Coronary angiography is the gold standard in the diagnosis of coronary artery disease; Cardiology - Allergy Medicine

Coronary angiography – the gold standard in the diagnosis of coronary artery disease

Coronary angiography – X-ray contrast method of research, with the help of which the condition of the arteries of the heart is assessed. Coronary angiography is the most accurate and reliable way to diagnose coronary heart disease, which allows you to decide on the tactics of treating a patient in each specific situation, for example, on the possibility of continuing medication treatment, the need for such medical procedures as angioplasty and stenting or coronary artery bypass grafting.
This procedure is invasive, which involves the introduction of a special catheter in the operating room and can be performed both for diagnostic purposes and to monitor the condition of blood vessels after previous operations.

Coronary angiography is an X-ray contrast method of investigation, which is the most accurate and reliable method for diagnosing coronary artery disease, allowing you to accurately determine the nature, location and degree of narrowing of the coronary artery.
This method is the "gold standard" in the diagnosis of coronary artery disease and allows you to decide on the choice and scope of further treatment procedures such as balloon angioplasty and coronary bypass grafting.

Tasks of coronary angiography:

determine the localization and anatomical structure of the coronary arteries;
identify the presence and degree of stenosis of the arterial lumen;
determine the exact localization of the lesion and extent;
determine the diameter of the lumen of the artery (unchanged and at the site of stenosis);
establish the presence and severity of collateral vessels.

Indications for coronary angiography

high risk of complications according to clinical and non-invasive examination, including in asymptomatic IB;
ineffectiveness of medical treatment of angina pectoris;
unstable angina, not amenable to drug treatment, which occurred in a patient with a history of myocardial infarction, accompanied by left ventricular dysfunction, arterial hypotension or pulmonary edema;
post-infarction angina;
the inability to determine the risk of complications using non-invasive methods;
upcoming open-heart surgery (eg, valve replacement, correction of congenital heart defects, etc.) in a patient older than 35 years.

Stages of coronary angiography

Coronary angiography is performed both on a planned and emergency basis. Indications for coronary angiography are determined by your attending physician, who will prescribe the necessary tests and studies necessary for the procedure.

On the first stage selection of patients for a diagnostic procedure is carried out, the necessary additional examinations are carried out.

Indications to CoronoanoHiography:

identified or suspected IBS;
Pains for the sternum, suspicious on angina;
myocardial infarction;
planned operation about heart defects;
Heart failure, ventricular rhythm disorders.

The testimony for coronary photography is determined by the attending physician in accordance with the criteria adopted. During the preparation of the patient, the necessary analyzes and research are carried out. In addition to these, additional research can be assigned.

Second phase Ambulator Kag– Actually the procedure Angiography. The patient enters the day hospital chamber. After evaluating the stability of its condition, premedication is carried out and it is transported to the X-ray control, where the procedure of coronaryographics is performed. After anesthesia, the access area is proceeded – a special catheter is carried out through the artery of the forearm in the lumen Coronary arteries. With the help of a catheter in the blood, an X-ray-contrast substance is injected, thanks to which the lumen of the vessels becomes visible on a special instrument – angiograph. During the coronary and the degree and size of the damage to the coronary vessels, which determines the further tactics of treatment. This procedure is small-acting, which allows its Under local anesthesia Without use of common anesthesia. The duration of the procedure, as a rule, does not exceed 20 minutes. From the operating patient, accompanied by medical personnel is delivered to the day hospital chamber.

Third stage Ambulator has a patient under the conditions of the chamber of the day hospital within 4-5 hours after the study performed. In the ward, the patient can drink water or juices without restrictions, dining. In the absence of complications, the patient is released home.

On the day of the outpatient kag, the patient receives a conclusion with the recommendations on the further tactics of treatment and disk with the results of Koronarography.
In the event of complications during the execution of the KAG or in a testing period, hospitalization of patients in the intensive observation unit is provided.

Frequently asked Questions:

Question: I am 56 years old, I have ischemic heart disease. The cardiologist recommends conducting coronary art. I did not really understand what it was?

Answer: Coronaryography is a study of heart vessels, which, like a crown, cover the heart, supplying it with rich blood blood. They are called koronary arteries. The narrowing of the coronary arteries leads to a decrease in the blood supply of the heart, which leads to oxygen starvation, i.e. To heart ischemia. Know in what condition the artery of the heart is very important, because The obstacle blood flow can be eliminated, radically delivering a person from symptomical heart disease.

Question: How is CoronaryRography?

Answer: Coronography – X-ray study, in which a special contrast agent is introduced into the heart vessels with a flexible thin probe.At the time of the passage of the contrast agent through the vessels, a short-term X-ray filming is carried out with a significant increase in high-resolution equipment. The slightest changes in the coronary bed are visible "at a glance". The results are recorded in digital format, available for viewing on any personal computer.

