Coronary angiography or cardiac catheterization is a common procedure done
to evaluate for "blocked arteries".
Why have this test?
Typically, patients with an abnormal stress test, or patients at high risk of heart disease and
symptoms compatable with angina, undergo this procedure. Angiography is the most accurate test to evaluate the coronary
arteries for disease.
What is coronary artery disease (CAD), or heart disease?
CAD is buildup of cholesterol in the arteries of the heart. Sometimes calcium also buids
up in the arteries, but this follows the cholesterol. This can happen even in the absence of elevated cholesterol levels,
especially in patients with diabetes or high blood pressure, smokers, and patients with a strong family history.
An example of an angiogram is shown on the right, with severe narrowing
in the beginning part of the right coronary artery.
What do the findings mean?
An angiogram will determine the degree of cholesterol buildup and blockage of flow to the heart
muscle. Small studies have demonstrated that repairing blockages of 70% or more will reduce the risk of heart attack
or death, even in the absence of symptoms such as chest pain, although this remains controversial. A recent large
study suggests that treating these blockages do not reduce the risk of death or heart attacks, unless symptoms become unstable.
Treating blockages of 50% or more will often improve symptoms of fatigue, shortness of breath, or chest pressure, and may
reduce the number of medications needed to treat angina symptoms.
The physician performing the angiogram will review the pictures with the patient and family,
and determine the best treatment strategy. Blockages of less than 50% are usually treated with medications, as are blockages
in small arteries of less than 2mm in diameter. Blockages of 50-60% are often treated initially with medications.
If symptoms persist, stents or bypass surgery may be necessary. Blockages of 60-99% are often treated with stents
or bypass surgery, depending on the number and location of the diseased vessels, and the severity of symtoms present.
An initial strategy of medical therapy can be considered in some patients. Blockages of 100% are much more difficult
to treat with stents, and medical therapy or surgery is often used. .
How do I prepare for an angiogram?
We ask that you arrive 1 hour before your scheduled start time. Our cath lab is located
on the third floor of St. Marks Hospital, in the Northwest wing, attached to the hospital. Follow the hallway northwest
to suite 3400. Your angiogram may be scheduled at another hospital instead.
It is important to avoid food or drink for 4-6 hours prior to you angiogram, so you
wont have an upset stomach to any of the sedative or pain medications. You may take you morning medications
with water, except for diabetes medications or water pills. If you have been on warfarin (Coumadin), discuss with your
doctor how many days prior to you angiogram you should stop it. You should continue aspirin or clopidogrel (Plavix)
if you are already taking these medications.
On arrival, you will be greeted by our staff, and given a gown. An intravenous line will
be placed, and blood work sent if needed. IV fluids will be given. Patients with kidney problems may be given
additional protective medications and fluids.
Is the procedure painful? How long does it take?
Patients are usually more anxious about the procedure, rather than experience pain. The
procedure is often reported as being better than going to the dentist. There is some discomfort when the numbing medicine
is given in the groin, but the rest of the procedure is not painful. We offer sedation and pain medication prior to
starting the case, and additional medication if you are experiencing discomfort. Some patients ask to be "knocked
out". We do not completely put patients to sleep for this procedure, but some patients sleep through the procedure
and remember very little of the procedure.
There will be a small injection of numbing medication with a needle in the upper leg or groin
area. This is usually a burning sensation that last for 10-20 seconds. Then a plastic sheath is placed inside
the leg artery, which takes a minute or two. At the end of the procedure, the sheath is removed, and there may
be a little discomfort from the pressure applied to prevent any bleeding. You may sense your heart skipping beats during
the procedure. Also, if a stent is placed, you may have some chest discomfort for a minute or so. Rarely, there
are complications that could cause some longer discomfort. The procedure takes about an hour total to place the sheath
in the leg, take pictures, and review the findings with you. If you elect to proceed with a stent, it may take another
20-120 minutes.
If no stent is needed, we usually will place a plugging device in your groin and remove
the sheath. We will require you to stay at bedrest for about an hour afterwards, and then usually you will be released
home. We ask that someone else drive you home, and you avoid heaving lifting or bathing for 3 days. If bypass
surgery is required, you may be admitted to the hospital for the procedure. If a stent is placed, you will be admitted
to the hospital overnight, and released the following morning.
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