by Elizabeth Peterson, MFA
Anatomy and Physiology
The heart is the muscle responsible for pumping blood throughout your body. It is made up of four chambers: the right and left atria, and the right and left ventricles.
Your heart must have a steady supply of oxygen and other nutrients to function properly. Normally, your heart receives all the oxygen and nutrients it needs from the blood passing through your coronary arteries. Two sets of coronary arteries emerge from the right and left side of the aorta.
In some people, cholesterol and other substances accumulate inside the coronary arteries over time. This build up, known as plaque, can become large enough to narrow or block the arteries. This may prevent enough oxygen and nutrients from reaching the heart muscle.
Reasons for Procedure
Insufficient oxygen reaching the heart muscle often causes a type of intermittent chest pain called angina. Many patients with coronary artery disease experience angina when they exert themselves. Sometimes angina pain can be felt in other locations such as the right arm, jaw, or back.
If a plaque ruptures, a clot may form that blocks off all blood flow to a portion of the heart muscle. If this occurs, the muscle quickly dies, a condition known as a heart attack or myocardial infarction.
Heart attack sufferers often experience severe, persistent chest pain. Other symptoms may include: shortness of breath, sweating, nausea, weakness, and/or lightheadedness.
Treatment options for coronary artery disease include: lifestyle changes, such as diet and exercise; medications that can reduce the narrowing in the coronary arteries or prevent it from getting worse; medications that prevent or treat angina; invasive cardiac procedures that restore blood flow inside the coronary arteries through the use of balloons; surgical procedures that bypass blockages in the coronary arteries.
In many cases, the treatment decision for coronary artery disease will depend on the results of a coronary angiography, also known as cardiac catheterization. This test involves the x-ray examination of the vessels and chambers of the heart. It is often done to identify any narrowed or clogged coronary arteries.
In the days leading up to your procedure: arrange for a ride to and from the hospital and for some help at home afterwards. The night before, eat a light meal, and do not eat or drink anything after midnight. If you regularly take medications, herbs, or dietary supplements, ask your doctor if you need to temporarily discontinue them. Do not start taking any new medications, herbs, or dietary supplements before consulting your doctor.
Most coronary angiographies last 1-2 hours. You will remain awake for the procedure, but may be offered a sedative to help you relax. To begin the procedure, you will be placed on a table equipped with a fluoroscope. The fluoroscope will x-ray your heart and coronary arteries from many angles.
Your doctor will numb the skin in your groin area and insert a needle into your femoral artery. In rare cases, a brachial artery at the elbow may be used instead.
Your doctor will then pass a wire through the needle and guide it up to your heart. He or she will slip a soft, flexible catheter over the wire.
To examine the coronary arteries, your doctor will remove the guide wire, position the tip of the catheter just inside each artery one at a time, and inject a special dye. This dye allows the fluoroscope to take x-ray images, called angiograms, and identify any blockages inside your arteries.
Once sufficient images of the coronary arteries are taken, your doctor will remove the catheter through the original insertion site in the groin.
Risks and Benefits
Complications of coronary angiography are rare, but can include: stroke, allergic reaction to the dye, abnormal heart rhythms, perforation or other damage to the arteries, infection, heart attack, accumulation of blood at the insertion site in the groin, accumulation of fluid around the heart.
Benefits of coronary angiography include: an accurate diagnosis of the cause of angina and other symptoms commonly associated with coronary artery disease, determination of the most appropriate options to treat any blockages that may exist in the coronary arteries, direct access to the coronary arteries for invasive treatments such as coronary angioplasty.
In coronary angiography, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you.
After the Procedure
After your procedure, you will be: closely monitored in the recovery area, asked to lie on your back for several hours with a pressure bandage overlying the groin area; this is to insure there is no bleeding from the femoral artery, asked to keep your arm straight using an arm board, if the catheter was inserted in your arm. Most patients are discharged from the hospital on the same day, but some are kept for an overnight stay.
After being discharged, you should contact your doctor promptly if you experience: chest pain, swelling, tingling, numbness, pain, bruising, or discoloration of your leg, redness, swelling, increasing pain, excessive bleeding, or discharge from the insertion site in the groin or arm, cough, shortness of breath, chest pain, or severe nausea or vomiting, and/or signs of infection, including fever or chills.
- Coronary angiography. American Heart Association. Available at: http://www.americanheart.org/presenter.jhtml?identifier=11222. Accessed July 24, 2003.
- Coronary angiography. Medline Plus Health Information. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003876.htm. Accessed July 24, 2003.
- Coronary angiography. Queensland Government. Queensland Health. Available at: http://www.health.qld.gov.au/informedconsent/ConsentForms/cardiac/coronary_angiography.pdf Accessed January 20, 2004.
- Heart catheterization at Mayo Clinic in Jacksonville. The Mayo Clinic. Available at:http://www.mayoclinic.org/heartcatheterization-jax/index.html. Accessed July 24, 2003.
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