Angiography is the procedure that uses X-Rays to produce a picture (the "angiogram"). This is an "minimal invasive procedure, because it requires the injection the substance which is commonly called a "Contrast Agent" or "Dye".
Usually a very tiny tube, that has a special shape, is used to place the contrast into a particular artery or vein. While the artery or vein contains this radiopaque material, it will block the X-Rays, and will cast a shadow of the injected vessels onto the X-Ray film or fluoroscope. This image will reveal the shape of the artery, and can help to diagnose an obstruction,blockage, or narrowing ("stenosis").
Angiography is an X-ray exam of the arteries diagnose blockages and other blood vessel problems.
An interventional Cardiologist performs this X-ray procedure, which is also called an angiogram. During the angiogram, the doctor inserts a thin tube (catheter) into the artery through a small incision in the skin about the size of the tip of a pencil. A substance called a contrast agent (X-ray dye) is injected to make the blood vessels visible on the X-ray.
One of the most common reasons for angiograms is to see if there is a blockage or narrowing in a artery that may interfere with the normal flow of blood through the body. In many cases, the interventional Cardiologist can treat a blocked blood vessel without surgery at the same time the angiogram is performed. Interventional Cardiologists treat blockages with techniques called angioplasty.
Some other reasons for performing an angiogram
• Aneurysms -- an area of a artery that bulges or balloons out
• Cerebral vascular disease, such as stroke or bleeding in the brain
• Blood vessel malformations
• To diagnose problems not resolved by other tests. Angiograms are sometimes used by surgeons to plan an operation or choose the best surgical procedure.
What happens afterwards?
You will return to the ward after recovery from the anaesthetic. After a general anaesthetic, you may feel sick and may vomit. You may have a headache or a sore throat or experience some dizziness, but these side effects are usually short-lived and not severe.
You will need to stay in bed for a few hours after the procedure to make sure the catheter site has started to heal. The nurses will check you regularly during this time.
Who is angioplasty for?
When medications or lifestyle changes aren't enough to reduce the effects of the blockages in your Coronary arteries, or if you have worsening chest pain or heart problems, your Cardiologist might suggest coronary angioplasty
This procedure widens (dilates) blocked arteries, which can help prevent the complications of atherosclerosis. Angioplasty is usually combined with implantation of a stent in the blocked artery to help it Remained open and decrease the chance of reblockage.
How do you prepare for angioplasty?
In general, your Cardiologist will examine you before an angioplasty and review your medical history with you. You'll receive instructions on what you can or can't eat or drink before the procedure. Typically you have to stop eating or drinking by midnight the night before. Your preparation may vary slightly if you're already hospitalized.
Whether the angioplasty is prescheduled or done as an emergency, you'll likely have some routine tests first, including:
• Chest X-ray
• Blood tests
You'll also get instructions about making any adjustments to your current medications. You may need to stop taking certain medications, particularly if you have diabetes and take insulin or oral medications for the condition. Take all of your medications to the hospital with you, including nitroglycerin. Take approved medications with only small sips of water. Tell your doctor or nurse if you're allergic to any medications.
Angioplasty usually requires an overnight hospital stay. Make sure you arrange for transportation home.
How is angioplasty performed?
Angioplasty is performed by a heart specialist (Interventional cardiologist) and a team of specialized cardiovascular nurses and technicians, usually in a cardiac catheterization laboratory(Cath Lab). It should be done only at a medical institution with backup cardiac surgical facilities because of a small risk of complications that could require emergency heart surgery.
Coronary angioplasty isn't considered surgery because it's less invasive — your body isn't cut open. Rather, angioplasty uses tiny balloons threaded through a blood vessel and into a coronary artery to widen the blocked area. In most cases stent is placed inside the artery to hold it open more widely and prevent renarrowing in the future.
Angioplasty is commonly performed through an artery in your groin (femoral artery). Less commonly, it may be done using an artery in your arm or wrist area(Radial Approach). Before the procedure, the area is prepared with antiseptic solution and a sterile drape is placed over your body. A local anesthetic is injected into your groin to numb the area. Small electrode pads are placed on your chest to monitor your heart rate and rhythm during the procedure.
General anesthesia isn't needed, so you're awake during the procedure. You'll receive fluids and medications for relaxation and mild sedation through an intravenous catheter. You'll get blood-thinning medications (anticoagulants) to reduce blood clotting and other medications
What is arteriosclerosis?
Atherosclerosis comes from the Greek words Athero and Sclerosis (hardness). It's the process in which of fatty substances, cholesterol, calcium and other substances deposits in the inner lining of an artery. This buildup is called as plaque. Sometimes hardening of arteries often occurs when people grow older.
Plaques can grow large enough to significantly reduce the oxygenated blood flow through an artery. But main damage occurs when they become fragile and rupture. Plaques that rupture causes blood clots which leads to restriccted blood flow or break off and travel to another part of the body. If either happens and blocks a blood vessel that feeds the heart, it causes a heart attack. If it blocks a blood vessel that feeds the brain, it causes a stroke.
How does atherosclerosis start?
