A-fib, TIAs and angiogram

  My step-father (72) had TIAs in early Dec.  Ended up in the hospital and was diagnosed with Atrial Fibrilation.  Dr. told him he had to stop drinking alchol and smoking, as well as walk daily, and take Warafin (sp?? - coumadin).  While he has not been walking as much as he should, he has done everything else.  He was told that his carotid flow is excellent, his BP and cholestoral are low.  He had a stress test (treadmill)last week - Dr. told him yesterday that his heartbeat is still irregular & he wants to do an angiogram.  Why?  Where is this heading?  An angiogram was not done when he was hospitalized for the TIAs.  WHat would cause the Dr. to want one now?  He feels fine, looks really good - and is slowly increasing his exercize.  What are the risks with an angiogram?  Thanks for your help.

[CCF Cardio MD - MTR]

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Dear Karen, thank you for your question.  There are multiple causes of atrial fibrillation (afib) including alcohol, leaking cardiac valves, high blood pressure, and coronary artery disease.  Your father's treatment has been appropriate from what I can ascertain.  Warfarin is a blood thinner that needs to be given to prevent clots from forming in the heart from the afib.  The cause of his TIA's was presumably a small clot from the heart that formed while he was in afib.  An angiogram is a procedure that is performed to determine if coronary artery blockages are present (coronary artery disease).  Presumably, your father's stress test was abnormal and indicated there is part of the heart muscle that is not getting enough blood flow.  Quite possibly, your father may have no symptoms, but a stress test is never 100% accurate for determining if blockages are present.  An angiogram can accurately determine where a blockage is and how it can be treated.  The risk of a serious complication with an angiogram is less than 1 in 1000.  I suggest that you speak with your father's cardiologist to inquire exactly why he thinks an angiogram should be done, what the risks and benefits are, and what his other recommendations are.

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