Coronary Angiography: Procedure and Duration

Coronary Angiography Definition

Coronary angiography is a procedure used to visualize the coronary arteries, the blood vessels supplying the heart muscle. This allows determination of whether these arteries are patent (open) or obstructed by narrowing due to clots or cholesterol-rich plaques.

Coronary angiography is the most effective X-ray examination for visualizing the coronary arteries (the vessels that nourish the heart) and highlighting narrowings and obstructions that can hinder blood flow to the heart muscle, thus causing cardiac problems.

The main causes of coronary artery occlusion or narrowing are atheromas (due to atherosclerosis) and thromboembolic phenomena, followed by episodes of coronary vasculitis and coronary spasm.

Why is a Coronary Angiography Performed?

A doctor may order a coronary angiography in the presence of:

• Coronary artery disease (CAD);
• Sudden, increasingly severe chest pain;
• Congenital heart defects. A congenital anomaly refers to an anatomical malformation of the heart present from birth;
• Heart failure;
• Defects in the heart valves, requiring surgery. There are four heart valves, which can undergo anatomical changes during life, affecting their efficiency;
• Suspicious pain in the stomach, arm, jaw, or neck unexplained by other diagnostic tests;
• Cardiovascular problems other than those mentioned above;

Coronary angiography is also useful:

• To plan complex heart surgery. For example, it can precede or be associated with coronary angioplasty, a procedure in which a stent is inserted into the coronary arteries to restore blood flow;
• To assess potential complications of heart surgery;
• To monitor the results of coronary artery surgery, such as coronary artery bypass grafting (CABG);

Due to its invasive nature, coronary angiography is only performed when strictly necessary and only if other non-invasive diagnostic tests, such as electrocardiogram (ECG), echocardiography, stress tests, etc., suggest a problem in the coronary arteries.

Otherwise, a procedure that is not without risks and complications is not advisable.

Nevertheless, there are no absolute contraindications to coronary angiography, only relative contraindications; these include:

• Severe hypertension;
• Ventricular arrhythmias;
• Severe anemia;
• Severe allergy to contrast medium;
• Acute renal failure;
• Electrolyte abnormalities and imbalances (e.g., hypokalemia);
• Coagulopathies;
• Active gastrointestinal bleeding;

The Examination

For a coronary angiography, anesthesia is usually administered. The doctor anesthetizes the area to insert the catheter (a small tube) into the artery leading to the heart.

Coronary angiography is performed by introducing the catheter, generally into the radial artery (wrist) or the femoral artery (groin). The catheter is then advanced to the heart and positioned at the opening of the coronary artery. A contrast medium is injected into the catheter, making the artery's path completely opaque and allowing any narrowing to be visualized. The procedure is monitored on a screen.

Once the catheter is removed, the artery used for the procedure must be compressed to stop the bleeding and allow a clot to form, closing the small entry hole with an elastic bandage.

The examination takes about 1 hour, although the actual coronary angiography time, excluding preparation, is approximately 10 to 20 minutes.

The patient must keep the compression bandage applied to the puncture site for a few hours.

Similarly, the patient will need to stay in bed for about 2 to 4 hours if the procedure was performed from the wrist, and a few more hours if it was performed from the groin.

The total hospital stay is 2 to 3 days.

Following the procedure, the doctor will report the results and indicate possible treatments based on:

• The extent of coronary artery disease;
• The severity of coronary artery disease;

If the coronary angiogram reveals one or more hemodynamically significant coronary narrowings (i.e., obstructing blood flow), it may be indicated to reopen the arteries concerned by a coronary angioplasty procedure. This is often performed immediately after the diagnostic coronary angiography.

EXPRESS QUOTE

Expected Results of a Coronary Angiography

Coronary angiography allows the cardiologist to clearly analyze any abnormality in the coronary arteries. The examination detects any occlusion of the coronary vessels, its exact location, and severity.

It also offers the valuable possibility of immediately performing coronary angioplasty, as it shares several procedural aspects with the latter.

However, the advantages and disadvantages must be weighed: coronary angiography is an invasive and potentially dangerous procedure that cardiologists only perform when necessary.

After a coronary angiography, it is recommended to drink plenty of water to accelerate the elimination of the contrast medium from the body and to rest for a few days.

After coronary angiography, the patient should immediately contact the cardiologist or go to the nearest hospital in the following cases:

• The access point bleeds (hemorrhage) without stopping and/or swelling. In case of hemorrhage, while waiting to reach the hospital for treatment, pressure on the wound is a temporary solution;
• Pain at the puncture site increases instead of decreasing;
• The wound becomes infected. Classic signs of infection are redness and fever;
• Symptoms such as weakness, fainting, chest pain, and/or dyspnea are present;

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