Coronary Angiography What I should Know?

A specialised test to find out detailed information about the arteries of your heart. Coronary arteries do not show up on a plain X-ray. With coronary angiography, dye is injected down the coronary arteries. The arteries and their smaller branches then show up clearly 'like a road map' What is it???

Heart Disease: Blockage of the vessels Failure of oxygen delivery caused by a decrease in blood flow in front of increased oxygen demand of the heart Pain/Angina Heart Attack WHY I Need to Know State of my coronary Arteries

coronary angiography can show the exact site and severity of any narrowing of the coronary arteries THEN(5-6 years from now) It is mainly used if you have angina, to assess the extent and severity of the angina. Now It is used to know if your heart is healthy or has the disease started & to assess the extent & severity. ANGIOGRAPHY

Before the day of the test you may need a blood test and an ECG to make sure you are OK to have the procedure. If you take a 'blood thinning' drug (anticoagulant), then you are likely to need to stop this for 2-3 days before the test. (This prevents excessive bleeding from the site of the catheter insertion.) You may be asked to stop eating and drinking for a few hours before the test. A blood test to check your Kidneys are fine You may be asked to shave both groins before the test. You will have to sign a consent form at some point before the test to confirm that you understand the procedure, understand the possible complications and agree to the procedure being done How do I prepare for the procedure

Complications!! Oh My God!

What are these?? A bruise, which may form under the skin where the catheter was inserted (usually the groin). This is not serious, but it may be sore for a few days.

You may need to have few stitches at the groin if a small cut has been made.

There May be risk of Excessive Bleeding or Bleeding may not stop all together May lead to balooning of vessel–Aneurysm formation

The small wound where the catheter is inserted sometimes becomes infected. Tell your Doc if the wound becomes red and tender. A short course of antibiotics will usually deal with this if it occurs.

 some people have had a stroke or a heart attack (myocardial infarction) during the procedure.  rarely, the catheter may damage a coronary artery.  some people have even died during this procedure.

DO I Have an Alternative

Really

CT CORONARY ANGIOGRAPHY

Now What is It?? Same Procedure to see artery of the heart But Without any need to insert the catheter

How is this performed With the help of an Ultrafast CT Scan Machine

Can All CT Machines perform this test No Only multidetector CT Scan with atleast 64 slice /detectors Other machines : 128 detectors CT, 256 Detector CT and best of all Dual Source CT(DSCT)

SOMATOM Definition DSCT-Dual Source CT Scanner The World’s First Dual Source CT Two X-Ray sources and two detectors at the same time

Is Dual Source CT and Dual Slice CT one n the same thing Not at all Dual Slice CT is capable of only taking 2 Images /rotation and is a basic entry level CT machine only A 64 Slice CT can take upto 192 images /sec Where as a Dual Source CT (the best one and the fastest) can take upto 776 images/sec

64 slice CT : is it sufficient for CTA Maybe. It would require to give you medicines to lower your heart rate to less than 60/minute to achieve the diagnostic quality images and heart beet needs to be very regular. Otherwise, we may not be able to perform angiography on 64 Slice CT Presently- it is considered outdated machine to perform a CT Heart Angiography

DSCT ANGIO- No Need To Reduce Heart Rate Dual Source CT is independent of heart rate and is capable of imaging any beating heart

Experience with CT Angio Just Walk in and Walk Out

Any preparation needed Simply 2-3 hrs Fasting prior to the test A blood test to check your Kidneys are fine

Why Kidney test The dye used in Angiography is excreted by kidney If Kidney is not functioning properly then this dye can act like poison We have a better but costlier option which can also be used instead

Visipaque – Renal safe contrast agent when kidney functioning is compromised & test must be performed. ‘Because we care’... – Renal safe contrast agent when kidney functioning is compromised & test must be performed. ‘Because we care’...

Do I need hospital care In less than half an hour u r free to resume your daily routine No Hospitalisation No admission No Drugs to reduce ur heart rate No pains & all Gains

Who can get this test done Anyone who wants to know the state of his heart Person with – Diabetes – History of heart disease in family – Hypertension – Bad Cholesterol levels

Other modifiable risk factors Smoking

Obesity

Bad eating habits

Lack of exercise or sedentary life style

Who else A person who has not very high pretest probability of severe heart disease i.e A person who has not had angina but effort intolerance is there.Other test such as Echo and TMT are normal. ECG is normal.

Is it for heart patients too It is advisable that a cardiac patient who has had Heart attack should ideally go in for Conventional Invasive catheter Angiography as it can even lead to Angioplasty at same time BUT If a patient is afraid or evading an angiography This is definite answer to persuade the patient

If I already am diagnosed and treated for the Heart disease- can it help me Definitely For Stent patients- followup for stent patency or recurrance of disease in any other vessel or any other cause of symptoms For Post CABG/Bypass surgery; to look for graft occlusion.

Is this test as effective to diagnose disease as routine angiography yes & No

If it is 64 slice CT it depends on your heart rate If Dual source CT then as effective and sometimes better as it can also tell about plaque character – whether soft or hard

How is a CT Angiography done

This is how ordinary single source machine with high heart rate show heart