Heart disease: Should I have an angiogram?

1. Get the Facts

Your options

Have an angiogram to find out if you need treatment for coronary artery disease.
Don't have an angiogram.

Key points to remember

An angiogram can show how serious your coronary artery disease is and how best to treat it. It shows if your coronary arteries are clogged, where they are clogged, and by how much. The test can help your doctor see if you need treatment such as medicines, angioplasty, or coronary artery bypass surgery.
Your doctor may recommend that you have an angiogram if:
- The results of a cardiac stress test suggest that you have severe heart disease.
- You are having chest pain (angina) while you are at rest or during only moderate physical activity. Or you are taking medicines for chest pain, but they do not control it.
- You have another heart problem, such as heart failure, that may be caused by heart disease.
If during the test the doctor sees that your arteries are badly blocked, you may need to have an angioplasty or bypass surgery right away. So before you have the test, it's a good idea to talk with your doctor about these treatments. Ask what the test might show and what your choices are in each case.
You may not need an angiogram if you can control your chest pain and other symptoms with medicines and are otherwise healthy.
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 clogged, where they are clogged, and by how much. An angiogram helps you and your doctor decide what treatment is best for your coronary artery disease. Treatments include medicines, angioplasty, and coronary artery bypass surgery.

During an angiogram, a thin tube called a catheter is placed in an artery of your arm or leg and gently threaded up into your heart. A special dye goes through the catheter. The dye helps the arteries show up on the X-ray. The doctor checks the X-rays to see if your coronary arteries are clogged or blocked.

What is coronary artery disease?

Coronary artery disease occurs when fatty deposits called plaque (say "plak") build up inside the coronary arteries. The coronary arteries wrap around the heart and supply it with blood and oxygen. When plaque builds up, it narrows the arteries and limits how much blood can get to your heart.

Coronary artery disease can occur slowly over time without your knowing it. You may not have any symptoms until the arteries are very narrow. Symptoms include chest pain (angina) and shortness of breath.

Without treatment, coronary artery disease can lead to serious problems, such as a heart attack or a stroke.

Part of your decision to have an angiogram is knowing your risk for heart attack. Try this Interactive Tool: Are You at Risk for a Heart Attack?

How might the test affect your treatment for heart disease?

Your doctor is likely to suggest that you adopt healthy habits such as quitting smoking, eating a heart-healthy diet, and getting regular exercise. By doing these things, you can slow the spread of the disease and improve your quality of life.

You may need to take medicines to lower your cholesterol or high blood pressure. Your doctor may prescribe aspirin to reduce your risk of heart attack. And he or she may prescribe other medicines to control chest pain (angina), if you have it.

If lifestyle changes and medicines don't work well enough to relieve your symptoms and lower your risk for a heart attack, you may need to have angioplasty or bypass surgery.

If during the angiogram the doctor sees that your arteries are badly blocked, you may need angioplasty or bypass surgery right away. You may want to talk with your doctor about these treatments before you have an angiogram. During the test, you will not be able to decide about more treatment, because you will be sleepy from medicines.

Why might your doctor recommend having an angiogram?

Your doctor may suggest that you have this test if:

A cardiac stress test suggests that you have severe heart disease. This test checks for changes in your heart while you exercise.
You have chest pain (angina) while you are at rest or during only moderate physical activity. Or you are taking medicines for chest pain but they do not control it.
You have another heart problem, such as heart failure, that may be caused by heart disease.

You probably do not need an angiogram if you can control your angina and other symptoms with medicines and lifestyle changes and if you are otherwise healthy.

2. Compare 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 must stay in bed for several hours with your arm or leg straight. You may go home the same day or the next day.	Try lifestyle changes such as quitting smoking, eating a heart-healthy diet, and getting regular exercise if you are worried about heart disease. You may take medicines to control your cholesterol and blood pressure. Your doctor may suggest that you take medicines to help control chest pain or aspirin to lower your risk of heart attack.
What are the benefits?	The test helps you and your doctor decide which treatment will improve your symptoms and lower your risk for a heart attack.	You may be able to manage your symptoms without taking this test. You avoid the cost and risks of an angiogram.
What are the risks and side effects?	An angiogram has some rare but serious risks. They include: Heart attack. Stroke. Allergic reaction to the dye used to see the coronary arteries. Kidney damage related to the dye. Bleeding at the site where the tube is placed.	Medicines and lifestyle changes may not work. Your heart disease could get worse. If you have severe heart disease and you do nothing, it could lead to a heart attack or a stroke.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Coronary Artery Disease.

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 medication 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 vacations my wife and I always planned, without the fear of having a heart attack. 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. "

— Julian, age 68

" I asked my doctor what she thought we would find out from an angiogram. She said that based on my other tests, she was pretty sure that I had a blockage in one of my main heart arteries, but that the only way to be sure was to do the angiography. When I asked her what she'd recommend if she found the blockage, she felt either angioplasty or open-heart bypass surgery would be needed. Well, I had watched my sister go through open-heart surgery, and I can tell you that it's not for me. So my doctor and I decided that we would try some different kinds of medication to keep my angina under control, and see how things went. I can still have the test—and the surgery—if I change my mind, but for now I'm doing just fine as I am. "

— Reynaldo, age 75

" After my father died of a heart attack at 58 and my brother had one at 55, I was worried that I was next. When my chest pain got bad and my doctor recommended an angiogram, I was all for it. I decided I would rather have the test, and then surgery if I need it, to avoid a heart attack if possible. "

— Mabel, age 60

" 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 and based on my results, my doctor thought I probably had some blockage in my heart arteries, but it didn't seem too bad. We decided to try some medication and see if that helps instead of having that test where they look at the dye in your heart. I have been doing well and almost never get chest pain anymore. "

— Jean, age 62

3. Your Feelings

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 chest pain is affecting my quality of life.

I'm able to control my chest pain with medicines.

More important

Equally important

More important

I'm worried that I could have a heart attack if I don't get treatment.

I'm not that worried about having a heart attack.

More important

Equally important

More important

If an artery is badly blocked, I know I may need emergency angioplasty or surgery.

I already know that I don't want angioplasty or bypass surgery.

More important

Equally important

More important

I'll be more motivated to adopt healthy habits and quit smoking if I know how bad my heart disease is.

Finding out that my heart disease is bad won't help me make changes.

More important

Equally important

More important

My other important reasons:

More important

Equally important

More important

4. Your Decision

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. Quiz Yourself

Check the facts.

1. An angiogram can help me and my doctor decide which treatment is best for my heart disease.

True
False
I'm not sure

You're right. An angiogram helps you and your doctor decide whether you need medicines, angioplasty, or coronary artery bypass surgery.

2. I may not need an angiogram if I can control my chest pain and other symptoms with medicines and I'm otherwise healthy.

True
False
I'm not sure

You're right. Some people will do well just by taking medicines to control their symptoms.

3. If I have an angiogram, I don't need to do anything else to treat my heart disease.

True
False
I'm not sure

You're right. If the test shows that you have heart disease, you will need to adopt healthy habits such as quitting smoking, eating a heart-healthy diet, and getting regular exercise. You may also need to take medicines.

Decide what's next.

1. Do you understand the options available to you?

Yes
No

2. Are you clear about which benefits and side effects matter most to you?

Yes
No

3. Do you have enough support and advice from others to make a choice?

Yes
No

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.

Nothing. I'm ready to take action.
I want to discuss the options with others.
I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.