coronary angiography | Dr Raghu

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In our previous blogs, we’ve discussed various tests doctors use to monitor cardiac health and diagnose conditions like coronary artery disease and heart failure.

It’s worth noting that commonly used diagnostic tests like coronary angiography rely on a procedure called cardiac catheterization. In this blog, we’ll discuss the procedures in greater detail to help you understand the benefits and risks.

Cardiac catheterization is a procedure in which doctors insert a thin, flexible tube called a catheter into your heart through an artery. 

What Is Cardiac Catheterization?

Cardiac catheterization is a procedure that uses a thin tube (called a catheter) to examine the heart and blood vessels. The catheter is inserted into a blood vessel in the groin or arm. Thereafter, it’s advanced through the blood vessels and into the heart to measure pressures within different chambers of your heart.

cardiac catheterization

The test lets doctors see if there’s any blockage in the blood vessels that supply blood to your heart. Also, they can assess whether the cardiac muscles and valves are in proper working condition. Also, it may be used to insert wires (called stents) in coronary arteries if they become narrow due to plaque buildup or after an injury.

To perform balloon angioplasty, the doctor inflates a tiny balloon at one end of the catheter inside one of the blocked coronary arteries. It creates more space for oxygen-rich blood flow through your coronary arteries and helps improve symptoms like chest pain caused by a heart attack

How Does Cardiac Catheterization Work?

In this procedure, a doctor inserts the catheter into a blood vessel in your arm or groin. The catheter is guided through the blood vessels to the heart, where it’s used to look for blockages or other problems in the coronary arteries that supply oxygen-rich blood to your heart muscle.

Afterward, a dye is injected into your bloodstream from an intravenous (IV) line connected to your vein. It helps doctors see how well blood flows through different parts of your heart on X-rays taken during the procedure.

Why Do Doctors Use Cardiac Catheterization?

Cardiac catheterization can be used to diagnose or treat various heart ailments. It can help your doctor determine if your heart is getting enough blood and if there are any blockages in the arteries that supply blood to the rest of your body. Also, it can help identify any problems with the heart muscles and valves.

What Are the Risks of Cardiac Catheterization?

While the risk of complications from cardiac catheterization is low, there are some things you should know before your procedure. For example, you might also experience bleeding or bruising around where the cut was made.

The most severe risk is having a stroke due to excess pressure in the brain caused by increased blood flow due to plaque shaving off from arteries. Other risks include allergic reactions to dyes, bleeding at the puncture site where the catheter was inserted, and infection.

Conclusion

Cardiac catheterization is a standard procedure that can be done in a cath lab or hospital. It allows doctors to check for problems with your heart and blood vessels. Ask your doctor any questions about how long it will take and whether there are any risks associated with cardiac catheterization before scheduling an appointment for this test.

Dr. C Raghu is an accomplished cardiologist with decades of experience in interventional cardiology. If you or anyone you know is experiencing symptoms of cardiac ailments, book an appointment with Dr. Raghu today.

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      CT-Coronary-Angiography.jpg

      Doctors use various diagnostic tests to assess cardiac health and diagnose conditions like coronary artery disease and heart failure. While a coronary angiogram is commonly used to identify these conditions, your doctor can prescribe other tests like CT coronary angiography. 

      In our previous blogs, you can read more about the use cases and risks of coronary angiography. In this article, we’ll delve deeper into CT coronary angiography and understand why it’s crucial for people with cardiac ailments.

      What Is CT Coronary Angiography?

      CT coronary angiography is a type of CT scan that uses special dyes to evaluate the heart’s blood vessels. It can detect blockages in the coronary arteries that supply blood to the heart. It can identify blockages that are too small for other methods, such as a regular angiogram or an electrocardiogram (ECG), to pick up.

      CT Coronary Angiography

      A CT coronary angiography scan aims to find any abnormal areas in your coronary arteries that could be causing stenosis (narrowing) or occlusion (blockage). It helps doctors identify underlying heart-related ailments and determine the right course of treatment.

      How Does CT Coronary Angiography Work?

      The test is usually done in a hospital or clinic. To begin with, the doctor or radiologist will start an intravenous (IV) line to administer the contrast dye. As the contrast flows through your veins, it will appear on the scan as bright white areas on a black background. It’ll help the doctor see your heart and coronary arteries. 

      The test usually lasts about 30 minutes to one hour. The CT coronary angiogram procedure involves two scans: one with diastolic blood flow and another with systolic blood flow

      When Is CT Coronary Angiography Used?

      CT coronary angiography is used to diagnose a heart attack and evaluate blood flow in the heart. Also, doctors use it to detect blockages in arteries that supply blood to the heart muscle.

      What Are the Risks of CT Coronary Angiography?

