Coronary angiography - several types of diagnostics of the condition of the coronary vessels. Is it necessary to do coronary angiography after a heart attack? Coronary angiography of the heart - what is needed?

30.06.2020 -

Cardiovascular diseases are a very common pathology for people over 40 years of age. And among these diseases, the most common are associated with imperfection of the vascular bed and limited nutrition of the heart muscle.

To clarify the causes of heart disease, there are many diagnostic methods. One of the most informative checks is coronary angiography of the heart vessels - what is it, is it dangerous to do it, and how is the examination performed?

This is an invasive manipulation that serves to determine the condition of the vessels that carry blood and oxygen to the heart. They are called coronary. Left and right coronary arteries Normally, they provide nutrition to the muscles and maintain the performance of the entire organ.

In case of unfavorable development of events, these arteries for various reasons narrow () or become blocked (occlusion). The blood supply to the heart is significantly limited or stops altogether in a certain area, which causes ischemic heart disease and heart attack.

To exclude such a defect or, if present, to determine its extent, coronary angiography is performed.

This X-ray examination lumen coronary vessels using an angiograph and a contrast agent injected through a catheter precisely into the vestibule of the cardiac arteries. The survey is carried out from different angles, which allows you to create the most detailed picture of the condition of the object being examined.

Indications for the procedure

Routinely, coronary angiography is performed for:

confirmation or refutation of the diagnosis of IHD;
clarifying the diagnosis when other methods of determining the disease are ineffective;
determining the nature and method of eliminating the defect during the upcoming operation;
audit of the condition of the organ in preparation for an operation on open heart, for example, at .

In case of emergency the procedure is carried out in the presence or pre-infarction condition, which requires immediate intervention for health reasons.

Let's look at how to prepare for coronary angiography of the heart, as well as how this procedure is done.

Preparation

Before prescribing coronary angiography, it is necessary to undergo a series of examinations in order to exclude or confirm the presence of factors that do not allow the use of this diagnostic method. Training program:

blood tests (for sugar, for hepatitis B and C, bilirubin and other liver indicators, for HIV, for RW, for group and Rh factor);
urine test for the presence of renal pathology;
examination and conclusion of specialists on existing chronic diseases.

Upon admission to manipulation, it is carried out immediate preparation before the procedure:

the doctor stops some medications in advance, for example, those that reduce blood clotting;
exclude food intake on the day of diagnosis - to avoid complications such as vomiting, the study is carried out on an empty stomach;
The doctor collects an allergic history and conducts a test with a contrast agent.

How it's made

The patient lies down on a special table. Heart monitors are attached to his chest. In the area where the catheter is inserted, local anesthesia and skin disinfection. A micro-incision is made in the vein through which a catheter is inserted.

The catheter is passed through the vessels under the control of an angiograph to the mouth of the coronary arteries. Alternately, they introduce into each of them contrast agent, which outlines the internal space of these vessels. Held shooting and recording from different positions. The location of stenosis or occlusion is determined.

Once monitoring is complete, the catheter is carefully removed from the vein. The wound is carefully sutured. The patient remains lying down for some time, and doctor writes a report. It indicates the size of the smallest lumens in the vessels, the degree of narrowing and the recommended method of correcting the situation - stenting or. If there are no problem areas, it is given general description coronary arteries.

Video about how outpatient coronary angiography of the heart vessels is performed:

Conditions

Most often, coronary angiography is performed in a hospital setting as part of a routine examination for coronary artery disease. In this case, all tests are taken here, a few days before the intervention.

Diagnostics can also be carried out on an outpatient basis. But the patient must first independently undergo all the examinations on the list, obtain a cardiologist’s opinion on the possibility of coronary angiography and a referral for it, indicating the purpose of the study.

Outpatient The insertion of a catheter for coronary angiography is most often carried out through the wrist vein and in the arm - in the postoperative period, the load on it, in contrast to invasion through the femoral vessel, can be minimized in order to avoid dangerous bleeding.

Contraindications

A number of conditions do not allow this method to be used diagnostics, so they resort to alternative ones. Preliminary examination may reveal these conditions:

uncontrollable arterial hypertension – intervention can provoke stress, resulting in a possible hypertensive crisis;
post-stroke condition– excitement can cause a re-attack of the disease;
internal bleeding in any organ - with invasion, blood loss may increase;
infectious diseases– the virus can contribute to the formation of blood clots at the incision site, as well as peeling of areas on the walls of blood vessels;
diabetes in the stage of decompensation - this is a state of significant kidney damage, high level blood sugar, the possibility of a heart attack;
elevated temperature of any origin - accompanying and rapid heartbeat can lead to heart problems during and after the procedure;
severe kidney disease– the contrast agent can cause organ damage or worsen the disease;
contrast agent intolerance– on the eve of diagnosis, a test is carried out;
elevated or low blood – may cause thrombosis or blood loss.

With preliminary preparation, all these conditions are identified and treatment is prescribed to compensate for them. There are no absolute contraindications to the procedure. Once stabilization has been achieved, the procedure can be performed in a hospital setting.

Risks, complications and consequences

Coronary angiography, like any invasion, can have side effects caused by the body’s incorrect response to intervention and the patient’s stress. Rarely, but the following events occur:

bleeding at the insertion gate;
arrhythmia;
allergy;
detachment of the inner layer of the artery;

Pre-procedural testing is intended to prevent these conditions, but sometimes they happen. The doctors involved in the examination are coping with the situation, the procedure is stopped at the first unfavorable signs, the patient is removed from dangerous condition and transferred to a hospital for observation.

According to the conclusion of the doctor who conducted the study, the cardiologist determines the patient's treatment path. If there are indications, the time for stent installation is scheduled (in the same way as coronary angiography - using a catheter).

Sometimes this procedure is performed directly during diagnosis, if there is the prior consent of the patient. The cardiologist may also prescribe outpatient treatment or coronary artery bypass surgery.

Diagnostic cost

If you have a compulsory medical insurance policy Coronary angiography, if indicated, is performed free of charge. But the equipment of most hospitals does not allow covering everyone with this diagnostic method in a short time. Usually the queue lasts for months, because... Limited quotas for examination are provided. It is possible to undergo this study on a commercial basis.

The cost in Russia is in a wide range - from 10 to 45 thousand rubles. Abroad, this intervention is also not always covered by insurance and is also not cheap - from 300 dollars to 2500 euros.

Coronary angiography is included in the mandatory list of diagnostic procedures to determine the degree of damage to the heart vessels. The procedure has been worked out and standardized long ago - this serves as a guarantee of patient safety. The level of cardiology in the country makes it possible to identify pathology at early stage and take measures to eliminate it or prevent its development.

Coronary angiography is contrast study heart vessels. The patient is fully conscious, and the surgeon works under the control of an angiograph machine. Through a puncture in the radial artery, a catheter is inserted into the coronary vessels of the heart and a contrast agent is injected. The contrast agent colors the blood that fills the heart vessels, and a distinct pattern appears on the x-ray. This allows the doctor to see changes in the vessels, pathological narrowings - stenoses, and determine the percentage by which the artery is narrowed. Coronary angiography allows the doctor to have a realistic idea of the condition of the patient’s coronary vessels and what the prognosis for his life is.

1 Procedure technique

Puncture during coronary angiography of the heart vessels

The procedure is performed under local anesthesia. The procedure takes about half an hour on average, during which the patient is conscious. To conduct the study, one of 3 arterial approaches is usually used: radial, brachial or femoral artery. First, aseptic treatment of the access is performed and local anesthesia is performed in the puncture area. The artery is punctured with a special needle, through which a metal conductor is inserted into the vessel, and then a catheter through which an X-ray contrast agent is injected.

The administration of contrast is necessary to ensure that the coronary vessels are clearly visible on X-rays or a computed tomography scan. The internal lumen of the artery is stained with this drug, which comes with the blood flow, thanks to which the doctor sees the location and degree of narrowing of the vessel. Already at this stage, the cardiac surgeon determines whether there are indications for coronary stenting.

For example, if a critical stenosis is detected as a result of coronary angiography of the heart vessels, a stent can be immediately implanted and the patency of the coronary arteries can be restored. The results of coronary angiography are displayed as a series of images or video recordings on the monitor, which are then saved on any digital media. Coronary angiography of the heart vessels can be performed both on an X-ray machine and on a more modern, progressive computed tomograph.

2 Diagnostics, not surgery!

Coronary angiography of the heart vessels

Many patients are afraid to undergo coronary angiography of the heart vessels. For many of them, this procedure is associated with heart surgery. It should be clearly understood: coronary angiography is a diagnosis of the coronary vessels of the heart, and not an operation! You shouldn't be afraid of her. In the hands of an experienced doctor, this diagnostic procedure becomes quite safe and accessible. Coronary angiography of the heart vessels provides maximum information about the real state of the patient’s blood vessels at a given time. This research method is rightly called the “golden” standard for diagnosing heart vessels, and if your doctor has recommended coronary angiography to you, you need to do it without fear and keep up with 21st century medicine.

