Carrying out coronary angiography as a method of examining the cardiovascular system

0
2017.06.17
3
Ischemia

Coronary angiography is one of the methods of diagnosing the cardiovascular system, which allows the doctor to determine the degree of patency of the blood by coronary arteries, the presence of clots or clusters of cholesterol in them, as well as the possibility of occurrence in the heart muscle of all kinds of spasms or ischemia.

Content

  • Indications for the appointment of coronary angiography
  • Preparation for the procedure
  • Stages of the procedure
  • Explanation of results

Indications for the appointment of coronary angiography

As a rule, this study of heart vessels is prescribed only to those patients who have a number of the following clinical indications:

  • Acute heart attack. In this case, the patient is examined no later than 12 hours after the first manifestations of pathology.
  • Stable angina in severe form.
  • Any form of stable angina in which the patient experiences complications in the form of ischemia arising from physical activity.
  • Angina of Prinzmetal.
  • The patient does not respond to drug treatment, and the condition of his cardiovascular system is significantly deteriorated.
  • The heart has a disturbed rhythm, acquired as a result of experienced clinical death or severe myocardial infarction.
  • High probability of sudden cardiac arrest.
  • The patient has contraindications, in which ultrasound examination of the heart is strictly prohibited.
  • If the results of previous procedures of ultrasound or ECG are doubtful, the doctor appoints the patient an additional procedure of angiography of the coronary vessels, to verify the reliability of the diagnosis or disprove him.
  • If a patient has 9-12 months after CABG or stenting procedures, pronounced recurrence of a heart attack or angina pectoris, he must be assigned coronary angiography, which will help to identify the cause relapses.
  • When preparing a patient over the age of 40 years to cardiac surgery (on the valves), coronarography is assigned to him by default.
Arrangement of coronary vessels and arteries

Important! Despite the relative harmlessness of this survey, there is also a category of patients for whom CT angiography is strongly discouraged. As a rule, this category includes patients with acute infectious diseases, anemia, low blood clotting, diabetes, bronchial asthma and stroke. As for the remaining patients, for them, coronary angiography is considered absolutely harmless.

.

Preparation for the procedure

Before the examination of the coronary arteries and the cardiac system through angiography, the patient must necessarily undergo a little preparation. Approximately 8 hours prior to the beginning of the study, the patient is not allowed to take any food, and 2 hours before the start of the procedure - taking the liquid. Such a regimen is observed in order that, if an X-ray contrast substance enters the coronary vessel the blood in it was absolutely pure, without the presence of any useful elements contained in food or drink.

If the patient is on a medication course of treatment and regularly takes medications containing acetylsalicylic acid, then this course should be stopped beforehand, otherwise performed coronarography will not give effective results. The same applies to drugs that artificially lower blood sugar levels.

Computer diagnostics of coronary arteries

In addition to the above-mentioned stages of preparation, the patient must also pass some examinations in advance, such as:

  • general urine analysis;
  • in-depth analysis of blood with a platelet count;
  • blood chemistry;
  • analyzes for the presence of HIV infection in the body;
  • computer procedure of ultrasound, ECG.

The results of all these tests necessarily provide the doctor before the procedure begins. When the examination of the coronary arteries and the heart by coronary angiography is completed, the patient will need a large amount of oral fluid to clear the coronary vessel and heart from the injected radiocontrast substance.

Stages of the procedure

In its type, coronary angiography refers to invasive diagnosis, and it is conducted in a strictly defined order. First of all, before starting the study, the patient is beaten with anesthetics and sedative drugs (the substance is injected directly into the coronary vessel, into the heart muscle or vein).

After the administered drugs begin to act, the patient is put on the operating table and additionally carries out localized anesthesia of the place where In the future, a puncture will be introduced (usually a radial artery located on the wrist or a femoral artery located in the area groin). As an anesthetic, lidocaine is used in this case, although other anesthetics have no contraindications.

Then the procedure can continue only after complete numbness of the treated area. The skin and artery are pierced by a special device, and the puncture site is installed A small sterile tube with a valve, through which further X-ray contrast substance.

Through this tube, an additional conductor with a catheter is inserted, through which the liquid passes through the artery directly into the coronary vessel. After the artery is partially filled with the injected substance, the procedure goes into a computer study that allows to fully trace the shadow of the artery and the movement of blood along it.

Taking a puncture

Important! During the work, the heart sends some short impulses, because of which the coronary vessel and arteries do not appear clearly on the screen. Therefore, the introduction of X-ray contrast fluid is a mandatory step in the procedure of coronary angiography.

.

With the help of a special ultrasound device, the coronary vessel and artery are visible in different projections, allowing the physician to see even the smallest clusters of cholesterol on their walls. When the procedure comes to an end, all the scanned data is stored on the ultrasound machine, and the catheter is carefully pulled out from the puncture site.

In the event that the coronarography was not too successful, and the patient after it has a pronounced stenosis, the doctor must necessarily hold a balloon angioplasty at the puncture site or insert a special stent so that the artery does not narrow completely, blocking the blood flow in a heart. Further, a pressure bandage is applied to the puncture site, which does not require further change for several days. This completes the procedure for coronary angiography.

Explanation of results

In contrast to similar studies, coronary angiography is able to show the doctor a fairly detailed picture of the patient's cardiovascular system, expressed in one of the following terms:

  • Occlusion - the coronary vessel or artery is completely clogged with a thrombus or an atherosclerotic plaque. With this condition of the arteries, the tomography will show no more than 10% of the lumen between the plaques on its walls.
  • Stenosis - the vessel narrows partially, leaving 10 to 70% of the lumen, which is clearly visible on the tomograph screen. The type of stenosis can be: estuarine (progresses at the mouth of the artery or at a distance of no more than 3 mm from it), local (takes an artery section no more than 3 mm long) or extended (located throughout the entire artery).
  • Aneurysm - the blood flow in the heart is difficult due to a significant deformation of the walls of the vessel. If, in such a situation, there is no timely investigation and elimination of this deviation, the patient may experience internal bleeding as a result of rupture of the artery.
  • Calcinosis - a coronary vessel is clogged with atherosclerotic plaques in combination with potassium salts, which greatly impairs the flow of blood into the heart.
The clogged vessel shown on the tomograph screen

Such a study of the cardiovascular system is able to show the doctor a complete picture of the pathology and the need for prompt intervention to eliminate it.

On average, this procedure takes about 20 - 30 minutes, it is completely painless. However, it should also be remembered that coronary angiography is performed on vital parts of the body, and with a severe complication, the study may well end in a fatal outcome. But according to statistics the probability of such an outcome of events is only 1%, so, in principle, the patient does not have to worry.

.. .