Coronarography of the heart features of the procedure and possible complications

The heart is the most important muscle in the human body and the general condition of the entire human body depends on its good functioning. Very often, a person can develop various problems not with the heart itself, but with vessels that deliver oxygen and blood to the heart.

And in order to correctly diagnose heart disease, as well as to find out how dangerous and serious this problem is, doctors prescribe for their patients such an examination as coronarography, which is also called in medicine – angiography.

It should be noted that coronary angiography helps to assess the condition of arteries that fit the heart. The method is based on the use of x-rays.

This method was first used in the middle of the last century, and all this time it is trusted by professional doctors. Thanks to this method, you can easily see what is happening in the vessels of the heart, check the blood flow, notice the formation of plaques, narrowing of the arteries. Coronary angiography also reveals congenital heart defects, the removal of which requires the installation of shunts.

The coronarography procedure allows the doctor to choose a more rational method of treating occlusions and stenosis of the heart vessels. Based on the results of the study, cardiac surgeons and cardiologists decide whether the patient needs surgical intervention: stenting or coronary artery bypass grafting. Sometimes, if necessary, both stenting and coronary angiography are performed.

A distinctive advantage of this method of research and diagnosis is the fact that the inner layer of blood vessels is completely visible. The human body remains a mystery today. Some of its sides are not unraveled at the present time. And sometimes, to fix the problem, you need to look inside.

Coronary angiography of the heart is just such a method that allows doctors to make a more accurate diagnosis and prescribe the right treatment in a timely manner. Therefore, patients with heart problems can safely rely on the attending physician.

It should be noted that no doctor will prescribe angiography. First of all, because it is a rather expensive research method. And not all clinics have the appropriate equipment. And yet, the main indicators for coronary angiography are pain in the chest, accompanied by severe shortness of breath.

Such symptoms indicate, primarily, vasoconstriction. It is important to remember that coronarography is a fairly serious procedure. And it is very important to conduct the right preparation in front of her in order to get the right results and conduct effective treatment.

Coronary angiography is an analysis of the state of the heart vessels, carried out using radiopaque research methods. At the moment, this is the most accurate way to obtain data on the condition of the coronary vessels, allowing timely diagnosis of coronary heart disease.

With its help, it is possible to reliably determine the localization, degree and nature of the narrowing of vital vessels. Coronary angiography of the vessels is necessary to determine lesions and assess the volume of necessary intervention before performing procedures such as balloon angioplasty, stenting and coronary artery bypass grafting.

All these operations are very important and serious, as they not only improve the blood supply to the heart, but can also save the patient’s life. This study is well tolerated by patients and provides a vivid and clear picture of the disease, helping to quickly and effectively take appropriate measures.

The procedure will indicate further progress and the choice of treatment method – medication or surgery, depending on the severity of the vascular lesion. Coronary angiography is considered a less traumatic operation and is performed under local anesthesia.

The femoral artery is most often used to insert a catheter, but in case of damage to the vessels of the lower extremities, it can be inserted into the brachial or ulnar artery. The puncture site is freed from vegetation and disinfected. Then it is treated with a local anesthetic for pain relief.

After the drug works, an artery puncture is performed using a special large needle. Then, a special thin thread is inserted into the puncture site, which leads the catheter to the cardiac arteries.

By means of a catheter, a radiopaque agent is introduced into them, which fills all the vessels and gives a clear picture of their location and condition.

After the procedure, the catheter is removed, and the injection site into the artery is disinfected and a tight pressure bandage is applied to it to avoid bleeding. On the first day, the patient is prescribed rest and strict bed rest, and it is forbidden to even bend the leg into which the drug was injected in order to avoid complications.

Then the staff checks the patient’s condition and, if everything is in order, they transfer him to the ward for further treatment, or discharge him from the hospital.

Types of coronary angiography

Depending on the scope of the study, traditional coronarography may be:

  • general: a study of all coronary vessels is performed;
  • selective: only one or several coronary vessels are targeted.

Currently, coronary angiography of the arteries of the heart can be performed using a CT scan. This technique is called CT coronary angiography or MSCT (multispiral computed tomography of coronary vessels).

After the introduction of radiopaque substances, the patient is placed in a multispiral computed tomograph. This technique successfully competes with traditional coronarography, because it can be performed in a shorter time and does not require hospitalization of the patient.

Each of the above methods has its own indications and has its drawbacks and advantages, only a doctor will be able to determine the necessary type of study of the blood vessels of the heart.

Indications and contraindications

Coronary angiography is performed in the following cases:

  • with angina pectoris, which is manifested by a certain clinical picture. Often this occurs after myocardial infarction;
  • heart ischemia, which is asymptomatic;
  • atypical chest pain;
  • heart failure;
  • preparation for the surgical treatment of heart defects;
  • to test the effect of drug treatment or surgery for diseases of the cardiovascular system;
  • if necessary, coronary bypass surgery;
  • to confirm the diagnosis, if other studies did not provide enough information.

