What Is Coronary Angiography?

Coronary angiography (an-jee-OG-ra-fee) is a test that uses dye and special x rays to show the inside of your coronary arteries. The coronary arteries supply oxygen-rich blood to your heart.

A material called plaque (plak) can build up on the inside walls of the coronary arteries, causing them to narrow. When this happens, it's called coronary heart disease (CHD) or coronary artery disease.

CHD can prevent enough blood from flowing to your heart and can lead to angina (an-JI-nuh or AN-juh-nuh) and heart attack. (Angina is chest pain or discomfort.) Coronary angiography shows whether you have CHD.

Most of the time, the coronary arteries can't be seen on an x ray. During coronary angiography, special dye is injected into the bloodstream to make the coronary arteries show up on an x ray.

A procedure called cardiac catheterization (KATH-e-ter-i-ZA-shun) is used to get the dye to your coronary arteries. A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck.

The tube is then threaded into your coronary arteries, and the dye is injected into your bloodstream. Special x rays are taken while the dye is flowing through the coronary arteries.

Cardiologists (heart specialists) usually do cardiac catheterization in a hospital. You're awake during the procedure. It usually causes little to no pain, although you may feel some soreness in the blood vessel where your doctor put the catheter.

Cardiac catheterization rarely causes serious complications.

Who Needs Coronary Angiography?

Your doctor may recommend coronary angiography if you have signs or symptoms of coronary heart disease (CHD). Signs and symptoms include:

• Angina. This is unexplained pain or pressure in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina may only happen when you're active. Emotional stress also can trigger the pain.
• Sudden cardiac arrest. This is a condition in which your heart suddenly and unexpectedly stops beating.
• Results from an EKG (electrocardiogram), exercise stress test, or other test that suggest you have heart disease.

You also may need coronary angiography on an emergency basis if you're having a heart attack. This test, combined with a procedure called angioplasty (AN-jee-oh-plas-tee), can open the blocked artery that's causing the heart attack and prevent further damage to your heart.

Coronary angiography also can help your doctor decide how to treat CHD after a heart attack. This is especially true if the heart attack caused major damage to your heart, or if you're still having chest pain.

What To Expect Before Coronary Angiography

Before having coronary angiography, talk to your doctor about:

• How the test is done and how to prepare for it
• Any medicines you're taking, and whether you should stop taking them before the test
• Whether you have diabetes, kidney disease, or other conditions that may require taking extra steps during or after the test to avoid complications

Your doctor will tell you exactly which procedures will be done. For example, your doctor may recommend angioplasty if the angiography shows a blocked artery.

You will have the chance to ask questions about the procedure. Also, you'll be asked to provide written informed consent to have the procedures done.

It may not be safe to drive after having cardiac catheterization, which is part of coronary angiography, so you must arrange for a ride home.

What To Expect During Coronary Angiography

During coronary angiography, you're kept on your back and awake. That way, you can follow your doctor's instructions during the test. You'll be given medicine to help you relax. The medicine may make you sleepy.

Your doctor will numb the area where the catheter (a small plastic tube) will enter the blood vessel through a small cut in the arm, groin (upper thigh), or neck.

The doctor then threads the catheter through the vessel up to the opening of the coronary arteries. Special x-ray movies are taken of the catheter as it's moved up into the heart. The movies help your doctor see where to position the tip of the catheter.

Your doctor will put special dye in the catheter when it reaches the correct spot. This dye will flow through your coronary arteries and make them show up on an x ray. This x ray is called an angiogram. If the angiogram reveals blocked arteries, your doctor may use angioplasty to restore blood flow to your heart.

After your doctor completes the angiography, or the angiography and angioplasty, he or she will remove the catheter from your body. The opening left in the blood vessel will then be closed up and bandaged.

A small sandbag or other type of weight may be put on top of the bandage to apply pressure. This will help prevent major bleeding from the site.

