Coronary angiography ( coronary angiography ) - Causes, Symptoms and Treatment .MF .
Indications for coronary angiography
procedure Procedure coronary
As is known, in the heart are the blood vessels that supply blood and oxygen contained in it the myocardium (heart muscle).These vessels are called the coronary (coronary or own heart).Their normal functioning is very important for proper operation of the heart muscle, from which in turn depends on the well-being of the whole organism.In the case of blockage of the lumen vascular thrombus or atherosclerotic plaque there is an acute or chronic heart tissue hypoxia (lack of oxygen), entailing necrosis (death of tissue).As a result of developing diseases such as coronary heart disease (CHD) and myocardial infarction.In most cases, the disease easily diagnosed by clinical examination, ECG and ultrasound of the heart.
But not always based on these data alone can determine the presence of coronary artery disease and to develop specific therapeutic tactics.Sometimes doctors n
possibilities of modern medicine is constantly expanding.A hundred years ago, and the doctors could not imagine that one day they will be able to see inside the heart of a living person, to see how it beats, evaluate how its internal structures and blood vessels that provide it with blood.Nowadays, it has become possible thanks to special equipment and high-tech research methods.One of these techniques is coronary angiography (CAG).
Coronary angiography (or coronary angiography) - is an instrumental method for the diagnosis of cardiovascular disease, which is carried out by introducing a radiopaque substance into its circulatory system of the heart, causing the doctor receives X-rays of the coronary arteries, followed by an assessment of their terrain.This study reveals the degree of impairment of the blood flow in these arteries, which occurs due to a blood clot, atherosclerotic overlay, vasospasm (eg, as in Prinzmetal angina), to clarify the presence of myocardial ischemia, as well as to identify further doctor's actions in terms of cardiac surgery treatment - the need for stentingarteries or coronary artery bypass grafting (CABG).
Indications for coronary angiography
The main indications for this method of diagnosis are as follows:
- acute myocardial infarction patients, stenting physician who is regarded as a necessary (within the first 12 hours of the onset of clinical manifestations);
- severe stable angina 3 - 4 FC (functional class);
- stable angina with evidence of severe ischemia in minor physical activities;
- Prinzmetal variant angina;
- no effect on ongoing medical therapy in this case is solved the question of the appropriateness of stenting or CABG;
- myocardial infarction accompanied by fatal arrhythmias (ventricular fibrillation, complete AV - block, etc.) or near-death;
- a high risk of sudden cardiac death;
- the inability of the ECG or ultrasound of the heart with the load (low exercise tolerance, as well as for patients with a low ejection fraction by ultrasound);
- before carrying out operations on the heart valves in patients over forty years, as well as pain in the chest and in the heart;
- clarification of the diagnosis on clinical or professional reasons - in cases where the results of other methods of dubious survey;
- recurrence of angina or myocardial infarction within 9 - 12 - months after stenting and CABG, respectively.
Contraindications for coronary
absolute contraindications for this method no.
From relative contraindications are the following: acute infectious diseases, anemia (reduced hemoglobin in the blood), pathology of blood coagulation with the possible risk of prolonged bleeding, stroke, acute and chronic diseases of other organs (acute surgical or gynecological pathology, decompensation of diabetes mellitus, bronchialasthma and t. d.).
For each patient, the indications and contraindications are determined by a cardiologist, cardiac surgeon, and strictly individually as needed and physicians of other specialties.
Preparing to study
Before coronary angiography is very important to observe a drinking mode, and eating mode.Research conducted strictly fasting (last meal of 6 - 8 hours), as may develop in the process of emesis intravenous contrast and aspiration (Inhalation) vomit.Within two - three hours before the studies are not allowed to drink a very large number of clean drinking water for the kidneys to work properly, as it is they have to display the contrast agent from the body.
In the case of the planned study, when the patient is referred from the clinic or cardiology hospital, he must have the following methods of inspection arms: urinalysis, clinical detailed blood tests, platelet count, prothrombin index, clotting time and other indicators of coagulationblood biochemical blood tests, tests for HIV, syphilis, hepatitis B and C, ECG results, echocardiography (ultrasound of the heart).
If the patient is taken to study urgently (ambulance, of cardiac or intensive care unit with suspected myocardial infarction), the survey data can be carried out urgently if necessary.
