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Home » Treatment » Coronary Angiography

Coronary Angiography

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:

 

  1. 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. 

  2. Stent placement: A small metal mesh coil known as a stent may be placed inside the artery to prevent narrowing.

  3. Biopsy: A sample of your heart tissue may be taken for examination.

  4. 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. 


 

Need For Coronary Angiography

Your doctor may suggest that you have a coronary angiogram if you have:

  • Symptoms of coronary artery disease, such as chest pain (angina) are present.
  • Experiencing pain in your jaw, chest, neck or arm that can't be explained by other tests
  • A heart defect you were born with (congenital heart disease)
  • Blood vessel problems or a chest injury
  • Unfamiliar or increasing chest pain (unstable angina)
  • Uncommon results on a non-invasive heart stress test
  • Surgery for Heart Valve problem

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.

How to prepare for a coronary angiography

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:

  • The doctor will advise you to don't eat or drink anything for eight hours before the angiography. You should arrange for someone to give you a ride home and someone to stay with you for the night because you may feel dizzy or light-headed for the first 24 hours after the cardiac angiography.
  • The healthcare team may ask you to check into the hospital the morning of the test.
  • Ask your doctor if you could take your usual set of medications.
  • Also, let your doctor know about your medical history with any allergic reaction to seafood, or reaction to contrast dye in the past.

During the Procedure

  • You will be executed sedatives to help you relax. You will be conscious throughout the test.
  • The doctor will clean and numb an area of your body in the groin or arm with an anaesthetic. A thin tube called a catheter will be inserted up to an artery in your heart.
  • X-ray cameras will move over and around your head and chest to take pictures from many angles, and your doctor will supervise the whole process on a screen.
  • You may feel a slight burning or "flushing" sensation after the dye is injected.
  • It depends as to what your doctor discovers during your angiogram. And hence, you may have additional catheter procedures at the same time, such as balloon angioplasty or stent placement to open up a narrowed artery.
  • Also, other non-invasive tests, such as ultrasound, will help your doctor evaluate identified blockages.
  • All in all, it takes one hour for an angiogram test, although it may be longer, especially if combined with other cardiac catheterization procedures.

Risks associated with getting a coronary angiography

Cardiac catheterization is generally a very reliable option when performed by an experienced team, but there are risks.

These risks are:

  • Bleeding or bruising
  • blood clots
  • injury to the artery or vein
  • a small risk of stroke
  • Miniscule chance of a heart attack or a need for bypass surgery
  • low blood pressure

Recovery and follow-up when you get home

  • Relax and drink plenty of water. Don't smoke or drink alcohol.
  • You shouldn't drive, operate machinery, or execute any essential decisions immediately because you've received an anaesthetic.
  • Remove the bandage after 24 hours. If there's minor oozing, apply a fresh dressing for another 12 hours.
  • For two days, don't have sex or perform any heavy exercise.
  • Don't take a bath, use a hot tub, or use a pool for at least three days. You may shower.
  • You'll need to see your heart doctor a week after the test.

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