Coronary angiography is a diagnostic test that gives a thorough look at the arteries that bring blood to the heart muscle. It involves the insertion of a catheter through the peripheral artery into the coronary arteries, contrast is given, and films are recorded using X-rays to show the condition of the vessels being examined.
Indications for coronary angiography
A doctor may order coronary angiography as a preventative measure or as a life-saving procedure. In the following circumstances, the doctor might recommend coronary angiography:
- coronary artery disease (e.g. the appearance of angina pectoris , i.e. chest pain that worsens after exercise),
- heart attack,
- worsening of the symptoms of coronary artery disease,
- pre-infarction state ,
- aortic aneurysm,
- heart failure,
- planned cardiac surgery,
- inflammatory disease of the coronary vessels,
- valve defects,
- high cholesterol (check: cholesterol age norms ),
- chest injury.
Coronary angiography after myocardial infarction
Coronary angiography is a life-saving procedure in the event of a heart attack due to coronary artery stenosis, and is done urgently when the patient’s life is in danger.
How is coronary angiography performed?
Coronary angiography is done in a hospital treatment room in the hemodynamics lab, which has an X-ray machine and devices that monitor the heart’s work. Coronary angiography can take anywhere from 30 minutes to 1.5 hours in more difficult cases.
The patient lies flat on the treatment table during the procedure. The doctor injects local anaesthesia into the artery on the wrist (or, less frequently, the femoral in the groyne), then inserts a cannula and gently inserts a catheter (a soft, hollow tube) into the artery, directing it towards the heart. The catheter is visible on the monitor screen at all times thanks to the x-ray. Then, a contrast agent is injected into one of the arteries, and the procedure is documented on film (angiogram). It depicts the flow of blood in the heart’s vessels as well as any narrowing or defects in the artery structure. The doctor gently removes the catheter after the examination. He applies a compression bandage. An ECG and blood pressure are used to monitor the heart’s function during the procedure.
Placement of stents during coronary angiography
When a coronary angiography shows that the artery is not completely open and may soon be completely blocked, the doctor does a procedure called angioplasty. He puts a stent in the blood vessel. A stent is a small “spring” made of a modern metal that is safe for the body. It is put in through the catheter. As it moves through the arteries to the site of stenosis, it is compressed as much as possible. Only at the site of stenosis is it properly unfolded, creating a tunnel that supports the vessel walls so that blood can flow freely. This framework keeps them from “sticking together.”
Coronary angiography: preparation for the procedure
If the procedure is done because someone’s life is in danger, no special preparations are made (medication is administered just before the procedure). When a coronary angiography is planned, the doctor suggests getting a hepatitis B shot (hepatitis B). Some medicines need to be stopped as well. There are also tests for creatinine, urinalysis, and a full blood count, as well as any other lab tests that are needed.
You should eat a light breakfast and drink a little more water than usual in the morning before your coronary angiography. If you drink enough water, it’s easier to get rid of the contrast in your urine after the procedure. Before the actual coronary angiography, the patient needs to be cleaned, given a venflon covering, and have the hair at the puncture site shaved.
Coronary angiography: recommendations after the procedure
After a coronary angiography, the doctor may tell you to drink 1.5 litres of still water to get the contrast out of your body faster. After the femoral artery exam, you should lie flat on your back for a few hours to let the artery that was punctured heal. Most of the time, the procedure needs a few days in the hospital. If a stent was put in during coronary angiography, the patient must take medicine for several months to prevent blood clots and stent rejection.
Complications of coronary angiography
Studies show that the risk of problems after coronary angiography doesn’t go above 2%. Coronary angiography is a risky procedure because it involves cutting into the body (any procedure during which tissue continuity is interrupted is an invasive procedure). During the procedure, a cardiologist or surgeon keeps an eye on the patient at all times. People who are older or have other diseases, like diabetes or kidney failure, are more likely to have problems after a coronary angiography.
Possible complications of coronary angiography:
- harmless: external bleeding or hematoma (bruise) where the artery was punctured
- life-threatening: temporary or permanent kidney disorders, stroke, sudden cardiac arrest, severe bleeding at the puncture site.