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Dr Diana R Holdright
MD, FRCP, FESC, FACC, MBBS, DA, BSc

Consultant Cardiologist

Dr Diana Holdright
 
 

Cardiac Investigations - Coronary Angiogram

Coronary angiography, also called cardiac catheterisation, is a specialised X-ray test to find out detailed information about the coronary arteries. It is mainly used to assess the extent and severity of furring up in the coronary arteries, which can translate into symptoms such as chest pain or lead to a heart attack. A coronary angiogram is considered to be the “gold standard” for documenting the coronary anatomy, and the findings will help to determine the best type of treatment for the patient, i.e. medication, angioplasty or bypass surgery.

Patients undergoing coronary angiography will be admitted to hospital as a day case and asked not to eat or drink for 6 hours prior to the procedure. The patient lies on a table in the cardiac catheter lab, which looks similar to an operating theatre, and an X-ray machine is mounted above and moves around to take the pictures. The doctor injects some local anaesthetic into the skin above the blood vessel in the groin or wrist to numb the area. A short tube (catheter) is then inserted through a 3mm cut in the skin into the blood vessel in the groin or arm, and through this short tube different shaped catheters are passed to the heart and to the coronary arteries.

X-rays are used to monitor the progress of the catheter, which is positioned in the main pumping chamber of the heart, the left ventricle, to show how well the heart muscle is working. The catheter will also be positioned at the origin of the coronary arteries to determine whether or not there are any narrowings; dye is injected through the catheter to identify these.

Any procedure on the heart carries risks, which have to be balanced against the benefits.  Risks vary depending on patient factors, including age, presence of other medical problems such as diabetes, previous stroke, and kidney damage. The most common side-effect is bruising and some discomfort at the site of catheter entry (usually the groin). This is generally mild and short-lived, but may be greater in patients taking blood thinners such as warfarin.

Serious risks are rare, approximately 1 in 1000, but if they occur they can be potentially life-threatening; complications include damage at the site of arterial access, bleeding, heart attack, impairment of kidney function (although this is rare in patients with normal kidney function), allergic reaction to the dye, stroke, emergency heart surgery and death. However, it is important to remember that the procedure will be carried out in a fully-equipped cardiac catheter lab, with a cardiology team (doctor, nurses, radiographer and cardiac technician) with all the equipment necessary should there be a problem.

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