29 March, 2024

Understanding Coronary Angiography and Angioplasty

Let us decode the medical verbatim first. Below are a few commonly used terms and their meaning.

Cardiac: related to heart
Coronary artery: blood vessels that supply blood to the heart
Angiography: the process of looking at coronary arteries
Angioplasty: the process of fixing a blocked or damaged coronary artery

Introduction:
Your doctor may recommend an angiography if there’s reasonable suspicion that your coronary arteries may be having blockages. Doctors make such decisions based on your symptoms and available test results, such as ECG, echocardiogram, or stress tests. Angiography is the best test available to determine whether coronary arteries have any blockages or not. Sometimes, if the clinical situation is urgent (e.g. if an ongoing heart attack is suspected), an emergency angiography may be recommended, which should be done as soon as possible.

Angiography involves inserting thin, flexible tubes (catheters) from the wrist or groin. The catheter is then taken up to the heart, and pictures of coronary arteries are taken under X-ray. In a typical scenario, a diagnosis can be made in real-time. A routine angiography takes about 15 minutes. Patients typically spend less than one hour inside the cardiac cath lab (a place where angiography is performed).

Coronary angiography is a routine procedure for centres well versed in cardiovascular services, with most high-volume centres doing at least a few of those daily. Enormous operational experience exists in the cardiology community, making angiography one of the safest procedures. Although there is always a risk of significant complications (like death, stroke/paralysis) when catheters are inserted in the body, particularly around the heart, fortunately, such incidents are extremely rare. The procedure is virtually pain-free (this is not 100% since we all have different pain thresholds, and some perceive significantly higher pain for any given stimulus). Other complications listed in the literature, like infection, medication reaction, etc., are also very uncommon. Two issues worth listing are as follows: bleeding and kidney damage. Bleeding can occur in a few individuals, particularly those who are predisposed to it, to begin with, like patients taking blood thinners, the elderly population, etc. Temporary or permanent kidney damage can occur slightly more commonly in patients who have underlying kidney disease, and in such patients, angiography should be considered, weighing risks and benefits.

Angioplasty on the face of it looks similar to angiography. Since it involves fixing the blockage, it takes a little more time than a routine angiography. In most angioplasty procedures, one or more stents are implanted at the site of blockages. The procedure also uses special catheters, wires, and balloons to help with stent placement. After completing cardiology training (DM), certain cardiologists opt for additional training to gain further expertise in angioplasty and related procedures.

Because angiography or angioplasty is an invasive procedure, a certain level of preparation is required before the procedure. Patients are instructed to report to the hospital in a fasting state (meaning nothing to eat or drink after dinner the night before). Patients should take their routine medications as scheduled, except diabetes medicines which should be held on the morning of the procedure. Blood thinners (Warfarin, Acitrom, Rivaroxaban, Epixaban, etc.) should be stopped a few days prior or as the cardiologist advises. Patients who are sick due to other illnesses should report to their doctors before the procedure is scheduled.
Pre-procedure evaluation may involve blood tests, x-rays, ECG, and an echocardiogram. Only when the doctor is satisfied with the available information will he/she approve the procedure. Once angiography is done, results are typically available instantaneously. Please ask for a CD or any other form of recording of the procedure for your records. Be prepared to spend most of that day in the hospital. Driving is not recommended after the procedure, so one should have a designated driver or take a taxi back home. In the case of angioplasty, patients are typically kept in the hospital for 1-2 days for observation.

When introduced in the 1970s-80s, angiography and angioplasty were the most novel procedures. With experience and updated technologies, it is now considered a routine procedure with excellent safety and efficacy. When performed in urgent/emergent situations, it not only saves lives but also provides quality of life (compared to medications alone). While an elective (non-urgent) procedure merits a detailed analysis before deciding to go for coronary angiography, urgent cases should go for this life-saving procedure without any delay. At the time of a heart attack, there is ongoing irreversible damage to the heart muscle, and one should save every minute possible.

A patient hand-out on angiography or angioplasty is available for download

I am sure I didn’t answer all your questions on this topic. Feel free to message me with your queries; I will happily answer them.

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