Angiogram

Angiography is an important medical procedure for diagnosing and treating blockage of the arteries, especially the coronary (heart) arteries. Angiography is frequently accompanied by anxiety before the procedure and research shows that pre-angiography preparation with relaxation and guided imagery reduces anxiety and complication rates from the procedures. To be more relaxed and allow the procedure to go more easily, use our “Preparing for Surgery” or “Anxiety Relief” CD once or twice a day for 5 days or so before your procedure.


    RESEARCH

The Role of Angiography

The value of these procedures is unquestioned; most cardiologists recommend an angiography for any patient having surgery on blood vessels Angiography is also useful for both immediate diagnostic purposes and can sometimes predict future problems (Grossman, 1986). Angioplasty can treat some blocked arteries, allowing some patients to avoid surgery.

Angiography is a widely performed procedure, costing upwards of $3500 for an uncomplicated coronary arteriogram in 1999 (Society of Nuclear Medicine, 2002). Two million angiographies with contrast materials were performed in American hospitals in 2001; there were 1.27 million cardiac catheterizations performed (Popovic,& Hall, 2001 ).


Patient Anxiety

Patient anxiety can be a significant problem in invasive cardiac procedures. According to Lang and Hamilton (1994): “Insufficient treatment of pain and anxiety can cause cardiovascular strain and restlessness, which may jeopardize the success of the procedure. On the other hand, pharmacologic oversedation [over-medication] can provoke respiratory and cardiovascular depression, thereby increasing the procedural risks and delaying the patient's recovery.”

High levels of patient anxiety can prolong procedures and can increase need for sedation and pain medication, and increase risks of complication (Lang & Hamilton; Lang, Joyce, Spiege, Hamilton & Lee, 1996).


Non-drug treatment of patient anxiety

One of the simplest and least expensive ways to alleviate patient anxiety is the use of specially selected music (McCaffrey, Taylor, 2005; Thorgaard, Henriksen, Pedersbaek, Thomsen, 2004). Massage prior to a procedure is also useful (McNamara, Burnham, Smith, Carroll, 2003).

Among the most effective non-drug approaches to reducing patient anxiety are relaxation with guided imagery (self-hypnosis) and pre-procedure provision of information (Lang & Hamilton, 1994; Lang, Joyce et al, 1996; Ludwick-Rosenthal & Neufeld, 1993). Pre-procedure teaching, tailored to each patient's coping style, can reduce tachycardia and other signs of distress during procedures (Ludwick-Rosenthal & Neufeld; Wilson, Moore, Randolph & Hanson, 1982).

Mind-body approaches, especially those incorporating guided imagery, relaxation, or self-hypnosis, can result in shorter procedures, less need for medication, lower anxiety, and fewer complications (Lang & Hamilton, 1994; Lang, Joyce et al, 1996; Ludwick-Rosenthal & Neufeld, 1993; Fick, Lang, Logan, Lutgendorf & Benotsch, 1999). Self-hypnosis (guided imagery) was effective even in patients with low hypnotizability scores (Fick et al). In a study where patients develop their own images (“interactive imagery”), it was more effective than pre-scripted imagery presented to patients (Fick et al,). Similar benefits have been found for imagery and self-hypnosis in other procedures including endoscopy and MRI (Friday, Kubal, 1990; Zimmeran, 1998).


References

  • Fick LJ, Lang EV, Logan HL, Lutgendorf S, Benotsch EG. Imagery content during nonpharmacologic analgesia in the procedure suite: where your patients would rather be. Acad Radiol, 1999 Aug;6(8):457-63.

  • Friday PJ, Kubal WS. Magnetic resonance imaging: improved patient tolerance utilizing medical hypnosis. Am J Clin Hypn, 1990 Oct;33(2):80-84.


  • Grossman W. Cardiac Catheterization: Historical Perspective and Present Practice” in Cardiac Catheterization and Angiography 3rd Edition Grossman W ed. Philadelphia, Lea & Febiger 1986 pp.6-14.

  • Hlatky MA, Rogers WJ, Johnstone I, Boothroyd D, Brooks MM, Pitt B, Reeder G, Ryan T, Smith H, Whitlow P, Wiens R, Mark DB. Medical care costs and quality of life after randomization to coronary angioplasty or coronary bypass surgery. Bypass Angioplasty Revascularization Investigation (BARI) Investigators. N Engl J Med, 1997 Jan 9;336(2):92-9.

  • Lang EV, Hamilton D. Anodyne imagery: an alternative to i.v. sedation in interventional radiology. AJR Am J Roentgenol, 1994 May;162(5):1221-6.


  • Lang EV, Joyce JS, Spiegel D, Hamilton D, Lee KK. Self-hypnotic relaxation during interventional radiological procedures: effects on pain perception and intravenous drug use. Int J Clin Exp Hypn, 1996 Apr;44(2):106-19.

  • Ludwick-Rosenthal R, Neufeld RW. Preparation for undergoing an invasive medical procedure: interacting effects of information and coping style. J Consult Clin Psychol, 1993 Feb;61(1):156-64.

  • McCaffrey R, Taylor N. Effective anxiety treatment prior to diagnostic cardiac catheterization. Holist Nurs ract. 2005 Mar-Apr;19(2):70-3. Review.

  • McNamara ME, Burnham DC, Smith C, Carroll DL. The effects of back massage before diagnostic cardiac catheterization. Altern Ther Health Med. 2003 Jan-Feb;9(1):50-7.

  • Popovic JR, Hall MJ. 1999 National Hospital Discharge Survey. Advance data from vital and health statistics; no 319. Hyattsville, Maryland: National Center for Health Statistics. 2001.

  • Society of Nuclear Medicine www.snm.org/about/press_releases/card_press.html Accessed January, 2002.

  • Thorgaard B, Henriksen BB, Pedersbaek G, Thomsen I. Specially selected music in the cardiac laboratory-an important tool for improvement of the wellbeing of patients. Eur J Cardiovasc Nurs. 2004 Apr;3(1):21-6.

  • Wilson JF, Moore RW, Randolph S, Hanson BJ. Behavioral preparation of patients for gastrointestinal endoscopy: information, relaxation, and coping style. J Human Stress, 1982 Dec;8(4):13-23.


  • Zimmerman J. Hypnotic technique for sedation of patients during upper gastrointestinal endoscopy. Ám J Clin Hyp, 1998 40(4): 284-7.


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