Be sure to carry out coronarography for heart attack in acute form, during the first 6 hours from the manifestation of pain. As well as with angina pectoris, which is insensitive to drug treatment.

Contraindications are certain diseases or pathological conditions of the body. Namely:

  • if there is an allergy to the administered substance. This is rare enough;
  • anemia;
  • diabetes;
  • fever;
  • renal and liver failure. This can be explained by the fact that the contrast agent is quite toxic and accordingly negatively affects the affected organ;
  • the presence of infectious inflammatory processes. Because of this, a blood clot may form;
  • hypertonic disease. Only if it is spontaneous and uncontrollable. Such a procedure is a kind of stress for the body and a hypertensive crisis may occur;
  • stroke (in the acute period). Due to the procedure, blood pressure rises sharply and a second stroke may occur;
  • the presence of internal hemorrhage, for example, in the stomach or lungs;
  • poor blood coagulation. In this case, bleeding may occur in the place where the catheter will be installed.

Also, such a study is not conducted for older people and overweight people.

How to prepare for the procedure

Preparation for the procedure, the patient must begin in advance. The night before, one should refrain from eating food and drinks after 18:00 p.m., otherwise, vomiting may occur during coronary angiography.

As for the use of drugs, you need to consult a doctor. Basically, it is not forbidden to use medicines. The only exceptions are drugs for diabetes.

Since the patient will not be able to eat until after the diagnosis, it is not worth lowering the sugar level, because the indicators can reach a critical point after the procedure.

Prepared for coronary angiography as follows:

  1. A week before the examination, they stop using medications that thin the blood.
  2. Diabetics consult an endocrinologist about taking insulin preparations.
  3. All jewelry and jewelry are left at home, it may also be necessary to remove contact lenses (if the patient wears them).
  4. Be sure to empty the bladder and intestines before the procedure.
  5. A standard set of things is taken to the hospital: bed linen, bathrobe, slippers, toothbrush and paste, soap, toilet paper. After the procedure, the patient will need to stay in the hospital for 2-3 days.

Before starting the examination, the patient must report an allergy to medicines, especially if he has an allergic reaction to alcohol, iodine, rubber products, novocaine, antibiotics, or to X-ray drugs.

If emergency coronarography is performed, then the patient is given an ECG (electrocardiogram). If the procedure is carried out according to plan, then a number of additional examinations are prescribed, namely:

  • clinical and biochemical blood analysis;
  • general urine analysis;
  • analysis for hepatitis markers;
  • screening for HIV and syphilis;
  • ECG;
  • ECG monitoring by Holter.

Additionally, an x-ray of the chest organs can be prescribed. After coronary angiography, the patient must strictly observe all the recommendations of the doctor so that complications do not appear.

The patient is prescribed bed rest, restrictions on movements, especially in flexion of the limb on which the procedure was performed. This is the prevention of bleeding at the puncture site.

To prevent impaired renal function, it is necessary to use liquid in large quantities. If you experience severe cutting pain in the puncture area, the appearance of swelling and bruising, as well as worsening of well-being, weakness, shortness of breath and lowering pressure, you need to go to the hospital.

How to conduct an examination

There are two options for coronary angiography: planned or emergency. Before the procedure, the patient undergoes an examination, where it is mandatory to identify the blood group and Rh factor.

The procedure is completely safe, but to a small extent pleasant. Usually it is carried out on an outpatient basis, but in some cases (if the operation will be performed immediately after) it is done in a hospital in cardiology.

During the diagnosis of blood vessels, a person is conscious, coronary angiography is done under local anesthesia. After the introduction of an anesthetic, the person does not feel pain or discomfort.

If the procedure is not carried out for the first time, then in the puncture zone the patient may feel unpleasant sensations: all because the analgesic acts much weaker during repeated manipulations on the arteries.

When performing coronary angiography, the patient’s condition is monitored by a team of specialists: cardiorenatologist, anesthetist. Before the artery puncture, the surgeon performs local anesthesia. The following actions are performed:

  1. After puncture of the femoral, axillary, brachial or radial artery (the choice of access is determined depending on the equipment available or the doctor’s preferences), a special catheter is inserted into the lumen of the puncture needle using a guide (intrauser).
  2. After the catheter and the introducer are inserted, the puncture needle is removed, and heparin is administered to the patient to prevent blood coagulation and the entire system is washed with a mixture of saline and heparin.
  3. A catheter under the control of fluoroscopy or Echo-KG moves through the blood vessels to the upper section of the aorta.
  4. From this moment, the patient begins to constantly measure blood pressure, and the catheter gently moves into a common trunk or into one of the branches of the coronary arteries.
  5. A radiopaque drug is injected into the catheter using a special syringe, which enters the coronary vessels with a blood stream and fills them after a few seconds.
  6. Using a special apparatus-angiograph, the results are recorded: pathological changes in the coronary arteries, tortuosity of the chords, sections of stenosis and a reaction to the contraction of the heart muscle. When taking pictures, the right and left coronary arteries are visualized.
  7. The results can be recorded on x-rays or x-ray film. Using software, the results are digitized (if necessary, a three-dimensional image of the coronary arteries can be performed). A record of the results is given to the patient in his hands in the form of a written opinion and a record of x-ray images (on a disk or film).

