Sarah Lewis, PharmD
What is coronary angiography?
Coronary angiography is a procedure that allows your doctor to take a picture or image (an angiogram) of the blood vessels (arteries) that supply your heart muscle. Doctors use coronary angiography to study the arteries of your heart that are obstructed, blocked, or narrowed, and diagnose the underlying cause.
Coronary angiography is only one method used to diagnose a variety of heart and vascular diseases, and conditions. Discuss all the testing options with your doctor understand which options are right for you.
Types of coronary angiography
The types of coronary angiography procedures include:
Catheter coronary angiography involves inserting a catheter into a vessel in your groin or arm. The catheter wire is then fed, or guided to the area to be examined. X-rays are used to produce the angiogram or picture of the vessel.
Noninvasive coronary angiography uses computed tomography (CT), or sometimes magnetic resonance imagining (MRI) or ultrasound, to produce the angiogram. CT involves radiation exposure but MRI and ultrasound methods do not.
Catheter coronary angiography, and in some cases, noninvasive coronary angiography, use a contrast agent, sometimes called a dye. This is administered intravenously (through an IV). The contrast agent improves the quality of the image.
Other procedures that may be performed
The following catheter procedures can be performed during a catheter coronary angiography:
Angioplasty to widen a narrowed or obstructed vessel
Blood clot removal by injecting clot-dissolving medications into the artery via the catheter
Cardiac catheterization to examine the interior of the heart chambers, the heart valves, and evaluate heart function
Stent placement with a mesh tube, which is permanently inserted into the blood vessel to keep the vessel open
These procedures cannot be performed during noninvasive coronary angiography because it does not use a catheter. Your doctor may recommend a catheter procedure or surgery if a noninvasive coronary angiography diagnoses serious heart disease.
Why is coronary angiography performed?
Your doctor may recommend a coronary angiography to diagnose diseases and conditions of the heart and its blood vessels. It evaluates the function of the heart, heart valves, and the major blood vessels of the heart. Coronary angiography is also used to find the underlying cause of symptoms, such as chest pain.
Coronary angiography helps your doctor plan the best treatment for you. Some treatments, such as angioplasty, can be performed with coronary angiography.
Coronary angiography diagnoses and helps treat the following:
Aortic stenosis, a disorder of the valve between your heart and your aorta. Your aorta is the main artery leaving your heart.
Blood clots, or coronary thrombosis
Chest pain due to abnormal heart function, atherosclerosis (hardening of the arteries), or other conditions
Coronary artery disease (CAD), a buildup of plaque on the walls of the coronary arteries that supply blood to the heart
Coronary blood vessel malformations. Your doctor may use coronary angiography to identify the specific defect.
Heart attack, which usually due to atherosclerosis and a blood clot that block blood flow to the heart
Heart failure when the underlying cause cannot be determined by other tests
Unclear stress test results for symptoms such as shortness of breath or chest pain
Unstable angina, which is chest pain that occurs suddenly in the absence of activity. Unstable angina is primarily due to atherosclerosis, or hardening of the arteries that supply the heart with blood.
Who performs coronary angiography?
The following specialists perform coronary angiography:
Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons
Cardiologists, pediatric cardiologists, and interventional cardiologists often perform catheter coronary angiography. These specialists are specially trained in diagnosing and treating heart disease using catheter procedures and radiological imaging
Radiologists and radiologic technologists perform noninvasive coronary angiography. A radiologist is a doctor who specializes medical imaging. A radiologic technologist is a medical professional who is specialized in medical imaging and the care of patients during imaging procedures.
Thoracic surgeons specialize in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs and esophagus. Thoracic surgeons may also be known as cardiothoracic surgeons.
How is coronary angiography performed?
Your coronary angiography will be performed in a hospital or outpatient setting, depending on your condition. It takes several hours and generally includes these steps:
You will dress in a patient gown and lie on a procedure table.
Your team will insert an IV to provide fluids, medications, or a contrast agent.
Your team will attach devices to monitor your heart rate and blood pressure.
For a catheter coronary angiography:
Your team takes a small amount of blood for laboratory tests to test kidney function and blood clotting.
Your team may give you sedative medications through the IV to help you relax.
Your physician will determine the location to insert the catheter. The catheter is often placed in the artery in the groin. The area will be shaved, cleaned and numbed before a small incision is made. Your physician will insert the catheter and wire through the incision and guide it to the vessel to be examined.
Once the wire is in place, your team will deliver a contrast agent through the catheter and take X-rays as the contrast agent flows through your blood vessels. You may feel a sensation of warmth when the contrast agent is injected.
