Coronary heart disease is the abbreviation of coronary atherosclerotic heart disease, which currently includes five types: asymptomatic myocardial ischemia, angina pectoris, myocardial infarction, ischemic cardiomyopathy, and sudden death. The mechanism of its occurrence is mainly caused by various risk factors (hypertension, diabetes, hyperlipidemia, smoking, etc.) that cause damage to the intima of blood vessels, which in turn causes substances in the blood to deposit there, forming atheromatous plaques, narrowing the lumen, reducing the blood supply to the heart and causing symptoms of myocardial ischemia. Coronary angiography is a common and effective method to diagnose coronary artery disease. 1964, Sones completed the first case of coronary angiography through the brachial artery, and in 1967, Judkins adopted the method of puncturing the femoral artery to perform selective coronary angiography, which further improved this technique and was widely used, and is now considered the gold standard for the diagnosis of coronary artery disease.
I. Indications for coronary angiography.
1, unexplained chest pain, non-invasive examination cannot confirm the diagnosis, clinical suspicion of coronary heart disease.
2, unexplained arrhythmias, such as intractable ventricular arrhythmias or new conduction block; sometimes coronary angiography is required to exclude coronary artery disease.
3.Unexplained left heart insufficiency, mainly seen in dilated cardiomyopathy or ischemic cardiomyopathy, often requires coronary angiography to differentiate the two.
4, recurrent angina after percutaneous coronary intervention (PCI) or coronary artery bypass grafting.
5, congenital heart disease and valve disease before major surgery, age > 50 years, their susceptibility to combined coronary artery malformation or atherosclerosis, can be intervened at the same time as surgery.
6, asymptomatic but suspected coronary artery disease, in high-risk occupations such as: pilots, car drivers, police officers, athletes and firefighters, or medical insurance needs.
(B) for treatment: clinical coronary artery disease is clearly diagnosed, coronary angiography can further clarify the scope and degree of coronary artery lesions and select the treatment plan.
1.Stable angina pectoris or old myocardial infarction, the effect of medical treatment is not good, affecting study, work and life.
2, unstable angina pectoris, first take internal medicine active intensive treatment, once the condition is stable, actively perform coronary angiography; internal medicine treatment is ineffective, usually need emergency angiography. For high-risk patients with unstable angina pectoris, mainly spontaneous, accompanied by obvious ST-segment changes in ECG and post-infarction angina, coronary angiography can also be performed directly.
3, acute myocardial infarction (AMI) within 6 hours of the onset or onset of persistent chest pain in more than 6 hours, the proposed emergency PCI procedure; if no conditions for PCI, for patients with contraindications to thrombolysis after AMI, should try to transfer to a hospital with conditions. patients who have not recanalized intravenous thrombolysis after AMI, should seek remedial PCI in due course. for patients with no complications of AMI, should consider Elective coronary angiography should be performed about 1 week after infarction.
AMI with complications such as cardiogenic shock and ventricular septal perforation should be treated with reperfusion with the help of assisted circulation as early as possible. For patients with high suspicion of AMI but cannot confirm the diagnosis, especially those with left bundle branch block, pulmonary embolism, aortic coarctation and pericarditis, coronary angiography can be performed directly to clarify the diagnosis.
4.Asymptomatic coronary artery disease, among them, coronary angiography should be performed in patients with positive exercise test and accompanied by obvious risk factors.
5.CT and other imaging examinations reveal or highly suspect moderate or above stenosis of coronary arteries or the presence of unstable plaques.
6.Patients with successful resuscitation from primary cardiac arrest, left main stem lesions or lesions in the proximal segment of the anterior descending branch are all at high risk and should undergo early interventional treatment for vascular lesions, requiring evaluation of the coronary arteries.
7.After coronary artery bypass grafting or PCI, angina recurs, and coronary artery lesion evaluation is often required again.
II. Contraindications to coronary angiography.
1.Allergy to iodine or contrast agent.
2. Those with severe cardiopulmonary insufficiency who cannot tolerate the procedure.
3. Uncontrolled severe arrhythmias.
4.Electrolyte disturbance.
5.Severe liver and kidney insufficiency.
Preoperative preparation for coronary angiography
1. The catheterization laboratory should be equipped with certain equipment, drugs and staff.
2.Patients and family members should sign the informed consent form to agree to the procedure.
3.Preoperative echocardiography, X-ray, biochemical, three routine, coagulation indexes and other tests should be completed.
4.Preparation of skin.
5.Iodine allergy test.
6.Immediate-needle puncture, etc.
IV. Routine treatment after coronary angiography
1.Monitor the patient for any discomfort, pay attention to ECG and vital signs, etc.
2.Replenish sufficient fluid to prevent vagal reflex, except for those with poor cardiac function.
3.The radial artery puncture pathway can be removed after removing the sheath and local compression of the puncture site for 4-6 hours. After the femoral artery access for coronary angiography, the tube can be removed immediately. After 20 minutes of routine compression of the puncture site, if there is no active bleeding at the puncture site, braking and compression bandage can be applied, and the bandage can be removed after 18-24 hours to start light activity. If a blocker is used, the patient can start bed activities 6 hours after lying down and braking.
4. Pay attention to the puncture site for blood oozing, redness, swelling and murmur, and the pulsation of the artery of the punctured limb, skin color, tension, temperature and activity for any abnormalities.
5.Check blood, urine routine, electrolytes, liver and kidney function, cardiac enzymes and three cardiac infarcts after the operation or the next day.
6.Patients with femoral artery puncture were discharged on the 3rd day.
7.Encourage patients to drink more water or intravenous rehydration after the procedure to promote the excretion of contrast agent.