Introduction
In order to diagnose the exact location of a coronary artery obstruction, we use an X-ray image of the heart circulation. The aim of an angiogram is to identify the obstruction to blood flow and to choose the best technical solution for the treatment of heart angina or acute myocardial infarction.
The decision about the best technical solution will determine whether to do a direct intervention either through a more radical coronary bypass or through angioplasty, or through an intravascular approach, or a more conservative treatment relying exclusively on medical therapy.
Description
From beginning to end, the procedure will take around 90 minutes, of which about half an hour is strictly necessary to accomplish the coronary angiogram.
During this procedure, a small catheter with a diameter of 2 to 3 millimetres is introduced through the skin into the artery in the groin or an arm.
With the help of a fluoroscope (a special x-ray instrument), the catheter can be identified and guided to pass through the openings of the coronary arteries, these are the blood vessels which supply blood to the heart.
Next, the patient is injected with an iodine containing contrast dye by an intravenous line to guarantee the best images of the blood flow inside the arteries, as well as to show blockages and any irregular motions of the heart wall.
During this period, the patient may feel some discomfort and may be hot and flushed.
When the angiogram is finished, the catheter is removed and the puncture wound is sealed with a cap inserted under the patient’s skin, or with pressure on the point where the catheter was inserted.
Anesthesia
This procedure is performed with a local anaesthetic and an intravenous sedative. Sedation is used both to calm down the patient and to stabilise the heart frequency, thus allowing better images to be achieved.
Indications
The coronary angiogram is performed on patients with chest pain or angina and on patients with a history of heart attack, shortness of breath, palpitations or dizziness.
Risks, Complications and Side Effects
Complications in a coronary angiogram occur in less than three percent of all such patients. Risks increase significantly in patients who are above 70 years age, or patients with diabetes, atherosclerosis, carotid artery disease or kidney failure.
One of the major complications is an allergic reaction induced by the dye injection, which can cause shortness of breath, a drop in blood pressure, loss of consciousness, or skin swelling.
If the patient has kidney problems, the dye used can decrease renal function. Blood can form a clot around the catheter and that clot could be responsible for an arterial thrombosis which will require surgical intervention.
Also, some debris on the wall of the artery can be released and pass down the artery, causing a stroke or a blockage, which also may need surgery. Bleeding is another possible complication when dealing with this technique.
Post-operative care, Convalescence
The patient should rest with the legs kept straight for a few hours. The patient can then be discharged quite soon after the procedure. Following the procedure, patients cannot carry heavy objects and cannot perform exhausting activities.
Usually, patients may feel severe pain or swelling, which can be minimized with pain medication. Take care of the area where the catheter was inserted. Both significant swelling and severe pain resulting from the catheter will require medical attention.
Recovery Time
Patients are able to return to their normal life, usually one week after the procedure.