heart and blood vessel disorders
Cardiac Catheterization and Coronary Angiography
Coronary Angiography
In Angiography , a After injecting a local anesthetic, a doctor inserts a thin catheter into an artery through an incision in an arm (near the elbow or wrist) or the neck or groin. The catheter is threaded toward the heart, then into the coronary arteries. During insertion, the doctor uses fluoroscopy (a continuous x-ray procedure) to observe the progress of the catheter as it is threaded into place. After the catheter tip is in place, a radiopaque contrast agent is injected through the catheter into the coronary arteries, and the outline of the arteries appears on a video screen and is recorded. Doctors use these images to detect blockages ( Overview of Coronary Artery Disease (CAD) ) or spasms of the coronary arteries. Images can help determine whether Miniature ultrasound transducers on the end of coronary artery catheters can produce images of coronary vessel walls and show blood flow. This technique (intravascular ultrasound or IVUS) is being increasingly used at the same time as coronary angiography. Miniature pressure sensors on the tip of the catheter can determine how much the pressure changes before and after a narrowing in a coronary artery. This technique (called fractional flow reserve or FFR) is used to determine the severity of the blood vessel narrowing. Coronary angiography is seldom uncomfortable and usually takes 30 to 50 minutes. Unless the person is very ill, the person can go home a short time after the procedure. When the radiopaque contrast agent is injected into the aorta or heart chambers, the person has a temporary feeling of warmth throughout the body as the contrast agent spreads through the bloodstream. The heart rate may increase, and blood pressure may fall slightly. Rarely, the contrast agent causes the heart to slow briefly or even stop. The person may be asked to cough vigorously during the procedure to help correct such problems, which are rarely serious. Rarely, mild complications, such as nausea, vomiting, and coughing, occur. Serious complications, such as shock, seizures, kidney problems, and sudden cessation of the heart's pumping ( Cardiac Arrest and CPR ), are very rare. Risk of complications is higher in older adults, although it is still low. Coronary angiography is essential when angioplasty or Percutaneous Coronary Intervention is being considered. 