After completing the images, the doctor removes the system and stops the bleeding with a sterile pressure bandage, which consists of a napkin pressed by a special device to create pressure on the area of ​​the punctured artery.

The pressure is weakened 15 minutes after the dressing is applied, and after half an hour the device is removed and the usual pressure dressing is applied to the puncture site. The bandage is removed one day after the examination.

During the examination, the pulse and blood pressure are necessarily measured. After the diagnosis is completed, a decision is made on further treatment. The most convenient and safe catheter for insertion is the artery on the leg in the groin area. But after the procedure, a person should not get up and bend his leg for an hour.

When a catheter is inserted through the arm, an artery spasm or thrombus formation is possible, therefore this method is risky for the patient. After coronarography, the tube may not be removed if surgery is performed after diagnosis.

If there are certain indications immediately after the completion of the study, the patient may be offered to perform reconstructive endovascular treatment: balloon angioplasty or coronary stenting.

When performing coronarography through the radial artery, the patient can return home within a few hours after the completion of the study. He is recommended to observe a sparing regime and restrictions in flexion of the upper limb, on which the artery was punctured.

After the procedure, the patient is recommended to drink plenty of water to prevent possible violations in the functioning of the kidneys. If you experience severe weakness, shortness of breath, decreased blood pressure, sharp pain or swelling in the puncture area, you should immediately consult a doctor.

With other types of access, the patient is under medical supervision during the day and observes bed rest.

Coronary examination of the blood vessels of the heart – a transcript of the results

A coronary examination of the blood vessels of the heart does not last long, and after this procedure, a sparing regime is recommended, which restricts the limb flexion used during surgical treatment to prevent further bleeding in the puncture area.

To prevent the occurrence of various disorders of the kidneys, the patient is recommended to drink as much as possible. There may be cases when sharp pain appears at the puncture site, a significant swelling with a pronounced bruise forms, a feeling of weakness, a decrease in blood pressure or shortness of breath are possible.

In this case, you should immediately inform your doctor. There may be a certain risk of complications from such a procedure as coronary heart vessels.

Often met from them:

  • the appearance of blood in the place where the puncture was performed;
  • arrhythmia;
  • occurrence of allergy;
  • strong detachment of intimal artery;
  • the development of myocardial infarction.

A thorough examination of several specialists at once makes it possible to reduce the risk of further development of such ailments. As for the results of CAG in cardiology, they represent a combination of numerous conclusions about the general condition of the vessels of the heart region, this also includes the level of their narrowing, as well as the sufficiency of blood supply to the myocardium.

If a narrowing of the lumen is detected to half, it does not cause changes that entail serious consequences.

If the coronary examination of the blood vessels of the heart showed an excess of the necessary indicators, then this indicates a significant violation. Recovery requires surgical treatment. The obtained images make it possible to determine the types of stenosis:

  • local – encompass a relatively small portion of the vessel;
  • diffuse – belong to a fairly large area.

Separation of stenosis is also implied with respect to the walls:

  • even and smooth;
  • Undermined and uneven.

The complicated form is quite common and occurs due to ulceration of the atherosclerotic plaque. As a result of a coronary examination of the vessels of the heart, a complete blockage of the lumen of the heart vessels can be detected.

In this case, the myocardial region is subject to the restriction of oxygen and many nutrients. Coronation of the vessels of the heart will also help to identify the severity and prevalence of atherosclerosis.

To do this, it is enough to assess the presence of stenosis and atherosclerotic plaques in the main arteries of the heart region.
Thus, the conclusion should indicate the presence of one, two or three-vascular lesions of the system. Note also that this procedure is quite expensive.

How to behave after the procedure

When the coronarography is completed, the catheter is removed from the patient’s hand or groin and the incision is sutured with manual compression, clamping or a small plaque. The patient will be taken to the recovery unit for monitoring and control.

When his condition stabilizes, he will be returned to the ward. The patient will have to lie for several hours to avoid bleeding. During this time, the doctor can press on the incision to prevent bleeding and promote healing.

Sometimes, a plastic sheath, which was first inserted into a blood vessel, remains in place for several hours or even at night if angioplasty is performed or stenting is performed.

