Name of the Procedure:

Catheter Placement in Coronary Artery(s) for Coronary Angiography, including Intraprocedural Injection(s) for Coronary Angiography and Imaging Supervision and Interpretation, with Right and Left Heart Catheterization including Intraprocedural Injection(s).
Common Name(s): Coronary Angiography with Right and Left Heart Catheterization.

Summary

Coronary angiography is a medical imaging procedure used to visualize the blood vessels of the heart. A catheter is inserted into the coronary arteries to diagnose the presence of blockages or other heart conditions. This procedure includes right and left heart catheterization and involves injections of contrast dye for enhanced imaging.

Purpose

Medical Condition: Coronary artery disease, chest pain (angina), heart valve disease, congenital heart defects. Goals/Outcomes: To diagnose blockages, evaluate the severity of coronary artery disease, assess heart function, and plan for further treatment such as angioplasty or surgery.

Indications

Symptoms/Conditions:

• Chest pain or discomfort (angina)
• Shortness of breath
• Heart attack
• Abnormal cardiac stress test results Patient Criteria:
• Patients with suspected or known coronary artery disease
• Individuals with unexplained symptoms suggestive of heart disease
• Evaluation before heart surgery

Preparation

• Fasting for 6-8 hours prior to the procedure.
• Potential medication adjustments (e.g., blood thinners).
• Pre-procedure blood tests, electrocardiogram (ECG), and possibly a stress test or echocardiogram.

Procedure Description

1. The patient is positioned on a specialized table and connected to monitors.
2. A local anesthetic is injected to numb the insertion site, typically in the groin, arm, or wrist.
3. A catheter is inserted through an artery and guided to the heart vessels.
4. Contrast dye is injected through the catheter to highlight the coronary arteries on X-ray images.
5. Images are taken to assess blood flow and identify blockages.
6. Right and left heart catheterization is performed by navigating the catheter into the right and left chambers of the heart for additional measurements.
7. The procedure is supervised by a cardiologist who interprets the images in real-time.

Duration

Typically 1-2 hours.

Setting

Performed in a hospital's catheterization laboratory (cath lab).

Personnel

• Cardiologist
• Nurses
• Radiologic technologist
• Anesthesiologist (if sedation is used)

Risks and Complications

Common Risks:

• Bleeding at the insertion site
• Bruising
• Allergic reaction to contrast dye Rare Complications:
• Heart attack
• Stroke
• Kidney damage
• Arrhythmias
• Infection

Benefits

• Accurate diagnosis of coronary artery disease
• Detailed assessment of heart function
• Informed decision-making for further treatment
• Potentially immediate treatment intervention (e.g., angioplasty)

Recovery

• Monitoring in a recovery area for several hours.
• Instructions to avoid strenuous activity for 24-48 hours.
• Hydration to help flush out the contrast dye.
• Follow-up appointment to discuss results and next steps.

Alternatives

• Non-invasive imaging tests (e.g., CT angiography, MRI).
• Medical management with medications alone. Pros/Cons of Alternatives:
• Non-invasive tests are less risky but may be less definitive.
• Medications might control symptoms but not address underlying blockages.

Patient Experience

During the Procedure:

• Mild discomfort at the insertion site.
• Sensation of pressure as the catheter moves.
• Warm or flushing feeling when contrast dye is injected. After the Procedure:
• Some soreness at the insertion site.
• Instructions for activity restrictions to aid recovery.
• Overall, pain is typically minimal and well-managed.