3 When can a doctor prescribe a coronary angiography?

Stenting of coronary arteries

Confirm the presence of heart disease: angina pectoris, heart attack, other forms of coronary artery disease;
Determine the function of blood vessels and their patency in order to choose the most appropriate tactics for the proposed surgical treatment of the heart vessels, as well as before performing any operations on the heart. In addition, during coronary angiography, minimally invasive interventions, for example, stenting, can be performed if necessary. Any proposed interventions must be carried out only with the consent of the patient;
Coronary angiography is performed in case of acute infarction, in which thrombolysis is ineffective, if less than 12 hours have passed since the onset of the infarction, or with severe hemodynamic disturbances, unstable angina;
Repeated resumption of angina pectoris, its relapse, after CABG surgery, stenting.

4 Complications

First cardiac catheterization

Doctor, is this not dangerous? - this is the most common question among patients who are recommended to undergo coronary angiography. The fears that the patient experiences before coronary angiography of the heart vessels are understandable and understandable. Firstly, this is still an invasive penetration into the vessels, and secondly, although small, there is a percentage of possible complications. The doctor is obliged to warn every patient about them. When the coronary angiography technique was first tested, it was truly dangerous.

This was due to the imperfect equipment that existed then, and to the lack of skills of surgeons; also, the contrast agents used at that time were unsafe for health. To date, possible complications from the procedure are less than one percent out of a hundred. Coronary angiography of the heart vessels today in many clinics is even performed on an outpatient basis, without hospitalization. This indicates how accessible and studied this research method is. In addition, the doctor will definitely inform patients who are afraid of pain that this diagnostic procedure is painless.

Allergic reactions to X-ray contrast agent

Possible negative consequences and complications of coronary angiography include:

allergic reactions to X-ray contrast agent,
bleeding at the puncture site,
heart rhythm disturbances,
thrombosis, embolism,
infection in the puncture area,
myocardial infarction.

Complications occur more often in the following categories of people:

patients over 68 years old,
patients with angina pectoris of the 4th functional class,
if the subject has serious illnesses other organs and systems, chronic diseases in the stage of decompensation.

5 Contraindications

What are the contraindications to coronary angiography of the heart vessels? There are no absolute contraindications (when the use of the study is strictly prohibited) to this method. Relative contraindications include:

acute renal or chronic severe (blood creatinine not more than 150 mmol per liter) renal failure,
gastric bleeding, exacerbation of peptic ulcer,
allergic reaction to contrast,
mental illness of the patient in the acute phase,
acute infectious diseases, fever,
severe anemia, coagulopathy,
patient’s refusal of possible further surgical treatment after the study,
uncontrolled ventricular arrhythmia.

6 How do you prepare for the procedure?

The day before the procedure, do not eat or drink

The doctor recommended you modern method checking the heart vessels - coronary angiography? Then you must take full responsibility in preparing for this study. But what does preparation for coronary angiography include?

It is necessary to undergo all types of examinations recommended by the doctor within a certain time frame: general clinical tests, ECG, coagulogram, determination of blood group and Rh factor, blood test for HIV and hepatitis, ultrasound of the heart, radiography;
10 days before the proposed study, it is necessary to discontinue blood thinning medications if the patient takes them regularly: aspirin, warfarin;
If the patient has chronic diseases, then it is necessary to stabilize them as much as possible and transfer them into a state of remission. Be sure to cure colds or infectious diseases;
The day before the procedure, do not eat or drink.

7 Types of research

Methods of performing coronary angiography

General coronary angiography,
Selective coronary angiography,
MSCT coronary angiography.

Let's talk about how essentially the same method of checking heart vessels differs from each other.

General coronary angiography is a classic method for diagnosing all cardiac vessels. And selective - only one or several vessels. Selective coronary angiography is a modification of the general one; it specifically studies a specific area of the vascular bed.

MSCT coronary angiography is performed only in diagnostic centers equipped necessary equipment- a special multislice computed tomograph.

This examination method has many advantages:

insertion of only an intravenous catheter for the administration of contrast. The integrity of the arteries is preserved, which ensures minimal interference with the structure and integrity of the vessels;
MSCT coronary angiography does not require hospitalization of the patient; the study can be performed on an outpatient basis;
the heart and blood vessels are visible in a three-dimensional image, which makes it easy to study all kinds of abnormalities from any position.

This research method is an alternative to standard coronary angiography, but has certain limitations and contraindications. Namely:

severe arterial calcification (calcium “lights up” a section of the artery on the device, making it difficult to diagnose the heart vessels);
intolerance and allergy to contrast, which includes iodine;
high heart rate, arrhythmias.

If there are contraindications, it is advisable to consider invasive coronary angiography of the heart vessels together with your doctor.

This method is widely implemented in large medical centers and, I want to believe, will become increasingly accessible even for small clinics and district hospitals.

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Coronary angiography of blood vessels: what is it and how is it done

World statistics say that heart pathologies rank first among all diseases. To prevent heart disease and to determine treatment tactics, patients are often prescribed vascular angiography.

Coronary angiography - what is it? This is a study of the coronary vessels of the heart with or without contrast agents and x-rays using modern equipment. Abbreviated as KAG. The procedure can be carried out routinely during a preventive examination, or urgently to determine the condition of the coronary vessels if suspected, or the first signs of a heart attack in the first 5 to 12 hours.

What is vascular coronary angiography?

Study of the coronary vessels that supply muscle tissue heart and ensuring normal functioning, is very important for identifying pathological changes and timely treatment.

Vascular coronary angiography is a visually informative type of examination that allows you to accurately identify the cause of a violation of the condition of the coronary vessels. The study is carried out only in a medical institution by cardiologists strictly according to the following indications:

cardiac ischemia;
preparatory stage before operations, stenting, bypass surgery;
constant severe pain in the chest;
suspicion of myocardial infarction;
heart rhythm disturbances that threaten the patient’s life;
control examinations after various heart surgeries;
diagnostic examination to clarify the diagnosis.

Is she dangerous?

With any intervention in the human body, complications are possible. With coronary angiography they account for only 1% of total number procedures carried out and can manifest themselves in the form of:

fibrillation of the heart ventricles;
when the catheter moves along the vessel bed, the blood clot breaks off;
the occurrence of air embolism;
damage to heart tissue;
myocardial infarction.

However, the procedure is carried out in a hospital setting, where specialists are available around the clock to provide timely treatment and reduce the risks of severe complications. Whether coronary angiography is dangerous, whether it is performed and how it is done is decided not only by the doctor, but also by the patient himself.

When performing non-contact coronary angiography directly with the heart, there are no complications.

How to do it

The attending cardiologist should tell you what coronary angiography is and how it is done. Before the procedure, additional diagnostic examination methods are routinely prescribed:

blood and urine tests;
Ultrasound of the heart;
echocardiography;
tests for the presence of viruses;
electrocardiography;
consultations with doctors of related specialties (in each case individually according to the need and the patient’s condition).

The patient prepares for the procedure in advance: the study is carried out on an empty stomach (you cannot eat food the evening before the procedure). As prescribed by a doctor, some patients are recommended to take special medications. If necessary, the site of the future puncture is shaved.

Coronary angiography is performed by two main methods: invasively or using tomography.

Invasive

The method of selective coronary angiography involves introducing a special catheter through the skin under local anesthesia into an artery (femoral, radial), which is passed to the coronary vessels. Then a special contrast is introduced.

During coronary angiography, the contrast agent is distributed throughout all coronary vessels, and with the help of an angiograph, you can see on the monitor the quality of distribution and filling of the vessels. To get a complete picture of the patency of the coronary vessels, images are taken from all sides.

After the contrast agent is injected into the patient's body, the patient may feel hot. Slows down heartbeat, which is clearly felt. This is necessary to take a clear picture and directly and thoroughly view the condition of the vessels on the device monitor. After the procedure is completed, the heart rhythm is restored.

The advantage of the contact method, if necessary, is the ability to immediately perform balloon dilatation or perform stenting, which are performed after agreement with the patient (the patient is conscious). The disadvantage is ionizing radiation exposure.

The entire coronary angiography procedure takes from 20 minutes to an hour, on average minutes. Patients are in a lying position and do not feel discomfort.

Non-invasive

The CT (computed tomography) coronary angiography method is performed without introducing any instruments into the body.

One hour before the diagnosis, the patient takes a medicine that reduces the number of heartbeats.

Immediately before taking pictures, a contrast agent is injected intravenously and the heart is scanned from different angles.

With additional synchronization of tomography with electrocardiography, images can be taken during diastole. This method produces a 3D image where the condition of the coronary vessels of the heart is clearly visible.

A feature of this type of diagnosis is the feeling of rare heartbeats, as well as the need to carry out various doctor’s commands during the examination.

The patient receives the results of the examination immediately after completion. diagnostic study.

Contraindications for

There are certain contraindications for performing coronary angiography:

pregnancy;
allergy to contrast agent;
diabetes;
liver or kidney failure;
uncontrolled cardiac arrhythmia (after its treatment, the procedure can be performed);
pathological blood clotting disorders;
high body temperature;
intoxication;
heart failure;
infectious heart diseases.