Arteriosclerosis is a slow, complex disease that typically starts from the childhood and often progresses when people grow older. In some people it progresses rapidly, even in their third decade. Many Doctors think it begins with damage to the innermost layer of the artery. This layer is called the endothelium. Causes of damage to the arterial wall include
• Elevated levels of cholesterol and triglyceride in the blood
• High blood pressure
• Tobacco intake
Tobacco smoke greatly worsens atherosclerosis and speeds its growth in the coronary arteries. Because of the damage to the innermost layer of vessel fats, cholesterol, platelets, cellular waste products, calcium and other substances are deposited in the artery wall. These may stimulate artery wall cells to produce other substances that result in further additions of cells.
What is blood pressure?
High blood pressure, or "hypertension", is a very common disorder. It is associated with an increased risk of coronary artery disease, stroke, heart attack, kidney failure, and death. Despite this, it has no symptoms in its early stages. The blood pressure must be measured to know whether it is high.
The heart is a small but very influential pump that beats steadily throughout the life, circulating five liters (more than 10 pints of blood) around the body every minute. The smaller blood vessels through which the blood passes produce a resistance to blood flow. The pumping of the heart against this resistance creates the blood pressure necessary for the circulation of the blood. This circulation is essential for nutrition of the major organs, such as the heart, kidneys, liver and brain, providing the vital oxygen and nutrients necessary for life. So, everyone needs to have a blood pressure to maintain their circulation!
When the heart contracts, the highest pressure it produced is called the systolic pressure; when it relaxes, the lowest pressure it produced is called the diastolic pressure. Both of these pressures are important in determining the risk of heart attack and stroke, so both will be measured by the doctor. A normal blood pressure in a younger person might be around 130/80 (often described as 130 over 80) - this is shorthand for a systolic pressure of 130 and a diastolic pressure of 80. We start thinking blood pressure is high when it is above 160/100.
The medical community’s knowledge of high blood pressure is great, but far from perfect. However, the biggest problem with treatment of high blood pressure is not a lack of knowledge, but a lack of the application of our current knowledge.
What causes high blood pressure? The majority of times, there is no clear cause which can be identified. In a few patients (approximately 2%), high blood pressure may be traced to other "secondary causes".
The actual mechanisms which explain why the blood pressure is high has to do mainly with the limitation of the small arterioles which are in all of the tissues of the body. When these are even slightly smaller than normal, the overall effect is that of a marked decrease in the volume that blood can flow in.
High blood pressure is more common:
• In patients whose families have high blood pressure
• In those over 35 years old
• In males
• In women on oral contraceptives
• High blood pressure has its roots in a lot of cases simply with the genes we received from our parents. High blood pressure is far more common in families where other members have this condition. This does not mean that one must have a history of high blood pressure in your family to have it themselves.
There are many other factors which have been felt to be related to high blood pressure. While these are interesting topics of debate and scientific curiosity, they are not nearly as important as the factors listed above.
Why do you need bypass surgery?
If one is suffering from chest pain or other symptoms that may indicate a cardiovascular problem, doctor is likely to suggest an angiogram (cardiac catheterization) to see if the coronary arteries are blocked by plaque. A blockage can cause a decrease in the supply of blood and oxygen to the heart and over time can lead to debilitating chest pain or a heart attack.
If angioplasty proves unsuccessful, the position of the blockage is too difficult to access by angioplasty, or one has severe blockages in multiple major vessels, doctor may suggest coronary artery bypass graft (CABG) surgery. Bypass surgery has been performed for nearly 30 years. Cardiovascular surgeons have received extensive training on bypass techniques.
What happens during bypass surgery?
Bypass surgery is a Expensive and major operation that usually lasts between a period of two to six hours. Medications are often administered by mouth, muscular or subcutaneous injection, or IV. Patient will receive general anesthesia and be completely asleep.
During bypass surgery, the chest bone is separated, and the ribs are spread apart to permit visible and physical access to the heart.Blood circulation and breathing functions will be taken over by a heart-lung machine. The cardiac surgeon uses a piece of vein or artery to form a bypass to enable blood to go around the blockage. Several blockages can be bypassed during surgery.
What are the risks?
The current success rate for bypass surgery is 95 to 98 percent, meaning that between 2 and 5 percent of all patients have complications, including death. The survival rate has improved over a period of time.
As with any surgical procedure, there are risks of infection and heavy bleeding. There is also a risk associated with anesthesia. This can include adverse reactions to medication and breathing problems. Postoperative pneumonia and wound infection also are common complications arising from open-heart surgery.
What is cholesterol?
High cholesterol is the best known of all the many threats to a healthy heart. When excess amounts of this fat-like substance build up along the walls of the arteries, you face a seriously high risk of a complete blockage, leading to a heart attack or stroke.
As one of a variety of fatty substances in the body, cholesterol is classified as a lipid. It is carried through the bloodstream attached to proteins, forming complexes called lipoproteins. There are two major types of lipoproteins: the low-density lipoproteins (LDL) commonly known as "bad" cholesterol, and the high-density lipoproteins (HDL) usually dubbed "good" cholesterol. It's the "bad" LDL cholesterol that tends to form deposits on the artery walls. HDLs, on the other hand, help to clear excess cholesterol from the bloodstream. The ideal situation to aim for, then, is a low level of LDL cholesterol, a high level of HDL cholesterol, and a moderate total of both.
Cholesterol is measured in milligrams per deciliter of blood
The tendency to build up high cholesterol may be in your genes, but excessively high levels are usually the result of a poor diet high in saturated fats and calories, combined with little or no exercise. In some cases, an elevated cholesterol level may be associated with an undiagnosed medical condition, such as diabetes.