      While CT coronary angiography is a non-invasive and safe procedure, it can cause the following side effects:

      • You may have an allergic reaction to the contrast dye.
      • Your body will be exposed to high levels of radiation, which can increase your risk of developing cancer.
      • You might have to pay out of pocket because the test isn’t always covered by insurance.
      • You might experience more anxiety and stress if the scans indicate blockages in your arteries.

      What Should I Expect When Having CT Coronary Angiography?

      If you are planning to get a CT coronary angiography, you should be prepared for the following:

      • The radiologist will ask you to change into a hospital gown.
      • The radiologist will give you an injection of a contrast dye.
      • You will lie on a table, and the table will move into the CT scanner.
      • The scan is painless and takes about 20 minutes.

      Conclusion

      CT coronary angiography is a painless and safe test that can help determine if you have blocked arteries. If you have chest pain, you should consider getting the test done as soon as possible because it may save your life.

      Dr. C Raghu is a renowned cardiologist with decades of experience. He specializes in interventional cardiology and has treated thousands of patients with cardiac ailments. If you or anyone you know is experiencing symptoms like chest pain, breathlessness, palpitations, etc., reach out to Dr. Raghu today.

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          What Is Coronary Angiography?

          Coronary angiography is a procedure that uses X-rays to visualize and inspect arteries. It shows if there are any blocked arteries and how well your heart muscle is working.

          During this procedure, a catheter is inserted into an artery in your arm or groin and advanced into one of your coronary arteries. Thereafter, contrast dye is injected into the coronary artery to make it visible on X-ray images.

          The procedure can help identify blockages in the heart’s blood vessels and guide treatment decisions for patients at risk of developing heart disease or having a heart attack due to narrowed or blocked blood vessels that supply oxygenated blood to various organs.

          When Is Coronary Angiography Performed?

          Coronary angiography is typically performed if you have chest pain or other symptoms that suggest the presence of heart disease. If you have had a heart attack or have been diagnosed with coronary artery disease. It can be used in conjunction with an exercise stress test.

          How Is Coronary Angiography Done?

          If you’re scheduled for coronary angiography, here’s what you can expect:

          • The doctor will give you a sedative, usually in the form of an injection, at the start of your procedure.
          • They’ll insert a catheter into one of your arteries, either in your groin or wrist, and guide it through your blood vessels to reach your heart.
          • They’ll inject a special dye (contrast agent) into the coronary arteries that supply blood to your heart muscle so that they can see them clearly on X-rays taken after injecting this contrast agent.

          Where Is Coronary Angiography Performed?

          Coronary angiography is performed in a cath lab (catheterization laboratory). The cath lab is a room with special equipment for performing coronary angiography and other procedures that entail inserting a long, thin tube (called a catheter) into the blood vessels of your heart.

          Why Is Coronary Angiography So Common Nowadays?

          Advancements in medical science have made coronary angiography more accessible to patients. The procedure has become simple and the risk has reduced significantly. Also, unhealthy diets and lifestyle choices put more people at risk of developing cardiac ailments. That’s why coronary angiography is commonly performed now-a-days.

          What are the risks involved in Coronary angiography?

          In expert hands coronary angiography is a near-zero risk procedure. The risk of complications can be broadly categorized into:

          Less severe complications

          • bleeding under the skin at the wound site (haematoma) – this should improve after a few days, but contact your Cardiologist if you’re concerned. Application of ice packs would be helpful.
          • bruising – it’s common to have a bruise in your groin or arm for a few weeks. Application of ice packs would be helpful.
          • allergy to the contrast dye used, causing symptoms such as a rash and a headache – this is uncommon, but you should discuss any allergies with your cardiologist before having the procedure

          Severe complications

          The chance for developing a serious complication during coronary angiogram is 1 in 1000. People with serious underlying heart problems are most at risk. Discuss with your cardiologist about the risks before the procedure.

          • damage to the artery in the arm or groin in which the catheter was inserted, with the blood supply to the limb possibly being affected 
          • heart attack – a serious medical emergency where the heart’s blood supply is suddenly blocked 
          • stroke – a serious medical condition that occurs when the blood supply to the brain is interrupted 
          • damage to the kidneys caused by the contrast dye 
          • tissue damage caused by X-ray radiation if the procedure is prolonged 
          • death

          In Conclusion

          Coronary angiography is used to diagnose and treat heart diseases, before cardiac surgery, angioplasty-stent procedures as well as other conditions such as aneurysms in blood vessels. It helps doctors identify underlying causes of heart failure and determine the proper course of treatment.

          Dr. C Raghu is a renowned cardiologist with decades of experience in interventional cardiology. He is one of the pioneers of trans-radial procedures in India. Consult him if someone is in need for coronary angiogram.

