What is coronary angiography

What is coronary angiography of vessels and heart? Not many have heard of such a diagnostic technique, but it is quite informative and allows you to identify many heart diseases. It is prescribed by the attending physician based on the patient's medical history. Consider what are the goals of coronary angiography when it is used. Are there any contraindications for this procedure?

The essence of the procedure

Cardiac coronary angiography - what is it? This is an x-ray study that makes it possible to see the blood vessels that form the "crown of the heart".

This technique allows you to consider the following with high accuracy:

• analyze the condition of the vessels;
• determine their location;
• find out the degree of narrowing of the coronary artery.

During the examination, all the results are displayed on the computer screen, which allows you to view the picture in an enlarged size. The doctor sees the condition of the vessels, whether there are constrictions, observes how the blood moves through the vessels to the heart. After the diagnosis, you can get a complete picture, follow the dynamics of blood circulation and understand if there is a blockage of blood vessels.

Coronary angiography is especially useful in the following cases:

• to detect congenital malformations of the heart vessels;
• before the operation on the coronary vessels, because it is possible to accurately determine the place where the intervention will be performed.

Consider what are the indications for such a procedure.

Indications for coronary angiography

Coronary angiography of the vessels of the heart is needed after a non-invasive examination of the patient and for the study of clinical symptoms. Without the appointment of the attending physician, the procedure is not carried out, since it has a high probability of developing complications.

And also such a diagnostic technique is used in case the drug treatment turned out to be ineffective and it is necessary to resort to operational methods.

So, the indications are as follows:

1. Diagnosis of coronary heart disease, which has developed against the background of blockage and narrowing of the coronary vessels of the heart.
2. Unstable angina that cannot be cured with medication. As a rule, such a disease occurs in patients with myocardial infarction, so patients have problems with the functioning of the left ventricle.
3. Postinfarction angina.
4. The inability to identify the degree of vascular damage using other methods.
5. Preparation for the operation (heart valve replacement, correction of congenital defects, bypass or stenting).

If the main indication for coronary angiography is surgery, then the operation is performed immediately after the examination. Very often, it is after the diagnosis that the doctor decides on the choice of one or another type of surgical intervention.

In some cases, coronary angiography is performed on an emergency basis after a short period of time after a heart attack. Are there any contraindications to this procedure?

Contraindications for coronary angiography

There are no absolute contraindications. You can refuse the procedure if there are good reasons for it, because the diagnosis is a voluntary procedure.

There are a number of factors that can affect your ability to get tested, including:

• high body temperature;
• low hemoglobin (anemia);
• the presence of bleeding;
• low levels of potassium in the blood;
• poor blood clotting.

In this case, it is not recommended to undergo an examination so that the patient's condition does not worsen.

It is undesirable to do coronary angiography for elderly people, as well as for patients who are allergic to a contrast agent. If you do not warn your doctor about such a problem, then there may be unpleasant consequences in the form of itching and rashes. With a strong allergic reaction, shortness of breath, a decrease in pressure, and even anaphylactic shock are possible.

There is a high risk of complications during the examination in the following cases:

• the presence of diabetes;
• obesity or underweight in the patient;
• kidney failure;
• lung damage;
• heart failure;
• diseases of the circulatory system.

If there is an urgent need for coronary angiography in such patients, patients first need special preparation. What complications can occur if the doctor's recommendations for diagnostics are not followed?

Complications after coronary angiography

Any intervention on the heart and blood vessels can have negative consequences for the patient, even if the diagnosis is carried out by an experienced specialist.

However, serious complications are very rare.

Coronary angiography is a painless and safe procedure. The probability of developing a complication is 2%. Fatal outcomes after the procedure occur in one patient per hundred thousand patients.

In order not to risk and not harm your health, it is worth undergoing an examination only as directed by a doctor and only if absolutely necessary.

After coronary angiography, the following complications may appear:

• heart attack;
• rupture of an artery or heart;
• heart attack or stroke due to a fragment of a blood clot from the vessel wall;
• arrhythmia;
• bleeding;
• allergy.

Although severe complications are rare, local complications at the puncture site are more common. This may be a hematoma, thrombosis, or injury to the artery. If an infection occurs, the wound may become inflamed.

Stroke and heart attack are rare. Only a doctor can assess the likelihood of complications before diagnosing.

How to prepare for coronary angiography

Preparation for the procedure of the patient must begin in advance. The night before, you should refrain from eating and drinking after 18:00, otherwise vomiting may begin during coronary angiography.

