What is Angiography ?
The process of taking a photo or movie with the help of X-ray, after injecting day (a specific type of radio opaque chemical) in any artery is known as angiography. The angiography of arteries supplying blood to the heart (coronary arteries) is known as coronary angiography.
This is a test to define the adequacy of blood supply to the heart. Several additional important information such as presence of block or obstruction, percentage narrowing created in the diameter of the artery, presence of calcium or blood clot in that block, etc. can be obtained with the help of angiography. Based on the symptoms of the patient, information obtained through angiography and some other important considerations, an expert cardiologist recommends further line of treatment. Whether a patient needs angioplasty or bypass surgery for coronary blockages is known only after angiography is done.
Is Angiography Risky ?
Angiography has been made an easy, almost risk free and a very acceptable investigation by modern science.
Common Problems : Vomiting like sensation or vomiting in 1% cases, slight pain at the site of angiography, minor reaction to dye, slight fluctuation in blood pressure or heart rate, etc. are observed.
More Serious Problems : Excessive bleeding from the site of angiography (in less than 0.25% cases) or clotting of blood at the puncture site (hematoma), paralysis or slight effect of paralysis, serious fluctuations in heart rate leading to requirement of pacemaker or electric shock, need of ventilator support due to respiratory arrest, need a balloon pump due to very low blood pressure, cardiac arrest and possibility of death.
In Current era, possibility of such complications has considerably reduced because of the use of best drugs prior to angiography, well-equipped hospitals and team work of expert doctors.
Who Would need to Undergo Coronary Angiography ?
Those who already have suffered from a heart attack.
Those who experience pain in the chest (angina) while performing routine activities of life.
If the stress test (TMT ECG. Stress Echocardiography, Stress Myocardial Perfusion Imaging) is Positive. i.e., there is a strong suspicion about the presence of a serious defect in blood supply to the heart.
Those who have serious reduction in efficiency of heart or a weak heart.
After examining the patient and reviewing his test reports if the cardiologist suspects a high probability of block in his coronary arteries, angiography is advised. Some patients are completely against angioplasty or bypass surgery because of their prefixed concepts or beliefs. In such cases angiography may not be performed, because angiography is not at all necessary for making choice of medicines. This can be meticulously done on the basis of symptoms and simple investigations like blood tests, stress test and echocardiogram.
In some cases angiography is done to risk stratify or ‘rule out’ serious coronary disease. As far as possible, use of angiography for this purpose is to be minimized. For such indications CT scan angiography is comparatively easier and more appropriate.
Angioplasty during Acute Heart Attack : Primary Angioplasty
A revolution took place in the treatment of heart attack after the year 1999-2000. The limitations of fibrinolytic medicines used for dissolving the blood clot were very well understood. It was confirmed that if a patient reaches the hospital after 3 to 6 hours of heart attack, there is very little chance of success with these medicines. Many victims of heart attack reach the hospital in a very serious condition with much lowered blood pressure, severe shortness of breath or very poor efficiency of heart. Fibrinolytic medicines do not work during these complications and there is very little time available to save a patient’s life. In such cases a method of treatment is needed which can open the block of the heart attack related artery quickly and consistently, and which has no serious side effects. Primary angioplasty is one such revolutionary invention.
The patient was taken to the cardiac catheterization laboratory during heart attack only. Angiography is done in emergency and the artery with 95 to 100 % blockage, which is the cause of heart attack, is opened immediately with a balloon.If need be, the catheter to suck blood clots and anticoagulant injections are also used. In the initial years there were some doubts about the usefulness of placing a stent during primary angioplasty, but through many studies it is now well proved that placing a stent and that also a drug eluting one, gives very good short-term and long-term results.
Teamwork of an experienced interventional cardiologist and well equipped hospital is a must for primary angioplasty. If best efforts are made, the artery can be opened in more than 95% of cases and chances of the patient surviving and getting rapid recovery are increased. It has now been proved that primary angioplasty is a highly superior treatment as compared to fibrinolytic. It preserves the efficiency of the patient’s heart, reduces chance of heart rhythm disturbances, reduces the possibility of heart attack complications and increases the possibility of saving a patient’s life. Hence, if this treatment is available in the hospital and if the patient is prepared to bear its expenses, primary angioplasty is the most desired treatment.