Coronary Angiography: Procedure, Preparation and Results

Why Is Coronary Angiography Done?

Coronary angiography is a diagnostic procedure that can be useful to diagnose different heart conditions and functions as a guide for further treatment.

The human heart consists of two small chambers at the top called Atria and two bigger chambers at the bottom called Ventricles. Both the ventricles are equipped with two valves to regulate the blood flow to and from the ventricles. Using coronary angiography, your doctor can find out how well your heart valves and chambers are functioning.

Indications:

1. Diagnosing Heart Conditions like:

• Coronary Heart Disease (CHD): Medical condition defined by the deposition of cholesterol (fatty substances) in your coronary arteries (blood vessels that supply blood to your heart). This hampers the blood supply to the heart and may lead to angina (severe chest pain) or cardiac arrest (heart attack).
• Myocardial Infarction: It is commonly known as a heart attack. This is a medical emergency wherein the blood supply to your heart is blocked. A coronary angiogram is usually done after you suffer from a heart attack. 
• Angina: It is severe chest pain usually arising due to intermittent lack of blood supply to your heart due to the underlying coronary heart disease. 
• Valvular Heart Disease is defined by the malfunctioning of either one or more valves present within your heart. 
• Congenital Heart Disease: These include various heart defects like atrial septal defect (hole in the heart) present since birth that affect the normal functioning of your heart. 

2. Before undergoing various procedures like: 

• Coronary angioplasty: It is an invasive treatment to remove the blockages present in your coronary arteries.
• Coronary artery bypass graft (CABG): Coronary bypass surgery is performed in blocked heart arteries to facilitate better blood flow to your heart by deflecting blood around blocked or narrow arteries
• Sometimes tests such as echocardiograms, electrocardiograms and stress tests do not provide accurate results. Therefore, angiograms are taken to make a correct diagnosis to obtain more information

When to See a Doctor?

If you observe the following symptoms, please see your doctor immediately:

• Chest discomfort (Angina) with symptoms like heaviness, pressure, ache, and burning sensation
• Lightheadedness and dizziness
• Weakness and nausea
• Shortness of breath and difficulty breathing
• Sweating
• Anxiety
• Heart palpitations
• Discomfort that feels like indigestion
• Rapid breathing and heartbeat
• Swelling in the legs, stomach and around the eyes
• Fainting and extreme tiredness

What to Expect if You Delay Coronary Angiography?

Severe outcomes can be expected if the procedure is delayed, such as:

• Atherosclerosis (clogging of the arteries which supply blood to the heart).
• Angina (severe chest pain)
• Heart attack (injury to the heart muscle)
• Congenital heart disease
• Recurrent ischemia
• Heart stroke
• Heart failure
• Death

Procedure:

• Once the anaesthesia sets in, your doctor will insert a tiny hollow tube (catheter) through an artery (blood vessel) in your groin or wrist, from where it will reach your coronary artery. 
• The doctor will inject a special dye (contrast material) via this catheter to highlight your coronary arteries and blockages (if any).
• You may have an urge to empty your bladder or a sensation of body warmth during the procedure.
• Next, your doctor will take X-ray images and, with the help of a television monitor, guide the catheter in the correct position to identify any narrowed arteries or blockages. 
• You may experience chest pain during the procedure. In that case, inform your nurse. 
• The whole procedure can last for up to 30-90 minutes

What to Plan Before the Procedure? 

You can expect the following:

• Your doctor will assess your vitals like blood pressure, pulse, and other vital signs. 
• Your doctor will brief you about the procedure to clear your doubts if you have any.
• The hospital will request you to read and sign the consent document.
• The healthcare professional will instruct you not to drink or eat at least eight hours before the procedure. 
• The doctor might ask you to get an electrocardiogram or blood tests done.
• You will be asked to wear a hospital gown.
• Your doctor will also perform your complete physical examination and give you instructions regarding your medications if you are taking any.
• If you are pregnant, you should tell your doctor.
• You should also inform if you have an allergy to any medicine or had an allergic reaction to the dye (contrast dye) in the past.

What to Expect During the Procedure?

You can expect the following:

• The doctor will give you medication to keep you relaxed during the entire procedure. 
• You will lie on a cath table in the laboratory. A heart monitor is placed to record your heartbeat during the test
• The healthcare professional will clean and prepare a small area of your wrist or groins for the procedure.
• The doctor will administer local anaesthesia in your wrist or the groin so that you do not get hurt during the entire procedure.
• You should follow your doctor’s instructions during the entire procedure, such as coughing or taking deep breaths and holding for a few seconds.
• After the angiography, you will be moved to a recovery room.

What to Expect After the Procedure?

You can expect the following:

In Cath Laboratory/at Healthcare Centre:

• After the completion of the procedure successfully, a nurse will apply pressure on your groin region (if the catheter was inserted there) for a few minutes to stop the bleeding after removing the catheter. Similarly, if the catheter was placed in your arm, the nurse will place a small cuff around your arm; this pressure is slowly decreased over several hours.
• Meanwhile, your doctor will monitor your vitals, and once stable; you will be allowed to go home on the same day.
• If you do not feel relaxed and comfortable after the procedure, you should immediately inform the healthcare professional.

At Home:

• You may have tiredness, and the catheter site (arm/groin) might be tender for up to seven days.
• Avoid taking a bath for 24-48 hours after the procedure. You can clean yourself with a damp cloth but keep the wound as dry as possible.
• If you have plaster on your groin region, you can get it removed the next day after the procedure, and it generally does not need to be replaced.
• Apply pressure to the wound area if you notice any bleeding. 
• Any bruising near the wound area may last for up to 14 days.
• Avoid driving until instructed that you can do it safely.
• Avoid heavy exercising or playing a sport for at least 48 hours after the procedure.
• You will need to adopt a cholesterol-lowering diet

Myth Busters

• Myth: Angiography is not a safe procedure.
  Fact: Angiography is usually a safe procedure and has fewer risks or complications following it. Few side effects are common. However, your doctor will only suggest the test if the benefits outweigh the risks.

When to See a Doctor?

Coronary angiography is generally a safe procedure. However, you might experience the following complications after the procedure, for which you should visit the doctor immediately: 

• Increased swelling, tenderness, redness, or discharge at the arm or groin region, wherever you had the catheter inserted. 
• Painful, hard lump (more than the size of a pea) under the skin around the catheter insertion site
• High-grade fever
• Numbness or discolouration in the arm or leg of the same side where the catheter was inserted

 In rare cases, the risks of coronary angiography include:

• Localized bleeding (haematoma) in and around the arm or groin region, wherever the catheter was inserted.
• Bruise in your arm or groin for a few weeks
• Allergy to the contrast dye used, which may cause headache or rash. 
• Injury to the artery in the groin or arm, wherever you had the catheter inserted, may impair blood supply to the limb (upper or lower) on the same side.
• Heart attack (an emergency condition wherein your heart’s blood supply is suddenly stopped)
• Stroke (another emergency condition that occurs when your brain does not get enough blood supply). 
• Kidney damage due to the contrast dye (primarily occurs in patients with diabetes or underlying kidney disease)
• Damage to the tissue due to X-ray radiation if the procedure is extended.
• Increased pressure on the heart (cardiac tamponade)
• Arrhythmia (irregular heartbeats)
• Death

However, these risks are infrequent and are likely to be less than one in 1,000 patients.