Coronary Angiography
Diagnostic Procedure For Coronary Artery Disease

Angio for CHD


Coronary Angiography


What Is An Angiogram?
Why Is Testing For CHD Important?
Why Has My Doctor Recommended Angiography?
How Is It Performed?
Could There Be Complications?
How Do I Prepare For The Test?
Results Interpretation
Should I Have An Angiogram?
Are There Limitations To Angiograms?
How Much Do Angiograms Cost?


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Heart Disease in Women
Heart Disese Testing

What Is An Angiogram?

Angiography or coronary angiogram is a test which is used to diagnose coronary heart disease (CHD). The procedure involves the use of heart catheterization which means inserting a thin long hollow tube (catheter) into the coronary arteries which supply blood to the heart. Once in place a contrast dye is injected which doctors trace on an X-ray machine. If there are any blockages in the arteries this will show up during the test. It should also show the exact location of the blockage and size (how tight the blood vessels look). This will help a doctor to determine the best course of treatment for the patient. An angiogram is only performed for diagnostic purposes. In other words the doctor will not do anything to open any blockages he finds. That is the key difference between angiography (a diagnostic procedure) and angioplasty (a treatment procedure which is used to open blockages). About 1.5 million Americans undergo an angiogram every year. The test is usually performed in a specially equipped room called a cardiac catheterization lab at a hospital. Not all hospitals have this facility but ideally a patient should request treatment in one that does. It is also worth pointing out that angiograms are not only performed on the heart (coronary angiogram) but can also be used in other areas of the body such as the brain (cerebral angiogram), lungs (pulmonary angiogram), head and neck (carotid angiogram), legs or arms (peripheral) and the aorta (aortogram).

Why Is Testing For CHD Important?

Coronary heart disease (CHD), also referred to as coronary artery disease (CAD), occurs when fatty deposits called plaque buildup in the arteries over time. This process is called atherosclerosis. When fatty deposits build up, the arteries become clogged and blood flow is limited. This means the heart does not receive enough blood or oxygen (oxygen is delivered to the cells of the body via our blood). This can lead to angina symptoms and shortness of breath. Without treatment, the arteries will gradually become more blocked until blood flow is stopped. This leads to heart attacks and strokes. See: Heart attacks in women and stroke in women for further explanations.

Why Has My Doctor Recommended Angiography?

It may be that you are experiencing symptoms of coronary heart disease and have several risk factors for heart disease such as hypertension (high blood pressure) and high cholesterol.

The results from an ECG exercise stress test or echocardiogram (echo) indicate severe signs of heart disease. A diagnosis can only be conclusively given by an invasive procedure such as an angiogram. The doctor physically needs to see inside the arteries to diagnose the extent of damage.

Occasionally doctors refer patients whose stress tests were negative (no sign of disease). It may be that the patient however has complained of symptoms which make the doctor continue to suspect the presence of CHD.

You may be experiencing angina attacks which are steadily become more severe and frequent.

You may have chest pain which is becoming worse or the medications you are taking for the pain have stopped working.

You may have had a heart attack and doctors want to find where the blockage in the arteries is to determine the correct heart attack treatment. This this instance, angiography is performed as an emergency surgery.

How Is It Performed?

Most patients will arrive in hospital on the day of the procedure. It is normally performed on an out-patient basis. They may be given a sedative to help them relax just before the procedure begins. After changing into a hospital gown they will be taken to the cardiac catheterization lab (if the hospital has one). An area of skin in the groin will be antiseptically cleansed and shaved (if necessary) or an area of the wrist will be cleaned, depending on where the surgeon intends to insert the catheter. An anesthetic is injected into the skin where the incision will be made to numb the area. The patient will remain awake throughout the operation but should feel very little discomfort. A small incision is made in the groin (or arm) which allows the cardiologist direct access to a vein or artery. Using a special needle he injects the catheter into the vein and directs it, using an X-ray guidance machine, towards the heart. You will not feel the tube inside the blood vessels, but you may experience the sensation of a skipped or missed heartbeat. This is no cause for alarm. Your heartbeat will be monitored by electrodes placed on your chest which are connected to an ECG machine. Once the catheter reaches its destination, a special X-ray iodine dye is injected which allows the doctor to view the structure of the heart more clearly. The dye will be excreted naturally by the kidneys within a few hours. As the dye in injected you may feel a sensation such as nausea or flushing (like you are urinating, which you are not) but again, this is quite normal. However if you feel any chest pain, inform your doctor immediately. At different times you may be asked to hold your breath as the X-ray camera moves around taking images. The images are recorded permanently by the X-ray machine. Once the doctor is satisfied all the images have been taken, the catheter is removed. A bandage is placed over the site of entry and pressure is applied to it for 15 minutes to stop the bleeding. You will be moved back to the recovery or day ward and advised to rest for another couple of hours, allowing time for the entry wound to heal. Unless there were any complications or the results indicated immediate surgical intervention was necessary, you will be discharged the same day. You should arrange for someone to pick you up. Once you are at home, you should rest for another 6 to 8 hours before attempting to walk around. After this, you can resume normal activity. If you are a nursing mother you should wait for 24 hours before resuming breast-feeding to allow the dye time to be excreted out of the body.

Could There Be Complications?

As with any invasive procedure (meaning one which involves cutting the skin and entering the body), there are always some risks. The risk however of serious complication is very small and only really occur in patients who already have severe heart problems. Yet, people have died during this procedure. As a consequence a doctor will only recommend an angiogram if they feel the benefits outweigh the small risk.

