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Coronary angiography

Definition

Coronary angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart.

Alternative Names

Cardiac angiography; Angiography - heart; Angiogram - coronary

How the Test is Performed

Coronary angiography is most often done with cardiac catheterization.

Before the test starts, you will be given medicine to help you relax.

An area of your body where the catheter will be inserted is cleaned and numbed with a local numbing medicine (anesthetic). The spot is usually the arm or groin.

The doctor passes the catheter through an artery and carefully guides it into the heart. X-ray images help the doctor position the catheter.

When the catheter is in place, dye (contrast material) is injected into the catheter. X-ray images are taken to see how the dye moves through the artery. The dye helps highlight any blockages in blood flow.

The procedure may last 30 to 60 minutes.

The catheter will be removed after the test. Pressure will be applied to stop bleeding at the site the catheter was inserted.

How to Prepare for the Test

You should not eat or drink anything for 8 hours before the test starts. You may need to stay in the hospital the night before the test. Otherwise, you will check in to the hospital the morning of the test.

You will wear a hospital gown. You must sign a consent form before the test. Your health care provider will explain the procedure and its risks.

Tell your doctor if you are allergic to seafood, if you have had a bad reaction to contrast material in the past, if you are taking Viagra, or if you might be pregnant.

How the Test will Feel

In most cases, you will be awake during the test. You may feel some pressure at the site where the catheter is placed.

You may feel a flushing or warm sensation after the dye is injected.

If the catheter is placed in your groin, you will usually be asked to lie flat on your back for a few hours after the test to avoid bleeding. This may cause some mild back discomfort.

Why the Test is Performed

Coronary angiography may be done if you have:

  • Angina for the first time
  • Angina that is becoming worse, not going away as fast, occurring more often, or happening at rest (called unstable angina,)
  • Aortic stenosis
  • Atypical chest pain, when other tests are normal
  • Had an abnormal heart stress test
  • To have surgery on your heart and you are at high risk for coronary artery disease
  • Heart failure
  • Recent heart attack

Normal Results

There is a normal supply of blood to the heart and no blockages.

What Abnormal Results Mean

An abnormal result may mean you have a blocked artery. The test can show how many coronary arteries are blocked, where they are blocked, and the severity of the blockages.

Risks

Cardiac catheterization carries a slightly increased risk when compared to other heart tests. The test is very safe when performed by an experienced team.

The risk of complications is very small. Risks of the procedure include the following:

  • Pressure on the heart from the buildup of fluid (cardiac tamponade)
  • Irregular heart beats
  • Injury to a heart artery
  • Low blood pressure
  • Allergic reaction to contrast dye
  • Stroke
  • Heart attack

Small risks from catheterization include:

  • Bleeding, infection, and pain at the IV site
  • Damage to the blood vessels from the catheter
  • Formation of blood clots catheters that could later block blood vessels elsewhere in the body
  • Kidney damage from the contrast (more of a risk in people with diabetes)

Considerations

If a blockage is found, your health care provider may perform a percutaneous coronary intervention (PCI) to open the blockage. This may be done during the same procedure or at later time, depending on your medical needs.

You may need coronary artery bypass surgery if you have many blockages or blockages in certain arteries. Your doctor may also suggest this surgery if you also have other heart or medical problems.

References

Fraker TD Jr, Fihn SD, Gibbons RJ, et al. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007;116:2762-2772.

Kern M. Catheterization and angiography. In: Goldman L,Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 57.

Popma JJ. Coronary arteriography. In: Bonow RO, Mann DL,Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 21.


Review Date: 5/1/2013
Reviewed By: Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.
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