The animation below shows the process of coronary angiography. Click the "start" button to play the animation. Written and spoken explanations are provided with each frame. Use the buttons in the lower right corner to pause, restart, or replay the animation, or use the scroll bar below the buttons to move through the frames.

The animation shows the step-by-step process your doctor will follow to do coronary angiography.

What To Expect After Coronary Angiography

After coronary angiography, you'll be moved to a special care area, where you'll rest and be checked for several hours or overnight. During this time, you'll need to limit your movement to avoid bleeding from the site where the catheter was inserted.

While you recover in the special care area, nurses will check your heart rate and blood pressure regularly and see whether you're bleeding from the tube insertion site.

A small bruise may develop on your arm, groin (upper thigh), or neck at the site where the catheter was inserted. That area may feel sore or tender for about a week. Let your doctor know if you develop problems such as:

• A constant or large amount of blood at the catheter insertion site that can't be stopped with a small bandage
• Unusual pain, swelling, redness, or other signs of infection at or near the catheter insertion site

Talk to your doctor about whether you should avoid certain activities, such as heavy lifting, for a short time after the test.

What Are the Risks of Coronary Angiography?

Coronary angiography is a common medical test that rarely causes serious problems. But complications can include:

• Bleeding, infection, and pain at the site where the catheter was inserted.
• Damage to blood vessels. This is a very rare complication. It may occur if the catheter scrapes or pokes a hole in a blood vessel as it's threaded up to the heart.
• An allergic reaction to the dye used.

Other less common complications of the test include:

• An arrhythmia (irregular heartbeat) that often goes away on its own, but may need treatment if it persists.
• Damage to the kidneys caused by the dye used.
• Blood clots that can trigger stroke, heart attack, or other serious problems.
• Low blood pressure.
• A buildup of blood or fluid in the sac that surrounds the heart. This fluid can prevent the heart from beating properly.

As with any procedure involving the heart, complications can sometimes be fatal. However, this is rare with coronary angiography.

The risk of complications from coronary angiography is higher if you have diabetes or kidney disease, or if you're 75 years old or older. The risk of complications also is greater in women and in people having coronary angiography on an emergency basis.

Key Points

• Coronary angiography is a test that uses dye and special x rays to show the inside of your heart's arteries (the coronary arteries). Coronary angiography can reveal any blocked or narrowed areas in your coronary arteries that might be limiting blood flow to your heart.
• A procedure called cardiac catheterization is used to get the dye into your coronary arteries. Your doctor will put a thin, flexible tube (catheter) into a blood vessel in your arm, groin (upper thigh), or neck and thread it through your coronary arteries.
• You may need coronary angiography if you have signs or symptoms of coronary heart disease (also called coronary artery disease). You also may need coronary angiography on an emergency basis if you're having a heart attack. This test, combined with a procedure called angioplasty, can open blocked arteries and prevent further damage to your heart.
• Before having coronary angiography, discuss with your doctor how to prepare for the test and any special instructions you need to follow.
• During coronary angiography, you're kept on your back and awake. That way you can follow your doctor's instructions during the test. You'll be given medicine to help you relax.
• After the test is over, you'll be moved to a special care area, where you'll rest for several hours or overnight. During this time, your movement will be limited to avoid bleeding from the site where the catheter was inserted.
• It may not be safe to drive after the test, so you must arrange for a ride home.
• A small bruise may develop at the site where the catheter inserted. That area may feel sore or tender for about a week. Let your doctor know if you have a lot of bleeding from that area or signs of infection. You may have to avoid doing certain activities, such as heavy lifting, for a short time after the test.
• Coronary angiography is a common medical test that rarely causes serious complications. The risk of complications is higher in people who have diabetes and kidney disease, and in older people and women.

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Source: Information published by the National Institute of Health

Important Notice: HeartPatients.com does not provide medical advice, diagnosis or treatment. The information provided on this site is intended for your general knowledge only and is not a substitute for professional medical advice or treatment for specific medical conditions. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition.

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