Coronary Angiography

What I should Know?

• A specialised test to find out detailed information about the arteries of your heart.

Coronary arteries do not show up on a plain X-ray. With coronary angiography, dye is injected down the

coronary arteries. The arteries and their smaller branches then show up clearly 'like a road map'

What is it???

Heart Disease: Blockage of the vessels

• Failure of oxygen delivery caused by a decrease in blood flow in front of increased oxygen demand of the heart

Pain/Angina Heart Attack

WHY I Need to Know State of my coronary Arteries

coronary angiography can show the exact site and severity of any narrowing of the coronary arteries

THEN(5-6 years from now)• It is mainly used if you have angina , to assess the extent

and severity of the angina.

Now It is used to know if your heart is healthy or has the disease

started & to assess the extent & severity.

ANGIOGRAPHY

• Before the day of the test you may need a blood test and an ECG to make sure you are OK to have the procedure.

• If you take a 'blood thinning' drug (anticoagulant), then you are likely to need to stop this for 2-3 days before the test. (This prevents excessive bleeding from the site of the catheter insertion.)

• You may be asked to stop eating and drinking for a few hours before the test.

• A blood test to check your Kidneys are fine

• You may be asked to shave both groins before the test.• You will have to sign a consent form at some point before the test to

confirm that you understand the procedure, understand the possible complications and agree to the procedure being done

How do I prepare for the procedure

Complications!! Oh My God!

What are these??

A bruise, which may form under the skin where the catheter was inserted (usually the groin). This is not serious, but it may be sore for a few days.

You may need to have few stitches at the groin if a small cut has been made.

• There May be risk of Excessive Bleeding or Bleeding may not stop all together• May lead to balooning of vessel–Aneurysm formation

• The small wound where the catheter is inserted sometimes becomes infected. Tell your Doc if the wound becomes red and tender. A short course of antibiotics will usually deal with this if it occurs.

some people have had a stroke or a heart attack (myocardial infarction) during the procedure.

rarely, the catheter may damage a coronary artery.

some people have even died during this procedure.

Serious Complications

DO I Have an Alternative

•

Really

CT CORONARY

ANGIOGRAPHY

Now What is It??

Same Procedure to see artery of the heart

But Without any need to insert the catheter

How is this performed

• With the help of an Ultrafast CT Scan Machine

Can All CT Machines perform this test

• No• Only multidetector CT Scan with atleast 64 slice /detectors• Other machines : 128 detectors CT , 256

Detector CT and best of all Dual Source CT(DSCT)

SOMATOM Definition DSCT-Dual Source CT Scanner The World’s First Dual Source CT

Two X-Ray sources and two detectors at the same time

Is Dual Source CT and Dual Slice CT one n the same thing

• Not at all• Dual Slice CT is capable of only taking 2 Images

/rotation and is a basic entry level CT machine only

• A 64 Slice CT can take upto 192 images /sec• Where as a Dual Source CT (the best one and

the fastest) can take upto 776 images/sec

64 slice CT : is it sufficient for CTA• Maybe. • It would require to give you medicines to lower

your heart rate to less than 60/minute to achieve the diagnostic quality images and heart beet needs to be very regular. Otherwise , we may not be able to perform angiography on 64 Slice CT

Presently- it is considered outdated machine to perform a CT Heart Angiography

DSCT ANGIO- No Need To Reduce Heart Rate

• Dual Source CT is independent of heart rate and is capable of imaging any beating heart

Experience with CT Angio

• Just Walk in and Walk Out

Any preparation needed

• Simply 2-3 hrs Fasting prior to the test• A blood test to check your Kidneys are fine

Why Kidney test

• The dye used in Angiography is excreted by kidney

• If Kidney is not functioning properly then this dye can act like poison

• We have a better but costlier option which can also be used instead

Visipaque– Renal safe contrast agent when kidney functioning

is compromised & test must be performed.

‘Because we care’...

Do I need hospital care

• In less than half an hour u r free to resume your daily routine

• No Hospitalisation• No admission• No Drugs to reduce ur heart rate• No pains & all Gains

Who can get this test done

• Anyone who wants to know the state of his heart

• Person with – Diabetes– History of heart disease in family– Hypertension– Bad Cholesterol levels

Other modifiable risk factors

Smoking

Obesity

Bad eating habits

Lack of exercise or sedentary life style

Who else

• A person who has not very high pretest probability of severe heart disease i.e A person who has not had angina but effort intolerance is there.Other test such as Echo and TMT are normal. ECG is normal.

Is it for heart patients too

• It is advisable that a cardiac patient who has had Heart attack should ideally go in for Conventional Invasive catheter Angiography as it can even lead to Angioplasty at same time

BUTIf a patient is afraid or evading an angiography This is definite answer to persuade the patient

If I already am diagnosed and treated for the Heart disease- can it help me

• Definitely

• For Stent patients- followup for stent patency or recurrance of disease in any other vessel or any other cause of symptoms

• For Post CABG/Bypass surgery; to look for graft occlusion.

Is this test as effective to diagnose disease as routine angiography

yes & No

• If it is 64 slice CT it depends on your heart rate• If Dual source CT then as effective and

sometimes better as it can also tell about plaque character – whether soft or hard

How is a CT Angiography done

This is how ordinary single source machine with high heart rate show heart

•