Gold Standard in Diagnosis of Heart Diseases: Angiography…
If tobacco products are your best friends and if you are good with hypertension and you also have famous Turkish muscle – abdominal fat deposition, you are almost a good candidate to be a station, where heart diseases stop very commonly.
We investigated the most commonly wondered aspects of coronary artery diseases, which are triggered by smoking, hypertension and fat deposition especially in abdomen and progress insidiously without any symptoms for many years, and of the angiography, which is the gold standard for diagnosis of this condition.
What is Coronary Artery Disease?
It implies atherosclerosis – hardening of blood vessels due to plaque formations – in coronary arteries. The most important function of the endothelium – the lining of coronary arteries – is to ensure proper flow of blood without formation of clots. Certain risk factors, such as smoking, hypertension, fat deposition especially in abdomen and diabetes mellitus, cause damage to the endothelium. Similar to efforts of body’s defense mechanism to close a wound that occurs in any part of the body, the endothelial damage is also repaired, but this process leads to formation of an unwanted tissue, which occupy space inside the lumen, in both myocardium and inside the blood vessels in time. Narrowing of blood vessels results in obstructions over time. All those processes are called coronary artery diseases.
What are the symptoms?
The condition may progress without any symptoms for many years, but the most common symptoms are recent-onset poor exercise capacity (getting tired too quickly), exercise-induced chest, back and arm pain that also limits the exercise capacity and recent-onset exertional shortness of breath. In addition, the initial symptom of the coronary artery disease might be a sudden myocardial infarction and even sudden death – in more unfortunate people.
What is Coronary Angiography?
Coronary angiography refers to imaging the coronary arteries – the blood vessels that supply blood to heart tissues. The procedure is performed in an angiography laboratory. An opaque substance (contrast medium) that acts like a dye on radiology images is administered into the coronary arteries to visualize their anatomy.
Why is it performed?
It is performed if it is thought or strongly suspected that coronary arteries cannot feed the myocardium well. It is a unique diagnostic test to make diagnosis and plan treatment in patients with exercise-induced chest pain, who have abnormal results in cardiac stress test performed to investigate etiology of chest pain, or for recent-onset chest pain that progresses gradually or persists even at rest and for sudden myocardial infarction.
Which data are offered by angiography?
An angiography offers valuable data, such as size and diameter of blood vessels, whether there is narrowing, the severity of narrowing – if any – , location of the narrowing, length of the narrow segment and whether there is/are calcium deposit(s) and/or clot(s) inside the blood vessel and appearance of the blood vessel (straight or twisted), by imaging the coronary arteries. Coronary angiography is a diagnostic procedure in all aspects. Treatment (medications, balloon dilatation, stent, bypass) is planned according to the result.
When is it performed?
Angiography can be performed almost at any time, but patients should not eat and drink for 6 hours in case of elective (preplanned) angiography. For emergencies, it is performed as soon as possible through necessary precautions.
Is the radiation exposed during angiography hazardous?
Six to seven images, on average, are acquired, each lasting 2 to 3 seconds, while the opaque substance flows inside the blood vessel during angiography; the radiation exposed in such doses does not harm the health.
What should be paid attention in preparation for angiography?
6-hour fasting is required for planned or elective cases. Certain drugs should be stopped before the angiography. Patients are informed by their doctor about this issue. No special preparation is required, unless otherwise is instructed by the doctor.
Which body parts are used for angiography?
Although femoral artery (an artery located in groin) is commonly used, it can be also performed through radial artery – an artery located in wrist. If both arteries do not allow puncture, brachial artery – an artery located in medial side of the elbow – can be used, albeit more rarely.
Does it cause pain/ache?
The procedure is performed under local anesthesia. Although it may vary depending on pain threshold of the person, pain is usually felt only when local anesthetic agent is administered.
Is the medication used during angiography hazardous?
It may rarely cause allergy. Moreover, it may lead to kidney failure in some high-risk patients (patients with documented renal failure or under risk of renal failure and diabetic who use certain drugs).
Which approach is better, groin or arm?
Angiography does not differ between those two approaches regarding the images of coronary arteries following access to them and review of findings. However, there is no vein or nerve located close to the radial angiography (a procedure that uses an artery located in wrist). Moreover, since this artery has more superficial route, bleeding can be controlled more easily in this artery relative to the femoral artery after the angiography. There is almost no puncture site complication (bleeding, swelling etc.) in radial angiography. If the patient has documented obstructions in arteries of abdomen and leg, radial angiography is a healthier option to reduce complications especially in people with abnormal fat deposition in groin and abdomen. Moreover, the radial artery is thinner than the femoral artery and it has more tendency to the spasm. This hinders access to the coronary arteries especially in lean patients. In addition, femoral angiography is easier and healthier for both the patient and the physician especially in petite women who has thin wrist that also implies thinner radial artery.