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            Coronary Angiography Blog

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              Coronary angiography is a common diagnostic test used by doctors to identify conditions, such as coronary artery disease and aneurysms. In our previous blog, we discussed how the procedure is carried out and when it’s used. Click here to check it out.

              coronary angiography

              Angiography is a minimally invasive procedure, which makes it extremely safe. However, it can involve a few minor side effects. The benefits outweigh the risks for most patients. However, in some cases, coronary angiography can result in serious complications.

              In this article, we’ll delve deeper into the risks and side effects associated with coronary angiography.

              Common Side Effects of Coronary Angiography

              If you’re planning to visit the doctor for an angiography, you can expect one or more of the following side effects:

              • Bruising
              • Swelling
              • A buildup of blood (resulting in a bump)

              All these symptoms are localized to the area where the cut was made for inserting the catheter. Most patients experience a gradual improvement in these side effects without medical intervention. You can take painkillers to relieve discomfort after the procedure.

              Complications of Coronary Angiography

              If you’re lucky, you’ll come out of coronary angiography with minor bruising and swelling. However, some patients develop the following complications:

              • An infection near the cut :- It makes the area around the cut red, swollen, and tender.
              • An allergic reaction to the dye :- It usually results in an itchy rash.

              In both cases, proper use of medications can help control the side effects. For instance, antibiotics can be used in the case of an infection. Similarly, your doctor might prescribe antihistamines if you experience an allergic reaction.

              It’s worth mentioning that coronary angiography comes with a few potential serious complications. These include:

              • Kidney damage (from the dye)
              • Cardiac arrest or stroke
              • Internal bleeding (due to damaged blood vessels)
              • Anaphylaxis (due to severe allergic response to the dye)

              The good news is that these complications are extremely rare (affecting less than one in every 1000 patients). Also, kidney damage due to angiography is usually temporary. Moreover, internal bleeding can be contained with the help of catheter based approaches.

              Seeking Medical Help

              Complications from coronary angiography are rare. Nevertheless, it’s a good idea to consult your doctor if you notice anything unusual after the procedure. For instance, if the leg or arm where the cut was made looks pale or feels numb, it’s a cause for concern. Similarly, if you notice bleeding, redness, or a firm lump near the cut, it could indicate a potential infection. It’s always a good idea to watch out for these signs and consult your doctor for timely treatment.

              In Conclusion

              Coronary angiography is a safe and minimally invasive procedure. It can cause minor side effects, such as pain and swelling. However, in extreme cases, it can also lead to a heart attack or kidney damage. It’s crucial to talk to your doctor about the potential risks before going in for the procedure.

              Dr. C Raghu has more than two decades of experience in treating patients with different heart conditions. If you have queries or concerns about coronary angiography, feel free to reach out to Dr. Raghu today.

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                  Role of ECG in Heart Failure 

                  ecg

                  ECG is a simple inexpensive test to asses heart function. ECG is the short form for electrocardiogram  or electrocardiography.

                  ECG equips the doctor with basic heart information such as

                  • Rhythm of heart – Regular or irregular. The most common irregular heart rhythm is atrial  fibrillation and frequently seen in heart failure patients. 
                  • Heart rate – Normal heart rate is between 50-100 beats per minute. A slow heart rate (less  than 50) is called bradycardia and a fast rate (more than 100) is tachycardia.
                  • Heart enlargement – Heart chambers enlargement can also be reasonably assessed. But the  best test to assess heart chamber enlargement is cardiac magnetic resonance imaging (Cardiac MRI).
                  • Heart attack – current and those in the past can be identified by predefined patterns on ECG.

                  Advanced information from ECG in Heart Failure 

                  • Reduced blood supply to heart – if a patient had a previous heart attack it usually can be  diagnosed through an ECG. It is not necessary that all patients with reduced blood supply  can be identified through ECG. Coronary angiography is a common test performed by  doctors to estimate the blood supply to the heart.
                  • Pumping efficiency of the heart – presence of an abnormal ECG usually indicates abnormal  heart efficiency. The common abnormalities on ECG include but not limited to – complete  bundle branch block, hemiblock, features indicating a previous heart attack or chamber  enlargement.  
                  • Left bundle branch block (LBBB) – presence of LBBB (if the QRS duration is more than 150 m  seconds on ECG) and a reduced EF on echo (less than 35%) is a indication for specialized  therapies such as cardiac resynchronization therapy (CRT). Resynchronization means re  establishing the synchronous beating of the heart. 
                  • Abnormal rhythm may indicate need for advanced therapies such as pacemaker in heart  block, implantable cardioverter defibrillator (ICD) if EF is less than 35% on echo, catheter  ablation in atrial fibrillation and abnormal ventricular rhythm.  
                  • Unique and uncommon problems of the heart such as infiltrative disorder (amyloidosis,  restrictive cardiomyopathy) and rare diseases such as or arrhythmogenic RV dysplasia can be  identified on ECG.

