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Ischemic heart disease is considered one of the leading causes of death worldwide. This is a pathology that leads to disruption of the heart and is accompanied by a narrowing of the coronary arteries. Coronary angiography is used to diagnose coronary artery disease. The study shows the state of the vessels of the heart, blood circulation in them and the place of blockage. For such a procedure, there are rules for preparing the patient, contraindications and possible complications.
What’s this
The coronary arteries supply the heart with blood that carries nutrients and oxygen. This is necessary for the normal and uninterrupted functioning of the heart muscle. But sometimes, due to congenital anomalies, atherosclerotic plaques or spasms, the lumen in the arteries narrows, this is called stenosis. The most dangerous is occlusion, that is, the cessation of blood flow. This picture leads to coronary disease or myocardial infarction, in severe cases – death.
You can check the condition and functioning of the coronary arteries and vessels using coronary angiography. This is a type of angiography and fluoroscopy. The study is carried out by filling the arteries with a special substance that does not transmit x-rays – contrast. A catheter delivers contrast to the heart itself.
When the substance is distributed through the vessels, a series of x-rays are taken. On such images, the circulatory network, the patency of the arteries, and the stages of the disease are clearly visible. Based on such a study, the doctor makes a conclusion about the methods of treatment.
There are such types of examination:
- CT coronary angiography. The procedure is carried out using computed tomography, contrast is injected into a vein without catheterization directly of the coronary vessels of the heart. During the study, the radiologist sees the places of narrowing, the thickness of the walls of the vessels, the detailed structure of the circulatory system in this area.
- Interventional selective coronary angiography. The catheter is moved through the vein to the coronary artery itself, contrast is injected. The procedure takes place under X-ray control, the doctor sees the result in real time on the screen.
- Ultrasound coronary angiography. Unpopular technique, but used for research. It happens in the same way as the previous method, but an ultrasonic sensor is attached to the end of the catheter. Do this to assess the condition of the vascular walls.
- The most common method of examination in the CIS is interventional. Computed tomography is increasingly carried out in private clinics, as this method provides more information. Other methods of examination are prescribed in isolated cases.
When is coronary angiography indicated?
The purpose of this procedure is to examine in detail the condition of the arteries of the heart, to find a narrowing or blockage. Coronarography of vessels is usually used by cardiologists and cardiac surgeons. It is needed before complex operations to make the correct diagnosis and choose the right treatment. The patient is referred for coronary angiography in such cases:
- ineffectiveness of drug therapy in patients with coronary heart disease;
- positive stress test (stress echocardiography, velo-/treadmillmetry);
- before any heart surgery in patients over 40 years of age;
- angina pectoris after a previous heart attack, stenting or coronary bypass surgery;
- all urgent situations when there is a suspicion of a cardiovascular catastrophe – acute myocardial infarction (in the first 6 hours);
- unstable angina;
- uninformativeness of other diagnostic methods.
It is also prescribed to evaluate the effectiveness of therapy for the heart and blood vessels. Checking is needed for atypical pain in the chest without a clear cause. Often it is used before coronary artery bypass grafting and other interventions.
How to prepare
Coronary fluoroscopy is done after patient preparation. The procedure can be emergency or elective. Emergency diagnostics is carried out with minimal analyzes and tests, the type and number of such checks are selected by the attending physician depending on the situation. For a scheduled examination, appoint:
- consultation of specialists: neurologist, cardiologist, surgeon;
- blood tests: clotting, Rh factor and group, biochemical analysis;
- fluorography;
- allergy tests;
- Analysis of urine;
- electrocardiogram.
A complete list of examinations is prescribed based on the clinical picture. The procedure is carried out on an empty stomach to avoid nausea and gag reflex. If the contrast agent will be injected into the thigh, the day before you need to remove the hair from this part.
A few days before the scheduled study, the patient is shown a large amount of water, alcohol is prohibited. You can’t eat on the day of the event.
Before the examination itself, the doctor must be warned about what medications were taken, about his state of health. You also need to take a change of clothes and personal hygiene items for your stay in the hospital.
