Coronary angiography

Alternative names
Cardiac angiography; Angiography - heart

Definition

Coronary angiography is a procedure in which a contrast material that can be seen using x-ray equipment is injected into one of the arteries of the heart. This allows your health care provider to view the flow of blood through your heart.

How the test is performed

Coronary angiography is usually performed in conjunction with cardiac catheterization. You will be given a mild sedative prior to the test to help you relax.

The study is carried out in a laboratory by a trained cardiologist or radiologist and technicians or nurses. An intravenous (IV) line is inserted into one of the blood vessels in your arm or groin after the site has been cleansed and numbed with a local anesthetic.

A catheter is then inserted through the IV and into your blood vessel. The catheter is carefully threaded into the heart using an x-ray machine that produces real-time pictures (fluoroscopy). Once the catheter is in place, contrast material is injected and pictures are taken.

How to prepare for the test

Food and fluid are restricted 6 to 8 hours before the test. The procedure takes place in the hospital and you will be asked to wear a hospital gown. Sometimes, admission the night before the test is required. Otherwise, you will be admitted as an outpatient or an inpatient the morning of the procedure.

Your health care provider should explain the procedure and its risks. A witnessed, signed consent for the procedure is required.

Tell your doctor if you are allergic to seafood, if you have had a bad reaction to contrast material in the past, if you are taking Viagra, or if you might be pregnant.

How the test will feel

You will be awake and able to follow instructions during the coronary angiogram. A mild sedative is usually given 30 minutes before the procedure to help you relax. The procedure may last from 1 to several hours.

You may feel some discomfort at the site where the IV is placed. Local anesthesia will be used to numb the site, so the only sensation should be one of pressure at the site.

Occasionally, a flushing sensation occurs after the contrast media is injected. Discomfort may also arise from having to remain still for a long time.
After the test, the catheter is removed. You might feel a firm pressure at the insertion site, used to prevent bleeding. If the IV is placed in your groin, you will usually be asked to lie flat on your back for a few hours after the test to avoid bleeding. This may cause some mild back discomfort.

Why the test is performed
Coronary angiography is performed to detect obstruction in the coronary arteries, which can lead to heart attack. It may be performed if you have unstable angina, atypical chest pain, aortic stenosis, or unexplained heart failure. The test may also be performed for other reasons.

Normal Values

Adequate blood supply to the heart is a normal finding with a coronary angiogram.

What abnormal results mean

Coronary angiography shows the following:

     
  • How many coronary arteries are blocked  
  • Where are they blocked  
  • The degree of each blockage

These results can help your health care providder make decisions regarding treatment for your heart disease.

What the risks are

Cardiac catherization carries a slightly increased risk when compared with other heart tests. However, the test is very safe when performed by an experienced team.

Generally the risk of serious complications ranges from 1 in 1,000 to 1 in 500. Risks of the procedure include the following:

     
  • Cardiac arrhythmias  
  • Cardiac tamponade  
  • Trauma to the artery caused by hematoma  
  • Low blood pressure  
  • Reaction to contrast medium  
  • Hemorrhage  
  • Stroke  
  • Heart attack

Considerations associated with any type of catheterization include the following:

     
  • In general, there is a risk of bleeding, infection, and pain at the IV site.  
  • There is always a very small risk that the soft plastic catheters could actually damage the blood vessels.  
  • Blood clots could form on the catheters and later block blood vessels elsewhere in the body.  
  • The contrast material could damage the kidneys (particularly in patients with diabetes).

Special considerations
Your health care provider may perform a percutaneous coronary intervention (PCI) to open the blockage of your coronary artery during the procedure.

Johns Hopkins patient information

Last revised: December 3, 2012
by Levon Ter-Markosyan, D.M.D.

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