|
Angiography
What is it?
A special liquid dye is injected into the coronary arteries of heart and
x-rays are taken. The dye shows up on the x-ray monitor revealing the
inside of the arteries and 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 heart.
How is it done?
Coronary 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
· 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. Angiography
is performed under local anesthesia.
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.
Before ... Precautions & prerequisites
1. 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.
2. 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.
3. You will be normally admitted to the Institute on the day of the procedure.
4. 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.
5. 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.
Before
Admission
1. Please report to the Admission Counter (Information Counter, when it
is closed) on the ground floor of Main Building for your admission on
the day of the Angiography (with relevant reports - X-ray, ECG, if they
are in your possession) at the time indicated to you by the Consultant-in-charge.
2. Once admitted, you will be sent either to the Cath Lab or to the Day
Room where you will be prepared for the procedure.
3. The groin will be shaved to minimize chances of infection.
4. A plastic cannula will be put in one of the arm veins. This will stay
in place during your stay in the Institute. It will not cause any problem
in using the arm.
5. You will be asked to sign a consent form for the procedure.
6. Before the procedure you will be given an injection of mild sedative
and anti-allergic medicine.
Angiography Procedure
1. In the cath lab you will be moved onto an X-Ray table. Groin will be
cleaned with antiseptic lotion. You will then be draped with sterile sheets
and local anesthesia will be administered in your groin.
2. A small nick is made in the groin and your femoral artery will be punctured
and a plastic sheath will be inserted into it.
3. Angiography catheters will be introduced through this sheath and your
coronary arteries will be selectively incubated. Contrast agent is injected
through these catheters to visualize your coronary arteries on the fluoroscopy
monitor. During the procedure you may be asked to take deep breaths or
to cough.
4. The X-Ray tube will be moved in many different directions so that your
coronary arteries are viewed from all sides. After this, the dye will
be injected in your heart to look for its functions. This is the time
when you may feel the sensation of warmth. This is a normal phenomenon
and occurs because of the contrast agent, which is injected into your
heart for seeing its contractility.
After
1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
Discharge
1. You will be discharged either in the evening or next day morning depending
on whether your angiography was done in the morning or evening.
2. 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.
3. You are requested to instruct your attendant to get Finance Clearance
to enable your discharge.
4. The Nursing Station looking after you will give you the discharge summary
and angiography report at the time of discharge.
5. Please collect dietary precautions from the in-house Dietician before
you leave. Her extension no is 4034
6. 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
1. You can remove the dressing placed over your angiography puncture site
the next day. Subsequently, you can bathe and no further dressing is required.
2. 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
Angiographies
i. Coronary / Cerebral Rs. 15,000
ii. Peripheral/Venogram Rs. 11,000
iii. Angioscopy procedure Rs. 11,000
iv. Intravascular Ultrasound procedure Rs. 11,000
v. Ventricle assisted device Rs. 11,000
vi. Osymetry(L-R Shunt) Rs. 14,000
vii. Right Heart (Catheterisation)(PAP-PCWP) Rs. 15,000
viii. Renal/Carotid Rs. 8,000
-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
extra)
-Non-ionic spl. Dye, if used will be charges extra
|