Coronary Angiogram

What is Coronary Angiogram?

Coronary Angiogram is a diagnostic procedure that uses X-ray imaging to identify narrowing of the blood vessels supplying the heart.

• Coronary arteries are blood vessels supplying blood to the heart
• A contrast agent (iodine dye) is injected through a long thin plastic tube (catheter),which will demarcate the heart vessels and narrowing.
• A coronary angiogram is also called coronary angiography (CAG), coronary arteriography (CART).
• In certain countries, these are part of the general group of procedures known as cardiac catheterization.
• It is a gold standard procedure for diagnosing blockages in the arterial system.

How does one reach the heart during a coronary angiogram?

• To identify any heart vessel blocks the catheter is inserted majorly from two different sites.

1. Groin (trans-femoral angiogram)
2. Wrist (trans-radial angiogram)

• In extremely rare circumstances based upon the clinical scenario alternate access sites can also be used.

 When is coronary angiogram advised?

History of new-onsetunusual chest pain

• Abnormal noninvasive cardiac stress test results
• Abnormal CT angiogram results
• In the setting of heart attack
• People with poor left ventricular function
• Preoperative evaluation before major heart surgery like valve replacement, closure of heart defects, tumour removal etc.
• To evaluate the functioning of stent or bypass graft after surgery
• As a part of the preoperative workup for certain high-risk surgeries such as vascular surgery, aortic surgery etc.

What are the risks of a coronary angiogram?

Generally, this is procedure is safe and have no major complications. However, some potential risks and complications include:

• Allergic reaction to the contrast dye
• Kidney damage consequent to contrast dye utilization
• Infection and bleeding or burning at the site of the procedure
• Blood clots formation potentially leading to a heart attack or stroke
• Irregular heart rhythms (arrhythmias)
• Leakage from the artery leading to a pseudoaneurysm

Understanding The Procedure

Before The Procedure

Dietary instructions:

• Stop heavy meals or processed food before 8 hours of the procedure
• Stoplight meals, milk, carbonated drinks before 6 hours
• Stop drinking water or clear fruit juice before 2 hours
• Adequate hydration is important to reduce the risk of kidney damage

General instructions:

List all the current medications and supplements used

• Any allergies towards the medications should be reported
• Vitals are checked
• Baseline ECG, echocardiography, blood investigations to estimate kidney function and haemoglobin are essential before an angiogram
• Reports of previous blood investigation reports and medical records should be available
• It is important to have some beside you to take care of you and to drive back home after the procedure
• Plan to have someone beside you to take care of you and back home after the procedure

During the procedure:

To reduce the risk of infection the following precautions are taken

• Hand wash and sanitization of the team of doctors
• Your skin will be washed with disinfectant
• Hair is clipped at  the site of catheter  insertion
• You will be made to lie on the X-ray table and strapped
• An intravenous cannula will be inserted
• Electrodes will be placed over your chest to monitor for vitals during the procedure
• A mild sedative will be administered to make you drowsy but still alert.
• Local anaesthesia at the catheter insertion site to make the area numb.
• A catheter is inserted with guidewire support into the radial/femoral artery and advanced under X-ray guidance to reach the heart.
• Medicine to opacify the heart vessels (contrast dye) will be injected and X-ray is taken.
• Opacification of the heart vessels identifies the blocks
• The heart has three blood vessels, on the left the main vessel ( left main coronary artery -LMCA) that divides into a left anterior descending coronary artery (LAD) and leftcircumflex coronary artery (LCX); Right coronary artery (RCA) on the right.
• The number of blood vessels affected, lesion- number location, and characteristics are assessed
• Once the procedure is completed, the catheter is removed and a bandage is placed over the procedure site.

After the procedure

Vitals such as Blood pressure, heart rate, temperature, respiration rate, blood oxygen levels will be monitored.

• One needs to rest for 6 to 8 hours.
• If the catheter insertion is at the groin, you may be asked not to bend or cross your legs for 12 hours.
• Infection and bleeding are checked for at the procedure site
• It is very important to take plenty of liquids that keep you hydrated as well as wash off contrast from the body. Accumulation of contrast leads to kidney damage.
• Blood investigations and ECG need to be repeated before the follow-up visit

How does catheter coronary angiogram compare with CT coronary angiogram?

What is the uniqueness of the angiograph procedure by Dr C Raghu?

Our team is a pioneer in performing angiography, angioplasty procedure through the wrist. Procedures performed through the wrist have a zero per cent of bleeding complications from the catheter insertion site. Over the last 20 years, Dr C Raghu’s team has performed 40 thousand procedures through the wrist with high success and low complication rates.