RESEARCH FINDINGS USING GUIDED
IMAGERY FOR
ANGIOGRAPY,
ANGIOPLASTY, AND
CARDIAC CATHETERIZATION
July, 2006
The
Value of Angiography
An
angiography is an X-ray of the arteries. It is an invasive
procedure, meaning that the X-ray is taken from inside the
body, usually by injecting a dye into a blood vessel.
In cardiac catheterization, the heart chambers as well as
the arteries are entered, and measurements of blood flow
and pressure in various parts of the heart and vessels that
supply the lungs are often done.
In angioplasty, the clinician attempts to open partially
blocked arteries with a small tool designed to reduce
deposits that cause narrowing or “hardening” of the
arteries (Baim and Faxon, 1986).
This procedure is very valuable. Many authorities recommend
an angiography for any patient who is having surgery on
blood vessels because it gives the medical team a
“snapshot” of the patient’s individual body. Angiography is
also useful for diagnostic and prognostic purposes
(Grossman, 1986). Angioplasty can treat some blocked
arteries. This allows some people to avoid surgery (Hlatky,
Rogers et al, 1997).
Angiography is a widely performed and expensive procedure
(about $3,000-$6,000 for an uncomplicated coronary
arteriogram in 2004) (Advanced Body Scan of Newport, 2004).
In 1999, 2 million angiographies with contrast materials
(dye) were performed in American hospitals. There were 1.27
million cardiac caths performed,(Popovich and Hall, 2001).
The
Role of Patient Anxiety
Patient
anxiety appears to be a significant problem in invasive
procedures including angiography. Lang and Hamilton (1994)
wrote: “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 angiographies.
Patient anxiety can also increase use of sedation and pain
medication, and increase risks of complication (Lang and
Hamilton; Lang, Joyce et al, 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 and Taylor, 2005;
Thorgaard, Henriksen et al, 2004). Massage prior to a
procedure is also useful (McNamara, Burnham et al, 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 and Hamilton, 1994; Lang, Joyce et al, 1996;
Ludwick-Rosenthal and Neufeld, 1993). Pre-procedure
teaching, especially if tailored to how individual patients
cope with stress, can reduce tachycardia (racing heartbeat)
and signs of distress during procedures (Ludwick-Rosenthal
and Neufeld; Wilson, Moore et al, 1982).
Self-hypnosis, or relaxation
with guided imagery can result in shorter procedures, less
need for medication, lower anxiety, and fewer complications
(Baglini R, Sesana, et al, 2004; Lang and Hamilton, 1994;
Lang, Joyce et al, 1996; Ludwick-Rosenthal and Neufeld,
1993; Fick, Lang et al, 1999). Self-hypnosis (guided
imagery) was effective even in patients with low
hypnotizability scores (Fick et al).
In one study, imagery in which patients develop their own
images (“interactive imagery”) 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 and Kubal, 1990; Zimmerman, 1998).
Conclusion
Guided imagery can reduce
patient anxiety and medication use, and probably reduce
time of procedures and frequency of complications.
References
Baglini R, Sesana M, Capuano C,
Gnecchi-Ruscone T, Ugo L, Danzi GB. Effect of hypnotic
sedation during percutaneous transluminal coronary
angioplasty on myocardial ischemia and cardiac sympathetic
drive. Am J
Cardiol. 2004 Apr 15;93(8):1035-8.
Baim D, Faxon D. (1986). “Coronary Angioplasty” in
Cardiac
Catheterization and Angiography 3rd Edition.
Grossman W., ed. Philadelphia: Lea & Febiger.
pp.473-491.
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. (1986).Cardiac Catheterization:
Historical Perspective and Present Practice” in Cardiac
Catheterization and Angiography 3rd Edition.
Grossman W., ed. Philadelphia: Lea & Febiger. 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
Pract.
2005 Mar-Apr;19(2):70-3. Review.
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.
[no authors] FDA approved alternative to conventional
coronary angiography. Advanced Body Scan of
Newport. June 22, 2004.
http://www.newportbodyscan.com/NoninvasiveCTCoronaryAngiography.htm
Accessed July,
2006.
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.