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RESEARCH FINDINGS USING GUIDED IMAGERY FOR
Angiography, 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.