Coronary angiography – Instructions and basic information

Coronary angiography is an invasive diagnostic method that shows the coronary arteries – blood vessels on the heart that supply the heart muscle with blood. The procedure is most often carried out when there is a suspicion of poor blood supply to the heart muscle, or when there is an obstacle to blood flow due to a narrowing or blockage of a blood vessel, which gives symptoms of angina pectoris and myocardial infarction. On the basis of the findings, a decision is made as to whether further treatment is based only on the use of drugs, whether it is necessary to insert a stent into the blood vessel of the heart, or whether a bypass operation (aortocoronary bypass) is required. Coronary angiography is also performed as part of preoperative preparation for other heart diseases that require operative or invasive treatment.

How is it performed?

Coronary angiography is performed in the angiosal, i.e. the room for cardiac catheterization, respecting the measures of sterility and invasive and non-invasive monitoring of the patient’s status. The patient is conscious, and the access points are the wrist (where the radial artery is punctured) or the groin (when the femoral artery is punctured), which are treated with local anesthetic. A tube – a catheter is inserted into the artery, which is used to reach the aorta and target arteries on the heart through the arterial system, and an iodine contrast medium is injected, thus staining the artery. The stained artery is imaged with an X-ray machine from different positions. The complete procedure with preparation lasts about 30 minutes if there are no difficulties, and it can take longer (in case of difficult vascular access, spasm of the arteries of the upper extremities, and in the case of anomalies and diseases of the arterial system). Not a sign of complication of the procedure.

Complications of the procedure
bruises at the puncture site gradually disappear over a couple of weeks,
access artery or coronary artery dissection,
pseudoaneurysms that may also require surgical treatment
retroperitoneal bleeding,
allergic reactions to the contrast medium,
contrast nephropathy (kidney disease caused by contrast medium),
cerebral vascular incident (stroke),
heart rhythm disturbances that may require an emergency electroshock
myocardial infarction,
fatal outcome.

Bleeding occurs more often with femoral access. Complications are rare and listed due to legal notice and general information.

Preparation at home

If you are using anticoagulant drugs (medicines against blood clotting – Martefarin, Warfarin, Sintrom, Markumar, etc.), in agreement with your doctor, stop taking them 3 days before coming to the hospital, but it is necessary to replace the drug with another drug (low molecular weight heparin, e.g. enoxaparin) ).

If you use Xarelto or Eliquis, the last pill is taken 24 hours before the planned coronary angiography and no replacement therapy is required. It is important that you do not voluntarily stop taking anticoagulant therapy under any circumstances.

If you are already taking Clopidogrel 75 mg (Plavix, Zyllt, Clodil), do not exclude it from the therapy because if there is an urgent need for percutaneous intervention, it is better that you took the medicine regularly and without interruption.

If you suffer from diabetes, consult your doctor about taking insulin and oral antidiabetic drugs.

It is advised not to eat anything at least 6 hours before the procedure and you can take your regular therapy at the usual time with water or tea.

Take with you the findings of the cardiologist, ultrasound of the heart, ergot test, discharge letter (if you were previously hospitalized) and laboratory findings: KKS, potassium, urea, creatinine, AST, ALT, INR, blood group, Rh factor.

After the procedure

A compression bracelet is placed on the arm at the affected area, which is gradually loosened over the next 6 hours and then removed. The patient’s movement is limited in the first hours due to possible early reactions such as a sudden drop in pressure or pulse. The access point on the groin is compressed with compression gauze and sand pads, and the patient lies in bed for about 8-10 hours, longer if necessary.

If you feel warmth, wetness, or bleeding at the injection site after coronary angiography, inform the doctor and/or nurse/technician, as well as in the event of any other complaints such as chest pain, shortness of breath, fainting, headache, ringing in the ears, pain in the stomach, pain in the arms/legs.

Instructions for patients whose injection site was on the arm:

It is normal for you to feel slight tingling or discomfort in your hand for the next 3 days. If severe pain occurs, contact your doctor!
You can shower 24 hours after coronary angiography. Do not strain your arm for the next 5 days (lean on it when you stand up or lift something heavy).
You can drive a car 2 days after discharge from the hospital.

Instructions for patients whose injection site was on the leg:

It is normal for there to be a hematoma/bruise around the puncture site.
If you have to sneeze, cough, laugh or defecate, gently press on the injection site for the next 2 days.
You can shower on the 1st day after coronary angiography,
Do not sit for more than one hour on the first day after discharge from the hospital
You can drive the car after 7 days.
Release

After chorography, patients are ready to be discharged home the next day. Nurses and a doctor will examine the puncture site during a visit to the department. If it is in order, you will be sent home. Before discharge, you will receive a report and a discharge letter with a recommendation for further treatment. Leave the bandage on the puncture site for the next 24 hours. It is not recommended to put creams, lotions on the puncture site. During the next 10-14 days, avoid physical exertion such as cycling, swimming pools, saunas and the gym.

Contact a doctor in case of:

large hard growths under the skin in the area of the puncture wound, which is painfully sensitive to touch and restricts movement,
discoloration, numbness or coldness of the extremities,
if you have a fever,
bleeding at the injection site,
chest pain that does not go away with the prescribed therapy.