INVESTIGATIVE PROCEDURES

CORONARY ANGIOGRAPHY

Coronary arteries don't usually show up on an x-ray, but coronary angiography allows them to be seen by injecting a special dye that shows up on x-ray. The dye flows into the arteries and outlines them. The dye can be injected right next to the heart (at the origin of the coronary arteries) with the aid of a catheter, or into a vein. In the latter case, the dye first flows through the right side of the heart and then through the lungs and the left side of the heart before entering the coronary arteries.
Coronary angiography can help doctors decide how to treat Coronary Artery Disease (CAD) after a heart attack. This is especially true if the heart attack caused major damage to the heart, or if the person is still having chest pain.

How Coronary Angiography Is Done

During coronary angiography, the patient is awake and can follow the doctor's instructions during the test. He or she receives medicine to help with relaxation, which may cause sleepiness.

The doctor numbs the area where the catheter will enter the blood vessel through a small cut in the arm, groin (upper thigh), or neck. Since the coronary arteries begin near the aortic valve, where oxygenated blood leaves the heart, the catheter must be pushed against the flow of blood up to the opening of the coronary arteries. Special x-ray movies are taken of the catheter as it is moved up into the heart. The movies help the doctor determine correct placement of the catheter tip.

The doctor puts a special dye in the catheter when it reaches the correct spot. The dye is designed to be radiopaque, ie opaque to x-rays. This dye is carried with the flow of blood through the coronary arteries, during which time multiple x-ray images are taken. This x-ray (or the collection of x-rays) is called an angiogram. If the angiogram reveals blocked arteries, the doctor may use angioplasty to restore blood flow to the heart.

After the doctor completes the angiography, or the angiography and angioplasty, the catheter is removed from the person's body. The opening left in the blood vessel will then be closed up and bandaged. A small sandbag or other type of weight may be put on top of the bandage to apply pressure. This prevents major bleeding from the site.

How long do I have to be hospitalized?

After coronary angiography, the person is moved to a special care area, where he or she rests and is monitored for several hours or overnight. During this time, the patient is asked to lie still to prevent bleeding from the site where the catheter was inserted. While the patient is recovering in this area, nurses check the person's heart rate and blood pressure regularly and see if there is any bleeding from the tube insertion site.

Recuperation

A small bruise may develop on the person's arm, groin (upper thigh), or neck at the site where the catheter was inserted. That area may feel sore or tender for about a week. Keep an eye on bleeding from the site, unusual pain, swelling, redness, or other signs of infection at or near the insertion site. Certain activities, such as heavy lifting, may need to be avoided for a short time after the procedure.

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AORTOGRAM

An aortogram is an angiogram of the aorta. The aorta is the main artery that carries blood from your heart to your body. An aortogram may show the location and size of an aortic aneurysm and the arteries that are involved.

CARDIAC COMPUTED TOMOGRAPHY SCAN

A cardiac computed tomography (CT) scan provides computer-generated, x-ray images of your internal organs. A liquid dye that can be seen on an x ray is injected into a vein in your arm. The dye outlines arteries and veins in your heart on the CT scan. A cardiac CT scan can show whether plaque is narrowing your coronary arteries or whether you have an aneurysm. A CT scan also can find problems with heart function and heart valves.

CARDIAC MAGNETIC RESONANCE IMAGING (MRI)

Cardiac Magnetic Resonance Imaging (MRI) is a safe and noninvasive test that uses magnets and radio waves to create images of the inside of your body. Cardiac MRI uses a computer to create images of your heart as it is beating. The computer makes both still and moving pictures of your heart and major blood vessels.

Cardiac MRI shows the structure and function of your heart. This test is very accurate at finding aneurysms and determining their size and exact location.

EKG (ELECTROCARDIOGRAM)

An EKG is a simple and painless test that records the electrical activity of your heart. This test is used to help detect and locate the source of heart problems.
A technician attaches sticky patches, called electrodes, to the skin of your chest, arms, and legs. The electrodes are attached with wires to a machine that records your heart's electrical signals.
An EKG shows how fast your heart is beating and whether its rhythm is steady or irregular. It also shows where in your heart the electrical activity starts, and whether it's traveling through your heart in a normal way.

ECHOCARDIOGRAPHY

Echocardiography is a painless, noninvasive test. "Noninvasive" means that no surgery is done and no instruments are inserted into your body.
This test uses sound waves to create a moving picture of your heart. Echocardiography provides information about the size and shape of your heart and how well your heart chambers and valves are working.
The test also can show areas of poor blood flow to your heart, areas of heart muscle that aren't contracting normally, and previous injury to your heart muscle caused by poor blood flow.

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