Coronary Angiogram


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 angiogramadvised?

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
NCA 1
NCA 2
Normal coronaries 3
Normal coronaries 4

How does catheter coronary angiogram compare with CT coronary angiogram?

Catheter coronary angiogram
 

CT coronary angiogram
A catheter is inserted through an artery to reach the heart and directly inject contrast to opacify the heart vessels An intravenous cannula is inserted and contrast material injected which passes through the veins to reach the heart vessels
Advantages: Advantages:
The gold standard for delineating blocks in the heart vessels Ideal procedure to rule out blocks in the heart vessels
Allows performing treatment, angioplasty-stent, if required procedure due can be performed with a limited quantity of contrast Ideal procedure to rule out blocks in the heart vessels
Essential for planning complex angioplasty. Very useful for people witha low probability of heart vessel block
Mandatory before bypass surgery Identify small-sized arteries that may not be visualized in a scenario of totally occluded heart vessel
Enables blood pressure measurement in various chambers of the heart; allows one to understand heart functioning ability Useful for delineating bypass graft vessels
Does not require a hospital stay
Limitations: Limitations:
Invasive procedure Limited information about heart vessel narrowed lesions
Remote risk of brain stroke and heart attack Cannot plan or perform angioplasty-stent or bypass surgery based on CT angiogram results
Complications at the site of catheter insertion Requires a relatively larger volume of contrast that can potentially worsen kidney function in vulnerable patients
Allergic reaction to contrast Allergic reaction to contrast material

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.

Keywords:

  • Coronary angiogram
  • Coronary arteries
  • Angiography
  • Blood vessels
  • Femoral
  • Trans femoralCatheter
  • Angioplasty stent

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Copyright © 2019, Dr C Raghu. All rights reserved.
Designed & Developed by R R Deepak Kambhampati.



Copyright © 2019, Dr C Raghu. All rights reserved.
Designed & Developed by R R Deepak Kambhampati.