CORONARY ANGIOGRAPHY (NOT AN ORDINARY TEST)
Coronary Angiography (or Angiogram) is an X-ray examination of the blood vessels of the heart. A tube is inserted in your groin. The tube is now blindly passed into the body from outside. When positioned either in the heart or at the beginning of the arteries supplying the heart, a special fluid (called a contrast medium or dye) is injected. This fluid is visible by X-ray and the pictures that are obtained are called angiograms.
Coronary Angiography is not an ordinary test. It is an invasive procedure where a foreign body in the form of catheter is inserted inside the body through a cut. This carries a lot of amount of risk. Followings can occur during or after the procedure.
Death: Certain patient groups are at risk of death during the angiography. They can be elderly above 60 years, patients with angina class IV, those with blockages in the left main coronary artery. Also patients with previous heart attacks and low cardiac function, with valvular heart diseases or with non-cardiac diseases like kidney disease, diabetes (IDDM) etc. are at risk.
Heart Attack or Myocardial Infarction: The wire can cause an injury to the intima (inner covering of blood tubes) leading to formation of a blood clot and eventually a heart attack. Again patients with excessive blockages or blockages in left main with IDDM having angina at rest are more prone for heart attack.
Brain Injury : The blood clots as described above can move to the arteries of the brain which can lead to Brain Stroke (paralysis).
Delayed hemorrhage (bleeding) is also one of the complications. The collection of blood can compress nerves and other blood tubes. This can cause severe brain injury.
Injury or puncture of the blood tubes: The wire after inserting and moving towards the heart can puncture any blood tube through which it passes. It can also move into blood tubes of other organs like the kidney's, legs etc. and cause injury. This, in turn can result in internal hemorrhage and organ damage. In the same manner, the heart tubes can be punctured. The scratches in the blood tubes during the procedure caused by the wire always help in more deposition of cholesterol and triglycerides and hence development of new blockages.
Arrhythmias (Disturbances in the normal rhythm of the heart): The normal beating of the heart can be disturbed and may result in extra beats or reduced heart beats. Also, the pattern of the heart contraction may be damaged.
Cardiac Arrest or Cardiogenic shock: The vaso-vagal reaction can lead to cardiac arrest or shock.
Infection, fever: The wire introduced is a foreign body. It can lead to infection inside the blood tubes and create further complications. Reactions can also result by contaminating materials that may remain on incompletely cleaned wire surfaces.
Allergies and Anaphylaxis (severe reactions): The local anesthesia and the dye used can cause severe allergic reactions which can even cause death.
Hypotension: The reactions mentioned above can result in lowering of blood pressure. This can lead to damage to other organs. It can also cause kidney damage, bleeding lungs and respiratory insufficiency.
RESULT OF ANGIOGRAPHY - Is it accurate?
If you notice, most of the blockages are reported as 70%, 80% or 90%. Why these round figures? Some write 75%, 85%, 95%. The results are only a visual estimation. The figures often change by 10-20%, if you take an independent opinion from cardiologists. The surgeons have a tendency to increase all the blocks and the Angioplasty doctors enhance one blockage but reduce the figures of others. The bias is to benefit themselves. If the results were accurate the figures would have been 71.7% or 92.5%.
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