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Angiography

Coronary Angiography

Coronary angiography is a test that uses dye and special X-Rays to show the insides of your coronary arteries. The coronary arteries supply oxygen-rich blood to your heart. During coronary angiography, special dye is released into the bloodstream. The dye makes the coronary arteries visible on X-Ray pictures. This helps doctors see blockages in the arteries. Coronary catheterization is done to perform coronary angiography.

A coronary catheterization is a minimally invasive procedure to access the coronary circulation and blood filled chambers of the heart using a catheter.

Indications:

Coronary angiography is performed if you have, or are suspected to have, coronary heart disease. Your doctor may recommend that you have the test if:

  • You have chest pain that your doctor suspects is caused by narrowed coronary arteries, but he or she wants to be sure
  • Your doctor wants to assess the degree of narrowing in your coronary arteries to see if you could benefit from a procedure such as angioplasty or bypass surgery, to relieve your symptoms and reduce your risk of further heart problems
  • You have had a heart attack—if you had treatment to dissolve the clot blocking your coronary artery, or you have continuing chest pain, or the results of an exercise test indicate the need for further investigation, your doctor will need detailed information about your heart and arteries.
  • Before surgery of valvular lesions

Advantages:

  • Coronary catheterization is a visually interpreted test performed to recognize occlusion, stenosis, re-stenosis, thrombosis or aneurysmal enlargement of the coronary artery lumens; heart chamber size; heart muscle contraction performance; and some aspects of heart valve function.
  • Important internal heart and lung blood pressures, not measurable from outside the body, can be accurately measured during the test.
  • The relevant problems that the test deals with most commonly occur as a result of advanced atherosclerosis – atheroma activity within the wall of the coronary arteries.
  • Less frequently, valvular, heart muscle, or arrhythmia issues are the primary focus of the test. Coronary catheterization is performed in a catheterization lab, usually located within a hospital.

Risks:

Cardiac catheterisation carries a slightly increased risk when compared with other heart tests. However, the test is very safe when performed by an experienced team.

Generally the risk of serious complications ranges from 1 in 1,000 to 1 in 500.

Risks of the procedure include the following:

  • Irregular heart beats
  • Injury to a heart artery
  • Low blood pressure
  • Allergic reaction to contrast dye
  • Stroke
  • Heart attack

Considerations associated with any type of catheterisation include the following:

  • There is always a very small risk that the soft plastic catheters could actually damage the blood vessels.
  • The contrast dye could damage the kidneys (particularly in patients with diabetes).

Procedure:

You lie on a couch in a catheterization room. An X-ray machine is mounted above the couch. A catheter is inserted through a wide needle or small cut in the skin into a blood vessel in the groin or arm. Local anaesthetic is injected into the skin above the blood vessel. Therefore, it should not hurt when the catheter is passed into the blood vessel. The doctor gently pushes the catheter up the blood vessel towards the heart. Low-dose X-rays are used to monitor the progress of the catheter tip which is gently manipulated into the correct position. You may be able to see the progress of the catheter on the X-ray monitor. The tip of the catheter is pushed just inside a main coronary artery. Some dye is then injected down the catheter into the artery. Several X-ray films are rapidly taken as the dye is injected (the dye shows up clearly on X-ray films). The X-ray films are recorded as a moving picture and this is called an angiogram.

The angiogram shows the vessels filling with blood and the sites of any narrowing can be seen. The tip of the catheter is then put into the other main coronary artery and the test is repeated. So, an angiogram picture is built up of each of the coronary arteries and their branches. You cannot feel the catheter inside the blood vessels. You may feel an occasional ‘missed’ or ‘extra’ heartbeat during the procedure. This is normal and of little concern. During the procedure your heartbeat is monitored by electrodes placed on your chest which provide a tracing on an ECG machine (electrocardiograph). Sometimes a sedative is given before the test if you are anxious.

When the test is over, the catheter is gently pulled out. If it was inserted through a small cut in the skin in the arm then you will normally need a few stitches. If it was inserted through a wide needle in your groin then a nurse will press over the site of insertion for about 10 minutes to prevent any bleeding.

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