Coronarography (assessment exams)

Content

Introduction

Coronary angiography is a radiological examination that allows the visualization of the coronary arteries, the arteries that carry oxygenated blood to the heart.
Coronary arteries originate from the aorta and are often the site of narrowing caused by accumulations of fat and calcium deposits that reduce the flow of blood within them. These changes cause chest pain or, in the case of complete closure of the coronary arteries, myocardial infarction.

When you do

Coronary angiography is a recommended examination when the presence of narrowings or occlusions within the coronary arteries or other abnormalities such as heart malformations or heart valve defects is suspected. The narrowing of the coronary arteries is caused by the formation of an atherosclerotic plaque (atheroma), which is a thickening of the inner layer of the artery wall (intima) directly in contact with the blood. The accumulation of lipid (fat) material and inflammatory cells, with proliferation of connective tissue (supporting tissue present in the vessels), are the main cause of these narrowings.

Chronic inflammation of large and medium diameter (caliber) arteries, caused by the thickening of the vessel wall, is called atherosclerosis.

How it is done

Coronary angiography is performed by injecting a contrast medium into the coronary arteries to highlight the internal contour of the vessels and photograph it with precision radiological instrumentation. To this end, the person is made to lie down with his stomach up (supine), he is given drugs to calm him down but remains conscious. The instruments for monitoring vital functions are then connected. To get the contrast medium to the coronary arteries, long and small cannulas called probes or catheters of plastic. They are usually inserted into the femoral artery (after making a small incision in the groin area) or, more rarely, into the brachial (arm) or radial (wrist) artery. The probe is pushed through the artery up to reach the base of the coronary arteries where the contrast medium will be released which will allow to visualize the inside. In this way, using X-rays, a series of radiographic images of the coronary arteries, right and left, can be acquired.
Coronary angiography allows to visualize also the left ventricle and to evaluate in this way the capacity of contraction.

It is an exam in which the cooperation of the person is very important. In fact, he will have to hold his breath or take deep breaths according to the doctor's requests.

The exam ends on average after 20-30 minutes. After acquiring all the necessary radiographic images, the doctor will remove the catheter and compress the site of the incision for about 15 minutes. If the femoral artery has been used for the insertion of the catheter, the person will have to remain with the leg extended and immobile on the table for 6-8 hours. Finally, he will have to drink plenty of water to get rid of the contrast medium as soon as possible. At the end of the examination, you will receive from the doctors the report and the images obtained (for example a CD).

Risks or side effects

Although coronary angiography is an invasive test, the risk is generally very low. However, it is necessary that the person be informed of the possible complications.

Very rarely there may be pain in the area where the probe was inserted or discomfort or tingling in the leg used for the examination. In some rare cases, the person may feel the sensation of losing blood. medical or nursing staff immediately.

For about 1 hour after the exam you will have to fast without taking solid food but you can drink.

Mild complications:

  • allergic or mild skin reactions (always report any allergies first)
  • nausea / vomiting
  • formation of bruises at the site of the puncture, which usually resolve spontaneously

Serious complications:

  • severe allergic reaction to the contrast agent
  • brain stroke, due to occlusion of the carotid artery in the neck or a cerebral artery that prevents blood from reaching the brain
  • embolism, migration of a blood clot into the peripheral arteries. The most frequent case of embolism is the pulmonary one which occurs when the clot carried by the bloodstream reaches the lung and stops in a small vessel causing a rapid reduction of oxygen and nutrients and severe respiratory failure.
  • death

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