Do’s and Don’t before Elective Coronary Angiography: Agra Heart Center Perspective.
Coronary Angiography is a highly sought after test to determine the presence or absence of overt Coronary Artery disease and most often done to determine the risks and the cause of cardiac symptoms.
Coronary Angiography is also known as CAG or CART in some parts of the world.
1. What is a coronary angiography test?
CAG is an invasive procedure, where one of the main arteries of the heart is accessed and a catheter or a thin tube like structure is traveled through that artery to the heart coronaries and through it small amounts of contrast dye is injected into the coronary (heart arteries) that when scanned through the cath machine can show the presence or absence of blockages (or stenosis).
2. What are the risks involved in the coronary angiography test?
No invasive procedure is without risk. Even a small incision to the skin has it’s own risks- however in skilled hands, the rate of complications is very less.
On an average, the total risk of coronary angiography is about 1.7% and risk of mortality (death) is about or less than 0.1%. Hence, coronary angiography is a relatively safe procedure.
The total risks involved/ complications involved can be summarized in the table below:
At Agra Heart Center, lead by Dr. C.R. RAWAT sir and Dr. RAJAT RAWAT sir, a policy of exclusive transradial approach is undertaken (ie angiography via the hand) hence the rate of complications in such cases become very less and almost negligible, as the most common vascular complications seen with femoral route is avoided.
Dr. Rajat Rawat is well versed with the superficial radial access approach and the ulnar approach and even the left radial/left ulnar approach (all techniques of angiography via the hand route) and avoids femoral route until and unless absolutely necessary or no other access is available.
3. Are all the risks involved in coronary angiography life threatening?
No, most of the risks are actually non-life threatening and mild in nature, like allergic reactions (until severe). Most vascular complications are also mild in nature, and hence can be dealt with most of the time.
Again remember, the rate of complications is very low to begin with.
4. What information can be obtained with coronary angiography/angiogram?
To put it simple, the information that will be obtained is the one your Cardiologist is trying to get from it.
Most often CAG is done to know about blockages, if present, whether they require only medical management or would require angioplasty and stenting or drug eluting balloons or other specialized procedures or surgical bypass?
It can also give information on presence of congenital abnormalities like – Myocardial bridge, anomalous origin of coronary arteries or coronary fistula etc. And the approach one needs to take to deal with it, if present.
4. What are the different techniques or approaches through with cag (coronary angiography) can be done.
There was a time, many years ago, when angiography used to be done by the femoral (leg) route. However, with the changing timeS, new technologies , and better and younger operators with good experience, radial approach (hand) is preferred as the first choice due to low rates of complications and better comfort to the patient.how
However, please note, that still femoral (leg) route is utilized in some patients who have no radial access or who have very tortuous radial route or radial route has been utilized quite a few times before and there is loss of good pulsation. In such cases, femoral route is still used. Some old operators still prefer the femoral route (leg) as they are well versed with it, and not so well versed with the newer radial routes.
Please understand, that your Cardiologist has your best interests at heart- and uses the toute that he or she thinks is most suitable for you, and the route that he is well versed with and according to clinical scenario.
5. Should I not eat anything before the procedure/ should I be empty stomach for the procedure?
See, every institution has it’s own Protocols. Agra Heart Center is ranked 15th in National single center cardiology unit all over India and with highest rank in Agra.
It is our policy that we ask the patient undergoing elective angiography to not remain empty stomach and have some light meal in the morning or at other normal time of the day like lunch, dinner etc. We generally ask to avoid milk before the procedure in adults, but if it is a regular part of your meal, we do not have a problem with that too.
Basically, be natural, and do not worry, and trust your doctor. Eat whatever you are used to in the normal run of life.
At Agra Heart Center, We try and calm the patient and talk to them before any procedure and explain to them the procedure.
6. Will I be given any medications before the procedure?
Again, every institution has it’s own policy. At Agra Heart Center, We avoid giving unnecessary medications. However, all patients undergoing coronary angiography will have to get an iv cannula placed and will also receive medications in the artery to allow easy passage of the catheter without problems and to increase the diameter if the artery.
7. Will I be sedated or made unconscious during the procedure like in other operations?
No. You will be fully conscious, we shall be talking during the procedure and asking you about your symptoms during the procedure. You will be given a small 2-5ml of local anesthesia to numb the wrist area or the groin area (depending on what route is used) and that’s it.
8. If everything goes alright, which is most often the case, and the report is also alright, how soon can I go home?
Again, institutional policy differs. At Agra Heart Center, no patient is kept unnecessarily. If you have undergone the procedure via radial (hand) route – we mostly discharge the patient within 2-4 hours. If your procedure was done using the leg (femoral) route – then patient is kept for atleast 8 hours and preferably overnight.
9. I am allergic to Iodine, shellfish, sea foods, and some other components, can I undergo angiography?
So, if you are a person with allergies, let your doctor know before hand, so an allergy test for contrast dye can be done and procedure planned accordingly.
10. What are the basic tests to be done before angiography?
Again, institutional policies vary. Agra Heart Center is ranked 15th in National rankings in all india in single specialty cardiology unit and highest rank in Agra. We maintain global standards in our procedures.
A basic ECG, 2D echo within a reasonable time as determined by the clinical condition and your Cardiologist- Dr. C. R. RAWAT sir or Dr. Rajat Rawat sir is a pre-requisite. This helps to determine what to expect and to avoid surprises and plan procedures, and decrease the risks involved.
A Sr. Creatinine and viral markers is a must, however, if it is already available, and within stipulated time, then may not be repeated.
11. If I undergo angiography, will I be put a stent inside?
No. Angiography is only a diagnostic test. Based on angiography, you may be recommended accordingly- like medical management only or stenting or surgical bypass. However, what you are talking about is angioplasty and not angiography. Based on angiography, you may be recommended angioplasty, but not always.
12. Are there any other alternatives to invasive coronary angiography? What about ct coronary angiography?
Invasive coronary angiography is the gold standard for diagnosis coronary artery disease or blockages. Invasive cag looks at the arteries from the insides, while CT coronary angiography looks at the arteries from outside, so if you have a lot of calcium, which is most often the case, or you have a stent already in place, ctca (ct coronary angiography) will not be able to give a very good diagnosis, and would require Invasive coronary angiography anyhow. Also, the cost of ctca is almost similar to an Invasive cag and one will have to get an Invasive cag anyhow, if any blockages are detected on ctca to confirm by Invasive cag. Also, any procedure planning for stent placement can only be done on Invasive coronary angiography. Hence, most patients require Invasive coronary angiography and only a select group require ctca. Your Cardiologist will recommend when you need it.
13. When will i require an angiography?
Let your Cardiologist determine that. To book an appointment, call on 7830000618
These are some of the frequently enquired questions that we often encounter, and it is better that patients know them before hand.
Stay Healthy.
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