A thin tube
called a catheter is inserted into an artery in your groin and
is carefully threaded into your heart under the guidance of continuous
x-ray imaging, or fluoroscopy. Pressures within your heart and
coronary arteries are recorded through the catheter. Next, a
contrast dye is injected through the catheter to help delineate
your coronary arteries and other heart structures on x-ray films;
this portion of the test is termed coronary angiography or arteriography.
In some cases,
this procedure is immediately followed by treatment, such as
percutaneous transluminal coronary angioplasty, which uses a
catheter equipped with a small balloon to unblock coronary arteries.
Purpose of the Test
the coronary arteries, identify any blockages due to atherosclerosis,
and determine the need for treatment.
To assess the
function of heart valves, coronary artery bypass grafts, and
other heart structures.
pressures in the hearts chambers and the pumping function
of the heart.
To study congenital
Who Performs It
is performed in a hospital catheterization laboratory.
The risks associated
with this test are increased in people with bleeding disorders
or poor kidney function; the test may not be possible in those
with severe atherosclerosis in the arms or legs.
have an allergy to shellfish or iodine may experience an allergic
reaction to the contrast dye.
should not undergo this test because exposure to ionizing radiation
may harm the fetus.
Before the Test
Tell your doctor
if you regularly take anticoagulants or nonsteroidal anti-inflammatory
drugs (such as aspirin, ibuprofen, or naproxen). You will be
instructed to discontinue them for some time before the test.
Be sure to
tell your doctor if you have a known shellfish or iodine allergy
or have ever had an adverse reaction to x-ray contrast dyes.
You may be given a combined antihistamine-steroid preparation
for several days before the test to reduce the risk of an allergic
Do not ingest
food or fluids for 6 to 8 hours before the test.
bladder before the procedure.
before the test, an intravenous (I.V.) line is inserted into
a vein in your arm. You may also be given a mild sedative, but
you will remain conscious throughout the procedure
What You Experience
You lie on
your back on a padded table, and ECG leads are applied to monitor
your heart rate and rhythm.
The area of
catheter insertion (your groin) is shaved, cleansed with an antiseptic
to help prevent infection, and numbed with a local anesthetic.
The doctor then makes a small incision and inserts a catheter
into the artery; you will feel pressure during insertion, but
no other discomfort.
guides the catheter to your heart, using fluoroscopy to watch
its progress on a viewing monitor.
dye is administered through the catheter. You may feel a hot,
flushing sensation for about 15 to 20 seconds after the injection;
rarely, some people experience nausea and possibly vomiting.
takes several moving and still x-ray pictures (angiograms) of
your heart for later analysis.
If you develop
chest pain during the procedure, nitroglycerin may be administered.
The test itself
usually takes 1 to 2 hours.
Risks and Complications
include blood clot formation, bleeding, blood vessel damage,
or infection at the site of catheter insertion.
may experience an allergic reaction to the iodine-based contrast
dye, which can cause symptoms such as nausea, sneezing, vomiting,
hives, and occasionally a life-threatening response called anaphylactic
shock. Emergency medications and equipment are kept readily available.
procedure may provoke a heart attack, stroke, or cardiac arrest;
emergency equipment is available at the catheterization lab.
Among stable patients, the risk of heart attack or death is very
low (about 1 in 1,000).
After the Test
is removed, and pressure is applied to the incision site until
the bleeding stops (up to 30 minutes). A pressure bandage is
then applied, and a small sandbag is typically placed over the
incision site for several hours to prevent bleeding.
You will rest
in a recovery room for about 6 to 8 hours. During this time,
you should not move the limb where the catheter was inserted.
Nurses will check you periodically to ensure there is no bleeding
at the incision site, to look for signs of delayed reaction to
the contrast dye, and to monitor your blood pressure and other
You are encouraged
to drink clear fluids during this period to avoid dehydration
and help flush the contrast dye out of your system.
are able to return home after about 5 to 6 hours, though some
may require overnight hospitalization.
leave, a doctor or nurse will demonstrate how to apply pressure
to stop any bleeding at the incision site.
lifting and do only light activities for a few days after the
test. You may develop a small lump at the insertion site, but
it should disappear in a few weeks.
will examine the x-ray films and other test data for signs of
significantly narrowed or blocked coronary arteries and other
This test is
usually definitive. Based on the findings, your doctor will then
decide on a course of medical or surgical treatment.
From The Johns
Hopkins Consumer Guide to Medical Tests. You can order
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