Coronary angiography of the vessels of the heart: what is it?
Today one of the most informative methods of detection of cardiac ischemia is coronary angiography. This article explains what it is identify the indications and contraindications, as well as features of this survey.
Specified diagnostic technique is x-ray study of the arteries of the heart. It is performed using special contrast media and helps to identify the place of constriction of the vessels, the nature of the violations and their severity. In addition, with the help of coronary angiography fails to diagnose coronary artery disease and to draw conclusions about the need for appropriate therapeutic procedures (e.g., angioplasty, coronary bypass surgery) or to determine the amount of drug therapy. Indications for use patients with coronary angiography:
- unstable angina that is not amenable to treatment via pharmacological agents, accompanied by a decrease in blood pressure, pulmonary edema and disruption of the left ventricle of the heart occurs after myocardial infarction;
- determination of risk of various complications if it is impossible to do non-invasive ways;
- before operations in patients older than 35 years (e.g. before prosthetic heart valves or correction of congenital anomalies);
- ineffective drug therapy of atherosclerosis vessels of the heart;
- for the differential diagnosis with lesions of nacionalnogo origin (e.g., with atypical pain);
- for social reasons (if a patient has minimal symptoms of ischemia in the myocardium, and from his professional activities affect the lives of others, such as drivers, pilots, etc.);
- if you feel unwell patients who underwent endovascular surgery (when it causes them pain, negative ECG changes, or when you increase levels of certain enzymes in the blood);
- with the progression of strokes;
- emergency coronary angiography of the heart vessels is performed in acute coronary syndrome.
- renal failure and kidney damage, which creatinine is above 150 mmol/l;
- severe form of hypertension;
- severe circulatory failure;
- decompensated form of diabetes;
- mental disorders;
- peptic ulcer disease in the period of exacerbation;
- severe allergies;
- aggravation of any chronic disease;
In addition, it is not recommended to pass the said examination at an elevated temperature, anemia, low level of calcium in the body, if blood clotting. Higher risk of complications seen among persons with severe pathology of lungs, obesity, and elderly patients.
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Preparing and conducting
When coronary angiography is carried out as planned, patients should have a blood test to determine blood group and Rh factor, to exclude the presence of hepatitis type b, C, syphilis and HIV. In addition, they are referred to ECG and ultrasound of the heart. In some cases, can appoint additional examination.
Before the procedure the patient explain the essence and warn of possible adverse reactions. If the patient gives consent for it, start examination. To do this under local anesthesia impose special catheter into the femoral artery. It slowly advanced to the arteries of the heart. After this, the radiopaque agent injected (through a catheter), which with blood is delivered to the coronary vessels. This process is fixed by a special device that allows you to visualize image on the monitor and save them.
Coronary angiography is often complicated by arrhythmias and fibrillation of the heart. Basically register the beat. Its appearance can be explained by the occlusion of the artery by the tip of the catheter and displacement of her blood contrasting composition. This is equivalent to clamping the blood vessel. Short-term hypoxia of the myocardium thus has a local character, however, violates the correlation of biopotentials in the heart, which in turn leads to changes of rhythm in the myocardium (in severe cases, to ventricular fibrillati). To correct such arrhythmias, the use of an external electroimpulse, so during the procedure there should be a defibrillator.
Another group of common adverse reactions when performing coronary angiography are allergic reactions. As a rule, after the examination, patients may be rash, swelling and itching of the body, lowering blood pressure, and difficulty breathing. In severe sensitivity to contrast medium, which is used during the procedure, the possible development of anaphylactic shock.
In addition, the introduction of a contrast agent can greatly impair kidney function. For this reason, among patients diagnosed with concomitant severe form of diabetes, cardiac and renal failure, coronary angiography is carried out under strict indications and only on the advice of a doctor. Other negative effects after this study:
- heart attack;
- violation of the integrity of the blood vessels;
- a broken heart;
- massive bleeding;
- the radiation of x-rays.
In the removal of blood clots from the vascular walls in the survey may develop a heart attack or stroke. In addition, in rare cases, it may be air embolism. To prevent such complications, patients are encouraged heparin, which after manipulation is neutralized with Protamine sulfate.
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Coronary angiography is considered a powerful diagnostic method which helps to detect a blockage or narrowing of the coronary arteries. It is important for the timely diagnosis of coronary artery disease, however, given the severe complications that can occur during the survey, coronary angiography is assigned exclusively by the physician considering all the risks.