In acute life-threatening conditions, some contraindications are conditional (at the discretion of the attending physician and the patient's condition). After a course of treatment for certain types of pathological conditions and stabilization of the patient’s health, a study can be carried out.

Find out from this article what Doppler ultrasound is.

Consequences of coronary angiography

In case of any unknown conditions after a diagnostic study, you should immediately consult a doctor. The consequences of coronary angiography are minimal, but still occur:

developing a heart attack when a person is too worried;
arterial injuries;
rupture of a blood clot, which can lead to a stroke or heart attack;
complication of kidney condition;
if the diagnosis takes too long, X-ray exposure;
too thin walls of the heart or blood vessels may rupture;
bleeding at the puncture site through the skin or inside when a vessel or heart tissue is damaged;
infection entering the body after the procedure (poorly treated catheter or its insertion site);
allergic reactions to additional medications.

Conclusion

Every intervention in the human body has its own risks. The possibility of developing complications is reduced when the patient strictly follows everything preparatory stages for a diagnostic examination.

Despite the contraindications and minimal risk of complications, coronary angiography remains one of the most informative methods for diagnostic examination of heart vessels, which has saved many lives.

Coronary angiography of the heart vessels - what is it, is it safe, when is it performed?

general information

This is an invasive manipulation that serves to determine the condition of the vessels that carry blood and oxygen to the heart. They are called coronary. The left and right coronary arteries normally provide nutrition to the muscle and maintain the functionality of the entire organ.

In case of unfavorable development of events, these arteries narrow (stenosis) or become blocked (occlusion) for various reasons. The blood supply to the heart is significantly limited or stops altogether in a certain area, which causes coronary artery disease and heart attack.

This is an X-ray examination of the lumen of the coronary vessels using an angiograph and a contrast agent introduced through a catheter precisely into the vestibule of the cardiac arteries. The survey is carried out from different angles, which allows you to create the most detailed picture of the condition of the object being examined.

Indications for the procedure

Routinely, coronary angiography is performed for:

confirmation or refutation of the diagnosis of IHD;
clarifying the diagnosis when other methods of determining the disease are ineffective;
determining the nature and method of eliminating the defect during the upcoming operation;
audit of the condition of the organ in preparation for open-heart surgery, for example, in case of a defect.

In emergency cases, the procedure is performed in the presence of the first signs and symptoms of a heart attack or in a pre-infarction condition that requires immediate intervention for life-saving reasons.

Let's look at how to prepare for coronary angiography of the heart, as well as how this procedure is done.

Preparation

blood tests (general, sugar, hepatitis B and C, bilirubin and other liver parameters, HIV, RW, group and Rh factor);
urine test for the presence of renal pathology;
ECG in 12 leads;
examination and conclusion of specialists on existing chronic diseases.

Upon admission to manipulation, immediate preparation is carried out before the procedure:

the doctor stops some medications in advance, for example, those that reduce blood clotting;
exclude food intake on the day of diagnosis - to avoid complications such as vomiting, the study is carried out on an empty stomach;
The doctor collects an allergic history and conducts a test with a contrast agent.

How it's made

The patient lies down on a special table. Heart monitors are attached to his chest. In the area where the catheter is inserted, local anesthesia and skin disinfection are performed. A micro-incision is made in the vein through which a catheter is inserted.

The catheter is passed through the vessels under the control of an angiograph to the mouth of the coronary arteries. A contrast agent is injected into each of them one by one, which outlines the internal space of these vessels. Filming and recording are carried out from different positions. The location of stenosis or occlusion is determined.

Once monitoring is complete, the catheter is carefully removed from the vein. The wound is carefully sutured. The patient remains lying down for some time, and the doctor writes a report. It indicates the size of the smallest lumens in the vessels, the degree of narrowing and the recommended method of correcting the situation - stenting or bypass surgery of the heart vessels. If there are no problem areas, a general description of the coronary arteries is given.

Video about how outpatient coronary angiography of the heart vessels is performed:

Conditions

Most often, coronary angiography is performed in a hospital setting as part of a routine examination for coronary artery disease. In this case, all tests are taken here, a few days before the intervention.

In an outpatient setting, the insertion of a catheter for coronary angiography is most often carried out through the wrist vein and in the arm - in the postoperative period, the load on it, in contrast to invasion through the femoral vessel, can be minimized in order to avoid dangerous bleeding.

Contraindications

A number of conditions do not allow the use of this diagnostic method, so they resort to alternative ones. Preliminary examination may reveal these conditions:

uncontrolled arterial hypertension - intervention can provoke stress, resulting in a hypertensive crisis;
post-stroke condition - anxiety can cause a re-attack of the disease;
internal bleeding in any organ - with invasion, blood loss may increase;
infectious diseases - the virus can contribute to the formation of blood clots at the incision site, as well as peeling of areas on the walls of blood vessels;
diabetes mellitus in the stage of decompensation is a state of significant kidney damage, high blood sugar levels, and the possibility of a heart attack;
elevated temperature of any origin - accompanying high blood pressure and rapid heartbeat can lead to heart problems during and after the procedure;
severe kidney disease - the contrast agent can cause organ damage or worsen the disease;
intolerance to contrast agent - a test is carried out on the eve of diagnosis;
increased or decreased blood clotting - can cause thrombosis or blood loss.

Risks, complications and consequences

Coronary angiography, like any invasion, can have side effects caused by the body’s improper response to the intervention and the patient’s stress. Rarely, but the following events occur:

Pre-procedural testing is intended to prevent these conditions, but sometimes they happen. The doctors involved in the examination cope with the situation, the procedure is stopped at the first unfavorable signs, the patient is removed from the dangerous state and transferred to a hospital for observation.

Based on the conclusion of the doctor who conducted the study, the cardiologist determines the path of treatment for the patient. If there are indications, the time for stent installation is scheduled (in the same way as coronary angiography - using a catheter).

Diagnostic cost

If you have a compulsory medical insurance policy, coronary angiography according to indications is performed free of charge. But the equipment of most hospitals does not allow covering everyone with this diagnostic method in a short time. Usually the queue lasts for months, because... Limited quotas for examination are provided. It is possible to undergo this study on a commercial basis.

Coronary angiography is included in the mandatory list of diagnostic procedures to determine the degree of damage to the heart vessels. The procedure has been worked out and standardized for a long time - this serves as a guarantee of patient safety. The level of cardiology in the country makes it possible to identify pathology at an early stage and take measures to eliminate it or prevent its development.

Why and who needs coronary angiography of the heart vessels?

Coronary angiography is the introduction of a radiopaque substance into the coronary vessels of the heart to determine their patency. An image of the vascular network is obtained on an x-ray and serves as a guide for choosing a method for further treatment of coronary artery disease. This is one of the most reliable ways to determine the localization of narrowing, severity and its extent for subsequent stenting or bypass surgery of the coronary arteries.

Indications for coronary angiography of the heart

The appointment of a study of the condition of the vascular bed may be for emergency indications. These include a sharp destabilization of the condition of patients with angina pectoris or after cardiac surgery. Signs of such deterioration are increased pain, pathological changes ECG, increase in the concentration of troponin, ALT and AST in the blood.

Planned coronary angiography is performed in the following cases:

Coronary heart disease, confirmed by ECG, stress tests, in the absence of response to drug treatment.

Before heart surgery in patients over 35 years of age.
Early angina after a heart attack.
Availability clinical signs ischemia in persons with increased occupational risk.
After surgical interventions on the heart or great vessels.

And here's more about laboratory diagnostics myocardial infarction.

Contraindications to cardiac coronary angiography

In the presence of severe cardiac and non-cardiac pathology, the study is not performed, as there is an increased risk of complications. The study is not indicated for patients with:

renal failure with creatinine level more than 150 mmol/l;
severe heart failure;
decompensated diabetes mellitus;
complex types of arrhythmia;
malignant arterial hypertension;
acute period of heart attack or stroke (less than a week from the date of occurrence);
endarteritis, endocarditis;
allergic reactions (relative contraindication).

Preparation for coronary angiography of the heart

The preparatory stage before the procedure includes collecting an anamnesis to clarify the severity of coronary heart disease (conditions for the occurrence of attacks, previous heart attacks). It also reveals the presence of allergies, diabetes, hypertension, ulcerative lesions of the stomach or intestines, hemodynamic disorders, vascular diseases, and uterine bleeding.

Patients need to undergo the following types of examination:

ECG, if necessary - daily monitoring;
X-ray examination chest;
echocardiography;
Doppler ultrasound of the subclavian and femoral arteries;
blood tests for HIV, hepatitis, syphilis;
coagulogram, electrolytes, creatinine, AST and ALT, glycemic level.

If you are prone to allergic reactions, prior consultation is required. skin test for radiopaque contrast agent.

How is coronary angiography done?

Coronary angiography refers to surgical diagnostic interventions, so it can only be performed in departments where there are specialists who are proficient in intravascular techniques and angiographic equipment. Intensivists are present in the operating rooms for this procedure to provide emergency care for complications.

