Definition & Overview
Coronary angiography is a diagnostic medical procedure performed to observe the heart’s blood vessels using x-ray imaging technology. It is performed mainly to observe how blood flows through the heart’s arteries and determine if the arteries are narrowed or blocked. It is considered as one of the most commonly performed types of cardiac catheterization procedures, which are helpful in diagnosing and treating conditions that are related to the heart and blood vessels.
A coronary angiography works by injecting a contrast dye into the heart’s blood vessels, which is visible when an x-ray is used. It helps confirm a blockage and its location. The x-ray machine is then used to scan the target area and then sends the images to a monitor attached to it. This allows the doctor to observe the blood vessels and check for signs of problems. Procedures such as angioplasty and bypass surgery can be performed, if needed, based on the results of the diagnostic test.
Who Should Undergo & Expected Results
The doctor may recommend coronary angiography if the patient has the following conditions or symptoms related to them:
- Angina or chest pain
- Pain in the jaw, arm, neck, and chest
- Congenital heart disease
- Heart failure
- Aortic stenosis
- Recent heart attack
- Chest injury
- Blood vessels and/or heart valve problems
The coronary angiography procedure is usually done if the doctor suspects that the coronary arteries have become narrowed. It can also help determine whether the best procedure for the patient is angioplasty or bypass surgery. Performing this procedure helps relieve the symptoms and can lessen the risk of developing further complications. The procedure also provides the doctors a detailed image of the heart and its arteries, empowering them to make an accurate diagnosis.
If a patient recently had a heart attack and has received treatment to dissolve the clot blocking the blood flow in the artery, a coronary angiography may be performed to assess the heart’s condition and the success of the treatment, especially if chest pains are still present or if there is something that suggests the presence of possible complications that need further medical attention. Post-treatment, it is performed to ensure that the heart is in good condition.
How Does the Procedure Work?
A coronary angiography procedure is performed by using a thin and flexible tube called a catheter. This instrument is inserted into a blood vessel in certain parts of the body, such as the arm, groin, or neck. Through the main blood vessel or aorta, the catheter is moved to the coronary arteries. Since there are no nerves in the arteries, the movement of the catheter through it will not cause any pain while the test is being performed. There are various arteries in the human body, so different catheters are necessary to observe them. After an artery has been observed, the catheter will be removed and a different catheter will be inserted through the same area where the previous one was inserted.
A contrast dye is also used to make the arteries easier to observe. This dye is released into the bloodstream through a tube. An x-ray machine is then used to take images of the coronary arteries while the dye is flowing through them. The images are then shown on a monitor.
The patient remains awake throughout the whole procedure, which is performed under local anaesthesia. It does not cause severe pain, except for a minimal discomfort in the area where the catheter is inserted. Patients should be prepared, however, for the possibility of some discomfort after the dye has been introduced to the body. This does not last very long and the dye mostly just gives a warm sensation in the upper chest for about 10 to 15 seconds. The whole procedure may take about 30 to 40 minutes to finish, after which the patient is usually given the permission to go home after four to six hours unless further observation is required. Through the images taken using the x-ray machine, the doctor can observe the heart and its different parts. This will allow the doctor to confirm the presence or absence of a blockage in the arteries and to determine whether it is best to perform a bypass surgery or angioplasty to correct the condition.
Possible Complications and Risks
Coronary angiography comes with lesser risks compared to other similar coronary diagnostic procedures. It is very safe as long as it is performed by a licensed medical professional. Like all procedures, however, there is a possibility of complications, however small. Serious complications that may occur include the following:
- Heart attack
- Allergic reaction to dye
- Low blood pressure
- Irregular heartbeat
- Injury to the artery
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Kern M. Catheterization and angiography. In: Goldman L,Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 57.
Popma JJ. Coronary arteriography. In: Bonow RO, Mann DL,Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 21.]