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Having a coronary angiography

Posted by Nathalie on June 18, 1999 at 10:23:26
A friend's grandfather needs to have a coronary angiography.  He is very afraid of hospitals and doctor's.  He has been having chest pains and the doctor wants to see if he has any blockage.  He also has diabetes.  Is there anything for him to be afraid of?  What are the risks?  How does the process work?  I think what he told me was they would go up from the groin area, put a catheter in the holw and slide up towards his heart where they would be able to see it on the TV.  Any information would be appreciated I was hoping I could give it to him to make him feel a little more comfortable with the procedure.  Thank you very much.
P.S.  Thanks for all of your help in the past, you've given me some very helpful information!

Posted by CCF CARDIO MD - CRC on June 18, 1999 at 16:11:12

Dear Nathalie,
Thank you for your question. I have provided information about catheterization and angioplasty below.  Feel free to write back with any additional questions.
cardiac catheterization - a small tube (catheter) is inserted into an artery in your arm or leg and guided to your heart, contrast dye is injected, and x-ray movies of the coronary arteries, heart chambers, and valves are taken.
What is a cardiac catheterization?
Cardiac catheterization is a procedure in which a long, slender tube (a catheter) is placed inside the arteries or chambers of the heart. It is used to check internal pressures in the heart, to measure blood flow, to assess valve leakage, and to examine the arteries for blockage.
Patients are given a mild sedative to help them relax, but they remain awake throughout the procedure. The patient may feel a slight pressure or discomfort, but the procedure is generally painless. The catheter is inserted into a blood vessel at the bend of the elbow or at the groin. The doctor then uses X-ray equipment to guide the catheter toward the heart.
Over 2 million cardiac catheterizaions are performed in the United States each year. The majority of these are done in an out-patient setting.
What is coronary angiography?
Coronary angiography is a diagnostic procedure performed with cardiac catheterization. A contrast material is injected through the catheter. The contrast material is photographed as it moves through the heart's chambers, valves, and major vessels. From these photographs, doctors can tell whether the coronary arteries are narrowed, whether the heart valves are working correctly, and whether strength of the heart muscle is adequate.
What is a coronary angioplasty?
If an important blockage is found in one of the heart's arteries, it may need to be corrected with angioplasty or bypassed with surgery. Angio is the latin word for artery, and plasty comes from the word plastic, which means to mold or shape. Angioplasty, therefore, is a reshaping of the inside of the heart's arteries. The full procedure name is percutaneous transluminal coronary angioplasty or PTCA. The most common method of PTCA is balloon angioplasty. In this procedure a small balloon (3 mm or 1/8" diameter) is placed across the blockage within the heart's artery and briefly (several minutes) inflated.
Can the blockage be removed or treated differently?
In addition to compressing and redistributing the atherosclerotic plaque (accumulated cholesterol) with a balloon, several newer technologies have been developed. These "atherectomy" or atheroma removal procedures cut away or ablate the blockage. The most common procedure currently used to treat severe blockages is the placement of a metallic stent or scaffold within the artery. The stent serves to keep the artery open as it heals following the balloon procedure.
How is it decided what therapy or procedure is best for a patient?
If a patient has a blockage that narrows the diameter of a coronary artery by 70%, the doctor must first decide whether the blockage can be treated adequately with medicines or if a corrective procedure is needed. If a procedure is needed, the doctor must decide whether to perform angioplasty or bypass surgery.
Many factors influence this decision, including the patient's age and overall health and the number and severity of blockages. Each year in the United States, about 550,000 angioplasty procedures and 450,000 bypass surgeries are performed.
What are the advantages and disadvantages to angioplasty procedures?
Angioplasty has the advantages of being relatively quick, safe, and effective. Many times, when a blockage is found during diagnostic cardiac catheterization, angioplasty can be performed as part of the same procedure. This extends the procedure time by only 1 to 2 hours, and the patient can be sent home the following morning. The risk of a serious complication is usually less than 1%, and nearly all patients will be free of chest pain following the procedure.
The greatest disadvantage of angioplasty is that scar tissue can develop at the site of the treatment. This problem occurs within 6 months in approximately 30% of patients. New techniques and procedures continue to improve angioplasty results. The large majority of patients who have angioplasty experience long-term success.
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

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