How is coronary angiography?
Coronary angiography is an invasive diagnostic method, that is in the process of research is done in the implementation of the tissues and organs of the human body.Performed in a planned or emergency basis.When examining a patient scheduled for a few days before hospitalized in cardiology and cardiac surgery department of the hospital, which conducted the necessary diagnostic methods described above, at the discretion of the attending physician.
Before the nurse takes the patient on a gurney into the office rentgenhirurgicheskih studies he conducted premedication - the introduction of anesthetics and sedatives (ketorol, relanium intramuscularly or intravenously).Then shift the patient on the table in the office, anesthetize the puncture site of the radial artery (in the wrist) or the femoral artery (in the groin) by subcutaneous anesthetic lidocaine or other anesthetic, then proceed directly to the puncture (puncture of the skin and arteries).After accessing the artery (usually radial) it introduced introducer - sterile disposable tube with a valve that prevents blood into it and a side port for injection of contrast.A sheath is introduced conductor, reaching at the radial artery of the aorta with the coronary sinus in it.Further, the guide catheter and is installed at the mouths of the right and left coronary arteries, the catheter is carried out on the introduction of a radiopaque substance, which allows you to see the shadow of the artery on the screen, as the arteries and heart without contrast absorb X-rays.Thus there is a survey with the help of an X-ray installation, allowing to evaluate the coronary artery in different projections (artery does not lie in the same plane).
contrasting results are displayed on the setup screen, and then stored in a computer with a further assessment and interpretation of results.Following the success of the catheter or the contrast is extracted, or doctors decide on the need for emergency balloon angioplasty or stent insertion in the narrowed artery.
After the procedure applied compressive bandage on the wrist, do not require further dressings and deliver the patient to the ward.The entire procedure takes about 15 - 30 minutes, without causing pain in the patient, apart from the puncture site (puncture).
After a survey conducted in a planned manner, the patient remains in the cardiology ward for a few days to evaluate the general condition and a decision on further treatment options.If necessary during hospitalization may be increased in accordance with the need to treat cardiac surgery.
In the case of a survey carried out by emergency indications, the patient is transferred to the Cardiac Intensive Care Unit for further observation and treatment.
Deciphering the results of coronary angiography
Evaluation of the data obtained during coronary angiography, performed rentgenhirurgom, heart surgeon and cardiologist.Depending on the degree of narrowing of the coronary arteries are the following terms:
- occlusion - complete blockage of an artery atherosclerotic plaque or thrombus - the artery as a result of coronary narrowed by more than 90%;
- stenosis - partial narrowing of the arteries by 30 - 90% - distinguish wellhead stenosis (at the mouth of the artery or not more than three millimeters from its origin), the local stenosis (for 1 - 3 mm artery), extensive stenosis (a considerable portion of the artery narrowing its lumen);
- aneurysm artery (bulging of the wall, which prevents normal blood flow, and is fraught with rupture of the wall with bleeding);
- artery calcification (deposition of calcium salts, usually in combination with atherosclerotic plaques in the artery wall, which also calls the narrowing and impaired blood flow in this artery).
The figure shows a partial obstruction of a coronary artery.
These findings are important for physicians in terms of the need for surgical treatment.For example, when the degree of narrowing of the arterial lumen by more than 75% of patient illustrates cardio reperfusion (restoration of blood flow) of the myocardium.
Complications of coronary angiography
Since this study is invasive, much less performed on the heart, there is a risk of complications developing on statistics in two cases out of a hundred.Mortality during coronary angiography is less than 1%.Still, in very rare cases may develop ventricular fibrillation, thrombosis, coronary artery with the development of extensive myocardial infarction, stroke, thrombosis of the radial artery, infectious inflammation at the site of puncture, acute renal failure as a reaction to the excretion of contrast through the kidneys, allergic reaction to the contrast dye, until the development of anaphylactic shock.
prevention of morbidity is a careful history against kidney disease, anaphylactoid (apllergicheskih) reactions, especially on the iodine preparations, as well as the timely appointment of anticoagulants (heparin, Fraksiparina, warfarin).
long-term complications can be considered statistical evidence that low doses of radiation received during imaging studies of the heart, increase the risk of cancer in patients by an average of 3%.
therapists Sazykina OJ