The first stage of coronary angiography may differ depending on the chosen technique:

According to Judkins, two separate coronary artery catheters are used, which are inserted through the femoral artery.
The Sones method uses one catheter, it sequentially passes through the right and left coronary arteries, the insertion site is the brachial artery.

All subsequent stages are similar, regardless of the research option used. The catheter is inserted into the coronary artery, first heparin is supplied through it, and then contrast (Visipak, Omnipaque, Ultravist or others). For the left coronary artery, X-ray images should be in five projections, for the right - in two. At the same time, the condition of the ventricles of the heart is analyzed.

During angiography, blood pressure and ECG readings are constantly monitored. By agreement with the patient, the narrowed lumen of the vessel can be widened using a balloon or a stent installed. After the procedure is completed, the catheters are removed and a pressure bandage is applied to the puncture site.

Angioplasty and stenting during coronary angiography

The conclusion includes the following information:

The predominant type of blood supply is right, left, uniform.
The condition of the muscular layer of the heart, which is supplied by a narrowed vessel.
The presence of collaterals and their characteristics.

To learn how coronary angiography of the heart is performed, watch this video:

How long does the study last?

Coronary angiography is performed under local anesthesia, so no preoperative preparation is required. Only sedatives can be used. After anesthesia of the puncture site and insertion of the catheter, the procedure itself begins, taking from 20 to 30 minutes. Total time stay in the operating room - about an hour. This is provided that no stenting is performed.

The patient can remain in the hospital after angiography from 5 to 24 hours. During this period, bed rest is recommended, you can drink water and fruit juices. If the heart function is stable, the patient is discharged.

At home, you need to follow a gentle regimen for at least a week, avoid physical activity, drinking alcohol and smoking. You do not need to take a bath for a day; the puncture site should remain dry when taking a shower. The car can be driven through.

You should immediately consult a doctor if you have the following symptoms:

bleeding from the puncture site of the artery;
pain, swelling and redness of the skin;
there is hardening near the catheterization area;
body temperature has increased;
the skin has changed color and the limb that was used to insert the catheter becomes numb and feels cold or hot to the touch;
excessive weakness, chest pain and shortness of breath occurred.

Possible negative consequences of coronary angiography of the heart

The most common complication– this is bleeding from the puncture site of the artery. In general, coronary angiography is a non-hazardous procedure.

Less than one percent of patients have arrhythmia in the form of ventricular fibrillation, damage to the vascular wall and myocardial infarction. As a rule, this is associated with manifestations of severe angina. Intolerance to the contrast agent and blockage of the vessel by a blood clot are also possible.

Cost of heart examination

The estimated cost of the procedure is within thousands of rubles, most often it depends on the technique used by the clinic, as well as the availability of high-precision equipment.

If during coronary angiography a decision was made (jointly with the patient) to stent the vessels, then an additional payment will be made for consumables and additional surgical treatment. Abroad, the cost of examination using contrast of the coronary vessels ranges from 7 to 15 thousand dollars.

And here is more information about the treatment of angina pectoris.

Current patient questions

Patients usually have many questions before the procedure. The most common include:

Is it possible to perform bypass surgery without coronary angiography? A preliminary assessment of the degree of damage to the arteries and the location of the impaired blood supply can only be accurately determined by coronary angiography, therefore it is recommended for all patients to undergo it before operations on the heart vessels.

I have type 1 diabetes. Is it possible to undergo coronary angiography? Diabetes mellitus is not a contraindication. But before the procedure is prescribed, you need to get a conclusion from an endocrinologist, undergo a blood test for sugar and glycated hemoglobin levels. The insulin dose should be adjusted so that glycemia is close to normal levels.

How often can coronary angiography be done? This diagnostic method is not dangerous, so it can be done as often as necessary to monitor the coronary vessels of the heart. Repeated examination may be prescribed if pain in the heart increases, drug therapy is ineffective, changes in the ECG or biochemical analysis blood.

Is it possible to undergo a coronary angiography without a doctor's referral? The indication for diagnostics of coronary vessels is primarily coronary heart disease. If it has typical symptoms and the patient’s condition is assessed as satisfactory, angina attacks occur only during high physical exertion, and surgery is not planned in the near future, then there is no need for such a diagnosis.

In order to finally decide whether coronary angiography is indicated, it is necessary to analyze all available medical documentation. This can only be done by a qualified cardiologist.

Thus, coronary angiography of vessels is the “gold standard” in diagnosing myocardial ischemia and planning the installation of a stent or shunt. The method is a relatively safe type of examination, therefore it can be recommended for almost all patients with coronary artery disease, with the exception of those with severe concomitant diseases or complex cardiac pathology.

Heart (IHD) with bicycle ergometry or coronary angiography, nevertheless it. when a bypass is placed between the aorta and the vessel that supplies the heart.

The patient is indicated for coronary angiography to identify problem areas in the vessels of the heart.

Heart defects. Non-inflammatory myocardial diseases. Vessels. . IN difficult cases Ultrasound of the heart, coronary angiography and others, more, come to the aid of ECG.

Heart defects. Non-inflammatory myocardial diseases. Vessels. . Coronary angiography.

Heart defects. Non-inflammatory myocardial diseases. Vessels. . ECG, ultrasound of the heart, coronary angiography and other techniques allow you to quickly and with a large share.

We will publish information soon.

Vasoconstriction (stenosis) due to atherosclerosis poses a great danger to humans. Depending on which vessel is affected, a decrease in lumen can lead to coronary heart disease (CHD), cerebrovascular accident, and atherosclerosis lower limbs and a number of other serious diseases. To restore the patency of the arteries, there are several methods, the main of which are: conservative treatment, angioplasty, stenting of the heart vessels and other affected arteries, coronary artery bypass grafting.

Initially, the narrowing of the lumen has virtually no effect on the person’s condition. But when the stenosis increases by more than half, signs of a lack of oxygen in organs and tissues (ischemia) appear. In this case, conservative treatment is usually powerless. More effective methods of therapy are required - intravascular surgical interventions.

One of the ways to treat ischemia is stenting. This is a minimally invasive endovascular intervention method, the purpose of which is to restore lumens in arteries affected by atherosclerosis.

A special catheter is inserted percutaneously into the affected area of the vessel, at the end of which there is a balloon. At the point where blood flow is disrupted, the balloon inflates and expands the walls of the vessel. To maintain the lumen, a special structure is installed in the artery, which subsequently plays the role of a frame. This design is called a stent.

Scope of stenting

Stenting of the coronary arteries is required when symptoms of coronary heart disease (CHD) appear, as well as when there is an increased likelihood of myocardial infarction. With ischemic heart disease, the blood supply to the myocardium is disrupted, and the heart does not receive enough oxygen for normal functioning. Cardiac muscle cells begin to starve, and then tissue necrosis (myocardial infarction) may occur. The main cause of IHD is atherosclerosis of the coronary vessels that deliver blood to the heart. Because of it, cholesterol plaques form inside the artery walls, narrowing the lumen. Sometimes cardiac stenting is performed in the acute period of myocardial infarction. If the operation is performed within the first six hours after the onset of a heart attack, restoring normal blood flow often saves the patient’s life and certainly reduces the risk of developing irreversible changes in the myocardium.

Stenting of the arteries of the lower extremities is the least traumatic and at the same time very effective method treatment of vascular diseases of the legs. When plaques form and blood flow is disrupted when walking, the patient experiences pain in the thighs, buttocks, feet and legs. As the disease develops, it leads to the most severe consequences, including gangrene.
Stenting of the carotid arteries is a low-traumatic treatment that allows you to restore the lumen of blood vessels. The carotid arteries supply blood to the brain, and with their stenosis, cerebral circulation is impaired. During the operation, in addition to the stent, special protective devices with a membrane are installed - filters. They are able to retain microthrombi, protecting small blood vessels in the brain from blockage, but without interfering with blood flow.
Coronary artery restenosis after angioplasty. After this procedure, after 3-6 months, 50% of patients experience restenosis - repeated narrowing of the vessel in the same place. Therefore, to reduce the likelihood of restenosis, angioplasty is usually complemented by coronary stenting.
In patients with coronary artery disease who have undergone coronary artery bypass grafting, stenosis of the shunt may occur ten to fifteen years after surgery. In this case, stenting becomes an alternative reoperation coronary bypass surgery.

Video: 3D animation of the stenting process

Types of stents

The purpose of stents is to provide support to the walls of a blocked vessel. They bear a heavy load, so these structures are made from advanced high-tech materials highest quality. These are mainly inert metal alloys.

In modern medicine, there are several hundred types of stents. They differ in design, type of cells, type of metal, coating, and method of delivery to the arteries.

Main types of coronary stents:

Simple metal without coating. This is the most commonly used type of stent. Typically used in narrowed medium-sized arteries.
Stents coated with a special polymer that releases a drug in a dosed manner. They can significantly reduce the risk of restenosis. However, the cost of such stents is significantly higher than the price of conventional ones. In addition, they require more long-term use antiplatelet drugs - about 12 months while the stent releases the drug. Discontinuation of therapy may lead to thrombosis of the structure itself. The use of a covered stent is recommended in arteries small size, where the probability of a new blockage is higher than in average.

