Coronary angiography & angioplasty

Information on coronary angiography and angioplasty

Dr Ashish Shah MBBS, MD (Medicine), MD-Research (UK), MRCP (UK)
Fellow- Coronary, Structural and Congenital Interventions
CCT – General and interventional cardiology (UK)
Toronto General Hospital
Toronto, ON, Canada

What Is Coronary Artery disease?

Various risk factors, such as hypertension, diabetes, high cholesterol, family history, smoking, lack of exercise results in fat deposition inside the coronary artery (atherosclerosis), that can affect blood supply to the heart, resulting in chest pain (angina). If symptoms remain unchanged over period of time, it is known as stable angina. Worsening symptoms or symptom at rest are sign of progressive disease or impending heart attack and this is known as ‘unstable angina’.

In some patients this fat deposition can have a small tear and blood can make a clot causing complete blockage to the blood flow, leading to heart attach (myocardial infarction or acute coronary syndrome).

What Is Coronary Angiography?

Coronary angiography is a routinely performed test to detect underlying coronary artery disease. It is also known as cardiac catheterization.

Coronary angiography uses contrast (dye) and x-rays to show the obstruction in the blood flow to the heart. A very thin catheter is taken up to the coronary artery, either through the artery in wrist or the groin, and special dye (colourless contrast) is injected. X-ray is used to take picture of the coronary artery. Dye can’t fill up the artery completely when there is fat deposition, and this helps cardiologist identify the blockage in the artery, based up on which he can also make treatment plan.

Who Needs Coronary Angiography?

Coronary angiography is a recommended test for those with chest pain (angina) or having heart attack.
Additionally, this test can be recommended in patients with:

1.    Unexplained symptoms of shortness of breath on exertion
2.    Patients who survived sudden stoppage of heart beating (sudden cardiac arrest)
3.    Abnormal electrocardiogram or exercise test

Before Coronary Angiography

Before recommending coronary angiography, your doctor will have performed various tests and will talk to you for the need of this test. He will also talk you about how the test is performed and what are the risk factors associated with this procedure. Doctor will also go through all the medications you are on and may need to check your blood sugar (is you have diabetes or suspected to have diabetes) and blood test to check kidney functions.

He may also talk to you about what may be the potential outcome based upon this test; e.g. medical management, coronary angioplasty (stenting procedure) or coronary artery bypass surgery (open heart surgery).

He may also ask you to sign a consent form, if you agree for this test to be performed.

You will have an opportunity to talk more about the procedure, if you have any questions. As this test is performed in hospital, doctor will provide you with the address, day and time of this test. They may also provide you with some written documents or pamphlet explain this procedure further in detail, which you can go through, when you are at home.

What To Expect During Coronary Angiography

Coronary angiography is performed in the hospital. Your doctor will ask you to avoid eating and drinking for 6-12 hours before the procedure, except in unavoidable circumstances.

This test is performed under local anaesthesia, so you are awake and should not experience pain, except when doctor gives you local anaesthesia in the skin to make it numb. Some doctors give you medication to keep you relaxed or making you feel sleepy, but it is not always necessary.

Coronary angiography can be performed through femoral artery in groin or the radial artery in wrist. By using a small needle doctors will insert a plastic tube known as ‘sheath’ in the artery, though which he will be inserting various different catheters to perform the coronary angiography.

As doctor uses x-ray to take picture of the coronary artery, you will see camera moving around you in various directions to take picture. Your doctor may instruct you during this procedure. Should you feel any pain or symptoms, you can mention it to your doctor, but you should not move much, as the bed you will be sleeping on during this test is a very small size.

It takes about 45 minutes to complete the procedure, but may take more or less in some patients.

At the end of the procedure, your doctor will remove the catheter and sheath and will close the hole in the artery. You will have to rest for few hours after the procedure.

What To Expect After Coronary Angiography

Once test completed, you will be taken to recovery area, where you will be staying for few hours in bed. Nursing staff will keep a close watch on your artery puncture site to make sure there is no further bleeding. They will also keep watch on your pulse, blood pressure and may take an electrocardiogram (ECG).

Your doctor will visit you after the procedure to explain the result. They may also show you the picture to make you understand the problem more in detail. Your doctor will also explain you the problem and what are the treatment options available.

You may find a small bruise or a lump (hematoma) at the site, where procedure was performed. It may feel sore for couple of days after the procedure, but if it hurt or swelling increased, you should seek immediate attention.

You should avoid driving for 2-3 days, heavy lifting or straining as these may increase risk of bleeding from the arterial puncture site.

What is coronary angioplasty (PCI):

Coronary angioplasty, also known as percutaneous coronary intervention (PCI) is a procedure to treat coronary artery blockage. It is performed similar to coronary angiography, but procedure lasts longer and risk involved is slightly higher than coronary angiography alone.

Your doctor will perform coronary angioplasty similar to angiography, but this time he will be passing a thin wire into the coronary artery beyond the blockage and open up the blockage with the help of the balloon. To keep the artery open, they use metal scaffold (stent).

On an average time required performing coronary angioplasty ranges from 1-3 hours, with some variations.

In some patients angioplasty can be performed immediately after the coronary angiogram, so that patient does not have to come to the hospital twice and does not require having artery punctured twice.

In those presenting with ongoing heart attack, coronary angioplasty is performed immediately after angiogram, as it is vital to open up the artery immediately to prevent heart muscle damage.

What Are the Risks of Coronary Angiography or angioplasty?

Coronary angiography is a commonly performed test. Even though complications are very rare, they include:

1.    Bleeding or bruise at the arterial puncture site
2.    Vascular injury
3.    Contrast related kidney damage
4.    Allergy to contrast
5.    Heart rhythm problem (slow or fast, but usually very transient)
6.    Low blood pressure
7.    Stroke, heart attack
8.    Death (very rare).

If there is significant bleeding, then there may be a need for blood transfusion. If patient experiences a heart attack that can happen very rarely, it may require coronary angioplasty or emergency coronary artery bypass surgery to correct the problem.

On an average risk for complications can be quoted as 1:1000 for coronary angiography and 1:100 for coronary angioplasty, but they seem to be higher in those who are old, have diabetes, abnormal kidney functions and encountered allergic reaction to contrast or any other material used in angiogram previously.

If you have experienced any complications before, please let your doctor know, so that they can use preventive measures prior to performing the test.

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