What is coronary angiography

Coronary angiography also known as a coronary angiogram or a cardiac catheterization, is an x-ray procedure during which a doctor injects radioactive dye into your coronary arteries to see your heart’s blood vessels. The dye shows up on an x-ray screen. Coronary angiography is generally done to see whether blood flow to and from your heart is blocked or restricted. Your doctor may ask you to have a coronary angiogram if they suspect you might have heart disease.

Coronary angiography allows your doctor to look inside your coronary arteries and find out where and how severe any narrowed areas are.

Coronary angiography procedures can both diagnose and treat heart and blood vessel conditions.

During a coronary angiogram, a type of dye that’s visible by an X-ray machine is injected into your blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a look at your blood vessels. If necessary, your doctor can open clogged heart arteries (angioplasty) during your coronary angiogram.

Why is coronary angiography done

Your doctor may recommend coronary angiography if you have symptoms that suggest you aren’t getting enough blood to your heart, such as chest pain or a heart attack.

You might also have a coronary angiography if you have a congenital heart defect, if you have had a significant injury to your chest or if you have problems with blood vessels elsewhere in your body.

Your doctor may recommend that you have a coronary angiogram if you have:

• Symptoms of coronary artery disease, such as chest pain (angina)
• Pain in your chest, jaw, neck or arm that can’t be explained by other tests
• New or increasing chest pain (unstable angina)
• A heart defect you were born with (congenital heart disease)
• Abnormal results on a noninvasive heart stress test
• Other blood vessel problems or a chest injury
• A heart valve problem that requires surgery

Because there’s a small risk of complications, angiograms aren’t usually done until after noninvasive heart tests have been performed, such as an electrocardiogram (ECG), an echocardiogram or a stress test.

What is a CT coronary angiogram?

CT stands for ‘computerized tomography’. A CT scan is a sophisticated type of X-ray.

A CT coronary angiogram shows the blood flow through the coronary arteries. This test is similar to a traditional coronary angiogram. However, in this test the dye is injected into a small vein in your arm rather than an artery in your groin. This makes the test less invasive than a traditional angiogram. You will then lie on a bed which passes through a doughnut-shaped opening in a CT scanner to create an image of your heart.

Preparing for a coronary angiogram

In some cases, coronary angiograms are performed on an emergency basis. More commonly, though, they’re scheduled in advance, giving you time to prepare.

Before your appointment, prepare a list of questions to ask your surgeon, radiologist or cardiologist.

They will talk to you, examine you and may do further tests such as blood tests, a chest x-ray and an electrocardiograph, or ECG.

Angiograms are performed in the catheterization (cath) lab of a hospital. Your health care team will give you specific instructions and talk to you about any medications you take. General guidelines include:

• Don’t eat or drink anything after midnight before your coronary angiogram.
• Take all your medications to the hospital with you in their original bottles. Ask your doctor about whether or not to take your usual morning medications.
• If you have diabetes, ask your doctor if you should take insulin or other oral medications before your coronary angiogram.

Before your angiogram procedure starts, your health care team will review your medical history, including allergies and medications you take. Your medical team may perform a physical exam and check your vital signs — blood pressure and pulse.

You’ll also empty your bladder and change into a hospital gown. You may have to remove contact lenses, eyeglasses, jewelry and hairpins.

Coronary angiogram procedure

Normally you are admitted to hospital a few hours before the procedure starts.

You will be taken to a special cardiac catheterization laboratory or operating room, and will be asked to lie on a narrow X-ray table. Your medical team will insert an intravenous (IV) line, and may give you a sedative to help you relax, as well as other medications and fluids. You’ll be very sleepy and may drift off to sleep during the procedure, but you’ll still be able to be easily awakened to follow any instructions.

Because the table may be tilted during the procedure, safety straps may be fastened across your chest and legs. X-ray cameras may move over and around your head and chest to take pictures from many angles.