Benefits of stenting

Does not require long-term hospitalization.
The body recovers quickly after surgery.
It is carried out under local anesthesia, which allows treatment even for those patients for whom traditional surgery is contraindicated.
The operation is low-traumatic - it does not require opening various parts of the body, for example, the sternum during bypass surgery when heart surgery is performed.
The likelihood of complications occurring is minimal.
Less expensive treatment compared to conventional surgeries.

Contraindications to vascular stenting

The diameter of the artery is less than 2.5–3 mm;
Poor blood clotting;
Severe renal or respiratory failure;
Diffuse stenosis - damage to too large an area;
An allergic reaction to iodine, a component of a radiocontrast drug.

How is stenting performed?

Before the intervention, the patient undergoes a series of examinations, one of which is coronary angiography - an x-ray examination method that can be used to identify the condition of the arteries and accurately determine the location.

Before surgery, the patient is given a drug that reduces blood clotting. Anesthesia is performed - usually local anesthesia. The skin is treated with an antiseptic before inserting the catheter.

First, angioplasty is usually done: a puncture is made in the skin in the area of the affected artery and a balloon is carefully inserted using a catheter; Having reached the point of narrowing, the balloon is inflated, expanding the lumen.

At the same stage, a special filter can be installed behind the narrowing site to prevent further blockage and the development of a stroke.

As a result of the operation, the lumen of the artery is opened, but a stent is installed to maintain normal blood flow. It will support the walls of the vessel to prevent possible narrowing.

To install the stent, the doctor inserts another catheter equipped with an inflatable balloon. The stent is inserted in a compressed form, and when the balloon is inflated at the site of narrowing, the metal structure is straightened and fixed on the vascular walls. If the lesion is extensive, then several stents can be installed simultaneously.

At the end of the operation, the instruments are removed. The surgeon controls all actions using an X-ray monitor. The operation lasts from 1 to 3 hours and does not cause pain in the patient. It will be a little unpleasant only at the moment when the balloon inflates - the blood flow is briefly disrupted at this time.

Video: report from coronary stenting surgery

Possible complications after the procedure

In approximately 90% of cases, after installation of a stent, normal blood flow through the arteries is restored and no problems arise. But in some cases the following complications are possible:

Violation of the integrity of the artery walls;
Bleeding;
Problems with kidney function;
Formation of hematomas at the puncture site;
Restenosis or thrombosis in the stenting area.

One possible complication is a blocked artery. This is extremely rare, and when it occurs, the patient is urgently referred for coronary artery bypass grafting. Only 5 out of 1000 cases require emergency surgery, but the patient needs to be prepared for this possibility.

Complications from this operation are quite rare, so vascular stenting is one of the safest surgical procedures.

Postoperative period and rehabilitation

After a surgical procedure such as stenting, the patient must remain in bed for some time. The attending physician monitors the occurrence of possible complications, and upon discharge gives recommendations on diet, medication, restrictions, etc.

In the first week after surgery, you should limit physical activity and avoid lifting heavy objects; you should not take a bath (shower only). At this time, it is not advisable to drive a car, and if the patient’s work involves transporting goods or passengers, then you should not drive for at least 6 weeks.

Life after stenting involves following some recommendations. After the stent is installed, the patient's cardiac rehabilitation begins. Its basis is diet, exercise therapy and a positive attitude.

Physical therapy should be done almost every day for at least 30 minutes. The patient must get rid of excess weight, shape up muscles, and normalize blood pressure. The latter significantly reduces the likelihood of developing myocardial infarction and hemorrhage. You should not reduce physical activity even after rehabilitation.
Particular attention should be paid to nutrition - it is necessary to follow a certain diet, which will help not only normalize weight, but also influence the risk factors for ischemic heart disease and atherosclerosis. The diet after stenting of heart vessels or other vessels should be aimed at reducing levels of “bad” cholesterol - LDL (low-density lipoprotein).
Nutrition after a heart attack and stenting should follow the following rules:
1. Minimize fats - it is necessary to exclude products containing animal fats: fatty meats and fish, high-fat dairy products, caviar, shellfish. In addition, you should avoid strong coffee, tea, cocoa, chocolate and spices.
2. The amount of foods high in polyunsaturated fatty acids, on the contrary, needs to be increased.
3. Include more vegetables, fruits, berries and grains in your menu - they contain complex carbohydrates and fiber.
4. For cooking, use only vegetable oil instead of butter.
5. Limit salt intake to no more than 5 g per day.
6. Divide meals into 5-6 meals, with the last one done no later than three hours before bedtime.
7. The daily calorie content of all foods consumed should not exceed 2300 kcal.
Treatment after stenting is very important, so after the operation the patient will have to take medications daily for six months to a year. Angina pectoris and other manifestations of ischemia and atherosclerosis are no longer present, but the cause of atherosclerosis remains, as well as risk factors.

Even if the patient feels well, after insertion of the stent he should:

Take medications prescribed by your doctor to prevent the risk of blood clots. Usually it's Plavix and aspirin. This effectively prevents blood clots and blockage of blood vessels, and as a result, reduces the risk of heart attack and increases life expectancy.
Follow an anti-cholesterol diet and take medications that lower blood cholesterol. Otherwise, the development of atherosclerosis will continue, which means new plaques will appear, narrowing the blood vessels.
If you have high blood pressure, take medications to normalize it - ACE inhibitors and beta blockers. This will help reduce the risk of developing myocardial infarction and stroke.
If the patient suffers from diabetes, follow a strict diet and take medications to normalize blood sugar levels.

Many patients are concerned about the question: can they become disabled after stenting? The operation improves the person’s condition and returns him to normal working capacity. Therefore, stenting itself is not an indication for disability. But if there are concomitant conditions, the patient may be referred to MSA.

Comparison of stenting and bypass surgery: their pros and cons

If you compare which is better – stenting or bypass surgery, you first need to decide how they differ.

Stenting, unlike bypass surgery, is an endovascular method and is performed without opening the chest and making large incisions. Bypass surgery is most often a cavity operation. On the other hand, installing a shunt is a more radical method that allows you to cope with stenosis with multiple blockages or complete occlusion. Stenting in such situations is often useless or impossible.

Stenting is most often used to treat young patients with minor vascular changes. Elderly patients with serious lesions are still advised to install a shunt.

During a stenting operation, local anesthesia is sufficient, but when installing a shunt, it is necessary not only to use general anesthesia, but also to connect the patient to a heart-lung machine.

The risk of blood clots after stenting forces patients for a long time take special medications. In addition, restenosis is also possible. New generations of stents, of course, help solve these problems, but, nevertheless, this happens. Shunts are also not ideal - they, like any vessels, are subject to degenerative processes, atherosclerosis, etc., so after some time they can fail.

Recovery times also vary. After minimally invasive stenting, the patient can leave the clinic the very next day. Bypass surgery involves a longer period of recovery and rehabilitation.

Both methods have their disadvantages and advantages, and their costs also differ. The choice of treatment method occurs individually and depends solely on the characteristics of the disease in each specific case.

Cost of stenting surgery

How much does cardiac stenting cost? First of all, the cost of the operation depends on which arteries will have to be worked on, as well as on the country, clinic, instruments, equipment, type, number of stents and other factors.

This is a high-tech operation that requires the use of a special x-ray surgical operating room equipped with complex, expensive equipment. In Russia, as in other countries where such operations are carried out, they are performed according to the latest techniques highly qualified specialists. therefore it cannot be cheap.

Prices for cardiac stenting vary depending on different countries. For example, stenting in Israel costs from 6 thousand euros, in Germany – from 8 thousand, in Turkey – from 3.5 thousand euros. In Russian clinics, this procedure is slightly lower in price - from 130 thousand rubles.

Stenting is one of the most popular operations in vascular surgery. It is low-traumatic, brings good results and does not require long recovery. All the patient must do during the rehabilitation period is to follow a diet, do not avoid physical activity and take medications.

Video: all about cardiac stenting

Coronary angiography of the heart vessels

Preliminary examinations
Indications
Contraindications
Preparation
Carrying out coronary angiography
Possible complications

Expanding the network of cardiac centers has the main goal - to bring urgent and planned surgical care cardiac patients. This is especially true for stenting and bypass operations on damaged vessels, which prevents the development of myocardial infarction and further irreversible changes in the heart muscle.

Modern treatment options for coronary heart disease have required clear diagnosis from all support services. To carry out the intervention, the doctor must receive answers to the questions: “What is the degree of narrowing and atherosclerotic damage to the blood vessels of the heart?”, “Is there a blood clot in the blood vessels of the heart?”, “If so, where is it located?”, “What is the size of the blood clot?”, “How developed are the auxiliary vessels - the reserve of cardiac blood supply?” Only coronary angiography (coronography) of blood vessels can provide answers.

