor:is there a pain while breathing?
Doctor:have you noticed a swelling or a lump or anything?
User:i could not feel any swelling...but when i touch i feel the pain
User:that is not same with right breast
Doctor:when you actually press on the sternum, a bone which is right there, it hurts
Doctor:Its normal
Doctor:But I would suggest you see a physician
Doctor:I want 2 things
User:oh...why is it not on my right breast?
Doctor:You got injured there right?
User:i got injured on my left
Doctor:There is a lot of the normal elastic tissue
Doctor:Yes, thats what
Doctor:You got injured, it led to a loss of elastic tissue and you can press the sternum here more easily
User:a general physician would e able to find out...or a gyneac
Doctor:A gynaecologist would be better
Doctor:Actually, I want you to have a Pap smear u suspect something ?
User:form the symptoms
Doctor:No, its normal preventive screening
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