Electrodes are placed on your chest monitor your heart throughout the procedure. A blood pressure cuff tracks your blood pressure and another device, a pulse oximeter, measures the amount of oxygen in your blood.

A small amount of hair may be shaved from your groin or arm where a flexible tube (catheter) will be inserted. The area is washed and disinfected.

Your medical team will inject a local anesthetic into your groin so it is numb before making a small cut. They will then a short plastic tube (sheath) is inserted into your artery and the catheter – a long thin tube – is inserted through the sheath into your blood vessel and carefully threaded to your heart or coronary arteries. Occasionally, the arm is used instead of the groin.

Because arteries have no nerves, you should not feel this. Threading the catheter shouldn’t cause pain, and you shouldn’t feel it moving through your body. Tell your health care team if you have any discomfort.

Once the catheter is in the right spot, dye (contrast material) will be injected into the catheter. When this happens, you may have a brief sensation of flushing or warmth. But again, tell your health care team if you feel pain or discomfort.

The dye is easy to see on X-ray images. As it moves through your blood vessels, your doctor can observe its flow and identify any blockages or constricted areas. Depending on what your doctor discovers during your angiogram, you may have additional catheter procedures at the same time, such as a balloon angioplasty or a stent placement to open up a narrowed artery.

Having an angiogram takes about one hour, although it may be longer, especially if combined with other cardiac catheterization procedures. Preparation and post-procedure care can add more time.

After the coronary angiography procedure

When the coronary angiography is over, the catheter is removed from your arm or groin and the incision is closed with manual pressure, a clamp or a small plug.

You’ll be taken to a recovery area for observation and monitoring until you are ready to return to the ward.

When your condition is stable, you return to your own room, where you’re monitored regularly.

You will need to lie flat for several hours to avoid bleeding if the catheter was inserted in the groin. During this time, pressure may be applied to the incision to prevent bleeding and promote healing.

You might be able to go home the same day, or you might need to stay in hospital overnight. Drink plenty of fluids to help flush the dye from your body. If you’re feeling up to it, have something to eat.

Ask your health care team when to resume taking medications, bathing or showering, working, and doing other normal activities. Avoid strenuous activities and heavy lifting for several days.

Your puncture site is likely to remain tender for a while. It may be slightly bruised and have a small bump.

Coronary angiogram risks

As with most procedures done on your heart and blood vessels, a coronary artery angiography has some risks, such as radiation exposure from the X-rays used. Major complications are rare, though. Potential risks and complications of coronary artery angiography include:

• Heart attack
• Stroke
• Injury to the catheterized artery
• Irregular heart rhythms (arrhythmias)
• Allergic reactions to the dye or medications used during the procedure
• Kidney damage
• Excessive bleeding
• Blood clots
• Infection
• Pain

Contact your doctor immediately if:

• You notice bleeding, new bruising or swelling at the catheter site
• You develop increasing pain or discomfort at the catheter site
• You have signs of infection, such as redness, swelling, drainage or fever
• There’s a change in temperature or color of the leg or arm that was used for the procedure
• Weakness or numbness in the leg or arm where the catheter was inserted
• You develop chest pain or shortness of breath

If the catheter site is actively bleeding and doesn’t stop after you’ve applied pressure to the site, contact your local emergency medical services number. If the catheter site suddenly begins to swell, contact your local emergency medical services number.

Coronary angiography results

A coronary angiography can show doctors what’s wrong with your blood vessels. It can:

• Show how many of your coronary arteries are blocked or narrowed by fatty plaques (atherosclerosis)
• Pinpoint where blockages are located in your blood vessels
• Show how much blood flow is blocked through your blood vessels
• Check the results of previous coronary bypass surgery
• Check the blood flow through your heart and blood vessels

Knowing this information can help your doctor determine what treatment is best for you and how much danger your heart condition poses to your health. Based on your results, your doctor may decide, for instance, that you would benefit from having coronary angioplasty or stenting to help clear clogged arteries. It’s also possible that angioplasty or stenting could be done during your coronary angiogram to avoid needing another procedure.