Referral for coronary angiography

This type of examination is not performed at the clinic level. Requires special equipment and personnel training. Therefore, the diagnostic method is used as a mandatory method in cardiac centers after consultation with a cardiac surgeon. Doctors at clinics have information about where the patient needs to be referred and a consultation appointment schedule. Most often you can make an appointment by phone.

Examination required for consultation with a cardiac surgeon

To prepare for an examination by a specialist in a clinic, it is necessary to conduct a full examination:

general blood test with formula and platelets;
blood clotting;
biochemical indicators indicating the condition of the heart muscle;
lipidogram to confirm the degree of development of the atherosclerotic process (study of total cholesterol, high-density and low-density lipoproteins);
some laboratories simultaneously calculate the risk of complications of atherosclerosis;
blood electrolytes;
blood and urine sugar;
tests to assess liver and kidney function;
other studies to exclude chronic infectious diseases and AIDS.

Required hardware methods are:

fluorography (allows us to judge not only the lung tissue, but also the size of the heart and its contours);
electrocardiographic study (ECG) over time confirms the need for consultation, gives a conclusion about the rhythm of heart contractions, the presence of overload in various parts, the state of muscle fibers and cicatricial changes in cases of myocardial infarction, reveals persistent ischemia with an unfavorable prognosis;
Ultrasound examination of the heart (ultrasound) visually and in the image indicates the functioning of different parts of the heart, the functioning of the valves between the atria and ventricles, as well as large vessels, hypertrophy (thickening of the wall) of the heart muscle.

Carrying out these examinations is necessary to reduce the waiting time for the result of a consultation with a cardiac surgeon at the center.

Who is indicated for coronary angiography?

The method of coronary angiography of the heart vessels is needed only if, with the consent of the patient, a method of surgical intervention is chosen to alleviate his condition. Heart surgeons must decide whether stenting (straightening a narrow vessel by inserting a stent) will help or whether bypass surgery (connecting blood vessels around the clot) is necessary. It is also possible to carry out both operations in stages.

if the patient has ever had an allergic reaction to a contrast agent;
with an increase in body temperature;
if there is insufficient blood clotting or severe anemia (anemia);
low content potassium in the blood;
the patient has diabetes mellitus, kidney, liver and lung diseases in a severe stage;
in old age;
with excess weight.

Rules for preparing for research

Since vascular coronary angiography is performed in a hospital setting, the patient must strictly follow the doctor’s instructions. The doctor decides which medications can be continued and which ones can be discontinued. You should not eat in the evening or eat on the day of the procedure. This is done to prevent nausea and vomiting during the examination.

How is coronary angiography performed?

Under local anesthesia, a thick needle is used to puncture the ulnar or femoral artery. The best access site is chosen by the surgeon. General anesthesia is not required; usually the patient is talked to and asked about his well-being. Some note discomfort in the area of needle insertion.

Then, a thin, long catheter (plastic tube) is inserted into the artery through the lumen of the needle. It must be brought as close as possible to the vessels of the heart. The cardiac surgeon observes the progress of the catheter on the monitor screen.

After installing the catheter in the right place, a contrast agent is injected, it fills the heart arteries and their small branches. As directed by the surgeon, X-rays are taken in various projections.

After removing the catheter, the port (insertion site) is closed with a special bandage or sutures. After the procedure, the patient is recommended to rest in bed and limit the movement of the limb used to “enter” the arterial system. A light diet is prescribed for several days and drinking plenty of fluids to remove the contrast agent through the kidneys.

If the bleeding at the puncture site does not stop, swelling and bruising may increase, and dizziness may occur. Medical personnel must be immediately informed about this.

What complications may develop?

Various complications after coronary angiography occur in approximately two percent of patients. A mild side effect is itching, the appearance of a rash on the skin, swelling of half the face and tongue. These are allergic reactions to the contrast agent. Allergic shock on the operating table is much less common. Local symptoms such as hematoma, thrombosis and vessel damage are possible. They are successfully treated in hospital.

Complications such as a heart attack or stroke are considered severe. Although it is difficult to associate the occurrence of an acute disease with the procedure performed in case of existing stenosis of the cardiac arteries and a pronounced atherosclerotic process. Medical statistics indicate death in one case out of a thousand.

Is this service considered paid or not?

The cost of coronary angiography of the heart vessels, according to various Moscow clinics, ranges from 10 to 33 thousand rubles. This is the case if the patient cannot wait in line for a free procedure in the quota allocated by the Mandatory Fund health insurance" All clinics keep records of people who need to consult a cardiac surgeon for coronary angiography. The priority is set by the cardiac centers themselves as subsidies become available.

Why does blood pressure rise at night during sleep: causes and treatment of increased blood pressure

Usually in the evening, after a busy day, a person feels tired and wants to rest.

Therefore, if at night, instead of relaxation, one feels excited for no reason, and at the same time blood pressure rises, everyone is wary - why is this happening?

What should be done? Is this a signal that not everything is in order in the body and treatment is required?

Why blood pressure rises in the evening and during sleep - the main reasons

It must be said right away: increased pressure at night, during sleep, is a pathological condition. In a healthy person, blood pressure normally rises during the day when he is active, at work, moving, or performing any activities. This is a completely natural phenomenon.

In a dream, a person is motionless, he is completely relaxed. This is why blood pressure drops slightly at night - and this is also absolutely normal. But why then do some people have blood pressure that rises at night, what are the reasons?

Scientists began looking for an answer to this question not so long ago, calling the increase blood pressure nocturnal hypertension during sleep. After a number of studies, doctors came to the conclusion that if blood pressure rises at night, this can be considered the same symptom of arterial hypertension as increased blood pressure during the day.

Treatment is necessary, otherwise sooner or later pressure surges will lead to the development of myocardial infarction, stroke, cerebral edema and other serious complications.

For a long time, many hypertensive patients do not even suspect that they are developing arterial hypertension, since the symptoms appear mainly at night, when the person is sleeping. Having experienced a jump in blood pressure in a dream, in the morning the patient may wonder why he feels exhausted and not rested, as should be normal after a night's sleep.

Also, if blood pressure jumps at night, in the morning a person may experience headaches, feel irritability, and lethargy. His performance and physical activity will be reduced, and his vision and hearing may deteriorate. You need to pay attention to the following symptoms:

Sleep disturbances, problems falling asleep in the evening, insomnia;
Sudden awakenings accompanied by attacks of unreasonable fear and anxiety;
Attacks of suffocation in the middle of the night, feeling of lack of oxygen;
Night sweats, chills.

If similar phenomena or some of them appear quite often, and the patient is over forty, he smokes, enjoys coffee or alcohol, is a professional athlete, or has two or more hypertensive patients in his immediate family, it’s time to sound the alarm. By the way, high blood pressure is a common occurrence in athletes.

First steps if you suspect nocturnal hypertension

What should you do to avoid this?

Buy a tonometer and regularly measure your blood pressure throughout the day, always before going to bed and after waking up. If possible, you can take measurements at night, but you shouldn’t wake up specifically for this by setting an alarm for a certain time.
Keep a diary and enter the results of all measurements into it in order to accurately determine when the pressure rises and when it drops. This will also help to find out the causes of pressure surges and under the influence of what factors this occurs.
You definitely need to make an appointment with a doctor - first with a therapist, and then with a cardiologist.
You should take blood and urine tests and do an electrocardiogram - this will help doctors correctly diagnose and prescribe treatment.

It is not recommended to start taking blood pressure medications on your own. They all act differently, especially in combination with others medicines, and if used and dosed incorrectly, they will only cause harm.

Your doctor will tell you after the examination how to behave correctly if your blood pressure rises in the evening and at night.

It is impossible to cure arterial hypertension, including nighttime hypertension, with pills alone. Treatment is aimed at normalizing blood pressure and maintaining it at the same level.

For this, a whole range of measures is used, among which taking medications ranks last - tablets should be taken only when the pressure has jumped very much and no other measures help.

Try not to overwork during the day, finish your work day earlier, and relax at home in the evening instead of cleaning and washing;
Create a calm, peaceful environment in the house before going to bed, do not make troubles or resolve conflict situations;
Do not take alcohol before bed, even if it seems to help you fall asleep faster and sleep more soundly, and do not drink coffee;
Do not visit the gym, fitness club, sauna or solarium in the evening;
Do not overeat, especially salty and spicy foods, which will take a long time to digest and retain salt in the body.

Ideally, if you have hypertension, make it a rule to take a walk every evening before going to bed in a nearby park or just in the yard. And it’s better to skip the dinner altogether, replacing it with a glass of kefir or herbal tea. It is recommended to brew tea from linden, lemon balm, valerian, and motherwort. You can buy a ready-made tincture of valerian or motherwort at the pharmacy and take it before bed, diluting a few drops in a tablespoon of water.

It fights well against insomnia, lowers blood pressure and soothes honey, preferably linden or sunflower. It is recommended to consume it before going to bed in the amount of one tablespoon with a glass of warm water.