Question: Is coronary angiography performed under anesthesia?

Answer: No general anesthesia required. In the groin area or on the wrist, the pulse is determined, under local anesthesia, a probe or catheter is inserted into the lumen of the artery using a puncture. The subject does not feel how the catheter is moving through the vessels, because there are no sensitive nerve endings inside the arteries. There is no pain, the patient is fully conscious and, together with the operator, monitors the progress of the study on the monitor. The duration of the procedure is no more than 15-20 minutes. Further observation of the patient for several hours is necessary. In the department, coronary angiography is performed exclusively by access through the radial artery (on the wrist). Immediately after the examination, the patient can get up, walk, the bandage on his arm does not restrict him in anything (see ambulatory coronary angiography). After 4 hours, the patient is discharged home. If the study is carried out through the groin, then bed rest is necessary and the period of stay in the clinic is extended to a day.

Question: If there is no narrowing in the vessels of the heart during coronary angiography, then there is no coronary heart disease?

Answer: Yes, the absence of changes in the coronary arteries practically excludes the diagnosis of coronary heart disease. In rare cases, ischemia of the heart muscle can occur in the presence of "normal" coronary arteries, but the absence of damage to the arteries of the heart is the most reliable predictor of a good prognosis. This is very important information for choosing the right tactics for managing the patient.

Question: At what age is coronary angiography performed, what are the contraindications for coronary angiography?

Answer: Coronary angiography is performed at any age, in all cases when it is necessary, namely if the patient has angina pectoris, after myocardial infarction. Coronary angiography, in the first hours of myocardial infarction, makes it possible to determine where the blockage of the vessel causing the infarction is and immediately eliminate it. Coronary angiography is necessary for all adults with heart defects before surgery, before "big" vascular operations. Some patients at high risk for coronary heart disease, such as those with diabetes, may not have symptoms of the disease. In this case, coronary angiography is, in fact, the only reliable way to exclude or confirm coronary disease.

List of documents and analyzes required for coronary angiography

general blood analysis,
blood type,
Rh factor
tests for hepatitis B and C, HIV, RW,
ECG in 12 leads,
Echo-KG.

If necessary, additional research can be carried out. Surveys The patient can pass both in the clinic at the place of residence and in the clinic where coronary artwork has to be held.

After hospitalization, you look at the attending physician and, if necessary, attracted specialists from other specialties. The state is specified at the time of coronary artwork, the essence and possible results of the procedure are explained.

The procedure is small-acting – during the entire procedure, the patient is conscious.
After local anesthesia, a study is proceeded – a special catheter is carried out through the femoral artery and the upper part of the aorta in the clearance of coronary arteries.
In some cases, the catheter is introduced through the arteries of the forearm, which reduces the observation period after the coronary frame.
Through the catheter, an x-ray-contrast substance is introduced, which is separated by blood with a coronary vessels. The process is fixed using a special installation – angiograph.
The result is displayed both on the monitor, it is placed in a digital archive.
During the coronary and the degree and size of the damage to the coronary vessels, which determines the further tactics of treatment.
If necessary, after agreeing with the patient, it is possible to simultaneously carry out balloon dilatation and (or) the installation of vascular endoprostheses – stents.
After the study, the specialist demonstrates the patient to record its coronary and explains the degree of damage to coronary vessels, recommends further treatment tactics.
After the study on the hands of the patient, a written conclusion and recording of coronary survey on the CD-disk is issued. It allows you to use an entry for study by specialists in any medical institution, on any computer when determining the dynamics of the disease.

Coronaryography in scheduled order for the patient is carried out in St. Petersburg GBUs GB No. 40, as follows, according to the testimony, treatment methods – balloon angioplasty with stenting coronary arteries and aorticoronary shunting.

Curliologist consultation to determine the testimony for coronary and appointment of the date of this procedure are carried out in the rehabilitation building of SPB GBUZ GB No. 40 on Tuesdays and Thursdays from 14 hours to 16 in 426 in the 4th floor.

For consultation needed:

passport, medical policy;
spitting from the polyclinic in which you are watching;
Medical examinations, among which should be ECG, the result of ECCG (heart ultrasound), the result of Holter monitoring ECG.

Balloon angioplasty and stenting coronary arteries are carried out in a planned order by the federal quota, which is issued in our institution (patient also this type of treatment is free) if there is a patient:

passports;
medical policy;
SNILS.

Consultations with a cardiologist to determine the indications for coronary angiography and set the date for this procedure are held in the rehabilitation building of St. Petersburg State Budgetary Health Institution No. 40

on Tuesdays and Thursdays from 14:00 to 16:00 in room 426 on the 4th floor.

For all your questions, you can contact the following numbers: