Coronary angiography of the heart – indications, course. How to prepare for coronary angiography? [WE EXPLAIN]

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Coronary angiography is a radiological diagnostic procedure that allows to assess the patency of the vessels supplying the heart muscle. This is otherwise the angiography of the coronary arteries, or literally x-rays of them. When is a coronary angiography performed and how? What are the contraindications to the procedure and possible complications?

The heart muscle is nourished by the oxygen-rich blood flowing through the coronary arteries. These are the vessels that depart from the main artery of the human body – the aorta. These arteries wrap around the heart muscle like a wreath. If the lumen of any of them is narrowed (most often as a result of atherosclerotic lesions), the heart muscle is not supplied with enough blood (nourishment). We are talking then about atherosclerosis of the coronary vessels, and clinically about ischemic heart disease (coronary artery disease). It manifests itself with retrosternal pains that occur most often during exercise, and sometimes also at rest.

Coronography is performed not only to diagnose the disease, but also before the planned surgery, eg before angioplasty or the establishment of “bypass”. On its basis, the patient can also be qualified for further treatment, which may be conservative, but also require cardiac surgery. This examination requires hospitalization for several days.

Coronary angiography is performed urgently or electively, using local anesthesia. The patient may be referred for a diagnostic procedure by a physician if appropriate indications are identified. Adequate is also important preparation for coronary angiographywhich may require additional preliminary tests and a detailed medical history, e.g. for other chronic conditions or medications you are taking. Additional recommendations regarding the immediate preparation of the patient before the examination should also be taken into account.

Read more: How is the heart examined?

Indications for coronary angiography

Coronary angiography is an invasive procedure, therefore it is performed only in specific situations and on the doctor’s orders. This is because the examination has some limitations, it should not be performed in every person, and it is necessary to carefully qualify the patient.

Coronary angiography is performed in the following cases:

1. as part of the diagnosis of ischemic heart disease,
2. assessment of the advancement and location of changes in the coronary arteries in people with:
3. suspicion of significant changes in the coronary arteries,
4. people diagnosed with stable angina,
5. patients with myocardial infarction with ST segment elevation (STEMI),
6. people with acute coronary syndrome without ST segment elevation (so-called NSTEMI) in people at high risk (age, male gender, hypertension, diabetes, hypercholesterolaemia),
7. recurrence of ischemia after revascularization surgery,
8. in people with valvular disease,
9. patients with heart failure if there is a suspicion that it has developed due to myocardial ischemia,
10. patients with dissection or aneurysm of the ascending aorta, if information about the condition of the coronary arteries is important for further management,
11. in the course of hypertrophic cardiomyopathy with angina,
12. after sudden cardiac arrest of unknown etiology

The test is also performed as part of the diagnosis of anatomical defects of the coronary vessels.

To check the condition of your heart, it is also worth performing blood tests that will check its basic parameters. Such tests should be performed at least once a year as part of the prevention of cardiovascular disease. You can now buy a package Heart control – blood tests on Medonet Market, thanks to which you can determine the fitness of your heart.

In the case of early established indications for coronary angiography, the examination is performed electively. There are also emergency procedures, especially when a patient develops one of the acute coronary syndromes. Such situations may require coronary angiography, which is then a pre-examination examination of a specific cardiac surgery.

Before an invasive examination or procedure, it is worth getting vaccinated against hepatitis B (hepatitis B), i.e. infectious jaundice. The vaccine is given in 3 doses (the second dose is 1 dose and the third dose is 6 months after the first dose). Approx. 3-4 weeks after receiving the second dose of the vaccine, the body gains immunity. It is worth remembering about good preparation for the examination.

A few days before the coronary angiography

Before the coronary angiography, ask your doctor if you can take all the medications you take every day before the examination. Some people are not recommended to take them on the day of undergoing coronary angiography (e.g. some diabetes medications – metformin). About 3 days before the planned procedure, stop taking Acenocoumarol (Sintrom) or Warfarin (Warfin) and use heparin (in the form of subcutaneous injections). However, it is not necessary to stop taking aspirin.

Before coronary angiography, it is worth doing several tests:

1. morphology,
2. coagulogram (PTT, INR),
3. biochemical tests,
4. determination of the blood group.

Ask the referring doctor whether all these tests will be performed at your hospital or whether they should be performed before reporting for the procedure.

On the eve of coronary angiography

Before coronary angiography, it is very important to hydrate the body properly (at least 1,5-2 liters of fluids per day). If you have been diagnosed with chronic kidney disease (formerly known as renal failure), you should drink more fluids (about 3 liters per day) also after the procedure.

On the day of the coronary angiography

You should go to the coronary angiography on an empty stomach (about 6-8 hours without food or drink). You can only take small amounts of water. Before the coronary angiography procedure, one should not smoke (approx. 6-8 hours). Usually, in the hospital itself, you have to shave the groin (if the procedure is to be performed through the femoral artery), take a shower. Women should remember to wash off the nail polish on their hands and feet. Jewelery (rings, pendants, earrings, watches etc.) must be removed. The dentures should be removed.

