An angiogram or angioplasty is a procedure during which it uses a long hollow catheter tube to diagnose and sometimes treat problems with the heart, coronary vessels and arteries. An angiogram is an invasive study, after which a short recovery period is needed in the hospital and then at home. Although the recovery period is short, there is a way to minimize the possible risks associated with the angiogram and recover quickly.
How is coronarography performed.
Coronary angiography is done in an X-ray room under local anesthesia.
The technique of coronary angiography is as follows: by puncture of the radial artery on the wrist (in most cases) or the femoral artery, the left and right arteries of the heart are catheterized alternately, then the coronary arteries are filled with an X-ray contrast medium through the installed catheter, and the images are taken in different projections.
Indications for coronarography.
Coronarography is performed in the following cases:
- first-born anginal (sternal) pain,
- with unstable angina,
- myocardial ischemia (malnutrition) detected on an ECG or during Holter ECG monitoring,
- positive: treadmill test, bicycle ergometry, stress Echo-cardiography,
- myocardial infarction
- post-infarction angina,
- with ineffective drug therapy for coronary heart disease,
- asymptomatic course of coronary heart disease,
- before open heart surgery,
Preparation for coronary angiography.
Before coronarography, the doctor explains to the patient the essence, purpose, possible complications and side effects of this procedure. Before performing coronarography, the patient is assigned the following examinations:
- clinical blood test,
- determination of blood type and Rh factor,
- blood coagulation test,
- blood chemistry,
- blood tests for hepatitis B and C, HIV,
- ECG in twelve leads,
- Echo KG
- Stress Echocardiography,
- Treadmill test.
With concomitant diseases, such as diabetes and hypertension, additional examinations and consultations of doctors of other specialties are prescribed.
The patient must inform the doctor about the presence of allergic reactions to iodine-containing drugs, chronic diseases and previously prescribed drugs.
Before coronarography, it is also necessary to shave the wrist areas on the right hand or inguinal region.
Coronary angiography results hearts are usually ready that day in the form of a protocol and video recording on disk.
Contraindications to coronarography.
There are no absolute contraindications to coronarography. There are the following relative contraindications that require special management tactics for the patient before and after coronary angiography:
- hypersensitivity of the patient to iodine-containing substances or drugs for local anesthesia,
- uncontrolled ventricular arrhythmias,
- uncontrolled arterial hypertension,
- severe heart failure
- high body temperature,
- severe renal failure.
Complications after coronarography.
The percentage of complications after coronary angiography is minimal. However, the following complications may still occur: pain in the hand after coronary angiography at the puncture site can be associated with a hematoma or the end of the anesthetic, bleeding at the puncture site, pain in the heart may be associated with arterial thrombosis and heart attack, which will require urgent re-intervention. Therefore, if the pain persists for a long time or intensifies, it is necessary to inform the attending physician about this.
Nutrition before and after coronary angiography.
Coronary angiography is performed on an empty stomach. If you are constantly taking medications, you must discuss with your doctor which ones to take, which ones to cancel. After coronarography, after 40 minutes you can already eat as usual. It is also necessary to increase fluid intake during the first days after coronary angiography.
What is the difference between MSCT of blood vessels of the heart from coronary angiography.
MSCT, in contrast to coronary angiography, is not an invasive diagnostic procedure. With MSCT, the contrast agent is administered systemically intravenously, and multilayer imaging of the chambers and blood vessels of the heart is performed. In coronary angiography, the catheter is placed directly in the arteries of the heart, and contrast is received through it during the survey, which allows the most accurate determination of the damage to the coronary arteries.
The cost of coronary angiography can be found here.
Angiographic studies of blood vessels are not absolutely safe diagnostic methods, since they carry a certain risk of complications. However, this risk is fully justified, since the angiography method is the most informative and accurate. An individual selection of methods, strict adherence to research rules and the use of modern capabilities can prevent the development of complications after angiography.
Types of postangiographic complications
Among the complications, the following are most often encountered:
- Allergic reactions to radiopaque substances (in particular iodine-containing substances, since they are used most often)
- Pain, swelling and bruising at the site of catheter insertion
- Bleeding after a puncture
- Impaired renal function up to the development of renal failure
- Injury to a vessel or heart tissue
- Heart rhythm disturbance
- Cardiovascular failure
- Heart attack or stroke
All possible complications can be divided into three groups: allergic, impaired functioning of organs and systems, traumatic. Let's consider each group in more detail.
Almost all substances used for angiographic studies contain iodine. Specialists distinguish two groups of side effects of these substances: side effects and allergic reactions.
Adverse reactions do not require medical intervention, they pass on their own within 2-4 hours after the procedure. Such reactions include:
- Progressive headache
- The appearance of a metallic taste in the mouth
- Increased sweat and heat
- Possible decrease in blood pressure up to 20 mmHg.
These consequences of angiography can be the beginning of more serious complications and therefore require careful attention and careful monitoring for at least 4-5 hours after the study.
Allergic manifestations require immediate medical intervention, with untimely therapy, their intensity increases up to a fatal outcome.
A mild allergic reaction can be distinguished, the manifestations of which include:
- Respiratory manifestations (runny nose, cough, sore throat)
- Manifestations from the side of the eyes (spontaneous lacrimation, redness and swelling)
- Skin reactions (small rash, urticaria).
Such conditions pass independently for several hours to 2 days after the procedure. Perhaps the appointment of antihistamines and vasoconstrictor nasal drops or sprays.
Severe allergic effects of angiography include:
- Rash or angioedema
- Saliva and lacrimation
- Spasm of the bronchi and larynx
- Development of anaphylactic shock
It is important! Treatment of complex allergic manifestations can be fatal and therefore should be carried out exclusively in a hospital.
Often during the administration of the radiopaque substance, the patient may feel pain along the vessel. When introduced into the ulnar veins, the pain can radiate (spread) into the armpit. The intensity of the pain depends on the following factors:
- Placement of the substance - when one of the small veins of the back surface of the brush is introduced, the painful sensations are more intense
- Contrast Properties
- Concentrations and degrees of dilution of a substance with blood
- The rate at which a substance is injected into a vein.
Vein spasm that develops after prolonged dilatation of the vessel can lead to phlebothrombosis. If an X-ray contrast substance is injected past a vein, a very painful infiltrate appears, which is fraught with the development of tissue necrosis.
Hematoma and bleeding
The development of a hematoma at the puncture site is associated with damage to the vessel wall with a needle, which leads to hemorrhage in the surrounding tissue. It is manifested by a change in skin color from crimson to lemon yellow in various periods of hematoma development. The appearance of bleeding at the puncture site.
In order to avoid the appearance of a hematoma, it is necessary to apply a tight bandage after puncture, which should not be removed within a day after the procedure.
Impaired functioning of organs and systems
The first signs of the development of acute renal failure may appear in the patient several hours after the administration of the radiopaque substance. A complication develops as a result of renal cortical ischemia.
Hepatic failure develops in violation of the antitoxic function of the liver. Carrying out an angiographic study of the heart is fraught with the development of heart rhythm disturbances, as well as left ventricular or right ventricular failure.
The treatment of these complications is carried out in exclusively hospital conditions, and their therapy is more symptomatic than pathogenetic.