Examining the coronary arteries (diagnostic coronary angiography)

What is it about ?

A diagnostic coronary angiogram is a test that can detect narrowed or blocked areas in the coronary arteries.

Coronary arteries are small blood vessels that line the muscle of the heart (myocardium). They form a sort of crown around the myocardium. These vessels supply the heart muscle with oxygen and nutrients.

If these vessels are narrowed or blocked, there is a lack of oxygen in the myocardium, which often leads to a heart attack (myocardial infarction).

The exam uses a long catheter, which is inserted at the groin or wrist and slid into the coronary arteries. Once this catheter is in place, the doctor injects a contrast medium and takes x-rays. The coronary arteries are thus ‘photographed’ and the doctor can assess the number, exact location and severity of any narrowing.

In addition to the diagnosis (observation of a disease, here the narrowing of the blood vessels), the doctor can take advantage of the examination to try a treatment: he can thus insert a balloon at the site of the narrowing and inflate it to widen. the passage. A stent (a small tube) can also be placed in the blood vessel to keep it open.

When will the doctor suggest this test?

• if you have symptoms suggesting a heart attack;
• if you have cardiovascular disease that seems to get worse despite good treatment;
• if the electrocardiogram (ECG) shows abnormalities which suggest a decrease in blood flow to the muscle of the heart;
• if you have an increased risk of coronary heart disease and have chest pain;
• if scans or ultrasounds of the heart show that part of the heart is not receiving enough oxygen;
• if your heart is not working well and your doctor needs to look for the cause of the heart failure;
• in preparation for a planned intervention on the valves of the heart;
• in preparation for a heart transplant.

In the following cases, the doctor may decide that the risk of coronary angiography is too high:

• if you have a serious infection;
• if you tend to bleed easily;
• if you have recently had neurological problems;
• if your kidneys are not working well (kidney failure);
• if you are allergic to contrast media.

How does the intervention take place?

The coronary angiography lasts between 45 and 65 minutes. To this must be added the preparation time. If the exam is done through the groin, you will still need to lie down for 2 to 6 hours after the coronary angiography.

The place where the catheter was inserted is compressed for a few hours with a pressure bandage to prevent bleeding.

What can you do ?

• Before the examination, the place of insertion of the catheter (the wrist or the groin) should be shaved thoroughly. You can optionally do this at home.
• It is necessary to be on an empty stomach for the examination; in other words, you cannot eat and drink for 4 to 6 hours before the exam.
• In principle, the examination is painless. You may feel a sensation of heat and the urge to urinate the moment the contrast medium is injected, but this does not last long. If you experience pain or discomfort during the test, you should report it to the doctor or nurse.
• In principle, recovery is also quick and painless. If you feel pain in the chest or where the catheter was inserted, or if you have a fever, you should tell your doctor.
• After the examination, you need to ease off a little for 3 days. Avoid exerting great effort and lifting weights.
• The first 3 days after the procedure, you can shower, but not take a bath yet.

What can your doctor do?

The general practitioner will make the necessary preparations, such as a physical examination and a blood test. They will also review your medication list as some medications will need to be stopped for the test.

If you are taking medicines which thin the blood, some should be continued, such as aspirin. On the other hand, anticoagulants must, in most cases, be interrupted for a few days and replaced by a drug administered by subcutaneous injection.

If you have diabetes and are taking metformin, you should stop this medicine the day before, the day and the day after the operation. Your doctor will give you the advice you need to maintain good blood sugar (blood sugar) levels.

At the hospital, the doctor will do a physical examination and send you to a nurse for an electrocardiogram (ECG). Sometimes an x-ray of the lungs (chest x-ray) or other tests are also needed.

After the examination, the doctor will discuss the results with you. If the coronary angiography showed strictures, different treatment options can be considered: drug treatment, placing a balloon at the level of the constriction (balloon dilation) or bypass (bypass). The doctor will explain to you which treatment is best for you.

Want to know more?

• Coronary angiography and coronary dilation, here, Where to find on this page of Cliniques St Luc UCL

• Aspirin – CBIP – Belgian Center for Pharmacotherapeutic Information
• Anticoagulants – CBIP – Belgian Center for Pharmacotherapeutic Information
• Metformin – CBIP – Belgian Center for Pharmacotherapeutic Information

Source

Foreign clinical practice guide ‘Diagnostic coronary angiography’ (2000), updated on 14.03.2017 and adapted to the Belgian context on 25.10.2019 – ebpracticenet