A B C D E F G H I J K L M N O P R S T U V W

CORONARY ARTERIOGRAPHY - CARDIAC CATHETERIZATION

Why is a Coronary Arteriography performed ?

Cardiac catheterization is a technique for obtaining detailed information about the way the heart works. It involves passing thin tubes, called catheters, into blood vessels. There are other ways of obtaining information without putting anything inside the body. These are called non-invasive methods and they include x-rays, scanning with ultrasound, magnetic fields or radio-isotopes. Because the heart is constantly moving, these techniques do not produce good pictures of very small structures such as the coronary arteries. These problems can be overcome by cardiac catheterization. The most important information obtained is about the coronary arteries. These arteries carry the fuel supply (oxygen) to the heart.

Narrowing and blockage cause coronary heart disease and may produce anginal pain. If anginal pain is new or is getting worse or if medical treatments do not abolish the pain, coronary artery bypass surgery or angioplasty may be considered. Cardiac catheterization is necessary to find out if this is possible. If angina returns after angioplasty or surgery, cardiac catheterisation may need to be repeated. In young people without angina, cardiac catheterization may be needed to see if there is a threat to life. Occasionally it may be undertaken when it is uncertain what is causing chest pain. Cardiac catheterization may also be necessary to examine the heart valves. Valves can be assessed non-invasively. If a valve operation is planned, surgeons usually need to know about the coronary arteries to reduce the risks of the operation. Congenital heart disease (disease you are born with), such as "holes-in-the heart", may also require cardiac catheterization.

Preparations needed for a Coronary Arteriography

Cardiac catheterization takes place in hospital. It is usually done during a single day without requiring an overnight stay in hospital. Transport should be arranged to take you home after the procedure. You should not eat for about 6 hours before the catheterization. The skin of the elbow or groin may need to be shaved, and some medication is often given first to reduce anxiety.

What Happens during a Coronary Arteriography

The test is done in a special cardiac catheterization laboratory, usually part of an x?ray department. It is necessary to lie under an x?ray machine for about 30 minutes. There will always be someone in the room who will talk to you during the procedure. First, local anaesthetic is injected. Then the catheters, which are a few millimetres in diameter, are inserted into the arteries and veins of the arms (in the front of the elbow) or in the groin, by a heart specialist. As all blood vessels are connected to the heart, gently passing the catheters through the arteries and veins carries them painlessly into the heart. X-ray screening is used to locate the position of the catheters. Blood samples and blood pressures can then be taken in the various chambers of the heart. More importantly, x?ray pictures can be taken whilst an x?ray dye (contrast medium), is injected through the catheter into the bloodstream. This dye is later eliminated by the kidneys. The pictures are taken with cine x?ray film, or now more commonly using modern digital imaging equipment. The resulting pictures are called angiograms or arteriograms; those of the coronary arteries are called coronary arteriograms. They are examined later as a "movie" to get the best information from them.

Possible Complications during a Coronary Arteriography

Cardiac catheterization is only carried out for patients thought to have coronary or other serious heart disease. In skilled and experienced hands problems are uncommon. Nevertheless, there is a small risk that a badly narrowed artery will block during the test. This can cause a myocardial infarction (heart attack) which can have serious consequences. This is more a risk of the disease rather than the technique. There are other small risks. Small blood clots in the heart or on the catheter may be dislodged and travel to other parts of the body. This may cause damage such as a stroke. This risk is greatly reduced by a medication (anticoagulant) which reduces blood clotting. A bruise in the arm or groin is not uncommon. The pulse in the arm can be weakened but this rarely causes problems. There is a small risk of an allergic reaction to any medication that is used or to the x?ray dye. This can be readily treated. All of these risks are extremely small. They generally are far outweighed by the advantages of making an accurate diagnosis which leads to correct treatment.

After a Coronary Arteriography

There will be a few stitches in the arm and it will be slightly sore. Pressure will be applied to the groin for about 30 minutes but there will be no stitches. This may also be a little sore afterwards. You may need painkillers for a day or two. You should stay in hospital for 4 to 6 hours to have the pulse rate and blood pressure checked. Electrocardiograms (ECGs) may be done before and afterwards to be sure that no heart damage has occurred. It is possible to return to work the following day, but if the arm or groin is sore it is reasonable to take another day off. Following this, a return to all your usual activities is permissible. At some stage, either before discharge from hospital or on a later visit to the hospital, the doctor will discuss the results with you and make any recommendations for further treatment.

If a Coronary Arteriography is not performed

The so-called non-invasive tests, mentioned above, give some information about the heart and the circulation. However, without catheterization and arteriography, it is very difficult indeed to make accurate decisions about whether an operation or other form of intervention will help in a given patient.