Coronary Angiography

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Contents 1 More Specific Terms 2 Introduction 3 Indications 4 Contraindications 5 Notes 6 More General Terms 7 Additional Terms 8 References

More Specific Terms

• cardiac computed tomography angiography; non-invasive coronary artery imaging; CT angiography (CCTA)

Introduction

• A test in which a contrast medium is injected into the coronary arteries in order to determine coronary artery anatomy, including the presence, severity, & location of any obstruction.

Indications

• unstable angina

• ongoing or refractory angina on maximal therapy
• need for intra-aortic balloon counterpulsation
• recurrent pain at rest
• angina associated with:

• congestive heart failure
• mitral regurgitation
• hypotension

• wide-spread ST segment abnormalities
• previous revascularization procedure

• myocardial infarction

• residual or recurrent ischemia
• sustained of symptomatic ventricular tachycardia
• cardiopulmonary arrest & neurologically intact
• pulmonary edema with preserved left ventricular function
• small infarct with wide-spread ST segment abnormalities on exercise tolerance testing

• myocardial ischemia at low workload (< 5 METS) on exercise tolerance testing
• stable angina with:

• LV dysfunction
• NYHA class 3 or class 4 angina, despite therapy
• positive stress test
• high probability of left main coronary artery or 3-vessel disease
• uncertain diagnosis after stress test
• survivors of sudden cardiac death
• suspected coronary vasospasm ( Prinzmetal's angina)

• chest pain in a pilot, bus driver or comparable profession suspected to be of cardiac origin

Contraindications

• uncontrolled ventricular irritability

• increased risk of ventricular tachycardia/ fibrillation during catheterization

• uncorrected hypokalemia
• digitalis toxicity
• uncorrected hypertension

• predisposes to myocardial ischemia &/or heart failure during angiography

• febrile illness
• decompensated heart failure

• especially with pulmonary edema
• catheterization may be done with patient sitting up

• anticoagulation with PT > 18 sec
• severe allergy to radiographic contrast agent
• severe renal insufficiency &/or anuria

• dialysis to remove fluid & contrast post catherization

Notes

• coronary angiography identifies obstructive coronary artery disease in ~ 40% of patients with a positive non-invasive stress test [4]

More General Terms

• cineangiography
• cardiac catheterization
• arteriography

Additional Terms

• cardiac computed tomography angiography; non-invasive coronary artery imaging; CT angiography (CCTA)
• coronary artery bypass grafting (CABG)
• percutaneous transluminal coronary angioplasty (PTCA, percutaneous coronary intervention, PCI)

References

1. nlmpubs.nlm.nih.gov/hstat/ahcpr/
2. Medical Knowledge Self Assessment Program (MKSAP) 11, 14 American College of Physicians, Philadelphia 1998, 2006
3. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1247
4. Patel MR et al Low Diagnostic Yield of Elective Coronary Angiography N Engl J Med 2010, 362:886-895 <PubMed> PMID: [1] <Internet> [2]
5. National Guideline Clearinghouse Diagnostic coronary angiography (Finnish Medical Society Duodecim) ngc-guideline: [3]

coronary angiography