What is Coronary Angiography?

Chest pain or suddenly feeling short of breath can be scary. You may wonder if you are having a heart attack or if something else is wrong with your heart.

You may need a coronary angiography when you visit a cardiologist or hospital to check your heart health. The procedure uses an injected contrast dye to check for blockages in the blood vessels that supply blood to the heart (coronary arteries).

A cardiologist may perform the procedure if you have symptoms of coronary artery disease (CAD), such as chest pain, fatigue or shortness of breath. CAD occurs when plaque—a sticky substance made of fat and cholesterol—builds up in your coronary arteries. It causes them to become narrowed or blocked. The smaller opening limits blood flow to the heart, which can eventually lead to a heart attack.

You may also need a coronary angiography if you have had abnormal stress test results or if your cardiologist needs to evaluate you before heart surgery.

What is the coronary angiography procedure like?

“If you need a coronary angiography, knowing what to expect before, during and after the procedure can be helpful,” said Dimple Pulipati, MD, Catholic Health Cardiologist. “Be sure to talk to your cardiologist about the benefits and risks of the procedure.”

Benefits

Dr. Pulipati explained that coronary angiography is beneficial for diagnosing certain heart conditions by providing cardiologists with a detailed view of the coronary arteries. This view allows a cardiologist to identify any blockages in the blood vessels and make informed decisions about your treatment plan. 

Other benefits of a coronary angiography include:

• Accurate diagnosis of heart problems
• Assessing heart function
• Evaluation of atherosclerosis (plaque buildup in the artery walls)
• Planning procedures, such as heart valve replacement or repair

Preparing for the procedure

You should not eat or drink anything for eight hours before the procedure. You will also need to arrange for someone to drive you home afterward. If you feel dizzy or lightheaded, you may need someone to stay with you after the test.

Coronary angiography is usually an outpatient procedure. You will change into a hospital gown and sign consent forms when you arrive. A nurse will then take your vital signs.   

Tell your cardiologist if you are:

• Allergic to any medications or have had a bad reaction to contrast dye.
• Taking sildenafil (Viagra), tadalafil (Cialis) or similar medicines that affect how your body reacts to the medicine you receive during the procedure.

During the procedure

A mild sedative will help you relax. Then, either the groin, wrist, arm or neck area will be cleaned and numbed. Your cardiologist will insert a thin, flexible tube called a catheter into an artery. They carefully move the catheter into the heart. You will not be able to feel it move through your blood vessels. X-ray images ensure the catheter is in the correct position. A catheter can sometimes cause abnormal heart rhythms. If this happens, your cardiologist will move it to another position. If this does not help, the catheter is removed.

Once the catheter is in place, your cardiologist will inject a contrast dye to highlight any blockages in blood flow. You may feel a slight burning sensation after they inject the dye. Using X-ray imaging, your cardiologist will watch as the dye moves through your blood vessels.

They may also use coronary angiography to widen blocked or narrowed arteries (angioplasty) or to place a wire mesh tube (stent) into the artery to keep it open. However, these procedures can be performed separately.

Recovery

Once the procedure is complete, you will move to a recovery room. You may feel sore at the insertion site after removing the catheter. If the catheter was inserted into your groin area, you will need to lie on your back for a couple of hours during recovery. A nurse will monitor and record your blood pressure and pulse and check for bleeding. Since anesthesia is used before the procedure, a nurse will also check for signs of grogginess.

“Patients can typically go home on the same day as the procedure,” said Dr. Pulipati. “Follow the instructions for being at home, which will include limiting your activities for several days, keeping the wound dry, and calling your cardiologist immediately if any discomfort or signs of infection.”

Frequently asked questions

It is normal to have questions about a procedure. Here are some frequently asked questions about coronary angiography.

Is coronary angiography painful?

“Coronary angiography is generally safe and painless,” said Dr. Pulipati. “However, you may experience discomfort during the process, such as during anesthetic injection or pressure from catheter insertion.”

She noted you may also feel warmth from the contrast dye. However, anesthesia will help you feel comfortable and relaxed during the procedure. Your doctor can give you a sedative if you are very anxious, but patients are typically awake.

What are the risks of coronary angiography?

A coronary angiography is safe, but, as with any procedure, potential risks can include:

• Allergic reaction to contrast dye
• Bleeding or pain at the injection site
• Blood clots
• Infection
• Injured blood vessel
• Low blood pressure

Serious complications, such as stroke, are rare. 

What happens after coronary angiography?

After your procedure, your team will discuss your test results with you. If you have severe blockages or narrowing, you may need treatment such as an angioplasty or stent. If you do not have severe blockages, your physician may prescribe a blood thinner to prevent blood clots.

“You may also need to make lifestyle changes, such as quitting smoking and, increasing your physical activity and eating a heart-healthy diet,” said Dr. Pulipati.

She also emphasized the importance of keeping up with routine visits to your cardiologist to check your heart health.

Are there alternatives to coronary angiography?

Other procedures can check your heart health. A computed tomography (CT) machine examines your blood vessels, a procedure known as CT angiography. Your cardiologist may also use an echocardiogram, which uses ultrasound to check your heart function and structure. This test can diagnose conditions such as cardiomyopathy and valve disease.

What is the difference between coronary angiography and CT angiography?

Coronary angiography and CT angiography have similar purposes, but there are a few key differences. Coronary angiography uses an injected contrast dye to check for blockages in coronary arteries. CT angiography is a diagnostic procedure that produces images of blood vessels throughout the body.

It uses a CT scan—a specialized X-ray—and a special dye injected into your veins to see your coronary arteries. CT angiography is an external procedure only and is quicker than coronary angiography. It only takes 15 to 30 minutes. If your cardiologist discovers an issue during a CT angiography, you will need another procedure to fix it.

A CT angiography or coronary angiography is performed based on your unique needs. A CT angiography may be more appropriate if:

• You have a medical condition that makes catheter insertion risky.
• Your cardiologist needs to evaluate blood vessels beyond the heart.

You may have a coronary angiography if:

• You have a suspected coronary artery blockage that can be removed during the procedure since the cardiologist is already inside.
• A cardiologist needs a detailed visualization of your coronary arteries.