Coronary Angiogram Or Angiography

In diagnosing coronary artery disease, it is invaluable to be able to "see" the coronary arteries and the shape and function of the heart chambers.

Coronary angiography is a procedure in which a special X-ray of your heart’s arteries (the coronary arteries) is taken to see if they are narrowed or blocked. It is an important test, used when your doctor suspects or knows that you have coronary heart disease.

The procedure for making an angiogram involves insertion of a catheter (a hollow, flexible tube) into an artery at your groin or elbow. This catheter is guided through your main artery, the aorta, into your heart. Then it is guided into a coronary artery. A dye that is opaque to x-rays is injected through the catheter to make the inside of the heart and artery visible on an x-ray picture.

Angiography can be done on many blood vessels in the body, but when it is done on heart arteries (coronary arteries) the test is called coronary angiography or cardiac catheterization.

In addition, the catheter can be placed in the left side of the heart where the function of the mitral and aortic valves can be studied; the shape and function of the left atrium and the left ventricle of theheart also can be observed.

Before the catheterization begins, you will receive a mild sedative, but you will remain conscious during the procedure. Leads (wires) of an electrocardiograph machine will be placed on your chest so that your physician can monitor the action of your heart throughout the test. A needle attached to a tube and bottle of 5 percent dextrose in water will be placed in your vein.

An artery in your arm, leg, or groin will be selected for insertion of the tube (catheter that is to be gently guided into your heart or other area. The insertion site is cleansed with an antiseptic and draped in a sterile fashion. A local anesthetic is injected into the skin and deeper tissues; there should be no further pain after this.

When the catheter is in place, a contrast medium (dye) will be delivered through the catheter to your coronary arteries to provide a clearer x-ray picture. If your physician also wants to widen your blood vessels you may be asked to hold a nitroglycerine tablet under your tongue. At certain times you will be asked to take deep breaths, which improves the quality of the x-ray pictures that are made during the examination.

Results of the catheterization are monitored on a television screen during the test. These video images are also recorded on a CD for further study and for your own records.Then the catheter is removed and the examination is complete. For the first 20 to 30 minutes after removal of the catheter, direct pressure is placed on the insertion site. You will be kept in bed for at least 4 hours. Your vital signs will be checked periodically. lf needed, you will also be given pain medication, and the insertion site will be checked for soreness,swelling, or blood loss. In most circumstances, you will be allowed home after four to six hours. Some people may need to stay in hospital longer so that their symptoms can be monitored further. Your doctor will explain the results of the test. The information about your heart and coronary arteries will help your doctor to recommend the best treatment for you.

Although this is a common procedure, some risks are associated with it. For example, if the catheter loosens an existing blood clot or cholesterol deposit within an artery, the result can be a stroke or heart attack. In rare instances, the heart or kidneys can be damaged. Anyone with a blood clotting disorder or poor kidney function is at increased risk. Still, the risk of a serious complication (such as stroke, heart attack, or even death) is approximately 1 in 1,000. The risks are lowest in young, healthy persons and highest in older persons with serious medical problems. Because of risks associated with this test, a surgical team usually is available during the catheterization procedure and can be called upon in the event surgery is required.

It is worth mentioning that Angiography can also be used to evaluate the right side of the heart and pulmonary arteries. In this case it is called right heart or pulmonary artery angiography. To study the right atrium and ventricle and its valves (tricuspid and pulmonic) or the pulmonary arteries, a catheter can be placed in a large vein in your leg or arm and advanced into your heart or into the main artery of your lungs (pulmonary artery). Contrast medium (dye) is then injected through the catheter and an x-ray picture of your pulmonary arteries is produced. This is usally used in kide to diagnose some complex congenital heart diseases. If a blood clot is discovered during the procedure, it is usually treated with a powerful anticoagulant drug. Rarely is surgery required to remove a blood clot in the pulmonary arteries.