Hypertension is rarely treated with one type of medication. Depending on its manifestations and stage, age and condition of the patient, the doctor selects several drugs and draws up a treatment regimen. In case of nocturnal arterial hypertension, the intake of basic antihypertensive medications is transferred to the evening, while diuretics, for obvious reasons, are best taken during the day.

You definitely need to stick to a diet and exercise. Yoga has a beneficial effect on blood vessels and blood pressure - the great advantage is that patients of any age can perform yoga exercises. Young people are more suitable for aerobics or swimming; these sports help improve blood circulation and strengthen the walls of blood vessels, but do not subject the body to extreme physical stress. And naturally, you need to be aware of how to deal with hypertension yourself.

Arterial hypertension, which manifests itself at night, indicates that a person’s biological rhythms are seriously disturbed. This means that the patient is especially susceptible to weather changes and climatic conditions. We must not forget about this and especially carefully monitor blood pressure during such periods.

In no case should you ignore an increase in blood pressure at night or try to heal it yourself without being examined by a doctor. It has been established that it is precisely this pathology that often leads to nocturnal heart attacks, strokes and sudden death during sleep.

Diseases of the heart and blood vessels seriously affect the length and quality of human life. In addition to the fact that the myocardium provides blood flow to all tissues and cells, it intensively nourishes itself, as this is necessary to maintain its constant work. The heart is supplied with oxygen and other required elements through the coronary arteries, which are located in the main muscle of the circulatory system. It is these vessels that provide nutrition to the myocardium and are the key to its successful functioning. To assess their condition, there is a special method - coronary angiography of the heart. This procedure is very common and is actively used by cardiologists and surgeons to visualize the extent of damage and select further treatment tactics for patients.

General information about the procedure

Coronary angiography is essentially an x-ray examination. It consists of injecting a contrast agent into the vessels of the heart and then creating a photo of the patient’s chest area using special devices. This procedure is minimally invasive, but allows you to accurately assess the nature, extent and location of damage to the coronary arteries and veins.

The study is most informative if there are several unconfirmed differential diagnoses. Coronary angiography is also prescribed by surgeons to preoperative patients, since only after it is performed the type of intervention required is determined. The procedure does not require long preparation for people in a stable condition, therefore it is safe compared to other, more invasive methods of assessing blood flow in the myocardium. Coronary angiography is also performed on young patients, especially if congenital heart defects are suspected. It allows you to accurately determine the location of damage, such as stenosis or blockage of a vessel by a thrombus. This makes it possible to competently plan the upcoming operation and improves the outcome of the surgical intervention. In clinics with the most modern equipment, coronary angiography is performed using a computed tomograph, which allows you to create a three-dimensional model of the affected organ and visualize disorders of the arterial and venous network as accurately as possible.

Indications for use

The study in most cases is ordered either by a cardiologist or a surgeon after conducting standard tests, such as hematological tests. It is necessary if you suspect a number of problems, which include:

Coronary heart disease (CHD). This pathology develops as a result of disruption of normal blood circulation in the myocardium, and also leads to muscle degeneration, when the clinical picture only worsens. IHD is an absolute indication for coronary angiography.
Angina pectoris that does not respond to drug treatment. There are many reasons that caused the formation of such a disease. Among them is a violation of coronary blood flow, the detection of which requires a special study.
Previous myocardial infarction with long and difficult recovery requires coronary angiography.
Preparation for operations for heart defects, aortic aneurysm, thrombosis of large veins and arteries includes X-ray examination. In most cases, the surgeon is directly present during the procedure, and immediately after its completion he prescribes the necessary operation.

In some cases, coronary angiography is performed urgently if there is a suspicion of severe course cardiac problem. However, in most situations, this is an elective procedure that is performed on an outpatient basis.

Existing contraindications

Since the study is minimally invasive and in many cases is the only method to make an accurate diagnosis, absolute contraindications does not exist for its implementation. However, there are conditions in which it is necessary to postpone coronary angiography and perform a number of actions to stabilize the patient and prepare him for manipulation:

Spicy and chronic diseases kidney The contrast agent, which is injected into the vessels during the procedure, has a slight but toxic effect on the nephrons, since it is excreted from the body in the urine. If the patient has a history of kidney disease, a number of additional hematological tests are required to assess the health of the urinary organs.
Bleeding disorders are considered a contraindication to any surgical procedure due to the incision and bleeding involved. During coronary angiography, the vessel is dissected with the insertion of instruments into the lumen, so the development of blood loss is possible during or after the operation. In diseases that affect the body's coagulation system, life-threatening hypotension can develop.
Anemia, or low levels of hemoglobin and red blood cells in the patient's blood. Since coronary angiography is associated with blood loss and invasion into the vascular bed, hematological tests before performing it should be close to ideal. This is required to minimize complications.
Low potassium levels in the blood. This microelement takes an active part in maintaining metabolic processes. One of its main functions is the regulation of heart contractions. Reduced potassium content is the cause of arrhythmia. Tachycardia or bradycardia can significantly complicate cardiac coronary angiography and lead to unpleasant consequences.
Allergic reaction to contrast agent. To identify individual intolerance to this component, a number of preoperative tests are performed. A negative reaction to contrast is extremely rare.

Severe concomitant diseases and elderly age are also considered contraindications for coronary angiography. This does not mean that the procedure is not carried out at all. The study is simply postponed until the patient's condition stabilizes.

Dangerous complications

Despite the availability of technology and the minimally invasive nature of the study, as with any other surgical intervention, a number of complications may develop.

There are risks associated with creating a puncture for intravascular access. This is fraught with the occurrence of infection in the postoperative period. It is also possible for hematomas, bruises and other hemorrhages to form at the site of the surgical wound. In the presence of concomitant diseases, the risk of developing thrombosis or even myocardial infarction increases. If coronary angiography is performed with poor technique, ruptures of arteries and veins are formed, which leads to internal bleeding.

Such consequences are extremely rare and develop only in the presence of aggravating factors.

Preparation for the procedure and technique for its implementation

Coronary angiography is a painless procedure that lasts on average 30–40 minutes. Since the examination is performed under local anesthesia, no special preparation of the patient is required. To protect the kidneys from the harmful effects of the contrast agent, 2-3 days before the study, plenty of fluids are prescribed, and infusion therapy is also carried out. The puncture site is first shaved, disinfected and injected with anesthetics to prevent possible painful sensations. Coronary angiography is carried out in stages:

The doctor makes an incision or puncture in the main vessel on the patient's arm or leg, where a guide element is inserted, through which the catheter goes directly to the heart.
A contrast agent is injected through a tube into the right and left coronary arteries, which is distributed throughout the microvasculature of the myocardium.
Directly during the procedure, special images are taken using X-rays or images are displayed on a computer monitor if coronary angiography is performed using a tomograph.
At the end of the study, the instruments are removed from the vessels, and the puncture is sutured.

Using the images obtained during the procedure, doctors determine the exact location and extent of damage to the coronary vessels of the heart. If a local increase in temperature is observed after coronary angiography, painful sensations or cardiac symptoms, you need to seek help from a doctor.

Stenting of coronary arteries

The heart muscle begins to function poorly after atherosclerosis affects the artery walls. Due to the deposition of atherosclerotic plaques, the walls of blood vessels lose their elasticity and cannot expand normally.

Stenting process
Diagnosis and indications for endovascular surgery
Contraindications
Stages of the operation
Forecast

Constriction of blood vessels leads to difficulties in delivering nutrients to the heart muscle. As a result, symptoms of hypoxia are observed. Lack of oxygen produces angina attacks. If the diameter of the vasoconstriction is more than 50%, there is blockage of the artery and subsequent necrosis, which leads to a heart attack and often death.

Innovative stenting of cardiac vessels, which was developed not so long ago, can prevent such consequences.

Stenting process

Stenting is a minimally invasive surgical procedure on the arteries that supply the heart. To relieve chest pain, relieve angina pectoris and prevent myocardial infarction, a coronary stent is used, which is a thin frame tube with a structure in the form of a flexible metal mesh.

The stent is inserted into the artery in a compressed state, after which it expands like a spring, expanding the walls of the vessels. The stent is expanded using a special balloon. As a result, the lumen of the coronary artery becomes wider after indentation of atherosclerotic plaques, and blood flow to the heart is restored. In this case, the implanted stent does not change its shape, keeping the lumen open.

The interventional cardiologist uses angiography to assess the location and size of the block (lesion) by injecting a contrast agent through a guide catheter. This makes it possible to view the flow of blood through the downstream coronary arteries.

Intravascular ultrasound is used to evaluate the thickness and hardness of the lesion (calcification). The surgeon uses this information to decide whether the lesion needs to be treated with a stent, and if so, what type and size of stent to use.

To elute the drug, a stent attached to outside balloon catheter. Therefore, doctors can perform “direct stenting,” in which a stent passes through the blocked vessel and widens it.

It is extremely important that the stent frame is in direct contact with the vessel walls to minimize possible complications, as blood clots may form. Very long lesions may require more than one stent, and this type of therapy is called "full metal sheath."

