Coronary Angiography

A coronary angiogram is a special X-ray test. It’s done to find out if your coronary arteries are blocked or narrowed, where and by how much. An angiogram can help your doctor see if you need treatment such as angioplasty or stent, coronary artery bypass surgery (CABG) or medical therapy.

The coronary arteries supply your heart muscle with blood. They can become clogged from a buildup of cholesterol, cells or other substances (plaque). This can reduce the flow of blood to your heart. If a blood clot forms and blocks blood flow through that artery, a heart attack may occur

What happens during an angiogram?

  • You may be given medicine to relax you, but you will stay awake.
  • You go to the hospital’s heart catheterization laboratory (“cath lab”).
  • You lie on a table near a camera and other equipment.
  • Your doctor numbs a spot on your groin or arm and inserts a thin tube (catheter) into an artery and up to the heart.
    This will hurt no more than a blood test.
  • X-rays are taken as the fluid goes through the artery.
  • You may be asked to hold your breath or cough.
  • By studying the X-ray images, the doctor can see any problems with your coronary arteries.
  • If you wish, you can see the X-ray pictures on the screen during or after the test.

Angioplasty

Angioplasty is synonymous to balloon angioplasty. It is an endovascular procedure performed to widening the arteries or veins that are narrowed or obstructed. This procedure is performed towards the treatment of atherosclerosis. Angioplasty can be performed in many of the surgeries.

1. Coronary Angioplasty

Coronary angioplasty or PCI (Percutaneous Coronary Intervention) is a therapeutic procedure performed as a treatment for stenotic coronary arteries. It is usually performed by specialized medical professionals like interventional cardiologist. After the procedure, the chest pain can be reduced.

2. Carotid Angioplasty

High risk carotid endarterectomy patients are treated with carotid artery stenosis.

3. Peripheral Angioplasty

During the peripheral angioplasty, the surgeon uses a balloon for opening the blood vessels that are present outside of the arteries. The procedure can widen the narrowed leg, abdomen and renal arteries. The procedure is usually performed in conjunction with atherectomey and peripheral stenting.

4. Venous Angioplasty

Venous angioplasty is preferred to be performed for treatment of venous stenosis.

5. Renal Artery Angioplasty

Renal artery angioplasty is performed to treat the atherosclerotic obstruction that can present in the renal artery. The procedure may or may not include renal artery stenting.

Types

There are many types of angioplasty, as the following.

(1.)PTCA(Percutaneous transluminal coronary angioplasty)also known as Balloon Angioplasty- Procedure: A balloon is passed to the narrow location, through a wire and after reaching the location, the balloon is inflated to a fixed size. It expands the stenosis in the vessel and eventually the surrounding muscular wall is expanded to improve the flow of the blood. After the expansion of the muscular wall, the balloon will then be deflated back to the normal position to withdraw. Depending on the requirement, a stent may be inserted, while the ballooning to make the vessel to be opened.

(2.)PTCA + Stenting Most of the angioplasty, close to 70 percent also involve stenting. The procedure stenting involves insertion of stent or small metal cylinder, inside the blood vessels. Initially a collapsed stent is taken place through the balloon at the catheter tip. After the balloon is inflated, the stent will be popped so that the artery walls can be opened and reinforced. Later, both catheter and balloon will be withdrawn and the stent stays in the blood vessel permanently. A tissue starts growing from artery lining over the stent in a few weeks.

Stents can be of bare-metal or drug-eluting stents(DES). Bare-metal stents are untreated and plain metal cylinders, whereas the drug-eluting stents are well coated with necessary medication.

After placing DESt at the right place, drug is released slowly so that the cell proliferation is blocked. This procedure helps preventing fibrosis. The procedure is performed by specialists, like interventional cardiologists.

Advantages

Most of the interventional cardiac procedures can be performed as minimally invasive procedure and so do not need larger incisions.

  • Sometimes need only a local anesthesia
  • Sometimes can be performed as an outpatient basis
  • Minimized pain
  • Decreased risk of infection
  • Large scars avoidance
  • Shorter recovery time

Pacemaker Implantation

A healthy heart regulates the pace of the heart beat through a natural pacemaker. But it does not happen naturally with some of the hearts. So, such hearts need external support from the pacemaker devices to regulate the heartbeat. The device pacemaker helps the heart to beat at regular intervals. So, too slow or too fast or sometimes irregular heartbeats because of arrhythmia can be regulated with this apparatus. Multiple functions of pacemaker are treatment of congestive heart failure, fainting spells and also sometimes hypertrophic cardiomyopathy.

Types

There are several types of pacemaker devices that are useful for various applications.

1. Single-chamber

The pacemaker has only one cable or wire present in one chamber.

2. Biventricular or Dual-chamber

It has two wires placed in both the lower and upper chambers present in the heart. So, both the functions of the atria and ventricle are well controlled and coordinated, allowing natural pace of the heartbeat.

3. Triple-chamber

It has three wires or cables. One lead is connected to the right atrium and the other two at right and left ventricles to stimulate them. Weakened heart muscle patients are benefited from this pacemaker.

4. External or Temporary

The device is connected externally and temporarily. Patients, who have gone through cardiac crisis, can get initial stabilization.

5. Internal or Permanent

This device is arranged internally under the skin, as a small packet. It is remained inside the body for the rest of the life.

Need for Pacemaker

Pacemaker is recommended to be inserted in the following medical conditions usually.

1.Bradycardia

For the condition of bradycardia or the condition, in which the adults have less than 40 beats/minute, pacemaker implantation is performed.

2.Heart Block

When there is blockage of the electrical signals in between the lower and upper chambers of the heart, the implantation is needed to be done.

3.Atrial Fibrillations

When the patient has had gone through arrhythmias medical procedure, he or she may need pacemaker implantation.

4.Heart Muscles Problems

The patients, who have the heart muscles problems that may lead to too slow travel of the electrical signals through the heart muscles usually need this device.

5.Heart Diseases or Aging Damages

If the heart diseases or aging result in damage of the sinus nodes and the ability to correct the heartbeat pace, then the device is needed.

Procedure

Pacemaker implantation can be performed under local anesthesia and so can be done on the basis of outpatient. Initially, a small incision is made near the collarbone. The device, pacemaker will then gets inserted through the collarbone blood vessels into the heart. After the lead or wire is inserted in the right place, the device is tested to ensure that it is functional. Then the wire or lead will be attached to the generator. Generator is inserted under the skin, through small incisions are made before. Once the implantation of the pacemaker is done, patient is kept under observation during several hours of the recovery period. Most of the times, the patient is allowed to discharge from the hospital, after ensuring there are no complications.

Advantages

  • Does not need complete or general anesthesia to perform the procedure.
  • Safe procedure that can be used under local anesthesia.
  • Slow heartbeat rate can also be treated effectively.
  • Irregular heartbeat can be relieved.
  • Helps improving the quality of life.

Specialists:

    DR PAWAN GOEL

  • M.D., D.M. (CARDIOLOGY)
  • (CONSULTANT INTERVENTIONAL CARDIOLOGIST)

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