Coronary angiography and cardiac catheterization are two similar procedures that are usually conducted at the same time. First, the doctor injects a local anesthetic and then they insert a thin tube known as a catheter into an artery through a small incision made either in the arm or the groin. The catheter is guided towards the heart and to the blood vessels that supply oxygen-rich blood to your heart muscles (known as the coronary arteries).
After the catheter has been inserted, the doctor uses a technique called fluoroscopy which requires a contrast agent or dye that can be seen on an X-ray to be injected through the catheter into the artery. Then, the arteries can be seen on the screen. In this manner, the doctor can see the progress of the catheter as it moves through the blood vessels, into the heart and the coronary arteries.
What is coronary angiography used for?
Coronary angiography helps provide information about the blood vessels that supply oxygen-rich blood to coronary arteries. The procedure can:
- Detect blockages of the arteries in patients with coronary heart disease.
- Determine whether the patient needs angioplasty, a process in which a blockage is opened using a small balloon that is put through the catheter.
- Determine whether coronary artery bypass surgery should be conducted.
What is cardiac catheterization used for?
Cardiac catheterization allows doctors to see how well your heart is being supplied by your blood vessels. This procedure allows your doctor to:
- Determine whether there is evidence of heart disease, including coronary artery disease, heart valve disease, or disease involving the aorta.
- Determine how well your heart muscle is functioning.
- Determine whether you need more surgery, such as interventional procedure or bypass surgery.
What can I expect from a coronary angiography?
Fortunately, a coronary angiography is not usually uncomfortable and patients can go home very soon after the procedure. The whole procedure will take between 30 and 50 minutes. In some cases, doctors may place a stent at the same time, in which case the patient usually stays in the hospital overnight.
When the contrast agent is injected into the blood vessels or the heart, you may feel a slight feeling of warmth that goes throughout your body as the dye spreads. Your heart rate may be raised slightly and your blood pressure may fall a little bit. In very rare cases, your heart can slow or even stop. If that ever happens, you may be asked to cough vigorously to help correct the problem, which is usually not serious.
What can I expect from a cardiac catheterization?
Generally, the procedure for cardiac catheterization will only take approximately 30 minutes, but longer if you are doing an intervention. If so, you should prepare adequately and expect to be at the hospital for several hours or even all day.
Before you start the cardiac catheterization, you will get an intravenous (IV) line in your arm so that the medicines and fluids can go through your body before the procedure. You will lie down on a table in a room that has a camera and many TV monitors so that you can watch your cardiac catheterization on the monitor.
The catheter is inserted through an incision and guided to the arteries of your heart. You may feel some pressure but no pain. Once the catheter is situated correctly, a dye will be injected that will allow the X-ray machine to see the vessels, valves, and chambers. When the dye is injected, you may have a strange feeling for some time but it will go away in a few seconds. The X-ray machine will take photos of your blood vessels and heart. You may be asked to hold your breath during the X-ray. After the photos have been taken, the catheter will be removed.
Once the procedure has been conducted, you will need to drink lots of fluids to clear the dye from your body and you will urinate much more frequently. Your doctor will discuss any potential treatments, dietary changes and future procedures before you head home, as well as to how to take care of your wound site.
What are the risks associated with coronary angiography?
Very rarely, people experience mild complications including nausea, vomiting and coughing. In extremely rare situations, some might experience serious complications, including:
- Shock
- Seizures
- Kidney problems
- Cardiac arrest
- Anaphylaxis due to allergic reactions from the dye
What are the risks associated with cardiac catheterization?
While generally very safe, cardiac catheterization is invasive and associated with some risks that your doctor will go over with you. Undergoing a cardiac catheterization can put you at a risk for:
- Bleeding at the point of incision
- Abnormal heart rhythm
- Blood clots
- Infection
- Anaphylaxis
- Stroke
- Heart attack
- Bursting of a blood vessel
- Very, very rarely, death
- Ambrose, J. A., Tannenbaum, M. A., Alexopoulos, D., Hjemdahl-Monsen, C. E., Leavy, J., Weiss, M., ... & Fuster, V. (1988). Angiographic progression of coronary artery disease and the development of myocardial infarction. Journal of the American College of Cardiology, 12(1), 56-62.
- Hertzer, N. R., Beven, E. G., Young, J. R., O'Hara, P. J., Ruschhaupt 3rd, W. F., Graor, R. A., ... & Maljovec, L. C. (1984). Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Annals of surgery, 199(2), 223.
- Grossman, W. (2006). Grossman's cardiac catheterization, angiography, and intervention. Lippincott Williams & Wilkins.
- Photo courtesy of SteadyHealth
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