What is a Coronary Angiography and is it Dangerous?

What is a Coronary Angiography and is it Dangerous?

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QUESTION: I have recently had a heart attack, and though I am following all
instructions completely, I am still having chest pains. My doctor has
recommended a test called coronary angiography. Can you tell me about it?
Should I have it? Is it dangerous?
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ANSWER: Coronary angiography is a very useful test, allowing doctors to
actually visualize the arteries that supply blood to the heart. By being able
to see these arteries, it allows the doctor to assess how severe a case of
coronary artery disease (CAD) the patient has. This is quite important, since
CAD is believed responsible for one-third to one-half of all deaths in the
U.S., or about 500,000 lives every year.
CAD is caused by a narrowing or obstruction of blood vessels that supply
the heart with oxygen and nutrients. If a patient's heart is continually
deprived of a sufficient amount of oxygen, it will not function normally.
When complete blockage occurs, and the blood no longer flows to the heart, the
heart tissue supplied by the blocked artery may die, causing a heart attack.
When there is a continuing complaint of pain (angina) the blockage may not yet
be complete. At that point (which seems to be where you are), it is
imperative that the problem is treated as aggressively as possible, and
coronary angiography will allow your doctor to choose the best treatment for
your case. Your previous heart attack is also an additional indication for
angiography at this time. To perform coronary angiography, a catheter is
introduced into an artery in the body. The catheter is passed up the artery
to the aorta (the main artery of the body). Contrast material or substances
(one which x-rays will not pass through, and frequently referred to as a
"dye") is then injected into the openings at the base of the aorta where the
coronary arteries originate.
The dye mixes with the blood and fills the passage inside the vessels and
allows the arteries to show up on x-ray film when photographed by a special
x-ray camera. This camera will take many pictures at a rate of from 3 to 6
times per second, which provides detailed information about the condition of
the arteries. At this point in time, coronary angiography gives the physician
the best look into the coronary arteries of any test. Almost any patient
whose treatment depends on the severity of CAD should have the procedure.
Heart patients who have had other tests with inconclusive results may also be
given this test. Other candidates for coronary angiography are those with
severe angina, chest pain, or frequent heart attacks. As with almost all
invasive procedures, there are risks associated with this test, although
coronary angiography is considered very safe. The problem most often reported
after this test is local damage or reaction at the place the catheter was
inserted. The most dangerous side effects of angiography are that it may
induce heart attack or stroke. Stroke may occur once or twice in every 4,000
cases. Heart attacks may occur one to four times in every 1,000 angiographs.
Death due to this test may occur in one to three cases per thousand.
Those at greatest risk are older patients, those with severe CAD or other
advanced cardiovascular disorders.
The decision is up to you, but my advice from the history you have
provided and my feeling that more information may help a well motivated
patient to overcome your present problem is to follow your physician's advice,
and have the procedure performed.