Coronary angiography
Coronary angiography is a radiopaque research method that evaluates the condition of the arteries of the heart. Coronary angiography is the most accurate and reliable way to diagnose coronary heart disease, which allows you to decide on the patient’s treatment tactics in each specific situation, for example, the possibility of continuing treatment with medications, the need for such treatment procedures as angioplasty and stenting or coronary artery bypass grafting. This procedure is invasive, which involves the introduction of a special catheter in an operating room and can be performed both for diagnostic purposes and to monitor the condition of blood vessels after operations already performed.
Interpretation of coronary angiography
How coronary angiography of the heart vessels is performed and what it is is clear. The main thing is not just to take a picture, but to interpret it correctly, that is, decipher it. For the most informative and accurate result, several specialists are involved in decoding: a radiologist, a cardiologist, a vascular surgeon and others.
The thickness of the vessels, their length and width are assessed from the images. Compactions and darkening are revealed. An alarming signal is a violation of the boundaries of blood vessels - blurriness and indistinctness. The pathology of the vessels will also be indicated by their incorrect location.
Why is coronary angiography performed only in a hospital setting?
The main reason that made it mandatory for the patient to be in the hospital when performing this study was the need for puncture (puncture) of the peripheral artery (femoral) and associated complications. The femoral artery is a large vessel located at a depth of 2-4 cm from the skin surface in the groin area. To prevent bleeding, which can be dangerous, after the study the patient is prescribed a limited motor regimen under the supervision of medical personnel. But recently another access has appeared - through the small radial artery, which we palpate on the wrist. An approach called radial, which does not result in serious bleeding. The patient can get up immediately after the examination; bed rest is not necessary. Observation is limited to a few hours. In the CELT clinic, radial (radial) arterial access is used as the main approach. Experience with this technique indicates a lower incidence of local complications, which is 0-0.7%. The possibility of early rehabilitation of the patient after CAG with radial access and the almost complete absence of side effects make it possible to perform CAG on an outpatient basis.
Contraindications for the procedure
Coronary angiography has only relative contraindications. 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. Coronary angiography is performed with extreme caution when:
- impaired blood clotting;
- decompensated diabetes mellitus;
- allergies to 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 must be taken into account when prescribing coronary angiography. Absolute contraindications include only a severe allergic reaction to contrast. In most cases, the study is simply postponed.
How is outpatient coronary angiography performed?
The algorithm for performing coronary angiography on an outpatient basis includes three stages. At the first stage, patients are selected for a diagnostic procedure, and the necessary additional examinations are carried out. Indications for coronary angiography : - identified or suspected ischemic heart disease; - pain in the chest, suspicious for angina pectoris; - myocardial infarction; - planned surgery for heart defects; - heart failure, ventricular arrhythmias. Indications for coronary angiography are determined by the attending physician in accordance with accepted criteria. In preparing the patient for coronary angiography , the necessary tests and studies are performed. In addition to these, additional studies may be prescribed. The second stage of outpatient CAG angiography procedure itself . The patient is admitted to the day hospital ward. After assessing the stability of his condition, premedication is administered and he is transported to the cath lab, where the coronary angiography . After anesthetizing the access area, research begins - a special catheter is passed through the artery of the forearm into the lumen of the coronary arteries . Using a catheter, a radiopaque substance is injected into the blood, thanks to which the lumen of the vessels becomes visible on a special device - an angiograph. During coronary angiography, the degree and size of damage to the coronary vessels is determined, which determines further treatment tactics. This procedure is low-traumatic, which allows it to be performed under local anesthesia without the use of general anesthesia. The duration of the procedure, as a rule, does not exceed 20 minutes. From the operating room, the patient, accompanied by medical personnel, is taken to the day hospital ward. The third stage of outpatient coronary angiography is observation of the patient in a day hospital ward for 4-5 hours after the examination. In the ward, the patient can drink water or juices without restrictions and have lunch. If there are no complications, the patient is sent home. On the day of the outpatient coronary angiography, the patient receives a conclusion with recommendations on further treatment tactics and a disk with the results of coronary angiography . If complications arise during coronary angiography or during the control period, patients are hospitalized in the intensive observation unit of the hospital.
Is this examination dangerous?
Everyone who is about to undergo this procedure is interested in what the consequences and complications may be. This type of diagnosis is considered a safe manipulation; the process is controlled using an X-ray or computed tomograph. Nevertheless, the risk of complications is still present; the most dangerous consequence is damage to blood 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 undergone proper preparation, an allergic reaction or bleeding may occur (with poor clotting). All these risks can be reduced if you carefully prepare and relax before the procedure.
If you are overcome by fear and anxiety in the X-ray operating room, you can warn the doctor about this and he will prescribe sedatives.
