Coronary Angiography

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Coronary angiography is a procedure to check for blocked coronary arteries.  The blockage prevents the heart from getting oxygen and essential nutrients. This procedure is used to diagnose coronary heart disease and coronary microvascular disease after chest pain, sudden cardiac arrest, or abnormal results from tests such as an electrocardiogram (ECG) of the heart or an exercise stress test.

Blockages in the arteries may cause chest pain, particularly with physical activity or stress, or a heart attack. If you have a heart attack, your doctor may perform coronary angiography to determine your treatment plan. 

A cardiologist will perform coronary angiography in a hospital or specialized laboratory. You will stay awake so you can follow the doctor’s instructions. However, you will be given medications to help you relax during the procedure. You will lie on your back on a movable table.

Often, coronary angiography is performed as a cardiac catheterization procedure. For this, the doctor will clean and numb an area on the arm, groin or upper thigh, or neck before making a small hole in a blood vessel. Your doctor will insert a catheter tube into your vein. Then, your doctor will take x-ray pictures to help place the catheter in your coronary artery. After the catheter is in place, the doctor will inject a contrast dye through the catheter to highlight any blockages and will take x-ray pictures of your heart. If a blockage is detected, your doctor may use percutaneous coronary intervention, also known as coronary angioplasty, to improve blood flow to your heart.

After coronary angiography, your doctor will remove the catheter, possibly use a closure device to close the blood vessels, and close and bandage the openings on your arm, groin, or neck. You may experience bruising and pain where the catheter was inserted. You will need to stay in the hospital for a few hours or overnight. During this time, your heart rate and blood pressure will be monitored. Your movement will be restricted to prevent bleeding from the hole where the catheter was inserted. You will need someone to drive you home after the procedure because of the medicines or anesthesia you received.

Coronary angiography is a common procedure that rarely causes serious problems. Possible complications may include bleeding, allergic reactions to the contrast dye, infections, blood vessel damage, arrhythmias, blood clots that can trigger a heart attack or stroke, kidney damage, and fluid buildup around the heart. The risk of complications is higher in people who are older or have certain conditions such as chronic kidney disease or diabetes.

An imaging test called coronary computed tomography angiography, or coronary CTA, may be preferred over coronary angiography to detect blockages in the heart. Although still using contrast dye, coronary CTA does not require the invasive cardiac catheterization procedure that causes the complications of coronary angiography.

What Is Coronary Angiography?

Coronary angiography is a test that uses a special dye and x-rays to show the insides of your coronary arteries. The coronary arteries supply oxygen-rich blood to your heart.

A waxy substance called plaque can build up in the coronary arteries. The buildup of plaque in the coronary arteries is called coronary heart disease (CHD).

Over time, plaque can harden or rupture (break open). The hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina.

If the plaque breaks open, a blood clot can form on the surface. A large blood clot can block most or all of the blood flow through a coronary artery. This is the most common cause of heart attacks. Over time, ruptured plaque also hardens and narrows the coronary arteries.

During coronary angiography, a special dye is released into the bloodstream. The dye makes the coronary arteries visible on x-ray images. This helps the doctor see blockages in the arteries.

A procedure called cardiac catheterization is used to insert the dye into the coronary arteries.

For this procedure, a thin, flexible tube called a catheter is inserted into a blood vessel in your arm, groin (upper thigh), or neck. The tube is inserted into your coronary artery, and the dye is released into your bloodstream. X-rays are taken as the dye flows through the coronary arteries.

Cardiologists (heart specialists) usually perform cardiac catheterization in a hospital. You are awake during the procedure, and it causes little or no pain. However, you may feel soreness in the blood vessel where the catheter was inserted.  

Cardiac catheterization rarely causes serious complications.

Who Needs Coronary Angiography?

Your doctor may recommend coronary angiography if you have signs or symptoms of coronary heart disease (CHD). Signs and symptoms include:

  • Angina. It may feel like pressure or squeezing in your chest. You may also feel it in your shoulders, arms, neck, jaw, or back. The pain even feels like indigestion. Angina may not only occur when you are active. Emotional stress may also trigger pain associated with angina.
  • Sudden cardiac arrest (SCA). This is a condition when your heart suddenly and unexpectedly stops beating.
  • Abnormal results from tests such as an ECG (electrocardiogram), exercise stress test, or other tests.

