An angiogram of the heart is a direct visualization of the coronary arteries and is the gold standard test to diagnose blockages in the arteries.
During an angiogram a light anesthesia is used to provide relaxation and a numbing medicine is administered in the groin over the femoral artery. A special IV (or sheath) is then placed in the artery. Through this IV a catheter is advanced to the heart and the coronary arteries are engaged. X-ray contrast is injected into the arteries and pictures are taken.
If a significant blockage is found (60-70% or greater) and this can be safely fixed, then an angioplasty will be done. A balloon is advanced to the site of the blockage and expanded to push the blockage to the sides of the artery. When the balloon is removed, blood can get through more easily. Most of the time a stent is also placed. A stent is a wire mesh tube that helps keep the artery open. Before stents were developed, about 2/3 of blockages came back. With bare metal stents only 1/3 of the blockages come back. With new drug eluting stents, less than 10% of the blockages come back.