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Coronary angiography is a medical procedure in which the heart's blood vessels are viewed through an X-ray machine by injecting a dye into the blood vessels. This procedure is done mainly to detect any blockages in these arteries.
A coronary angiogram is the most common subtype of one of the heart procedures known as cardiac catheterization to diagnose and treat heart diseases. If, after an angiography, a blockage is detected in the arteries, it may be treated right away with a procedure called angioplasty.
When is a coronary angiography done?
Coronary angiography may be advised in the following scenarios:
If you have chest pain (angina)
If you have jaw, neck, shoulder, or arm pain that could not be diagnosed with other procedures.
To detect heart diseases such as coronary artery disease, congenital heart defects, and heart valve abnormalities
In case of chest injury or blood vessel problems
Coronary angiography is performed, mainly after the primary cardiac investigations, such as an echocardiogram, electrocardiogram, and cardiac stress test, have been completed.
Probable Complications of coronary angiography
Though it is a minor procedure, it carries certain risks:
Bleeding
Infection
Blood vessel perforation (a hole in the blood vessel)
Blood clot
Entry of an air bubble into the blood vessels (air embolism)
Stroke
Heart attack
Effects of the dye such as allergic reaction or kidney damage
Arrhythmia (irregular heart rhythm)
Preparation for a coronary angiography
Unless performed as an emergency procedure, it is usually planned well in advance, providing optimum preparation time.
You will be explained about the possible complications and the reason why this procedure is being conducted. Once the date of the procedure is final, your doctor may advise regarding:
What to eat and when to eat before your procedure.
What medications to take or avoid before the procedure
They may enquire about any allergies to rubber, latex, iodine, shellfish, or X-ray dye
If you have diabetes, then whether you can take your diabetes medicine or insulin shot before the procedure
The procedure may take an entire day; hence you may carry your essentials and adequate medications as you may not go home the same day.
Before the procedure
The healthcare team will conduct a physical examination, check your blood pressure, pulse rate, and may also take your electrocardiogram or blood test before the actual procedure. You will also be required to empty your bladder and remove contact lenses, eyeglasses, hairpins, or jewelry if any.
During the procedure
This procedure is conducted in a specific room in the hospital. The entire procedure takes around 30 minutes to 1 hour, but the preparation may take a while; hence you should be prepared to spend the whole day at the hospital.
You will be asked to lie down on an X-ray table and strapped as the table might be tilted later on. As you lie down, you will see cameras and screens above you that would take images from different angles. To monitor your heart acitivty, electrodes will be placed on your chest, a cuff will be placed on your arm for blood pressure reading, and an oximeter will be used to monitor the oxygen concentration in your blood.
An intravenous (IV) cannula will be inserted into your arm for injecting the medications and fluids. A sedative may also be administered to help you relax, though you would remain awake during the procedure. After this, a long hollow tube known as a catheter has to be inserted into an artery. There are two choices of arteries to the doctor - one is the femoral artery at your groin, and the other is the radial artery present in your wrist. Depending on the choice of the artery, the area will be shaved, cleaned, and sanitized, followed by the administration of a local anesthetic to make it numb.
Now, the doctor will make a small incision in the numb area and insert the catheter slowly into your artery. The course of the catheter is monitored with the help of an x-ray machine that helps guide it to your heart. The dye will be injected into the catheter, making the blood vessels visible as it flows to the heart.
This way, the doctors can observe the blood vessels for any constriction/obstruction or blockages. If there any positive finding during this time, any one of the following procedures may be performed:
Angioplasty: This is done when there is a blockage of the artery with plaque or some other reason. To widen the gap and remove the blockage, a catheter is inserted into the artery with a balloon at the tip.
Stent placement: A small metal mesh coil known as a stent may be placed inside the artery to prevent narrowing.
Biopsy: A sample of your heart tissue may be taken for examination.
Repair of heart defects: If any hole in your heart or leakage in a valve is detected, the doctor may choose to repair the same.
After the procedure
The doctors will apprise you of the findings of the angiography and the further procedures if conducted. They will also inform you if any further investigations or procedures are required to be performed.
The catheter will be removed from your groin or arm, and the wound will be sealed and bandaged. If the wound is on your wrist, you may be allowed to walk around after the effect of the sedative wears off. But, if the wound is on the groin, you may be asked to lie down on the back for 2 - 6 hours with your head in a low position till the wound settles down.
If you feel any bleeding, numbness in your arms, legs, or fingers, then do speak to your doctor. You will also be required to drink a lot of water to drain out the dye from your system, resulting in frequent visits to the bathroom. If you are not allowed to walk, a urinary catheter will be inserted, or you may be provided with a bedpan or a urinal.
The doctors may instruct you not to put pressure on your abdomen or groin as it may open the wound. You may be asked to spend the night at the hospital, or if you are allowed to go, please ask someone to take you.
Self-care
Please follow the instructions of the doctors regarding physical activity, precautions, or medications. Also, take care of the wound and make sure to consult your doctor in case of any problems.
Your doctor may suggest that you have a coronary angiogram if you have:
However, there's a minuscule risk of complications. Therefore, angiograms are typically performed after non-invasive heart tests such as an electrocardiogram, an echocardiogram or a stress test.
To pinpoint problems with your heart, doctors will use an MRI or a CT scan before a coronary angiography test.
Following guidelines should be adhered to:
Cardiac catheterization is generally a very reliable option when performed by an experienced team, but there are risks.
These risks are:
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