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    Coronary angiography

    Cardiac angiography; Angiography - heart; Angiogram - coronary

    Coronary angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart.

    How the Test is Performed

    Coronary angiography is usually done along with cardiac catheterization.

    Before the test starts, you will be given a mild sedative to help you relax.

    An area of your body, usually the arm or groin, is cleaned and numbed with a local numbing medicine (anesthetic). The cardiologist passes a thin hollow tube, called a catheter, through an artery and carefully moves it up into the heart. X-ray images help the doctor position the catheter.

    Once the catheter is in place, dye (contrast material) is injected into the catheter. X-ray images are taken to see how the dye moves through the artery. The dye helps highlight any blockages in blood flow.

    The procedure may last 30 to 60 minutes.

    How to Prepare for the Test

    You should not eat or drink anything for 8 hours before the test starts. You may need to stay in the hospital the night before the test. Otherwise, you will check in to the hospital the morning of the test.

    You will wear a hospital gown. You must sign a consent form before the test. Your health care provider will explain the procedure and its risks.

    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

    Youwill usually beawake during the test. You may feel some pressure at the site where the catheter is placed.

    You may feel a flushing or warm sensationafter the dye is injected.

    After the test, the catheter is removed. You might feel a firm pressure at the insertion site, used to prevent bleeding. If the catheter 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 may be done if you have:

    • Angina for the first time
    • Angina that is becoming worse, not going away as fast, occurring more often, or happening at rest (called unstable angina,)
    • Aortic stenosis
    • Atypical chest pain, when other tests are normal
    • Had an abnormal heart stress test
    • To have surgery on your heart and you are at high risk for coronary artery disease
    • Heart failure
    • Recent heart attack

    Normal Results

    There is a normal supply of blood to the heart and no blockages.

    What Abnormal Results Mean

    An abnormal result may mean you have a blocked artery. The test can show how many coronary arteries are blocked, where they are blocked, and the severity of the blockages.

    Risks

    Cardiac catheterization 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 tamponade
    • Irregular heart beats
    • Injury to a heart artery
    • Low blood pressure
    • Allergic reaction to contrast dye
    • 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 dye could damage the kidneys (particularly in patients with diabetes).

    Considerations

    If a blockage is found, your health care provider may perform a percutaneous coronary intervention (PCI) to open the blockage. This can be done during the same procedure, but may be delayed for various reasons.

    References

    Fraker TD Jr, Fihn SD, Gibbons RJ,et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007;116:2762-2772.

    Kern M. Catheterization and angiography. In: Goldman L,Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 57.

    Popma JJ. Coronary arteriography. In: Bonow RO, Mann DL,Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of CardiovascularMedicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 21.

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          Tests for Coronary angiography

          Review Date: 6/22/2012

          Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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