1.What is coronary angiography?
Coronary angiography is the current gold standard for the diagnosis of coronary heart disease. Selective coronary angiography is performed by inserting a catheter into the left and right coronary arteries and injecting a contrast agent to visualize the main branches of the coronary arteries and their branches, which can accurately reflect the degree and location of coronary artery stenosis.
2.When will the doctor consider coronary angiography?
The main indications for coronary angiography are
(1) For those who have severe angina despite medical treatment, to clarify the coronary artery lesion in order to consider interventional treatment or bypass graft surgery.
(2) Those with chest pain resembling angina pectoris but cannot be diagnosed.
3.Is it dangerous to undergo coronary angiography?
Coronary angiography is a minimally invasive procedure, and the risks include vascular injury, contrast allergy, vascular embolism and infection.
4.What are the advantages and disadvantages of coronary angiography via radial artery or via femoral artery?
It is easy to master the technique, easy to obtain the equipment, and the surgeon is relatively experienced, and because of the larger internal diameter of the vessel, it can be suitable for larger diameter equipment.
Patients do not need to be bedridden after the transradial route and can be active early, which is especially beneficial for those patients with severe low back pain, and the radial artery has a dual blood supply, which has fewer vascular complications and does not require closure devices, but the radial artery has a smaller internal diameter and fewer device options, which makes it difficult to intervene in some complex lesions, and intraoperative complications such as radial artery spasm are common.
5.What preparatory work is needed before coronary angiography?
Patients should first provide detailed medical history to the doctor, including the onset of chest pain, diagnosis and treatment, history of previous diseases and drug allergies. Then the necessary laboratory tests should be completed before the procedure, including coagulation function, blood routine, fecal occult blood test, blood electrolytes, liver and kidney function, etc. Preoperative skin preparation is required, and iodine allergy test is required for patients with drug allergy history. In addition, maintain a calm and pleasant psychological state, eliminate fear (appropriate amount of sedative drugs can be taken), and practice activities such as defecation and eating in bed. Fasting and water fasting should be done 4 hours before the operation to avoid nausea and vomiting during the operation, which may cause asphyxia.
6.What do I need to pay attention to after coronary angiography?
Patients should rest in bed for about 24 hours after coronary angiography via the femoral artery. Eat appropriate amount of food containing more fiber, keep bowel movement smooth, and drink more water appropriately to speed up the excretion of contrast agent.
7.What do you mean by myocardial bridge and is it harmful?
Coronary arteries usually travel in the connective tissue under the epicardium. If a section of coronary artery travels inside the myocardial fibers, this bundle of myocardial fibers is called myocardial bridge, and the coronary artery that travels under the myocardial bridge is called wall coronary artery. As the wall coronary artery is compressed during the systole of each cardiac cycle, distal myocardial ischemia occurs, which can manifest clinically as angina-like chest pain, arrhythmias, or even myocardial infarction or sudden death, mainly related to the degree of coronary artery compression. The vast majority of patients with myocardial bridges are asymptomatic.
8.What are the abnormal findings of coronary angiography during the attack of variant angina?
Variable angina is characterized by resting pain, which is different from typical exertional angina, and the ECG shows transient ST-segment elevation. Coronary artery spasm may be detected on coronary angiography during an episode of variant angina, while the coronary arteries themselves may not be severely stenosed.
9. Can a normal coronary angiogram completely exclude coronary artery disease?
Since coronary angiography only shows the two-dimensional outline of the lumen filled with contrast, and indirectly reflects the atherosclerotic lesions located on the wall through the change of lumen morphology, a normal coronary angiography cannot completely exclude coronary atherosclerosis.
10.What is intravascular ultrasound and how does it help in the diagnosis of coronary artery disease?
Intravascular ultrasound imaging is to send a miniature ultrasound probe into the coronary artery through the cardiac catheter to show the cross section of the vessel from the lumen, which not only shows the narrowing of the lumen, but also can understand the lesion of the coronary artery wall, including the nature of plaque, the location of plaque rupture, the presence of thrombosis and other information, which can guide the further treatment.
11.What is non-invasive coronary artery imaging?
Non-invasive coronary artery imaging mainly includes electron beam tomography (EBCT), also known as ultra-high speed CT, which has been used in recent years to detect coronary artery calcification and predict the presence or absence of coronary artery stenosis; in recent years, the rapidly developing multi-row spiral X-ray tomography (MSCT) can establish three-dimensional imaging of coronary arteries to show their main branches, which has shown a good prospect in the field of non-invasive coronary artery imaging. It has shown great promise in the field of non-invasive imaging of coronary arteries. In addition, coronary magnetic resonance (MRA) imaging has also been used in clinical practice.
12.Can non-invasive coronary artery imaging replace coronary angiography at present?
Non-invasive coronary artery imaging has an important role in predicting and diagnosing coronary artery disease as well as following up after interventional and surgical treatment. However, due to the limitations of the test method, the accuracy of diagnosis for certain coronary lesions (e.g., calcification) or in the presence of certain arrhythmias (e.g., atrial fibrillation) is somewhat limited, so it cannot replace coronary angiography at present.