Angiogram: What is it? Why is it performed?

Lab Test and Medical Investigation

A coronary angiogram, as the name suggests, is a diagnostic procedure in which your doctor uses X-rays to see and examine the blood vessels of your heart.

If your doctor suspects that there might be something that is restricting blood flow to the heart, he or she is more likely to recommend a coronary angiogram. Also, this procedure helps in getting clear pictures of blood circulation into different body organs. Angiograms help doctors to diagnose major or minor disorders, which are affecting the blood flow to the heart, brain, or other organs of the human body.

Angiograms also help in checking the abnormalities in blood vessels, which include deteriorated blood flow, fatty deposits in arteries, and blood clots.

Why is the angiogram procedure performed?

An angiogram can detect many cardiovascular diseases like coronary atherosclerosis, vascular stenosis, and aortic aneurysms. Your doctor can recommend this procedure to you for several reasons, such as:

If you are observed with signs of coronary artery disease like angina (chest pain).
If you have issues like severe and unclear pain in your chest, neck, left arm, or jaw.
If you have new or sudden increase in chest pain, which is medically known as unstable angina.
If you were diagnosed with congenital heart disease—a heart defect since birth.
If the tests show abnormal results on ECG or any noninvasive heart tests like exercise stress testing, myocardial perfusion imaging, or echocardiography.
If the doctor observes any other blood vessel problems.
If you have had any past or present chest injury.
If you have an issue with your heart valve that requires surgery.
If you had a stroke, heart failure, or heart attack.

However, sometimes there is a possibility of complications during angiography. This is why it is not directly perfromed , until after any noninvasive heart tests like heart stress tests, echocardiograms, or electrocardiograms.

There are also other reasons why a doctor might recommend an angiogram:

To check the health of blood vessels before the surgery is performed
To detect the blood vessels nurturing a tumor
To create a treatment plan for problems like stenting, coronary bypass, or chemoembolization
To properly check the placement of a stent after surgery

What are the risks associated with angiogram?

Like any other heart and blood vessels procedures, a coronary angiogram also has certain risks involved, like exposure to X-rays (radiation). However, the incidences of any severe complications are rare. Some of the possible risks and complications may include the following:

Stroke
Heart Attack
Arrhythmias (Irregular rhythms of the heart)
Damage to the kidneys
Infection
Blood clotting
Bruising
Excessive bleeding
Damage to the catheterized artery
Allergic reactions owing to the drugs or dyes used for the procedure

How do doctors prepare for angiography?

In some extreme cases, an angiography is done on an emergency basis. However, this procedure is mostly scheduled in advance, allowing patients to get prepared.

The guidelines to follow are:

No consumption of food and water before angiography.
For diabetic patients, consult the doctor on dosage of insulin, and other oral medications before angiography.
Tell your doctor regarding any allergies and details of the current medications you are taking.

What to expect from an angiography procedure?

Before performing the procedure.

Before starting your angiogram, your doctor is more likely to examine your medical history, such as medicines you have been taking, allergies, etc. After medical history, he or she will perform a physical examination and examine your vital signs, including your pulse rate and blood pressure.

The doctor will go through your medical history and check for allergies and medications that you are taking.

They will perform a physical examination to check for your vital signs.

They will check your blood pressure and pulse rate.

During the procedure.

Depending on the reason for angiography and age of the patient, doctors decide whether or not general anesthesia will be given. However, for children, anesthesia is usually given during angiography.

After the X-ray machine is set to get a clear picture of your heart, the doctor makes a small incision in the skin to get to one of the arteries. Local anesthesia is given to patients to numb the area of the incision.

Your doctor will make a small cut at the site of entry and insert a sheath (short plastic tube) through it into your artery. Thereafter, he/she will insert a catheter into your blood vessel via the sheath and attach it to your coronary arteries or heart.

This procedure, including threading and moving of the catheter through your body, should not be painful or discomforting. However, if you feel any of these, do inform your doctor.

After that, your doctor will inject a contrast material or dye through the catheter. During this process, you might experience a feeling of warmth or flushing for a while. However, make sure to inform your doctor if it feels uncomfortable. The contrast material can be easily detected on X-ray images. So, as it flows through your body, your doctor will be able to see how and where it moves and if or not there is any kind of blockage in between.

Based on the inference of the procedure, your doctor may use additional catheter methods, like a stent placement or balloon angioplasty, for opening the blocked or narrowed blood vessel. Your doctor may use other non-invasive diagnostic procedures, like ultrasound, to evaluate your blockages.

The small incision is made over your wrist or groin, and a thin, long, and flexible tube is inserted into the artery. By using an X-ray, the catheter is directed to the area of the heart that is being examined.

A special contrast agent is inserted through the tube that makes it easy for the doctors to see and read X-ray.

A series of X-rays images are taken when the contrast agent flows through the blood vessels, as it helps to observe and detect the blockages and restricted areas inside the heart.

Normally, angiography takes around one hour. However, depending on the complexity of the procedure, it can take some additional time.

After the procedure.

If a catheter was inserted in the groin, you have to lie flat for many hours to avoid bleeding. During such time, pressure will be applied to the cut (incision) in order to prevent bleeding and also promote healing.

You can go home the same day, or you may also have to be in the hospital overnight. Consume lots of fluids to flush the dye from your body. If you are feel like it, you can have something to eat.

Ask your medical team when to start taking medicines, showering or bathing, working and performing other normal activities. Avoid heavy lifting as well as strenuous activities for many days.

Your site where the pucture was made may possibly remain tender for a while. It may be bruised slightly and have a small bump.

Post procedure care.

Take rest for at least 24 hours
Drink plenty of fluids
Don’t smoke or consume alcohol
Take medications as advised

What results are observed after angiography?

A doctor perfroms the angiography to check the issues with your blood vessels. The following could be identified :

Blockages in your blood vessels and arteries.
The amount of blood flowing through the vessels and how much is blocked.
Outcomes from earlier coronary bypass surgery.

When the angiography is done, your doctor can easily determine the next course of action. Based on the results from angiography, your doctor will decide the type of procedure to be initiated, like coronary angioplasty.