How is it made
Angiography of the heart vessels is performed in a hospital, the patient stays in the hospital for several days for careful preparation and supervision after the procedure. All manipulations are carried out in sterile conditions of the X-ray operating room – this is an office equipped specifically for such purposes. Before the invasion, the patient signs consent documents.
The patient then changes into a hospital gown. It is placed on the operating table and the position is fixed so that a sudden movement does not disturb the procedure. To monitor the heartbeat and pressure, a heart monitor is connected.
The anesthetist performs local anesthesia, the subject will not feel pain, but will remain conscious. A catheter is inserted into a vein in the thigh or arm.
The puncture site is selected depending on the clinical picture. More often, the radial artery on the arm is punctured – this is the most painless and safe, less often – the femoral artery in the inguinal region.
A conductor (thin wire) is inserted through the needle into the lumen of the vessel, the needle is removed. A catheter (hollow tube) is passed through the conductor. The catheter is advanced through the vessels to the coronary arteries themselves. There are no nerve endings in the vessels, so the patient will not feel anything. The catheter is supplied with contrast, which fills the vessels and is well visualized by fluoroscopy. On the screen, the doctor sees the progress of the catheter.
When the substance fills the arteries, they become clearly visible on the monitor. To obtain high-quality images, the radiologist may ask you to hold your breath. Data from the screen can be recorded on a digital medium so that doctors can later assess the patient’s condition.
If the patency of the vessels is impaired, a mesh stent can be installed or a balloon dilatation can be performed. This is done right during coronary angiography, such manipulations restore the lumen of the vessel and normal blood flow. After the procedure, the instruments are removed, the puncture site is disinfected and a tight bandage is applied.
The patient is still on bed rest for XNUMX hours. Some private clinics offer this service on an outpatient basis, the patient rests for a few hours and goes home. The whole process will take no more than an hour.
Reviews of patients confirm that fluoroscopy of blood vessels passes quickly and without severe pain. At the time of the introduction of the catheter, discomfort is felt, and when the contrast is received, warmth is felt in the chest.
Contraindications for the procedure
For coronary angiography, only relative contraindications are characteristic. There is a list of diseases that increase the risk of complications. But even against the background of such diseases, fluoroscopy of blood vessels can be performed if the patient’s life depends on it. Extremely carefully coronary angiography is performed when:
- impaired blood clotting;
- decompensated diabetes mellitus;
- allergies to a contrast agent;
- arterial hypertension;
- severe renal failure – the contrast agent has a bad effect on diseased kidneys;
- internal bleeding – postponed until this problem is resolved.
All possible contraindications should be taken into account at the time of the appointment of coronary angiography. Absolute contraindications include only a severe allergic reaction to contrast. In most cases, the study is simply transferred.
Is this test dangerous?
Everyone who has to go through this procedure is interested in what the consequences and complications can be. This type of diagnosis is considered a safe manipulation, the process is controlled by X-ray or computed tomography. Nevertheless, the risk of complications is still present, the most dangerous consequence is damage to the vessels by the catheter.
The likelihood of such a complication is very low, it can occur from sudden movements or carelessness of the doctor. If the patient has not been properly trained, an allergic reaction or bleeding may occur (with poor clotting). All these risks can be reduced if you carefully prepare, relax before the procedure.
If fear and anxiety prevail in the X-ray operating room, you can warn the doctor about this, he will prescribe sedatives.
Where can I go and how much does it cost
Such an examination can be done in a public or private clinic. It is carried out only in specially equipped operating rooms; in the private segment, CT is increasingly being used, which provides comprehensive information.
State medical institutions are also equipped with such equipment, but here they mainly use X-ray control.
The results of coronary angiography in both cases will be the same: the doctor will be able to determine the condition of the arteries. The price in the state segment will be from $ 140, for owners of compulsory medical insurance policy – free of charge.
In private medical and diagnostic centers, the cost of such a service is from $300.
When choosing, you should pay attention to the competence and experience of doctors, since the success of the operation will depend on this.
If doubts about complications and risks prevail, it is worth considering that not doing coronary angiography is much more dangerous.