Angiography

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Angiography is essentially X-ray pictures of the coronary arteries taken as part of a cardiac catheterization procedure. A small catheter is threaded through an artery, usually in the leg, to the coronary arteries. A dye is injected that allows the arteries to be seen on X-ray. A film is obtained during the injection of dye for analysis of the coronary artery anatomy and may reveal the presence of blockages if any.

Why is it Done?

Heart is a muscular pump whose primary job is to pump blood throughout your body. It expands and contracts roughly 70 times per minute. Approximately 5 liters of blood is pumped into our arteries every minute. When we are under physical or mental stress, heart has to function harder to cope with the increased demand of blood (up to 40 liters per minute). Like any other organ heart needs oxygenated blood to function. Coronary arteries are the vessels, which supply blood to the heart muscle. They are three in number and run on the surface of heart. The left main Coronary Artery divides into two branches - the Left Anterior Descending (LAD) and Left Circumflex (LCx) Artery. They supply the blood to the front, left side and back of heart. The Right Coronary Artery (RCA) supplies blood to the bottom and right side of heartCoronary Artery Disease is narrowing of the coronary vessels thus affecting supply of blood to the heart. There are several conditions in which the occurrence of the coronary artery disease is found to be more common. Some of these conditions are smoking, diabetes, high blood pressure, hyperlipidemia (increased fat in blood), obesity, lack of exercise, stressful life and family history of coronary artery disease or simply ageing. A plaque starts getting deposited in the inner walls of the coronary arteries leading to partial or full blockage of the arteries. The blood flow does not remain normal and this leads to chest pain (angina). If it is not treated promptly, a heart attack (myocardial infarction) may result. Incidences of Coronary Artery Disease have become more frequent even in the middle and young age group, more so in Indian subcontinent.Cardiologist will diagnose CAD on the basis of symptoms, ECG, stress testing (TMT), exercise thallium scan or stress echocardiography, and finally coronary angiography. Angiography till date remains the gold standard for diagnosis and decision making for further management of the coronary artery disease. One determines following information by way of angiography:

• Presence, location, severity and the extent of blockages·Angiography is performed under local anesthesia.
• Status of weakness of heart muscles after the heart attack.
• Measurement of chamber pressures if required.
• Status of valve function.

Angiography along with other clinical data will guide the cardiologist to take the proper decision regarding the final treatment.

How is it Done?

Some medications are given to make a patient feel relaxed, but they remain awake. Patient will lie on a table that allows special x-rays to be taken of heart that enable the doctor to see while heart is in motion. A local anesthetic is given in the groin or in the wrist to numb the area and to prevent pain when the tube is inserted. The doctor will insert the tube through a small incision. The tube is pushed toward the heart through the blood vessels. X-rays are used to follow the position of the tube. Patient does not feel the tube as it passes through blood vessels. By twisting the hub (the groin/wrist end) of the tube, the doctor will direct the tip of the tube to precise positions in the heart and its blood vessels. The tube hub is attached to a device that measures blood flow and blood pressure in various locations in the heart and blood vessels. If a picture of the heart chambers, valves, or heart blood vessels is needed, a special dye is injected through the catheter. During this injection, moving x-ray pictures are recorded. The tube is then withdrawn and pressure applied over the puncture site until bleeding stops.

Angiography - Myth and Reality

Some people feel that Angiography is a costly and risky procedure. Some feel that it has to be followed by Angioplasty or Bypass. This is not necessarily true. It all depends on what one finds in the angiogram. One of the commonest reasons to do angiogram is when there is high index of suspicion for coronary artery disease after a positive TMT or highly suggestive symptoms. Only a normal angiogram can provide reassurance and mental peace rather than living under the shadow of a suspected CAD in such situations. Even if certain blockages are found, many arteries may have just a minor blockage (up to 50%), in which case, treatment through medicines alone may suffice. In some cases, it is likely that arteries may be severely and diffusely diseased that even angioplasty or bypass procedure may not be possible. It is only in the remaining cases that angioplasty or bypass is advised to restore blood flow to the heart.

There is a less than 1% risk of complications, like bleeding at the local site, allergic reaction to the contrast, or deterioration of renal function or cardiac condition. The latter risks are only in such cases where the blockage already exists in substantial measure.

Preparation

Precautions & prerequisites

• In the OPD doctor will evaluate you in detail and explain the procedure to you. Tell your doctor if you are allergic to any medicines or if you cannot tolerate aspirin. Also tell him/her about any other medicine that you are taking.
• All tests - blood, X-ray and ECG necessary for the Day Cath procedure will be carried out in the OPD prior to the date of admission.
• You will be normally admitted to the Institute on the day of the procedure.
• You are requested to deposit the money at IPD Billing Counter (information counter after normal working hours) located in the basement of the main building before your admission.
• Please do not eat anything at least four hours before the procedure on the day of angiography. You can have tea, or clear fluids up to one hour before admission. After that you may have sips of water only. First course of the medication can be taken with morning tea. If your angiography is scheduled in the afternoon, you may be asked to take light breakfast or a glass of fruit juice.

