IntroductionHeart diseases are among the most common causes of death in the world. Timely and accurate diagnosis of narrowing or blockage of heart vessels can save human lives. Heart angiography (Coronary Angiography) is the most accurate imaging method of coronary arteries that allows doctors to observe the location, severity and extent of the blockage and make appropriate decisions for treatment (drugs, angioplasty or surgery).

What is cardiac angiography?

Angiography is an imaging method using X-rays and contrast material, in which the path and condition of blood vessels to the heart (coronary arteries) are checked. In an angiogram, a thin, flexible tube (catheter) is inserted into one of the body's large vessels (usually from the groin or wrist) and guided toward the heart. Then the contrast material is injected into the vessels and their images are recorded using fluoroscopy.

Purpose of cardiac angiography

Angiography is often performed to diagnose coronary artery disease. Its most important uses:

• Diagnosis of coronary artery stenosis or occlusion
• Determining the exact location of blockages
• Decision to perform angioplasty, stent or bypass surgery
• Examination of heart vessels after heart attack
• Evaluation of performance of coronary grafts (after CABG)

Who needs cardiac angiography?

The doctor may recommend angiography in the following conditions:

• Frequent or unexplained chest pain
Abnormal results of an exercise test or nuclear scan History of heart attack or unstable angina
• Severe decrease in sports capacity
• Diagnosis or follow-up of coronary artery disease
• Evaluation of the performance of coronary grafts after surgery

Stages of cardiac angiography

1. Initial preparation: The patient must be fasting (usually 6 to 8 hours before). 2. Local anesthesia: in the groin or wrist area. 3. Catheter entry: The thin tube enters the body through the artery and is directed to the coronary arteries. 4. Injection of contrast material: This material makes the veins visible in X-ray images. 5. Imaging: Consecutive and clear images of the blood supply path of the heart are recorded. 6. End: The catheter is removed and the entry site is closed with pressure or a special device.

How long does cardiac angiography take?

The duration of angiography is usually 15 to 30 minutes, but depending on the complexity of the vessels, it may take up to an hour. After that, the patient stays under observation for a few hours.

Angiography through wrist or groin?

Two common ways to perform angiography:

Access route Advantages DisadvantagesWrist (radial)More comfort, faster mobility, less risk of bleeding in some people Access route is difficultFemoralCan be used in all people, easier control, need for more absolute rest, higher risk of bleeding

Does angiography hurt?

No. Angiography is performed under local anesthesia and the patient will only feel mild pressure during the procedure. The injection of contrast material may cause temporary heat in the body, which disappears quickly.

Possible side effects of angiography

Although angiography is a safe procedure, like any medical procedure, it may have rare side effects:

• Bleeding at the catheter insertion site
• Allergic reaction to the contrast material
• damage to blood vessels
• cardiac arrhythmia
• In rare cases: heart attack or stroke (very rare)

Care after angiography

After angiography, the following recommendations are recommended for a better recovery:

• Absolute rest for several hours
• drinking a lot of fluids to eliminate the contrast agent
• Avoid intense activity for 24 to 48 hours
• Checking the catheter insertion site for bleeding or bruising
• Consumption of medicines prescribed by a doctor

What is the difference between angiography and angioplasty?

• Angiography: Used only for imaging and diagnosis
• Angioplasty (or stenting): is performed along with treatment; In it, the narrowed vessel is opened with a balloon and usually a metal stent is placed inside it

Sometimes the doctor decides to perform angioplasty immediately after angiography, if severe and treatable stenosis is seen.

Advantages of angiography

• The most accurate method of checking blood vessels
• Possibility of directly observing the place of stenosis
• Guidelines for subsequent treatment (stent or surgery)
• Recognition of asymptomatic strokes
• helping to save lives in emergency situations

Cost of angiography

The cost of angiography depends on the type of hospital (public or private), equipment, access route (wrist or groin), emergency or non-emergency status. This service is covered in many insurances.

Is angiography repeatable?

Yes. In case of recurrence of symptoms, abnormal test results or the need to check the effectiveness of treatment, the doctor may prescribe angiography again. Of course, its repetition should not be unreasonable and unnecessary.

Summary

Cardiac angiography is an effective and accurate method for diagnosing coronary artery blockage, which is performed using a catheter and X-ray imaging. This method allows the doctor to decide whether the patient needs drug treatment, stenting or surgery. Performing angiography at the right time can prevent heart attack and irreparable damage.

Resources:https://phc.gov.ph/invasive-cardiology/

https://clinicsoncall.com/en/clinics/cardiology-cardiovascular-surgery/procedure-coronary-angiography

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