Your team will tell you when to hold still for the X-rays. You may need to hold your breath briefly.
When the procedure is complete, your team will remove your IV and catheter and the catheter site will be closed.
5. For noninvasive coronary angiography:
If MRI is used, your team will give you earplugs because the machine makes loud thumping and humming noises. Closed MRI machines are long cylinders, so your team may give you a mild sedative if you are claustrophobic. The procedure table will slide into the machine for the test.
CT machines also have a tunnel, but it is much shorter than an MRI tunnel. The procedure table will slide into the machine for the test. You may need to hold your breath briefly during the imaging procedure.
If a contrast agent is used, it will be administered through your IV. You may feel a sensation of warmth when the contrast agent is injected.
It is important for you to lie still during the entire procedure. Any movement may cause blurry images. The MRI takes about an hour.
You will wait briefly while the radiologist verifies that the imaging is complete.
A member of the team will remove your IV.
Will I feel pain?
Your comfort and relaxation is important to you and your care team. You may feel a pinch or pinprick during the IV placement, but the imaging itself is painless. You will have pain and sedative medications to keep you comfortable during catheter coronary angiography. You may also have sedative medications for MRI procedures if you are claustrophobic. Tell your care team if you are uncomfortable in any way.
What are the risks and potential complications of coronary angiography?
Complications after coronary angiography are uncommon, but any procedure involves risks and the potential complications. Complications may become serious in some cases. Complications can develop during the procedure or recovery.
Complications of coronary angiography include:
Abnormal heart rhythms or cardiac arrhythmias
Adverse reaction or problems related to sedation or contrast agents, such as an allergic reaction and problems with breathing
Bleeding or clotting problems
Damage to an artery from the catheter
Exposure to radiation, which may be harmful in excessive doses
Injury from metal objects in or on your body or in the room during an MRI
Low blood pressure
Kidney injury from the contrast agent, especially if you have kidney disease
Reducing your risk of complications
You can reduce the risk of come complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before your procedure and during recovery
Informing your doctor if you have any metal in your body, including screws, pins, plates, pacemakers, implants of any kind, intrauterine devices (IUDs), and bullet fragments
Informing your doctor if you have kidney disease or diabetes
Informing your doctor or radiologist if you are nursing or there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Removing all jewelry and metal objects and leaving them outside the MRI room. This includes glasses, credits cards, hair accessories, and removable dental work.
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies, especially an iodine or shellfish allergy
How do I prepare for my coronary angiography?
You are an important member of your own healthcare team. The steps you take before your procedure can improve your comfort help get the most accurate results.
You can prepare for coronary angiography by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Arranging for a ride home if you have sedation
Following any instructions about eating and drinking before coronary angiography
Leaving jewelry, metal objects, credit cards, and other valuables at home
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. With certain types of contrast dyes, you should not take metformin (Glucophage), an oral medication for diabetes, for 48 hours before and after your angiography. Your doctor will give you specific instructions about taking your medications.
Questions to ask your doctor
Preparing for coronary angiography can be stressful. It is common for patients to forget some of their concerns during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before an angiography and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need coronary angiography? Are there any other options for diagnosing or treating my condition?
How long will the procedure take? When can I go home?
What restrictions will I have after the procedure? When can I return to work and other activities?
What kind of assistance will I need at home? Will I need a ride home?
How should I take my medications?
How will you manage my pain or anxiety?
When and how will I receive the results of my test?
What other tests or procedures might I need?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my coronary angiography?
Knowing what to expect after coronary angiography can help you get back to your everyday life as soon as possible.
How will I feel after the coronary angiography?
You may have mild drowsiness if you had sedative medications. It is unlikely that you will feel pain after coronary angiography. It is common to have mild tenderness and bruising at the catheter incision site. Let a team member know if you are uncomfortable.
Your activities may be restricted following a catheter coronary angiography. Follow your doctor’s instructions for eating, drinking and resting after coronary angiography.
When can I go home?
You will be monitored for four to six hours after catheter coronary angiography before going home. Patients usually go home immediately after a noninvasive coronary angiography without sedation. If you had sedation, you will go home when you are alert, breathing effectively, and your vital signs are stable. This generally takes less than an hour, depending on the type of sedation.
You will not be able to drive for about 24 hours after having sedation because you be drowsy. You will need a ride home from your procedure, and someone should stay with you for the first day.
When should I call my doctor?
It is important to keep your follow-up appointments. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Difficulty walking or talking
Facial weakness or facial drooping
Numbness or a feeling of coolness in the arm or leg that was used to insert the catheter
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