After (transfemorali.e. procedure through groin)

• Your procedure (angiography) will take approximately 15-20 minutes. After the procedure you will be shifted on to the trolley. You will be in the Cath Lab for some time after the procedure for observation and sheath removal.
• The plastic sheath, which was put in your groin, is removed. The artery is, then compressed for 10-15 minutes by the doctor or nurse. A sterile compression bandage is then applied over this site.
• You will be shifted to either on 4th floor / 5th floor in a double-bedded room or Cath Lab ward. Once you are shifted to the ward the nurses will put a sandbag on your groin for 4 hours. Although the sandbag will be removed after 4 hours, you are still not allowed to go to the toilet. You have to use a bed pot/pan for the same.
• One family member / attendant will be allowed to meet you for which an announcement will be made and a pass will be issued from the Information Counter.
• You shouldn't move your right lower limb for about 5-6 hours after the procedure as this may interfere with the sealing mechanism of your artery and you may start bleeding from the puncture site.
• In the ward you are advised to drink plenty of fluids so that the dye is washed off from your blood and excreted in the urine. Once in your room, a meal will be served to you.

Your Stay In The Institute

Your stay in the Institute will normally be for eight to ten (8-10) hours if the procedure was done in the morning; and overnight, if it was in the evening.

After (transradial ie procedure through wrist)

• Your procedure (angiography) will take approximately 15-20 minutes. After the procedure you will be shifted on to the trolley/ wheelchair/ you may be asked to walk out of the lab.. You will be in the Cath Lab for some time after the procedure for observation.
• The plastic sheath, which was put in your wrist, is removed in the cath lab immediately after the angiogram . A sterile compression bandage is then applied over this site. This is removed after 2 hours and a band-aid applied on the wrist. A meal will be served to you while you are waiting for the bandage to be removed.
• You will be shifted to either on 4th floor / 5th floor in a double-bedded room or Cath Lab ward. Once you are shifted to the ward the nurses will inspect your hand and feel your pulse. You are allowed to go to the toilet after the nurse has checked your sedation status , as well as your blood pressure and found it satisfactory.
• One family member / attendant will be allowed to meet you for which an announcement will be made and a pass will be issued from the Information Counter.
• You shouldn't use your upper limb used for the procedure for about 8 hours after the procedure as this may interfere with the sealing mechanism of your artery and you may start bleeding from the puncture site. To ensure this the nurse will put your arm in a sling.
• In the ward you are advised to drink plenty of fluids so that the dye is washed off from your blood and excreted in the urine.
  

After procedure through wrist , pl check with the nurse regarding time of discharge, which is usually 2.5-3 hrs after angiogram.

Discharge

• You will be discharged either in the evening or next day morning depending on whether your angiography was done in the morning or evening.
• The Cath Lab Attending Doctor will take a round before discharge on behalf of the Consultant-in-charge to check your condition. He/she will also inform you of when (time) to meet your Consultant-in-charge in the OPD the next day, who in turn will inform you of the final result of the test there.
• You are requested to instruct your attendant to get finance Clearance to enable your discharge.
• The Nursing Station looking after you will give you the discharge summary and angiography report at the time of discharge.
• Please collect dietary precautions from the in-house Dietician before you leave. Her extension no is 4034
• In case of any problem after discharge, please contact 682 5002/682 5003 and speak to the Doctor on call in the Emergency Department.

Some Precautions

• You can remove the dressing placed over your angiography puncture site the next day. Subsequently, you can bathe and no further dressing is required.
• Rest at home on the night after procedure. You can resume normal activities from the next day onwards.

Cath Film
If you want your angiography film, you will have to deposit Rs. 1,000/- at the cash counter and specify the medium i.e. cassette / VCD etc. The receipt will specify when you can collect your cassette / VCD from the Report Room in RC Building. It will be possible to see this VCD only on the computer with special software.

Tariff

• Coronary / Cerebral Rs. 16,000
• Peripheral/Venogram Rs. 11,000
• Angioscopy procedure Rs. 11,000
• Intravascular Ultrasound procedure Rs. 11,000
• Ventricle assisted device Rs. 11,000
• Oxymetry(L-R Shunt) Rs. 14,000
• Right Heart (Catheterisation)(PAP-PCWP) Rs. 16,000
• Renal/Carotid Rs. 10,000

The above tests include hopitalisation up to 2 days' stay in double bedded room including normal consumables, routine blood tests, one ECG and one X-ray (test, other than routine tests are chargeable extra0).

Non-ionic spl. Dye, if used will be charges extra