Coronary Angiography – minimally invasive diagnostic technique
Coronary angiography is a minimally invasive diagnostic technique for heart disease, but for which, there should be an indication. Like any invasive investigation coronary angiography has some risks. In this context, there are some preliminary examinations performed by cardiology specialists, which give the indication for coronary angiography. In this way the patient is protected regarding certain risks.
Examinations indicating the need for coronary angiography
Thus, beyond the examination of a cardiologist, which is essential, a test effort is also needed. It helps us to see if the patient, under a controlled exercise, presents or not the risk of a heart disease or to develop a heart disease. Electrocardiogram changes are recorded, which show us the need for a coronary angiography. The indication for coronary angiography is also given by ultrasound examination of the heart, and obviously a rhythm or tension Holter in case the patient needs such an investigation.
– Persistent chest pain (angina);
– Electrocardiogram (ECG) changes;
– Abnormal biological tests – elevated cardiac enzymes or troponin;
How is a coronary angiography realized?
After obtaining an overall picture of the patient’s illness in noninvasive terms and putting the coronary angiography indications, the technique itself will take place in a specialized center. Throughout the intervention the patient benefits from a protection against X-rays as the chest is crossed by radiation. Also, by using the contrast substance containing iodine, the coronary arteries are emphasized. However, some patients have allergic reaction to iodine, which can be an important risk factor during an intervention of this kind. After the patient has arrived in the catheterization laboratory, he is wearing everything sterile and is made a local anesthesia with lidocaine, which gives a slight burning, after that, the patient receives an introductory at the puncture site, a sheath, the only thing it could create a slight discomfort in inguinal region. The inguinal region is usually practiced for arterial puncture, but there are approaches at the radial artery level or brachial artery which are used at certain times and in patients with certain diseases.
In both cases of approach, femoral or radial, the patient will be indicated to keep bed rest, lying without foot or hand bend. In some cases, there is the indication to mount a hemostatic system in the femoral puncture. It is mounted in the angiography room, immediately after the intervention.
The pre-formed catheters used in coronary artery visualisation
From the point of view of the actual intervention, for the purpose of visualization of the coronary arteries, pre-shaped catheters are used; which will reach to the coronary artery level and by administration of the contrast substance will help visualizing the two coronary arteries. When we inject the contrast substance actually we see a difference in the caliber of vessels, which reveals a narrowing of a coronary artery (stenosis). Beyond 50% narrowing of the diameter which we take as the reference, is considered as pathological to the patient. A simple coronary angiography takes less than 30 minutes, the test is not painful.
The risks of coronary angiography
– Allergy to contrast substance or certain medicines
– The occurrence of hematoma at the puncture site
– Occurrence of palpitations (arrhythmias), or fainting
– Myocardial infarction (1/10000 of patients)
– hydrate yourself with at least 2 liters of water in the near future of intervention for “washing” of contrastive substance from the bloodstream
– At 12-24 hours after surgery the bandage is removed and is checked the punctured place
– ECG control
– In some cases are performed blood tests for kidney function (creatinine, urea)
What happens if the coronary angiography indicates an artery disease?
There are 3 types of treatment:
- medical treatment
- Coronary angioplasty (a surgical procedure to enlarge the coronary artery where it is blocked or narrowed by plaque. This procedure is performed either by balloon dilatation or placing a stent)
- Coronary bypass surgery.