Coronary angiography is the process of creating an angiogram of your heart using dye, a thin, flexible, hollow tube called a catheter and a rapid succession of x-rays resulting in a motion picture. Most doctors consider cardiac catheterization safe and low-risk. It relatively painless because local anesthesia is used and takes about 30 minutes.

A coronary angiogram is different than an ordinary, non-invasive x-ray because the dye is injected into the heart arteries with the catheter. This enables the x-ray to contrast the arteries with the surrounding body tissue.

A trained medical professional can then see which arteries are narrowed or blocked, even the very smallest ones, and recommend the best method of interventional cardiology to solve the problem such as balloon angioplasty, a coronary artery bypass graft (bypass surgery), stent placement, or treatment with drugs. He'll also be able to determine how well the heart is functioning by looking carefully at it's main chamber, the left ventricle.

There are risks and alternatives. Your doctor will consider the benefits and risks and discuss them with you and explain everything in detail, particularly if you already suffer from serious heart disease. It is likely he will request you undergo a thorough physical exam and some preliminary tests such as blood tests and Exercise Stress Test.

If your doctor decides a 15-second, non-invasive, high-resolution, 64-slice, multi-detector, spiral, computerized tomography scan (MDCT) would not be detailed or reliable enough and an angiogram is best, you'll be asked to lie down on an examination table below an x-ray machine. Local anaesthetic will be injected into the skin above the blood vessel where the catheter will enter your body which may be the bend of the arm at the elbow or the groin area. Electrodes will be placed on your chest to monitor your heartbeat using an electrocardiograph (ECG).

You'll be awake so can watch the progress of the catheter on the x-ray monitor as the doctor pushes it towards your heart. When the tip of the catheter is out of the aorta just after the last heart valve, he'll squirt the dye, also called contrast medium which most commonly contains iodine, into it and at the same time shoot multiple x-ray images to capture it's spread through the blood vessels. The process will then be repeated in the other main coronary artery. If you think the procedure will be stressful and/or frightening, request a sedative before it starts.

When the angiogram has been completed the catheter will be carefully removed. If it was inserted into your groin using a wide needle, the nurse will press a bandage on the wound for about 10 minutes to prevent bleeding. If it was inserted through a small incision in your arm, that usually requires a few stitches.

How to Prepare for an Angiography

Your heart specialist will give you detailed instructions on how to prepare for the procedure and will ask you to sign a "Consent Form" to confirm you understand what's going to be done and the possible complications but agree with his recommendation.

The physician may also ask:

• if you are pregnant;
• if you are allergic to iodine;
• to stop taking any blood thinners such as Warfarin 2-3 days before the test;
• to control the timing of any drugs you are taking for diabetes; and
• to refrain from eating or drinking several hours before the test.

Coronary Angiography Risks and Complications

Conventional Coronary Angiography (CAG) has long been the best and most accurateway to detect coronary artery disease. But the cost is substantial, patients frequently must be hospitalized for 24 hours and complications can occur such as stroke, injury to the blood vessel walls while the catheter is being pushed through them, and bleeding where the cathether is inserted into the groin or arm. For these reasons, some of our doctors may recommend an MDCT instead.

Heart attacks (myocardial infarction) occur during 1% of angiogram tests. Damage to the coronary arteries occur in about one of every 200 cases and require emergency heart surgery to repair. One person out of 500 dies during the test or from subsequent complications. The wounds can become bruised, infected or painful. Some patients have an allergic reaction to the dye.