When the doctor recommends a coronary angiogram to someone close to you, the initial reaction is denial and non acceptance. Some people also believe that anyone who undergoes this test would invariably have to go through bypass surgery. Others believe that it will be painful, requiring prolonged hospital admission. But the truth is that it is a simple X-ray of the heart blood vessels, virtually painless and requires a short stay. Coronary angiogram is one of the most accurate tests in the diagnosis of Coronary Artery Disease (CAD). It is used to pinpoint the location and severity of CAD and is relatively safe. A coronary angiogram is the ‘gold standard’ for evaluation of CAD. The test is done in a special laboratory called a cardiac catheterization laboratory, which is similar to an operating theater.
How is a coronary Angiogram performed?
The procedure will begin with the physician inserting an intravenous line into a blood vessel in the patient’s arm. Coronary angiography is performed with the use of local anesthesia and is generally not terribly uncomfortable. During a coronary angiogram, a small catheter (a thin hollow tube with a diameter of 2-3 mm) is inserted through the skin into an artery generally in the wrist. Guided with the assistance of a fluoroscope the catheter is then advanced to the opening of the coronary arteries, the blood vessels supplying blood to the heart. Next, a small amount of radiographic contrast, which is easily visualized with X-ray images, is injected into each coronary artery. The images that are produced are called the angiogram.
The procedure takes approximately 10-15 minutes. After the procedure, the catheter is removed and the artery at the wrist is treated with manual compression to prevent bleeding.
Risks and Benefits
Coronary Angiogram is the only test, which allows precise quantification of the severity of CAD to optimally take decisions for the treatment. In appropriate patients, the therapeutic information learned from the angiogram is far more valuable than the relatively small risk of the procedure. There is a small but finite risk of serious complication from coronary angiography, as it is an ‘invasive’ test, but in the hands of experienced physicians, this risk is quite small (well below one per cent). Following the test the patients will be given instruction from their physician regarding exercise and exertion, care for the incision area and the use of medications.
Long Term Outlook
Treatment depends on the diagnosis made after the angiography. Narrowed coronary arteries can be treated during the angiogram itself by angioplasty. Another option for severely narrowed coronary arteries is a bypass operation. A coronary angiogram, which is normal, is as precious as the one that shows disease. A normal angiogram rules out a life threatening disease and is an impetus for the further continuation of a healthy lifestyle.