Coronary Angiography

Coronary angiography is a medical imaging procedure used to visualize the inside of the coronary arteries, which supply blood to the heart muscle. It helps diagnose and guide the treatment of various heart conditions, including coronary artery disease (CAD).

Purpose

• Diagnosis of Coronary Artery Disease (CAD): To identify blockages or narrowing in the coronary arteries.
• Assessment of Chest Pain: To determine if chest pain (angina) is due to heart disease.
• Evaluation Before Surgery: To plan interventions such as coronary artery bypass grafting (CABG) or angioplasty.
• Assessment After a Heart Attack: To locate blockages that caused the heart attack and guide treatment.

Procedure

1. Preparation:

   • Fasting: Patients are usually required to fast for several hours before the procedure.
   • Medication Review: Some medications may need to be adjusted or stopped before the procedure.
   • Consent: Patients must provide informed consent after understanding the risks and benefits.

2. During the Procedure:

   • Local Anesthesia: Administered at the insertion site, usually the groin or wrist.
   • Catheter Insertion: A thin, flexible tube (catheter) is inserted into a blood vessel and guided to the coronary arteries using fluoroscopy (X-ray imaging).
   • Contrast Dye Injection: A special dye (contrast material) is injected through the catheter to make the coronary arteries visible on X-ray images.
   • Imaging: X-ray images (angiograms) are taken as the dye flows through the coronary arteries, highlighting any blockages or abnormalities.

3. Post-Procedure:

   • Monitoring: Patients are monitored for a few hours for any adverse reactions or complications.
   • Rest: Patients may need to lie flat for several hours, especially if the catheter was inserted through the groin.
   • Instructions: Patients receive instructions on activity restrictions and medication adjustments.

Risks

• Bleeding or Bruising: At the catheter insertion site.
• Infection: At the insertion site, though rare.
• Allergic Reaction: To the contrast dye.
• Kidney Damage: Due to the contrast dye, especially in patients with preexisting kidney conditions.
• Heart Attack or Stroke: Very rare but serious complications.
• Arrhythmias: Abnormal heart rhythms may occur during the procedure.

Benefits

• Accurate Diagnosis: Provides detailed images of the coronary arteries.
• Guided Treatment: Helps in planning and performing interventional procedures like angioplasty or stent placement.
• Immediate Results: Allows for real-time assessment and decision-making.

Alternatives

• Non-Invasive Imaging: Such as CT coronary angiography or stress testing, which do not require catheter insertion.
• Medical Therapy: Managing symptoms with medications alone, if appropriate.

Follow-Up

• Interventions: Depending on the findings, additional procedures like angioplasty (with or without stent placement) or coronary artery bypass surgery may be recommended.
• Lifestyle Changes: Patients are often advised to adopt heart-healthy lifestyle changes, including diet, exercise, and smoking cessation.