FAQ:
Question: I am 56 years old and have coronary heart disease . The cardiologist recommends a coronary angiography . I don't quite understand what this is? Answer: Coronary angiography is a study of the vessels of the heart, which, like a crown, surround the heart, supplying it with oxygen-rich blood. These are called coronary arteries. Narrowing of the coronary arteries leads to a decrease in blood supply to the heart, which leads to oxygen starvation, i.e. to cardiac ischemia. It is very important to know the condition of the arteries of the heart, because... the obstruction to blood flow can be eliminated, radically relieving the person of the symptoms of coronary heart disease . Question: How is coronary angiography performed? Answer: Coronary angiography is an x-ray examination in which a special contrast agent is injected into the vessels of the heart using a flexible thin probe. As the contrast agent passes through the vessels, short-term x-rays are taken with significant magnification using high-resolution equipment. The slightest changes in the coronary bed are visible “at a glance.” The results are recorded in digital format and are available for viewing on any personal computer. Question: Is coronary angiography performed under anesthesia? Answer: No general anesthesia is required. The pulse is determined in the groin area or on the wrist, and a probe or catheter is inserted into the lumen of the artery under local anesthesia. The subject does not feel how the catheter moves through the vessels, because There are no sensory nerve endings inside the arteries. There is no pain, the patient is fully conscious and, together with the operator, monitors the progress of the study on the monitor. The duration of the procedure is no more than 15-20 minutes. Further monitoring of the patient for several hours is necessary. At the CELT clinic, coronary angiography is performed exclusively through the radial artery (at the wrist). Immediately after the examination, the patient can get up and walk, the bandage on his arm does not limit him in any way (see ambulatory coronary angiography ). After 4 hours the patient is discharged home. If the examination is carried out through the groin, then bed rest is necessary and the period of stay in the clinic is extended to a day. Question: If coronary angiography does not reveal narrowing in the vessels of the heart, then there is no coronary heart disease? Answer: Yes, the absence of changes in the coronary arteries practically excludes the diagnosis of coronary heart disease . In rare cases, ischemia of the heart muscle can occur in the presence of “normal” coronary arteries, but the absence of damage to the arteries of the heart is the most reliable predictor of a good prognosis. This is very important information for choosing the right patient management tactics. Question: At what age is coronary angiography , what are the contraindications to coronary angiography? Answer: Coronary angiography is performed at any age, in all cases when there is a need for it, namely if the patient has angina pectoris after myocardial infarction. Coronary angiography, in the first hours of myocardial infarction , makes it possible to determine where the blockage of the vessel is causing the heart attack and immediately eliminate it. Coronary angiography is necessary for all adults with heart defects before surgery, before “major” vascular operations. Some patients at high risk for coronary heart disease , such as diabetes , may not have symptoms of the disease. In this case, coronary angiography is, in fact, the only reliable way to exclude or confirm coronary disease . Question: I need a coronary angiography . I contacted the Federal Center. They gave me a list of tests and put me on the waiting list. They said I needed hospitalization for 2-3 days. Answer: We coronary angiography on the day of admission! All tests and additional studies are carried out within 4-5 hours, including coronary angiography. Question: How can I get a coronary angiography at your center? Answer: You can come any day, appear at the clinic, at the cardiovascular surgery department in the morning at 08:30 on an empty stomach, PRIORLY AGREEING YOUR ADMISSION WITH US BY PHONE 305-34-04 or 788-33-88. Before admission, before performing coronary angiography , you should have on hand the results of the following tests and studies: - General blood test; — General urine analysis; - Biochemical analysis - protein, urea, creatinine, bilirubin and its fractions, lipid profile, potassium and sodium, glucose; — Coagulogram; — Blood type and Rh factor, Rh antibodies; — Blood test for HIV, RV, antibodies to hepatitis B and C; — Ultrasound of the heart, ECG. If you do not need tests and studies, then they can be performed with us on the day of admission. Question: coronary angiography cost you and what are the prices for coronary angiography in Moscow in other clinics? Answer: Coronary angiography including the stay costs 30,000 rubles. Today, if you analyze the prices for coronary angiography in Moscow, this is the minimum cost.
Possible complications after the procedure
Like any other surgical intervention and violation of the integrity of the vessel, coronary angiography can have a number of complications, even if it is performed by an experienced specialist. Possible complications include:
- heart attack;
- rupture of an artery or heart;
- heart attack or stroke due to a blood clot breaking off from the wall of a vessel;
- arrhythmia;
- bleeding;
- allergies.
Of course, complications do not always arise and are often limited to small hematomas or swelling at the puncture site. However, the possibility of serious consequences cannot be excluded, so before the procedure you need to carefully study the contraindications to it.
Contraindications for the study
Contraindications for cardiac vascular examination with contrast are:
- various respiratory diseases that are accompanied by elevated body temperature;
- anemia;
- open bleeding of various locations;
- low potassium levels in the blood;
- poor blood clotting;
- diabetes;
- obesity or underweight;
- renal, heart failure;
- lung damage.
Preparation
For a correct examination result, proper preparation for intestinal colonoscopy under anesthesia is important. It is necessary to free it as much as possible, for which cleansing enemas or special laxatives are used. 3-4 days before the procedure, fatty foods, gas-causing foods, flour products and milk should be excluded from the diet. You can have your last hearty lunch the day before, before 12 noon. The menu allows low-fat boiled fish, broth, semolina porridge, and scrambled eggs. Then only water without gas is allowed. You need to do an enema at night.
Given the significant pain of the examination, colonoscopy is best performed under anesthesia. Different types of anesthesia and anesthesia are used:
- local anesthesia involves lubricating the tip of the colonoscope with a gel that reduces sensitivity. However, this is an ineffective method that practically does not eliminate discomfort and pain;
- sedation is the process of putting the patient into a light sleep using intravenous administration of special drugs. The doctor begins the procedure only after he has completely fallen asleep, and awakening occurs after the end of the study. As long as the effect of the drug lasts, the patient is in a relaxed state, does not feel fear or pain, and awakening occurs easily and naturally.
Sometimes the procedure is done without anesthesia. Many people want to know what they will experience during the examination. However, it is impossible to answer unequivocally, because each person has his own, individual threshold of sensitivity. For some, the discomfort will be tolerable, but for others, the pain will not allow you to complete the procedure without the use of anesthetics. This issue is discussed with the attending physician, as well as how to prepare for a colonoscopy under anesthesia.