If the patient was injected with anticoagulants during the procedure, removing the membrane too quickly can cause severe bleeding. The patient may be able to go home that day, or may have to stay in the hospital for a day or longer.

Drink plenty of fluids to help wash paint out of the body. If the patient feels it, he needs to eat.

Ask your doctor when you need to resume taking medication, when you can take a bath or shower, return to work and resume normal activities. Avoid strenuous activities and hard work for several days.

Your injection site is likely to be sensitive for a while. A bruise and a small bump on it are possible. The patient should call a doctor if:

  1. He noticed bleeding, new bruising, or swelling at the catheter insertion site.
  2. Felt increased pain or discomfort at the catheter insertion site.
  3. There are signs of infection, such as redness, drainage, or fever.
  4. Change in temperature or color of the leg or arm that was used for the procedure.
  5. The patient feels weak or lethargic.
  6. Chest pain or shortness of breath intensifies.

If there is active bleeding at the catheter insertion site or if swelling begins, squeeze the wound and contact emergency medical care.

Stent placement or vasodilation using balloons

In the process of medical, therapeutic coronarography, an expansion of clogged or significantly contracted due to atherosclerotic coronary artery disease is performed. Atherosclerotic vascular disease occurs due to a violation of lipid metabolism and is accompanied by the deposition of cholesterol and lipids, and sometimes calcifications inside the vessel.

As a result of this, normal blood flow is disturbed, and in severe cases, a blood clot forms, clogging the vessel and causing heart attack. In the places of stenosis of one or several vessels, stents are installed in order to keep the lumen of the vessel open and ensure unhindered blood flow.

A special catheter with a balloon at the end is inserted into the vessel. Having reached the site of narrowing, the balloon is inflated, presses atherosclerotic plaques against the walls of the vessel and widens the lumen in the narrowed section of the vessel.

If a blood clot is detected, it is removed using a special catheter. A special, thin spiral that performs a supporting function is installed on the cylinder. This spiral is called a stent. The inflated balloon presses the stent against the walls of the vessel.

After removing the balloon, the stent remains on the vessel wall, thus leaving the vessel lumen open. It is possible to use several stents if it is necessary to expand narrowed areas in several vessels.

A stent placement is designed to improve the immediate and long-term results of balloon expansion of coronary vessels. The likelihood of recurrence of stenosis or occlusion of the coronary vessels can be significantly reduced by using new generation stents coated with a special substance (Eluting Stents Drug).

To date, the Institute of Invasive Cardiology Medical Center. Rabin uses different types of stents coated with medicine (cypher, taxus, endeavor, etc.). The type of stent is selected individually for each patient, depending on the state of the vessels and related diseases (such as, for example, diabetes mellitus).

Complications

Coronarography, subject to all the rules for its implementation and doctor’s recommendations, is complicated rather rarely. The most common complications are:

  • bleeding at the site of puncture of the artery (approximately 0,1% of patients);
  • the formation of a hematoma, edema or false aneurysm in the area of ​​the punctured artery;
  • the development of arrhythmias;
  • coronary thrombosis;
  • an allergic reaction to a radiopaque substance (iodine is part of it);
  • vasovagal reactions: blanching, cold sweat, decreased blood pressure, decreased heart rate.

Severe complications of coronarography are extremely rare. They can become:

  • myocardial infarction;
  • cerebral ischemia;
  • stroke;
  • damage or rupture of the vessel through which the catheter is inserted;
  • fatal outcome (less than 0,1% of cases).

The maximum risk of complications can be observed in such cases:

  • childhood;
  • patients older than 65 years;
  • stenosis of the left coronary artery;
  • left ventricular failure with ejection fractions less than 35%;
  • valvular heart disease;
  • severe forms of chronic diseases (diabetes mellitus, tuberculosis, renal failure, etc.).

Physician advice

The main recommendations are as follows:

  1. Bed rest and no stress.
  2. Limitation of mobility and flexion of the limb on which the manipulation was performed.
  3. Drink plenty of water to prevent kidney dysfunction.
  4. It is worth returning to physical labor only after a few days if the patient feels well.

All measures are aimed at restoring a person and preventing bleeding in the puncture area.

The patient spends a day in a hospital. In the event of a sharp pain or swelling in the puncture area, a doctor’s consultation is necessary. Shortness of breath, weakness and lowering of pressure may indicate arterial bleeding, which is a threat to the patient’s life.

Due to the high likelihood of complications after a hip artery puncture, the patient should not refuse to be in the hospital. It is worth considering that the femoral artery is located at a depth of 2-4 cm from the skin and is a rather large vessel.

If you start moving a few hours after the procedure, bleeding will begin, which is difficult to stop. Recently, patients have a choice.

Coronarography can be done through the radial artery on the wrist. Such access was called radial, but not all clinics perform the operation. This technique has the following advantages:

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.

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