Coronary Angiography in Delhi, India

An angiogram can be used to identify various conditions impacting blood vessels and their blood flow. These includes:

• Coronary Heart Disease: Occurs when the artery supplying blood to the heart muscle narrows, disrupting blood flow.
• Aneurysm: Involves a bulging outward of a blood vessel wall due to weakness in the wall structure.
• Atherosclerosis: Blockage of blood vessels caused by the buildup of fatty substances like cholesterol. An angiogram can assess the degree of atherosclerosis in specific vessels.

A contrast material (dye) is injected during an angiogram and is visible under an X-ray machine. The images on a screen allow the cardiac surgeon to observe blood flow and identify any blockages in the blood vessels.

In certain cases, coronary angiograms are performed on an emergency basis. However, more commonly, they are scheduled in advance, allowing individuals time to prepare.

These procedures occur in a hospital's catheterization (cath) lab. The healthcare team provides specific instructions and discusses the patient's medications. General guidelines include:

• The patient should refrain from eating or drinking anything after midnight before the angiogram.
• The patient is advised to bring all medications to the hospital in their original bottles. They should consult their doctor about taking the usual morning medications.
• If the patient has diabetes, they should inquire with their doctor about whether they can take insulin or other oral medications before the angiogram.

Before the angiogram procedure begins, the vascular surgeon’s team will thoroughly assess the patient’s medical history, taking note of allergies and current medications. A physical examination will likely be conducted, including the monitoring of vital signs such as blood pressure and pulse.

The patient will be required to empty their bladder and don a hospital gown. Additionally, they may need to remove contact lenses, eyeglasses, jewellery, and hairpins.

After the angiogram, the catheter is removed from the arm or groyne, and the incision is closed. The patient is then taken to a recovery area for observation and monitoring. Once stable, they return to their room, where regular monitoring continues.

If the catheter was inserted in the groyne, lying flat for several hours is necessary to prevent bleeding. Pressure may be applied to the incision during this time for healing.

The patient may be discharged the same day or stay overnight. Hydration is encouraged to flush out the dye. Resuming medications, bathing, working, and other activities should be discussed with the healthcare team. Strenuous activities and heavy lifting are to be avoided for several days. The puncture site may remain tender, with slight bruising and a small bump.

Patients can usually go home on the same day as their angiogram procedure, even if they underwent angioplasty and stenting. Due to the administration of anaesthesia, they must arrange for someone to drive them home.

After returning home, patients are advised not to lift anything heavier than 10 pounds or stoop or bend for the next two days to minimise the risk of incision bleeding.

A responsible adult should stay with the patient overnight after the procedure. In certain cases, patients might need to spend the night in the hospital for angiogram recovery.

For diabetic patients, it is advisable not to take metformin (Glucophage or Fortamet) for 48 hours post-test to reduce the risk of kidney complications.

Like many procedures involving the heart and blood vessels, a coronary angiogram is not without risks, primarily associated with the X-rays used, exposing individuals to radiation. While major complications are infrequent, it's essential to be aware of potential risks, which may include:

•  In rare cases, a coronary angiogram may trigger a heart attack.
• Stroke: There is a slight risk of stroke associated with the procedure.
• Injury to the catheterized artery: The artery through which the catheter is inserted may be at risk of injury.
• Irregular heart rhythms: The procedure can sometimes lead to irregular heart rhythms (Arrhythmias).
• Allergic reactions: Allergic reactions may occur in response to the dye or medications used during the procedure.
• Kidney damage: The contrast dye used in angiograms may pose a risk of kidney damage, particularly in individuals with pre-existing kidney conditions.
• Excessive bleeding: Although uncommon, excessive bleeding is a potential complication.
• Infection: There is a minimal risk of infection at the catheter insertion site.

Q. How long does Angiography take?

The duration of angiography varies, but it typically takes around 30 minutes to an hour.

Q. Are Angiography and Angioplasty the same?

Angiography is a diagnostic procedure using X-rays to visualise blood vessels. It helps identify blockages or abnormalities. Angioplasty, a separate procedure, is an intervention to treat blockages by inflating a balloon to open narrowed arteries and may involve placing a stent.

Q. What is the age limit for Angiography?

There is no strict age limit for angiography. The decision to perform an angiography depends on the individual's health condition and the procedure's necessity.

Q. Is Angiography very painful?

Angiography is generally not considered painful. Local anaesthesia is often used to numb the area where the catheter is inserted, minimising discomfort.

Q. Can Angiography clear blockages?

Angiography itself needs to clear blockages. It is a diagnostic procedure that provides imaging of blood vessels. Based on the findings, treatment to clear blockages, such as angioplasty or stent placement, may follow.

Q. What are the benefits or advantages of Angiography?

Angiography helps identify blockages, narrowing, or abnormalities in blood vessels, aiding in diagnosing various cardiovascular conditions. It guides further treatment decisions.

Q. Which type of Angiography is best for the heart?

Coronary angiography is specifically designed for the heart and is commonly used to visualise the coronary arteries.

Q. What are the side effects of Fluorescein Angiography?

Potential side effects of fluorescein angiography include nausea, vomiting, and allergic reactions. It is essential to inform healthcare providers of any allergies beforehand.

Q. How many times can Angiography be done?

The frequency of angiography depends on the individual's health needs. It may be performed as needed for diagnostic or interventional purposes.

Q. What is the duration of Heart Angiography?

The duration of coronary angiography typically ranges from 30 minutes to an hour.

Q. What happens if Angiography fails?

If angiography fails to provide clear images or complications arise, alternative diagnostic methods or interventions may be considered. The healthcare team will assess and determine the next steps.

Reviewed by Dr. Viveka Kumar, Principal Director & Chief of Cath Labs (Pan Max) - Cardiac Sciences, Cardiology, Cardiac Electrophysiology-Pacemaker, Interventional Cardiology on 19 Jan 2024.