Contrast is administered during coronary angiography. If you are allergic to contrast agents, be sure to inform your doctor before coronary angiography! People who are allergic to pollen, chemicals, and certain foods may develop a rash and persistent itching during the examination. If you start to feel itching or any discomfort during coronary angiography, please inform your doctor.

The relative contraindications for the study are:

1. advanced kidney disease
2. pulmonary oedema,
3. severe hemorrhagic diathesis,
4. active bleeding from the digestive system,
5. a recent stroke,
6. severe anemia,
7. severe arterial hypertension,
8. severe, symptomatic electrolyte disturbance
9. poisoning with drugs from the group of cardiac glycosides,
10. allergic to contrast,
11. chronic disease (e.g. cancer) significantly shortening the expected survival time,
12. aortic valve endocarditis,
13. patient’s lack of cooperation.

The coronary vessels can be accessed by a physician in two ways: groin – from the femoral artery or through the wrist – from the radial artery.

When you enter the operating room, a nurse will stick ECG electrodes to the skin on your chest. Then the area where the puncture will be performed (around the wrist or groin) is disinfected. Before that, you may need to epilate the area. Then you may feel a slight sting, local anesthesia is administered. The doctor cuts the skin and then punctures the artery with an angiographic needle. It is very important not to move at this point.

You may feel warmth around your thigh or forearm and hand when you cut the skin and artery. The doctor introduces the guide through the angiographic needle (also called the leader) that goes all the way to the aorta. The needle is then removed and the vascular sheath is inserted along the guide – a kind of plastic tube through which the contrast is administered. The moment of inserting the T-shirt can be unpleasant, sometimes a bit painful.

Thanks to the sheath and the leader placed in the aorta, the doctor introduces diagnostic catheters to the left and then to the right coronary artery. The catheter material absorbs X-ray radiation, thanks to which it is visible on the X-ray monitor screen throughout the procedure. Next contrast is administered through the catheters (a liquid substance that is clearly visible in the X-ray image). The X-ray tube registers the process of filling the vessels with the contrast. In order to visualize the coronary arteries more precisely, the contrast is applied several times to the left and right coronary arteries. The setting of the X-ray tube also changes while the contrast is being administered. Thanks to the administration of the contrast, the doctor will be able to see the course of the vessels supplying the heart muscle with oxygen in the X-ray image, and assess possible narrowing within them.

After giving the contrast, you may have the impression of a spreading feeling of warmth. It passes by itself after about 30 seconds. Contrast mixes with the blood and flows through the coronary vessels, which is recorded on the X-ray monitor. If there are constrictions in the vessels or the lumen of the vessel is completely occluded, the passage of the contrast will be difficult, which will be visible on the X-ray image.

After the contrast filling of the coronary arteries, the doctor may also perform ventriculography. It is a test consisting in inserting a catheter into the lumen of the left ventricle and administering a contrast through it. Ventriculography allows to assess the contractility of the left ventricle. The entire procedure is recorded in digital technology. After its completion, the doctor can watch the movie on CD.

Immediately after the end of the examination, that is, in the Hemodynamic Laboratory, the catheter will be removed. Then they are removed so-called. vascular sheaths, i.e. plastic tubes through which the catheter was previously inserted. After removing the sheaths, the puncture site must be tightly compressed with pressure dressings so that there is no bleeding or a hematoma. Depending on the injection area, they are left for about a few hours: 2-4 (groin) or about 1 hour (wrist).

During the procedure, the balloon is inflated, which expands the lumen of the artery and at the same time pushes the calcification into its wall. For strengthening, the doctor may additionally implant (implant) a stent. It is a cylindrical-shaped metal mesh placed in a narrowed or previously obstructed vessel.

If the coronary angiography shows strictures in the lumen of the coronary vessels, your doctor may suggest:

1. conservative treatment (taking medications),
2. performing lateral angioplasty at the stenosis site (e.g. with stents),
3. surgical treatment (coronary aortic bypass, commonly known as “bypass”).

If the procedure is not complicated in some centers, you can go home the same day or the next morning.

Complications after coronary angiography

Coronary angiography is an invasive examination. Its execution is therefore subject to certain risks. However, it is small and amounts to approximately 3-5 complications per 1 procedures performed. The most common complication is a hematoma at the injection site and pseudoaneurysm of the arterythrough which the guide was inserted (femoral or radial artery). The risk of complications increases in the elderly and those with numerous comorbidities (diabetes, hypertension, renal failure).

Temporary or permanent impairment of kidney or brain function, damage to large arteries, heart attack or cardiac arrest and death during or shortly after the examination is rare.

Read also:

1. Computed tomography of the heart – an alternative to coronography
2. How can I prevent a stroke?
3. Ventricular tachycardia – symptoms, treatment

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