Coronary Angiograms - Heartbt | Heart Disease | Heart Surgery | Chest Pains | Bypass

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Coronary Angiograms

Invasive Tests

Coronary Angiography

Coronary angiography is used to both establish whether or not a patient has significant coronary artery disease and to determine their suitability for interventional treatment, including Percutaneous Transluminal Coronary Angioplasty (PTCA) and Coronary Artery Bypass Graft (CABG) surgery.  

• Procedure

The procedure is carried out under local anesthesia and often as a day case. After administering a local anesthetic, fine plastic catheters are introduced using the femoral artery or brachial artery approach the former being the most commonly used. Different catheters are usually used to cannulate the left and right coronary arteries although it is often possible to cannulate both coronary artery vessels using a single catheter from the brachial artery approach. Once in the coronary artery opening, multiple views are taken of both coronary arteries from different angles to ensure that all proximal segments are adequately visualized.

For each view 5-10ml of contrast medium is injected by hand and the pictures are recorded on a digital storage system. Selective angiography is also the investigation of choice when re-examining patients who have recurrent symptoms following coronary artery bypass surgery (CABG). Specially shaped catheters are used to obtain views of the aorta, coronary veins graphs as well as the left internal mammary artery (LIMA), if these have been used as a conduit at the time of surgery. Also in this procedure a picture is taken of the left ventricle using contrast medium (dye) in order to determine its contractility. The doctor also pulls the catheter back from the left ventricle into the aorta in order to exclude any gradient due to aortic stenosis.  

• Indications

For further evaluation of patients diagnosed of coronary artherosclerosis, including patients with angina pectoris in whom correction via coronary bypass surgery or PTCA is contemplated.

  • Atherosclerosis in patients with ischemic heart disease.

  • An asymptomatic patient with a positive ECG ? believed that over 50% of these patients have significant coronary disease.

  • Postoperative angiography ? patients who have undergone coronary bypass surgery.

  • Presence of chest pain with uncertain etiology ? sometimes due to coronary artery disease.

• Contra- Indications

All contraindications are relative and best considered by determining whether or not coronary angiography is needed in an emergency or elective setting. In an emergency setting, information obtained by coronary angiography can be lifesaving and there may be no contraindications.
Examples of such emergency settings are:
1. acute myocardial infarction in a candidate for revascularization therapy
2. mechanical complication early after myocardial infarction that cannot be managed using medical therapy (such as suspected ventricular septal defect or papillary muscle rupture)
3. the presence, in some patients, of unstable angina refractory to medical management
4. suspected severe aortic stenosis in the patient with refractory heart failure or myocardial ischemia, acute aortic root dissection associated with myocardial ischemia
5. emergency assessment of a prospective cardiac transplant donor.  

Relative Contraindications:

  • A Recent stroke (within 1 month)

  • B Progressive renal insufficiency

  • C Active gastrointestinal bleeding

  • D Fever, which may be due to infection

  • E Active infection

  • F Short life expectancy due to other illnesses such as cancer or severe pulmonary, hepatic or renal disease

  • G Severe anemia

  • H Severe uncontrolled systemic hypertension

  • I Severe electrolyte imbalance

  • J Severe systemic or psychological illness in which prognosis is doubtful or behavior is unpredictable producing undue risk of cardiac catheterization

  • K Very advanced physiologic (not chronologic) age

  • L Patient refusal to consider definitive treatment such as angioplasty, coronary artery bypass surgery or valve replacement

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