As for the use of drugs, you need to consult a doctor. Basically, it is not forbidden to use medicines. The only exception is drugs for diabetes. Since the patient will not be able to eat before undergoing the diagnosis, it is not worth lowering the sugar level, because the indicators can reach a critical level after the procedure.

Prepare for coronary angiography as follows:

1. A week before the examination, stop using medications that thin the blood.
2. Diabetics consult an endocrinologist about taking insulin preparations.
3. All jewelry and jewelery is left at home, and contact lenses may also need to be removed (if the patient wears them).
4. Be sure to empty the bladder and intestines before the procedure.
5. The hospital takes a standard set of things: bed linen, bathrobe, slippers, toothbrush and paste, soap, toilet paper. After the procedure, the patient will need to stay in the hospital for 2-3 days.

The patient must report allergies to medications before the examination, especially if he has an allergic reaction to alcohol, iodine, rubber products, novocaine, antibiotics, or X-ray preparations.

If emergency coronary angiography is performed, then the patient is given an ECG (electrocardiogram).

If the procedure is carried out according to plan, then a number of additional examinations are prescribed, namely:

• clinical and biochemical blood tests;
• general urine analysis;
• analysis for markers of hepatitis;
• testing for HIV and syphilis;
• ECG;
• Holter ECG monitoring.

Additionally, a chest x-ray may be ordered.

After coronary angiography, the patient must strictly follow all the recommendations of the doctor so that complications do not appear. The patient is prescribed bed rest, restrictions on movement, especially in flexion of the limb on which the procedure was performed. This is to prevent the opening of bleeding at the puncture site. Drinking plenty of fluids is essential to prevent kidney dysfunction.

How is coronary angiography done?

How is coronary angiography performed?

There are two options for coronary angiography: planned or emergency. Before the procedure, the patient undergoes an examination, where it is mandatory to identify the blood type and Rh factor.

The procedure is completely safe, but to a small extent pleasant. Usually it is carried out on an outpatient basis, but in some cases (if an operation is performed immediately after) it is done in a hospital in cardiology.

During the diagnosis of blood vessels, the person is conscious, coronary angiography is done under local anesthesia.

After the introduction of an anesthetic, a person does not feel pain or discomfort. If the procedure is not carried out for the first time, then the patient may feel discomfort in the puncture zone: all due to the fact that the anesthetic acts much weaker during repeated manipulations on the arteries.

The order of the procedure:

• After the action of anesthesia in a vein, a puncture is made and a special tube is inserted into it, through which all actions are performed.
• The catheter is advanced through the veins directly to the heart. In this case, the patient should not experience any pain.
• A substance is injected through the tube to conduct x-rays, which, getting into the blood, spreads through all the coronary vessels.
• The entire examination process is displayed on the monitor, the doctor takes pictures. It is in the pictures that blood clots and places of vasoconstriction are visible.

• After diagnosis, the punctured place in the vessel is sutured or sealed, then a bandage is applied.

During the examination, pulse and blood pressure are necessarily measured. After the diagnosis is completed, a decision is made on further treatment.

The most convenient and safest for the introduction of the catheter is the artery on the leg in the groin area. But after the procedure, a person should not stand up and bend his leg for an hour.

When inserting a catheter through the arm, an artery spasm or thrombus formation is possible, so this method is risky for the patient.

After coronary angiography, the tube may not be removed if an operation is performed after the diagnosis.

Tips after the procedure

The main recommendations are:

1. Bed rest and no exercise.
2. Limitation of mobility and flexion of the limb on which the manipulation was performed.
3. Drink plenty of water to prevent kidney dysfunction.
4. It is worth returning to physical labor only after a few days, if the patient feels well.

All measures are aimed at restoring a person and preventing bleeding in the puncture area.

The patient spends a day in the hospital. In case of sharp pain or swelling in the puncture area, a doctor's consultation is necessary. Shortness of breath, weakness and a decrease in pressure may indicate arterial bleeding, which is a threat to the life of the patient.

Due to the high likelihood of complications after puncture of the femoral artery, the patient should not refuse to stay in the hospital. It should be noted that the femoral artery is located at a depth of 2-4 cm from the skin and is a fairly large vessel. If you start moving a few hours after the procedure, bleeding will begin, which is difficult to stop.

This technique has the following advantages:

• no chance of serious bleeding;
• the patient may not adhere to bed rest;
• under the supervision of doctors after the operation can be no more than two hours;
• no side effects.

Coronary angiography should be carried out only by a qualified doctor who can not only carry out the intervention without complications, but also make the right conclusions and prescribe treatment.