What is Diagnostic Coronary Angiography?
Diagnostic coronary angiography is a specialized medical procedure used to assess the condition of your coronary arteries which are the blood vessels that supply oxygen-rich blood to your heart. This test helps doctors determine if there are any blockages or narrowing in these arteries that could be causing chest pain (angina), shortness of breath, or other heart-related symptoms.
During the procedure, a special dye (contrast agent) is injected into the coronary arteries, and X-ray imaging is used to create detailed pictures of blood flow in your heart. These images allow cardiologists to diagnose conditions such as coronary artery disease (CAD) and decide on the best course of treatment.
Why might you need a coronary angiography?
Your doctor may recommend a coronary angiography if you experience symptoms that suggest a problem with your heart’s blood supply, such as:
• Persistent chest pain (angina): the most common indication for coronary angiography
• Shortness of breath: this is a common presentation in chronically blocked arteries
• Unexplained fatigue: an unusual presentation which should be coupled by abnormal tests
• Dizziness or fainting: an unusual presentation which should be associated with an abnormal test or significant rhythm disturbance
• Abnormal results from other heart tests, such as an electrocardiogram (ECG) or stress test
The procedure is also used in emergency situations, such as a suspected heart attack, to quickly identify and treat blockages in the coronary arteries.
Patients undergoing open heart surgeries such as valve replacement due to leaky or narrowed valve would need to have their coronary arteries checked before the surgical procedure. This would allow the cardiac surgeon to know the coronary anatomy and to plan whether there would be an indication for fixing the coronary artery disease at the same time or not.
Preparing for the procedure
Before undergoing a coronary angiography, Dr Amin will provide some specific instructions either in clinic consultation or over the phone if you are referred by a colleague. Here are some general guidelines:
• Consenting: Dr Amin will provide you a detailed discussion regarding the procedure steps, benefits and risks of the procedure. This can be done in a face to face consultation or over the phone if you have been referred for the procedure. You will need to sign a formal consent form on the day before attempting the procedure. If you have any questions, Dr Amin would be happy to discuss at any point before the day.
• Fasting: This is not indicated in most of cases unless there would be an indication for deep sedation or anaesthetics requirements. You may need to stop eating and drinking for a few hours before the procedure.
• Medications: Inform Dr Amin about all medications you are taking, especially blood thinners, diabetes medications, or any drugs that affect kidney function. Dr Amin might give you instructions to stop some medications particularly strong blood thinners such as Apixaban, Rivaroxaban or Edoxaban only on the day of the procedures. If you are diabetic, metformin might need to be stopped in certain cases.
• Allergies: Let your doctor know if you have allergies, particularly to iodine, shellfish, or contrast dye.
• Kidney Function: Since the contrast dye is filtered through the kidneys, patients with kidney disease may need additional precautions. Dr Amin or the admin team at the Great Western Hospitals Private Healthcare in Swindon might arrange for kidney function test ahead of the procedure. If the procedure is arranged at a short notice, bloods can be taken on the day.
What Happens During the Procedure?
1. Preparation
You will be asked to attend the Cardiac Cath Lab suite at the Great Western Hospital in Swindon early on the day usually 08:00. You will be met by our friendly nursing team who will guide you regarding preparation and will fill in a questionnaire for the procedure including medical history and medications. A cannula will be inserted in one of your veins in case you need medications to be given.
Dr Amin will meet you to discuss if you have any questions and to go briefly through the details of the procedure for recap. You will be asked to sign a consent form if you have not done earlier. There would be an opportunity to discuss any concerns and ask questions regarding the procedure and possible outcomes.
You will be taken to a catheterization lab, where you will lie on a special X-ray table. A nurse will clean and shave the area where the catheter (a thin, flexible tube) will be inserted – usually the wrist (radial artery) or groin (femoral artery). A local anesthetic is applied to numb the area.
2. Catheter Insertion
Dr Amin will make a small puncture and insert a thin flexible tube into your artery. The catheter is then carefully guided through the blood vessels to reach the coronary arteries under X-ray guidance.
3. Contrast Dye Injection
Once the catheter is in place, a contrast dye is injected into your coronary arteries. You may feel a brief sensation of warmth when the dye enters your bloodstream.
4. X-ray Imaging
A special X-ray machine (fluoroscopy) captures real-time images of blood flow in your coronary arteries. These images help the doctor identify any blockages or narrowing in the arteries.
5. Completion
After the necessary images are taken, the catheter is removed, and pressure is applied to the puncture site to prevent bleeding. A small bandage or closure device is usually used to seal the artery.
What happens after the procedure?
Recovery and Monitoring
• If the catheter was inserted through the wrist, you may be allowed to sit up sooner. If it was inserted through the groin, you may need to lie flat for a few hours.
• Your heart rate, blood pressure, and puncture site will be monitored for any complications.
• You may be advised to drink plenty of fluids to help flush the contrast dye from your kidneys.
Going Home
• Most patients can go home the same day, but someone should accompany you as you may not be able to drive.
• You should avoid heavy lifting or strenuous activities for a few days.
• If you notice excessive bleeding, swelling, or severe pain at the puncture site, contact Dr Amin immediately via the provided contact number. You may be asked to come back for checking by the Cath Lab team.
What does the result mean?
You will be provided with a detailed Diagnostic Coronary Angiogram report which includes the details of your coronary anatomy, medications and equipments used as well as the contrast volume and radiation dose. The report will also include the conclusions and recommendations for management plan. Some reports will include captured images for your coronary vessels.
Dr Amin will analyze the angiography images to determine:
• Normal Arteries: No blockages or narrowing, indicating a healthy blood supply.
• Mild Narrowing or atheroma: May not require immediate treatment but may need lifestyle changes and medication.
• Significant Blockage: If a major artery is significantly narrowed, further treatment may be required, such as:
- Medications to manage symptoms and slow disease progression.
- Angioplasty and Stenting: A procedure where a small balloon is inflated to open the blocked artery, often followed by placing a stent to keep it open.
- Coronary Artery Bypass Surgery (CABG): In cases of severe blockages, surgery may be needed to create a new pathway for blood flow.
Dr Amin will meet you after the procedure. The timing for this meeting will be determined by the flow of patients in the Cath Lab and whether emergencies are being treated on the day which might cause some delay. Dr Amin will provide detailed explanation for the outcome and the next step in management.
Procedure risks
Coronary angiography is a safe procedure, but like any invasive procedure, it carries some risks. These include:
• Bleeding or bruising at the catheter insertion site. The risk is higher if the groin access is used rather than the forearm.
• Allergic reactions to the contrast dye. This is rare complication and previous allergy to contrast should be notified before the procedure. If allergy is known, Dr Amin may still go ahead with the necessary precautions including administration of some medications to mitigate the risk.
• Irregular heart rhythms (arrhythmias)
• Blood vessel damage
• Kidney problems (especially in patients with pre-existing kidney disease)
• Very rarely, a heart attack or stroke can occur during the procedure
Death is a very rare scenario in diagnostic coronary angiography and the quoted risk is almost 1 in 4000 cases.
Dr Amin will discuss these risks with you and take necessary precautions to minimize them.
Conclusion
Diagnostic coronary angiography is a crucial tool for assessing heart health and guiding treatment decisions. It provides detailed images of the coronary arteries, helping cardiologists determine the best course of action for managing heart disease.
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