                  Does a normal ECG rule out a heart attack? 

                  An ECG is a simple yet powerful tool to assess the heart function. But at the same time a normal ECG  does not rule out a heart attack or other diseases if the disease is quite early stage. If the disease is  advanced the ECG remains a quite predictable and powerful tool. So, if the person had a heart  attack, we do not entirely rely upon ECG but we additionally incorporate the value of high sensitive  troponin to make a confirmed diagnosis of heart attack.

                  ECG complements advanced investigations 

                  Information obtained from ECG is utilized while interpreting advanced tests such as  echocardiography (echo), coronary angiography, cardiac MRI, PET CT scan etc.  

                  ECG is a powerful tool in advanced disease but in the early disease too it could be used as an adjunct  to other tests.


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                      Coronary-Bifurcation-Lesions.jpg

                      Coronary arteries are the vessels which supply blood (oxygen and nutrients) to the heart; this supply may be disrupted due to buildup of cholesterol and fatty deposits, called plaques, on the inner walls of the arteries (atherosclerosis) causing narrowing of the vessel lumen.

                      Coronary lesions branch out as they progress to supply various cardiac structures. A bifurcation lesion is a stenosis or abnormal narrowing of greater than 50% that occurs in a coronary artery at the origin of the side branch or adjacent to the origin of the side branch. Branching points a.k.a bifurcation points in the coronary arteries are prone to develop atherosclerosis as the shear stress is higher at the branch points.

                      The figure shows how a bifurcation stenosis appears schematically as well as on angiography.

                      bifurcation lesion

                       

                      Why bifurcation lesions are important?

                      A vast majority of coronary arteries obstructions happen at the branching point. About 15-20% of patients of referrals for bypass surgery are because of the presence of coronary narrowing at bifurcation location. They are considered a tough lesion to treat by angioplasty and stent.

                      How are bifurcation lesions diagnosed?

                      Bifurcation lesions are identified on coronary angiography. Only lesions affecting side branch blood vessels more than 2.25 mm is considered important and called bifurcation lesions. The main vessel that gives branches is called main vessel and the branches that originate from it are called side branches. The point at the division of the main vessel and side branch is called a bifurcation point.

                      How is a bifurcation lesion unique?

                      Bifurcation lesions can involve the coronary artery either before or after the bifurcation point. In addition, side branches could be either diseased or free from disease. Based on the location and severity of the cholesterol plaque at the bifurcation point, sub types of bifurcation lesions have been identified.

                      The challenge of performing angioplasty and stent for a bifurcation stenosis lies in the ability to preserve the main vessel and the side branch. Stents being metallic tubes risk occluding the side branch when placed across the side branch. This apprehension of losing the side branch, is one of the primary reasons for patients to be sent for bypass surgery instead of angioplasty and stent.

                      Coronary-bifurication

                      Can angioplasty and stent be performed for a bifurcation lesion?

                      Angioplasty and stent can be eminently performed for a bifurcation stenosis. Over the last 2 decades numerous techniques in stent implantation have been developed to treat the bifurcation lesions. Some of these techniques include:

                      • Provisional T stent technique
                      • Tap technique
                      • Double kiss crush technique
                      • Culotte technique

                      Advent of these techniques enabled experienced operators to perform angioplasty and stent successfully with chances of repeat narrowing seen in 3-6% patients at the site of stenting. Risk of losing a side branch after stenting is reduced to 1% once the new techniques are employed.

                      Dr. C Raghu is an expert in bifurcation lesion angioplasty and the center where he has been trained, ICPS Paris France is considered the “Mecca” for bifurcation lesion angioplasty techniques development. 

                      How does a bifurcation lesion angioplasty differ from a normal angioplasty?

                      Bifurcation lesion angioplasty, involves utilization of novel stent techniques mentioned above. In addition, angioplasty operator experience is a major factor in determining  outcomes. Choosing the “right” stent that allows side branch access, use of specialized technologies such as fractional flow reserve (FFR), expertise in deploying 2 stents especially the process of “stent crush” and the handling of two balloons through a single catheter – kissing balloon are key points for the best results in a stent procedure.

                      What are the chances of side branch occlusion in a bifurcation lesion angioplasty?

                      Contemporary bifurcation angioplasty using Intravascular imaging employing contemporary stenting techniques in the hands of expert bifurcation angioplasty operators carries a 99% success rate with a chance of losing side branch in 1% and repeat narrowing at the end of 9 months being 3-6%. These results are comparable and if not superior to bypass surgery as angioplasty entails a short hospital stay and fast recovery.

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