Definition and Overview
A coronary angiogram is a diagnostic imaging procedure performed to examine the blood vessels of the heart to determine if arteries are blocked or narrowed. It is considered as the most common among a group of cardiac catheterization procedures that are used for the diagnosis of various conditions affecting the heart and its blood vessels.
Who Should Undergo and Expected Results
A coronary angiogram is recommended for those diagnosed with the following heart conditions:
- Congenital heart disease
- Cardiovascular disease
- Coronary heart disease
- Heart valve problems
- Heart failure
Blood vessel problems
It is also carried out if patients experience any or a combination of the following symptoms of heart problems:
Chest pain or angina, especially when increasing in intensity
- Unexplained pain in the neck, arm, or jaw
- Chest injury
- Burning sensation in the chest and upper abdomen
- Shortness of breath
- Irregular heart rate
- Abnormal heart stress test results
- Heart attack
- Aortic stenosis
Studies show that diseases of the heart are among the major causes of death and the largest health problems in most countries. They are also a common cause of hospitalizations. However, statistics also show that a large number of deaths related to heart disease are preventable. This is why early diagnosis, especially at the onset of symptoms, and regular monitoring, are of the utmost importance.
Additionally, a coronary angiogram can also be performed on patients who are scheduled to undergo a surgical procedure that, although unrelated to the heart, may put the patient at risk of having a heart issue during the procedure.
Normal results of a coronary angiogram mean that there are no blockages in the arteries and blood vessels leading to the heart. In this case, the patient is discharged a few hours after the procedure. Abnormal results, on the other hand, will show either mild narrowing or severe blockage in the passageways through which blood passes. In cases where the blockage is severe and potentially life-threatening, percutaneous coronary intervention or PCI is performed immediately following a coronary angiogram to clear said blockages.
How is the Procedure Performed?
Patients who are scheduled to undergo a coronary angiogram should check in at the hospital a few hours before the scheduled time to allow sufficient preparation time, which is used to administer mild sedatives to ensure that the patient remains relaxed all throughout the procedure.
A coronary angiogram begins with the cardiologist passing a catheter, a thin hollow tube, through a major artery (which could be in the arm or groin) before it is gradually advanced toward the heart. A contrast dye material is then injected into the catheter, which movement is monitored through an x-ray machine. As the dye slowly moves through the artery going to the heart, areas where there are some narrowing and blockages are easily detected. The cardiologist then captures the X-ray images for further examination before the catheter is removed.
The procedure usually takes around 30 minutes to an hour and the patient is fully awake all throughout. Since sedation and local anesthetics are used, the patient will be mostly comfortable and will only feel some pressure when the catheter is inserted followed by a warm sensation once the dye is injected.
Possible Risks and Complications
A coronary angiogram is considered as a safe routine diagnostic test. However, it should only be performed by experienced cardiologists or diagnostic team. This is because despite its relative safety, the procedure still carries a certain amount of risk.
Although major complications occur very rarely, patients who undergo coronary angiogram face the following risks:
- Irregular heart rate
- Injury to an artery or damage to the blood vessels
- Low blood pressure
- Allergic reaction to the contrast dye or anesthetics used during the procedure
- Blood clot
These risks tend to be higher among patients who also suffer from diabetes and kidney disease. There is also an increased risk of serious complications among patients who suffer from left main coronary artery disease or 3-vessel disease, with a mortality rate of 0.10 to 0.25 percent.
Thus, patients are carefully evaluated before they are cleared to undergo a coronary angiogram to prevent major complications from occurring.
“ACC/AHA Guidelines for Coronary Angiography.” American Heart Association Journals. http://circ.ahajournals.org/content/99/17/2345.full
Jones WS, Patel MR, Holleran SA, et al. “Trends in the use of diagnostic coronary angiography, percutaneous coronary intervention, and coronary artery bypass graft surgery across North Carolina.” Am Heart J. 2011 Nov; 162(5):932-7. http://www.ncbi.nlm.nih.gov/pubmed/22093211
Jansson K. Fransson SG. “Mortality related to coronary angiography.” Clin Radiol. 1996 Dec;51(12):858-60. http://www.ncbi.nlm.nih.gov/pubmed/8972650