Coronary angiography can also be done on an emergency basis, such as during a heart attack. If the angiography shows blockages in your coronary arteries, your doctor may perform a procedure called percutaneous coronary intervention, also known as angioplasty. This procedure can open blocked heart arteries and prevent further heart damage.

Coronary angiography can also help your doctor plan treatment after you have a heart attack, especially if you have severe damage to your heart or if you still experience chest pain.

What to Prepare Before Coronary Angiography

Prior to getting your coronary angiography, you should consult your doctor about: 

  • How the test is done and how to prepare for it
  • Any medicines that you take, and whether you should stop taking them before the test
  • Whether you have a disease or condition that may require additional steps during or after the test to avoid complications. Examples of such conditions include diabetes and kidney disease.

The doctor will tell you which procedure he will perform. For example, your doctor may recommend percutaneous coronary intervention, also known as coronary angioplasty, if the angiography shows blocked arteries.

You will have the opportunity to ask about the procedure. Moreover, you will be asked to provide written consent for the procedure.

It should be noted that it is not safe to drive after cardiac catheterization – which is part of coronary angiography. You will need a companion to drive you home after the procedure.

What to Expect During Coronary Angiography

During coronary angiography, you will remain on your back and awake. This allows you to follow the doctor’s instructions during the test. You will be given medicine to help you relax, which may make you sleepy.

The doctor will numb the area in the arm, groin (upper thigh), or neck where the catheter will enter your blood vessel. Then, a needle is used to make a small hole in the blood vessel. The catheter will be inserted into the hole. Next, your doctor will insert a catheter through the vessel and into the coronary artery. A special x-ray film is taken from the catheter as it is moved towards the heart. The film helps your doctor see where to position the tip of the catheter.

After the catheter is properly inserted, your doctor will inject a special type of dye into the tube. The dye will flow through your coronary arteries, making them visible on an x-ray. This x-ray is called an angiogram. If the angiogram shows blocked arteries, your doctor may use percutaneous coronary intervention (PCI), commonly known as coronary angioplasty to restore blood flow to your heart.

After the doctor completes the procedure, the catheter will be removed from your body. The opening left in the blood vessel will be closed and bandaged. A small sandbag or other type of weight may be attached to the bandage to apply pressure. This will help prevent heavy bleeding from the site.

What to Expect After Coronary Angiography

After the procedure, you will be transferred to a recovery area in the hospital. You will be monitored closely for several hours or overnight. During this time, you will need to limit your movement to avoid bleeding from the site where the catheter was inserted.

As you recover, the nurses will monitor your heart rate and blood pressure regularly. They will also watch for bleeding at the catheter insertion site. You may experience a small bruise on your arm, groin (upper thigh), or neck at the catheter insertion site. You may feel tenderness or soreness at the site for about a week.

Make sure that you let your doctor know if you have problems such as:

  • A constant or large amount of blood at the catheter insertion site that cannot be stopped with a small bandage 
  • Pain, swelling, redness, or other unusual sign of infection at or near the catheter insertion site

Your doctor will advise if you should avoid certain activities, such as heavy lifting, not long after the procedure.

Risk Factors of Coronary Angiography 

Coronary angiography is a common medical test. It rarely causes serious problems. However, complications may include:

  • Bleeding, infection, and pain at the catheter insertion site.
  • Damage to blood vessels. Rarely, the catheter may scrape or poke a hole in the blood vessel as it is moved to the heart.
  • Allergic reaction to the contrast dye used during the test.

Other, less common complications may include:

  • Arrhythmia (irregular heartbeat). It may often go away on its own. However, your doctor may recommend treatment if it persists.
  • Kidney damage caused by the dye used during the procedure
  • Blood clots that can trigger a stroke, heart attack, or other serious problems.
  • Low blood pressure.
  • Buildup of blood or fluid in the sac-like structure around your heart. This excess fluid buildup may cause your heart to have irregular heartbeat beating properly.

As with any procedure that involves the heart, complications can sometimes be fatal. However, this rarely occurs with coronary angiography. 

The risk of complications is higher in older people and those with certain diseases or conditions (such as chronic kidney disease and diabetes).

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