Coronary Angiography: Procedure Overview

What is a coronary angiography?

Coronary angiography, or coronary arteriography, is an invasive procedure that uses a contrast medium, usually containing iodine, and X-rays to detect blockages in the coronary arteries caused by plaque buildup.

In simple terms, this exam allows visualization of the inside of the coronary arteries, which are thin tubes that carry blood, oxygen, and nutrients to the heart, ensuring its proper functioning. It checks for obstructions that would prevent or hinder this vital process.

Detecting these occlusions is important because, over time, they can cause chest pain, especially during physical activity or stress, or a heart attack.

What is coronary angiography used for?

To better understand this exam, it's helpful to explain the composition of the heart. It's divided into four chambers, two at the top and two at the bottom. The upper chambers are called atria, and the lower chambers are called ventricles.

Each of the two ventricles has two valves that regulate the flow of blood, oxygen, and nutrients to the heart. Coronary angiography allows for verification of the proper functioning of these valves and the four chambers that make up the heart muscle, detection of heart disorders, and visualization of the coronary arteries.

Why have a coronary angiography?

Coronary angiography can provide important information about the heart and the surrounding blood vessels that supply it. This allows the cardiologist to diagnose certain heart conditions, plan future treatments, and perform specific procedures. A coronary angiography is often prescribed by a doctor when clinical examination or biological test results reveal signs of narrowing of the heart's arteries.

Generally, this procedure can be used to diagnose a range of heart conditions, including:

• Coronary artery disease: when a buildup of fatty substances in the coronary arteries affects blood supply to the heart, with a risk of heart attack and angina;
• Congenital heart disease in children: a range of birth defects that affect the normal functioning of the heart;
• Valvular heart disease: problems with the functioning of one or more valves inside the heart;
• Cardiomyopathy, a disease of the heart muscle, sometimes hereditary;

Beyond its diagnostic use, coronary angiography can also be performed for therapeutic purposes, i.e., to treat certain heart problems.

For example, coronary angiography may be used if it is necessary to perform:

• Coronary angioplasty or percutaneous coronary intervention, a procedure to widen blocked or narrowed coronary arteries;
• Coronary artery bypass graft (CABG), a surgical procedure to divert blood around narrowed or blocked arteries and improve blood flow to the heart;
• Cardiac valve surgery, an operation to repair or replace heart valves;

The cardiologist assesses if and when to prescribe this particular exam.

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How is a coronary angiography performed?

As mentioned, coronary angiography is an invasive exam, so it's performed in hospitals or specialized laboratories. During the procedure, a catheter—a long, thin, flexible tube—is inserted into a blood vessel.

There are three locations where the catheter can be inserted to perform this exam:

• Into the femoral artery in the groin;
• Into the brachial artery along the arm;
• Into the radial artery at the wrist;

These three locations are where the puncture can be performed, allowing insertion of the catheter through which a contrast medium, a type of colored, dense substance, is injected. This makes the blood vessels visible and facilitates the acquisition of radiographic images.

The procedure is generally performed under local anesthesia at the catheter insertion site. You will therefore be awake and involved during the exam (for example, taking breaths at the doctor's request).

At the end of the coronary angiography, the catheter will be removed, and a compression bandage will be applied, which will remain for 6 to 12 hours.

If the catheter is inserted into the femoral artery (groin puncture), you will not be able to get out of bed or move your leg for 6 hours after the exam.

In the other two cases (wrist and arm), you can get up after about an hour.

Is coronary angiography painful?

Coronary angiography is generally performed under local anesthesia, meaning the area where the catheter is inserted is numbed, thus reducing discomfort and pain. However, some people may experience a slight pressure sensation or discomfort when the catheter is introduced into the artery. Patients may also feel a sensation of warmth when the dye is injected into the coronary arteries.

How to prepare for a coronary angiography?

Coronary angiography requires no specific preparation. It's performed while fasting and during a short hospital stay; patients typically leave within 24 hours. When the coronary angiography catheter is removed, the doctor will compress near the incision to stop the bleeding. In particular, if the femoral artery was used, the person will need to keep their leg straight for about 6 to 8 hours. They are also advised to drink plenty of water to easily eliminate the contrast fluid. Regarding the patient's medication, the doctor will specify which medications to stop and which to continue in view of the procedure.

As we have seen, coronary angiography is a very important exam to check the health of the heart muscle. Of course, it's always good to remember that heart health depends on good cardiovascular prevention, a balanced diet, and adequate physical activity.

What are the risks of a coronary angiography?

As with any invasive procedure, there is always a small percentage of risk, mainly related to possible allergic reactions to the contrast medium or anesthetic.

Possible minor complications include:

• Nausea and/or vomiting;
• Mild allergic skin reactions;
• Formation of hematomas at the puncture site;

Serious complications, however, are extremely rare:

• Severe anaphylactic reaction to the contrast agent;
• Stroke;
• Embolism;
• Kidney failure;
• Death;

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