Contents
Contents
1 General information 2 Indications for procedure 3 Preparation 4 How to do it 5 Conditions for carrying out 6 Contraindications 7 Risks, complications and consequences 8 Recommendations after performance 9 Diagnostic cost General information
This is an invasive manipulation that serves to determine the state of blood vessels carrying bloodand oxygen to the heart. They are called coronary. The left and right coronary arteries normally provide muscle nutrition and maintain the entire body.
In case of adverse events, these arteries for a variety of reasons narrow( stenosis) or clog( occlusion) .The supply of the heart with blood is significantly limited or at a certain site stops at all, which is the cause of coronary disease and heart attack.
To exclude such a defect or if it is possible to determine its degree, coronarography is performed.
This X-ray study of the lumen of the coronary vessels with the help of an angiograph and a contrast agent, introduced through the catheter precisely on the threshold of the cardiac arteries. The shooting is conducted under different angles, which allows you to create the most detailed picture of the state of the survey object.
Indications for procedure In a planned manner, coronary angiography is performed for:
confirming or refuting the diagnosis of IHD; specification of the diagnosis with ineffectiveness of other methods of determining the disease; determine the nature and method of repairing the defect during the forthcoming operation; a revision of the condition of the organ in preparation for an open heart surgery, for example, with a blemish. In emergency cases, the procedure is performed in the presence of the first signs and symptoms of a heart attack or in a pre-infarct condition, which require immediate intervention for vital signs.
Consider how to prepare for coronary angiography of the heart, and also how this procedure is done.
Preparation Before the appointment of coronary angiography, a number of examinations must be performed to exclude or confirm the presence of factors that do not allow the use of this diagnostic method. Training program:
blood tests( total, for sugar, for hepatitis B and C, bilirubin and other hepatic indicators, for HIV, for RW, for group and Rh factor); urine analysis for the presence of renal pathology; ECG in 12 leads; examination and conclusion of specialists on existing chronic diseases. is carried out directly before the procedure :
the doctor in advance cancels certain drugs, for example, reducing blood clotting; exclude food intake on the day of diagnosis - to avoid complications in the form of vomiting, the test is performed on an empty stomach; the doctor collects an allergic anamnesis, conducts the test with a contrast substance. Directly before coronary angiography is recommended to take a shower, shave off the groin, remove jewelry from the body ( earrings, rings, piercings), glasses, removable dentures, lenses, use the toilet.
How to do it The patient lays down on a special table. To his chest are attached heart sensors. In the area of insertion of the catheter, is given local anesthesia and skin disinfection .In the vein, make a microcut, through which a catheter is inserted.
A catheter is guided through the vessels under the control of an angiograph to the mouth of the coronary arteries. In turn, a contrast medium is introduced into each of them, which describes the internal space of these vessels. is shot and fixed from different positions of .The place of stenosis or occlusion is determined.
During the operation, the patient is conscious, his condition is monitored by observing the appearance, heart rate and his verbal behavior.
Upon completion of monitoring, the catheter is carefully withdrawn from the vein. The wound is carefully closed. The patient still remains for a while to lie, and the doctor writes the conclusion .It indicates the size of the smallest lumens in the vessels, the degree of constriction and the recommended method of correcting the situation - stenting or bypassing the heart vessels. In the absence of problem areas, a general description of the coronary arteries is given.
Video about the outpatient cardiac angiography of the heart vessels:
Conditions for The most common coronarography is performed by in a hospital as part of a planned examination for ischemic heart disease. In this case, all the tests are taken here, a few days before the intervention.
It is possible to carry out diagnostics and ambulatory. But the patient must previously independently pass all the examinations on the list, get a cardiologist's conclusion about the possibility of carrying out coronarography and referring to it with an indication of the purpose of the study.
In the outpatient setting of , the insertion of a catheter for coronary angiography is most often carried out through the wrist line and the arm - in the postoperative period the load on it, in contrast to invasion through the femoral vessel, can be minimized in order to avoid dangerous bleeding.
Contraindications A number of states do not allow this method of to be used, therefore they resort to alternative ones. A preliminary examination can reveal these conditions:
uncontrolled arterial hypertension - intervention can cause stress, as a result of a possible hypertensive crisis; post-stroke state - agitation can cause a re-attack of the disease; internal bleeding in any organ - when infecting blood loss may increase; infectious diseases - the virus can promote thrombus formation at the site of the incision, as well as exfoliation of the areas on the vessel walls; diabetes mellitus in the stage of decompensation is a state of significant damage to the kidneys, high blood sugar, the possibility of an onset of a heart attack; elevated temperature of any origin - accompanying high blood pressure and heart palpitations can lead to heart problems during and after the procedure; severe kidney disease - contrast agent can cause organ damage or aggravate the disease; intolerance of contrast agent - on the eve of the diagnosis, a sample is made; increased or decreased coagulation of blood - can cause thrombosis or blood loss. With the preliminary preparation, all these conditions are identified, and treatment is prescribed to compensate them. There are no absolute contraindications to the procedure. Once stabilization is achieved, the procedure can be carried out under stationary conditions.
Risks, Complications and Consequences Coronary angiography, like any invasion, can have side effects caused by an incorrect reaction of the body to the intervention and stress of the patient. Rarely, but the following events occur:
bleeding at the gates of injection; arrhythmia; allergy; exfoliation of the inner layer of the artery; development of myocardial infarction. Pre-procedure examination is designed to prevent these conditions, but sometimes this happens. Doctors participating in the survey cope with the situation, the procedure is terminated at the first adverse signs of , the patient is taken out of a dangerous condition and transferred to a hospital for observation.
Recommendations after Following the conclusion of the doctor who conducted the study, the cardiologist determines the path of treatment for the patient .If there are indications, the time of stent placement is prescribed( in the same way as coronary angiography - using a catheter).
Sometimes this procedure is performed right during the diagnosis, if there is a prior consent of the patient. The cardiologist can also prescribe an outpatient treatment or aortocoronary bypass surgery.
Cost of diagnostics
In the presence of the policy of compulsory medical insurance coronarography according to indications is free of charge. But equipping the majority of hospitals does not allow to cover all this method in a short time. Usually the queue lasts for months, becausethe quota for the survey is limited. It is possible to pass this study on a commercial basis.
The cost in Russia is in a wide range - from 10 to 45 thousand rubles. Abroad this intervention is also not always covered by insurance and is also not cheap - from 300 dollars to 2500 euros.
Coronary angiography is a mandatory list of diagnostic procedures for determining the degree of damage to the heart vessels. The procedure has been worked out and standardized by for a long time - it serves as a guarantee of patient safety. The level of cardiology in the country allows to identify pathology at an early stage and take measures to eliminate it or prevent development.
