Coronarography: to see the heart, duration, rest afterwards

Coronary angiography is an examination that allows the cardiologist to see the coronary arteries when he suspects coronary artery disease, such as a narrowing of the arteries of the heart for example. This is a invasive examination since it is necessary to puncture the femoral or radial artery to allow the introduction of a catheter (flexible tube) into the arteries.

What is the definition of a coronary angiography?

There coronary angiography East an examination to visualize the arteries of the heart (coronary arteries). This is an imaging test using X-ray radiography technique and injection of an iodinated contrast product. “It’s a invasive examination, immediately warns Dr Florian Zores, cardiologist. It requires the puncture of an artery (most often the radial artery at the wristmore rarely the femoral artery at the level of the groin fold) and the circulation of probes to the cardiac arteries.”

What are the indications for a coronary angiography?

Coronary angiography allows precisely visualize the anatomy of the three coronary arteries irrigating the heartand to highlight possible narrowings (stenoses) or occlusions of the arteries by atheroma and/or blood clots and assess their severity.

► First intention: Coronary angiography is the examination carried out during myocardial infarctionin order to identify the artery responsible for the “heart attack”.

► As a second intention: in case angina pectoris (angina) after performing a stress test, stress echocardiography or myocardial scintigraphy.

► Systematically: before cardiac surgery operations (heart valve operation in particular) in order to possibly treat diseased arteries during the same operating procedure.

► “Other indications may be given by the cardiologist, depending on the particular case of each patient” explains Dr. Zores.

What type of anesthesia for a coronary angiography?

The examination is done after local anesthesia of the area where the arterial puncture will then be performed. There is no general anesthesia.

The exam takes place in a specially equipped x-ray room. Due to the introduction into the body of material, the procedure is carried out in sterile conditions, like in the operating room. The interventional cardiologist is dressed like a surgeon: sterile coat and gloves, mask and cap. A systematic preliminary questioning will have made it possible to detect possible (but rare) contraindications such as an allergy to the contrast product (iodine).

► The patient, after having had local anesthesiais lying down, with an empty stomach (no drink or food 4 hours before), on an examination table, and a camera rotates around it to acquire images of the coronary arteries from many angles.

► The interventional cardiologist will prick (puncture) the chosen artery as an approach (radial or femoral) and place a catheter which will allow very thin hollow probes to pass through. The probes are pushed through the circulation to the origin of the heart arteries. Once properly positioned, they allow injection of iodized contrast agentopaque to X-rays, which makes it possible to visualize all of the coronary arteries via the camera. “The examination is painless. The injection of the contrast product may be accompanied by a feeling of heat“, specifies our interlocutor.

► At the end of the exam, the probes and catheter are removed and the radial artery (or femoral) is manually compressed to avoid bleeding; then a pressure dressing is put in place and the patient can return to their room.

How long does a coronary angiography take?

A simple coronary angiography generally lasts between 20 and 30 minutes.

Stent placement during coronary angiography

The results can be divided into two scenarios.

► In the first case, there is no anomaly ; there is therefore no need to offer specific treatment.

► In the second case, lesions are highlighted. Depending on the characteristics of the coronary artery disease, revascularization can be done in two ways:

• Dilation of the diseased artery(s) (angioplasty) and stentingcarried out by the interventional cardiologist,
• Coronary artery bypass grafting performed by the surgeon

Revascularization is not mandatory and some shrinkage does not justify stent placement or surgery. In all cases (angioplasty, surgery or neither), drug treatment is systematically prescribed to combat coronary artery disease. The choice of treatment depends on different factors and a discussion between the patient, the cardiologist and the surgeon (medical-surgical discussion)

Rest after coronary angiography

“There is no no particular fatigue expected after a coronary angiography, but the illness which motivated the examination can lead to fatigue (infarction in particular)” explains Dr Zores. Resumption of professional activity depends on the context in which the coronary angiography was carried out, and the result of the examination. The cardiologist will specify the duration of the possible work stoppage.

Complications

Some nausea can nevertheless occur following the injection of iodinated contrast material. Like any invasive examination, coronary angiography presents a risk of complications. “The risk of serious complications is rare, reassures Dr. Zores. The risk of death is estimated to be less than 1 in 1000“.

Advice after coronary angiography

Radial coronary angiography allows the patient to get up almost immediately at the end of the examination. That carried out by the femoral route requires lie down for a few hours to avoid a possible hematoma. Most often, the patient can return home the same evening or the day after the exam. In the event of an abnormality at the puncture point (place where the probes were inserted), medical advice is advisable.

Thanks to Doctor Florian Zores, cardiologist.