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Coronary Angiogram

What is Coronary Angiogram?

Coronary Angiogram is a diagnostic procedure of which the status of coronary arteries (arteries that give blood supply to the heart) is defined.

How is it done?

The procedure is performed either through the groin or the wrist or the front part of the elbow. The right side is preferable. It is done using local anesthesia. During the procedure, a small catheter is introduced to the root of the aorta (great artery). Contrast agent is injected directly into the coronary arteries. Pictures are taken during the contrast injection. There is no pain during the procedure.

Why is it done?

The procedure is done to see if one has any blockage in the coronary arteries. It also provides information of how severe the blockage is.

Coronary CT Angiography

What is Coronary CT Angiography?

A Coronary CTA is a heart-imaging test which non-invasively determines whether either fatty deposits or calcium deposits have built up in the coronary arteries.

According to the statistical data from the World Health Organization (WHO), coronary artery disease is one of the top causes of death. It mainly results from degenerative blood vessels or the formation of lipid-containing plaques which gradually block the bloodstream. Heart disease is often found in patients with diabetes, hypertension, hyperlipidemia, as well as those suffering from stress and heavy smokers.
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Diagnosis of Coronary Artery Disease

Nowadays, there are two main methods to diagnose coronary artery disease.

1. Coronary Angiography (CAG) is the gold standard for identifying the blocked coronary arteries. This method provides the most accurate result.

Advantage:

• Proper treatment can be immediately performed by or percutaneous coronary intervention (PCI).

Disadvantage:

• It poses some risk for complications, e.g. dissection, because the catheter has to be inserted into an artery from a patient’s groin or arm or wrist to be carefully threaded to coronary arteries. However, such risk is very slight under the expert treatment of qualified doctors.

• It is quite costly.

• Patient needs to remain in hospital for 4-24 hours after the procedure.

2. Coronary Computed Tomographic Angiography (Coronary CTA)

CT technology has been rapidly evolving over the past several years. It now provides a high-resolution and high-contrast image of a small and beating organ such as the heart.

Patients undergoing a Coronary CTA scan receive an iodine-containing contrast dye as an intravenous solution to ensure the best images possible. During the examination, this usually takes about 10 minutes, x-rays pass through the body and are picked up by special detectors in the scanner.
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Advantage:

• MDCT (Multi-Detector Computerized Tomography) procedure can be performed in a short time.

• Patient is not required to stay in hospital after the procedure.

• It delivers a high accuracy of over 90% in detecting coronary artery disease.

Disadvantage:

• It takes around 1-2 hours for image processing after the actual scan.

• Patient must have a regular heart rate and can hold the breath for about 10 seconds for each scanning with the newer generation of CT scanner. These requirements become unnecessary.

Who should undergo MDCT?

Patients who should undergo MDCT are:

1. Patients who have the following risk factors of coronary artery disease

• Hyperlipidemia

• Heavy smoker

• People who have a history of coronary artery disease within their family

2. Patients who are suspected of having coronary artery disease

• Having chest pain

• Electrocardiogram (ECG) or exercise stress test (EST) cannot clearly identify the abnormalities.

3. Patients who have been treated for coronary artery disease by balloon angioplasty (PTCA) or percutaneous coronary intervention (PCI) or , and need to see the result for further treatment.

Preparation for Examination

Preparation is similar to CT scanning of other parts of the body. Patients should not eat any food at least four hours before examination, except drinking water. However, before the procedure, they should not drink tea, coffee, and any beverages or medicines that stimulate the heartbeat rate.

Who should not undergo MDCT examination and injection of a contrast medium into veins?

Since patients are exposed to x-rays during the examination, those who are pregnant or suspect that they are should not undergo this examination.

Injection of a contrast medium into patients’ veins is required for the MDCT examination. Therefore, the patients with the following diseases or symptoms are not recommended for this test because they might be severely allergic to contrast medium or have acute renal failure.

1. Severe

2. Renal disease with high creatinine level or chronic renal failure

3. A history of severe allergy to seafood or contrast medium from x-ray examination

However, if patients who have the above diseases or history need to be treated by this method, they are required to inform hospital personnel in advance.

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