Possible Minor Complications
1. The entry wound bleeds excessively.
2. An infection occurs in the wound which needs to be treated with antibiotics.
3. A mild allergic reaction to the contrast dye occurs but this can be treated with anti-allergy drugs.
Possible Serious Complications
4. Blood vessel puncture - this may be caused by the catheter tearing a vessel. Immediate open heart surgery is usually necessary to correct this.
5. Blood clot can form around the tip of the catheter, blocking the artery. This makes it necessary to operate and open up the vessel.
6. Kidney damage may result from a reaction to the contrast dye. This is more common in diabetics.
7. Stroke
8. Anaphylaxis shock - serious allergic reaction to the dye contrast. If you have a history of allergy to contrast dyes then you will be given a special medication before the procedure to lessen the allergic reaction.

How Do I Prepare For The Test?

• On the day of the test, or beforehand, you may need an electrocardiogram (ECG/EKG) test and blood tests to ensure that you are physically able for the procedure.
• If you are taking blood thinners or anticoagulant such as warfarin you will need to stop them for 2 or 3 days beforehand. This is to prevent excess bleeding at the point of incision.
• If you are diabetic and taking insulin you will receive special advice on when to eat and take your insulin on the day of the test.
• Avoid eating or drinking after midnight before the procedure.
• You may be asked to shave your groin area, if necessary, before the test.
• Do inform your doctor if you think you may be pregnant. If you are not sure, they can arrange a pregnancy test. See also: Heart disease in pregnancy.
• Before the procedure, empty your bladder and remove all jewelry.
• Remove any toe or nail polish before the test.
• Inform your doctor if you have asthma or have ever had a serious allergic reaction to any substance.
• Arrange for someone to collect you after the procedure. You should not drive yourself home.

Results Interpretation

When Do I Receive The Test Results?
A radiologist will analyze the images from the angiogram and send a report to your referring physician who will discuss the results with you. This usually takes 2-5 working days.

The test should conclusively diagnose if you have CHD or not, and if you do, it will indicate the severity. If the disease is not too severe, your doctor may recommend following coronary heart disease prevention tips such as quitting smoking, exercising and adopting a healthier diet. This will at least slow the progression of the disease and give you a better quality of life. You may also need to take drugs to control symptoms such as chest pain, high blood pressure and cholesterol levels. If the medications do not work, or if the doctor feels the disease is severe enough to put you at risk of a heart attack, you may be recommended surgery. The main surgical options are coronary angioplasty or heart bypass surgery.

Should I Have An Angiogram?

Most people who are candidates for angiography have 2 choices:

(1) Not to have an angiogram and to continue treating their symptoms with lifestyle changes and medication if necessary.
(2) To have an angiogram and find out if they need angioplasty or bypass surgery.

The decision will ultimately be yours. You will need to take into account the medical facts as well as your own personal feelings and resources. See also living with heart disease.

Reasons For An Angiogram

1. Your symptoms are no longer controlled by medication and have affected your daily life. You find it difficult to get about without experiencing chest pain or shortness of breath.
2. You will find out if you need angioplasty or heart bypass surgery.
3. You have a job which involves the safety of others and you need to know your risk of a heart attack.

Reasons Against An Angiogram

1. It carries serious risk complications such as heart attack, although this is rare.
2. It is expensive.
3. If you can control your symptoms of angina with medication an angiogram may not be necessary.
4. You may have other health problems which make bypass surgery or angioplasty impossible, so there is no point in an angiogram.
5. You smoke. Studies show that the risk of dying after bypass surgery or angioplasty is considerably higher for smokers.

Are There Limitations To Angiograms?

Yes, there are some specific limitations. Doctors have discovered that angiogram can miss a dangerous heart disease called coronary microvascular syndrome (MVD). This disease affects the tiny coronary (heart) arteries as opposed to the main ones (CHD) and signs are often missed during an angiogram. The disease is more common in women and researchers think this is because it is caused by a drop in estrogen levels during menopause combined with traditional risk factors for heart disease. MVD is dangerous because it can cause sudden death. It typically affects women with high blood pressure or diabetes. Diagnosing the condition is challenging because standard tests for CHD do not work. It is estimated that between 2 and 3 million American women are living with the disease - and although they may exhibit chest pain and have abnormal stress test results, an angiogram can appear normal. If you have a 'normal' angiogram but are still experiencing chest pains, ask your doctor if he thinks you might have a problem with your smaller arteries. He might tell you to complete a questionnaire called the Duke Activity Status which measures how easily you perform everyday tasks. It is useful in predicting heart attack risks.

Another problem area is patients who suffer coronary artery spasm, symptoms of which can come and go. This is a dangerous condition which is caused by hormone or neurological changes that cause the artery to spasm (it is not caused by blockages in the arteries). If symptoms are not present during the angiogram, it will be missed.

Finally it is worth mentioning that even if doctors do find blockages in the arteries, it is not always clear which blockage may be causing the patient's symptoms.

Other Types of Angiograms

Less invasive procedures such as a magnetic resonance angiogram (MRA) or computed tomography angiogram (heart CTA) may be an alternative option to a standard coronary angiogram. All CTA tests and some MRA tests still require the injection of a dye.

How Much Does An Angiogram Cost?

Typically, an angiogram costs about $1,500. Although the newer alternatives such as a heart CTA may be cheaper ($700), many patients who have a CTA often end up still needing angiography.

Other Methods of Monitoring The Heart
Holter Monitor - 24 hour testing
Event Monitor - Monitoring heart rhythm over weeks and months
Chemical Stress Test - Alternative to treadmill tests
Calcium Score Test - Non-invasive, CT scan to screen for heart issues
Nuclear Heart Scan - For diagnosing heart conditions.

  Related Articles on CHD Testing

For more cardiovascular health, see the following:

Congestive Heart Failure / Cardiac Rehab Exercise Program

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