Since the operation is gentle, local anesthesia is used. The patient can contact the surgeon during stenting of the heart vessels. After a successful surgical process, the blood circulates perfectly, allowing the heart tissues to receive all the necessary nutrients and oxygen.

Besides, this operation stent installation requires maximum technical equipment, so stenting is carried out in the cardiovascular department.

Main features and objectives of the method:

Endovascular surgery is performed without violating the integrity of the affected area.
The arterial lumen is restored only with the help of a tube in the form of a metal mesh (prosthesis), and not by removing atherosclerotic plaques.
The purpose of the inserted stent is to press and expand atherosclerotic plaques.
Sometimes up to 3–4 stents are used to large quantities narrowed vascular zones.
Introduction of contrast agents into the coronary vessels to monitor the process using X-ray equipment.

Used to restore normal blood flow different types stents Since this implant is required to relieve narrowing over a long period of time, its reliability should not be in doubt.

The main requirement for a stent is to prevent re-narrowing of the vessel. However, due to the fact that a foreign body is sometimes rejected by the body, developers have thought through various modifications of stents.

Modern vascular implants have the following characteristics:

Covered with substances that can block blood clotting. In this case, blood clots do not form on the implant itself.
To change the required diameter, the developers came up with a structure that allows you to maximize the area of the blockade. Now ring, mesh or tube structures are being installed.
Externally, the stent resembles a tube up to 1 cm long. The diameter can vary from 2 to 6 mm.
Manufactured from special metal alloys using high technology. Typically, mesh tubes are made from an alloy of chromium or cobalt. Currently, most stents have begun to be coated with drugs to minimize the risk of re-stenosis and myocardial infarction. Typically, stents with medicinal substances are indicated for those who have one of the following diagnoses: diabetes mellitus, repeated stenosis, renal dysfunction.

Only the attending cardiac surgeon can select a stent design taking into account anatomical features patient. Today, there are more than 100 types of stents, which differ in material, structure and size.

Diagnosis and indications for endovascular surgery

One cardiologist was found guilty of billing patients for medically unnecessary coronary stenting. It is generally accepted that sometimes the use of this method is impractical. Before deciding to undergo endovascular surgery, you should undergo a complete examination.

The research course includes procedures such as:

laboratory analysis of blood and urine;
lipid profile - to study cholesterol levels;
Ultrasound of the heart (echocardioscopy) - to study the functioning of all departments;
TEE - transesophageal electrophysiological study;
electrocardiography - to clarify the affected areas and the extent of the blockade process;
coagulogram - to determine the level of blood clotting;
angiography with the introduction of a contrast agent - to identify the degree of vascular narrowing and the number of affected arterial branches.

After it has been carried out full course diagnostics, the cardiologist considers the feasibility of the operation taking into account all the examination factors.

As a rule, coronary stenting of heart vessels has several indications:

pre-infarction condition, provoked by constant attacks of angina pectoris;
chronic attacks of ischemia, which are caused by the blocking of 50% of the lumen by atherosclerotic plaques;
frequent angina after minor physical exertion;
narrowing of a blocked vessel after bypass surgery or balloon angioplasty, techniques that lose effectiveness after 8–10 years.

In addition to the listed clinical pictures, stenting of cardiac vessels is mainly indicated for heart attacks and acute coronary circulatory disorders. Sometimes surgery is performed to remove severe pain in the area of the heart. Moreover, this procedure does not guarantee longevity and the absence of any problems with cardiac activity.

Contraindications

Despite the high safety of intravascular surgery, there are several important contraindications to this technique for restoring blood flow.

As a rule, cardiologists exclude stenting for the following factors:

the impossibility of inserting a stent due to large-scale vascular damage, when after diagnosis the exact localization of the blockade was not determined;
hemophilia and low blood clotting;
the diameter of the affected artery is less than 2 mm;
the patient is allergic to a contrast agent, in particular to an iodide preparation;
respiratory failure;
kidney and liver pathologies;
acute infectious diseases;
serious condition of the patient (low blood pressure, impaired consciousness, shock, etc.);
cancerous tumors in an advanced stage.

Stages of the operation

After the attending physician has made an accurate diagnosis, the patient is prepared for endovascular surgery. Before stenting the heart vessels, only a dietary dinner is allowed; food should not be eaten in the morning.

Before a planned operation, patients are often given drugs that stop high blood clotting. To avoid blood clots, drugs such as Warfarin, Heparin, etc. are usually used.

After administering blood thinners, cardiac surgeons proceed according to the following steps:

Local anesthesia in the area where the catheter is installed.
Installation of an introducer - a tube for which, after anesthesia, a puncture is made in the femoral or inguinal artery.
Introduction of iodide contrast agent into the vessels so that it is possible to monitor the process through X-ray equipment.
Insertion of a stent with a balloon into the affected vessel to the site of blockade under the control of computer scanning.
Inflation of the balloon, during which the stent expands and presses atherosclerotic plaques into the vascular wall.
Repeated inflation of the balloon to secure the stent normally.
Removing microsurgical equipment from the vessel.
Apply a suture to the incision site.

There are usually no complications after this operation, but sometimes minor damage to the heart vessels and bleeding may occur. In rare cases, disturbances in the blood circulation of the kidneys and brain activity are observed. In addition, thrombosis is possible - blockage of the stent by blood clots.

Minimal physical activity. Physical activity is contraindicated for the patient for 1–2 weeks after surgery. A person can return to normal life after 1.5 months. But at the same time, heavy physical labor should be excluded. To quickly restore the body, doctors prescribe exercise therapy procedures. Doctors do not recommend driving a car for the first 2–3 months.
Diet. With such defeats of cardio-vascular system You should absolutely not eat foods high in fat and carbohydrates. Salty and spicy foods should be avoided. The diet should contain only dietary meats, fruits, vegetables, fish and vegetable fats. You need to monitor the amount of sugar and cholesterol in your blood.
Taking medications. With this pathology, constant use of medications is indicated. Doctors prescribe beta blockers for frequent heartbeats and attacks of pain (Egilok, Anaprilin, etc.). To reduce the risk of atherosclerosis, Atorvastatin or Atoris is prescribed. In addition, it is necessary to take anticoagulants: Clopidogrel, Fluvastatin, Warfarin, Plavix, Magnicor, etc. To normalize cholesterol levels, statins are taken.
Surveys. A couple of weeks after stenting, it is necessary to do an ECG and undergo a course of tests for lipid parameters and blood clotting. A year later, coronary angiography is required.

Forecast

Coronary artery stenting has several important advantages over other techniques for treating blocked heart vessels:

low invasiveness of the operation, after which you are discharged home within 2–3 days;
successful elimination of coronary heart disease;
minimal risk of complications;
fast recovery;
improving the quality of life, contributing to its duration.

Thanks to these advantages, the prognosis for stenting is very favorable: only 20% of clinical cases experience repeated narrowing of the lumen (restenosis). On average, stents provide good vascular patency after surgery from 5 to 10 years, and sometimes up to 15.

However, forecasting in to a greater extent depends not on the quality of the stent and the success of the operation, but on compliance with all the recommendations of the cardiologist: spend more time in the fresh air, do morning exercises, follow a diet, undergo timely examinations and take supportive medications.

Stenting is gentle surgery, which will help normalize the functioning of the cardiovascular system for a full life.

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What kind of heart surgery is performed during a heart attack?

Surgery for a heart attack is often prescribed to save a person’s life. Typically, indications for its implementation are emergency situation or lack of effect from long-term drug therapy. Often this pathology affects older people, in particular men aged 40-60 years. However, after the age of sixty, the risk of developing myocardial infarction in women increases. The disease often manifests itself in autumn and winter, when immunity is noticeably reduced.

Causes and symptoms

The cause of myocardial infarction is atherosclerosis, which is characterized by the formation of plaques on the walls of blood vessels, mainly in the coronary artery. It tends to expand and may burst over time.

The body perceives this process as bleeding, so the blood clots and a blood clot forms. As a result, it closes the artery, as a result of which blood supply is not provided in one of the areas of the myocardium, and tissue necrosis occurs. In the absence of timely medical care Death may occur due to cardiac arrest.

Myocardial infarction is characterized by paroxysmal pain in the area of the heart muscle. They are permanent and do not go away with painkillers. When these symptoms occur, blood pressure increases.

Main features of a heart attack:

heartache;
malaise;
labored breathing;
cold sweat;
nausea;
feeling of fear.

In case of myocardial infarction, resuscitation measures are taken. The patient is recommended to rest completely, pain relievers and sedatives are prescribed, and they also provide the heart muscle with oxygen and saturate the affected tissue with it.

Surgery for myocardial infarction is considered an effective measure. The indications for its use are the results of coronary angiography. If the heart is not functioning well or necrosis has occurred, surgical resolution is necessary.

Indications for surgery

Surgeries for myocardial infarction in most cases prolong a person’s life. If the functioning of the heart muscle is disrupted, the heart may stop. If the pathology begins to develop, then surgery is inevitable.

The decision about heart surgery is made by doctors after conducting all studies and confirming the diagnosis:

Ventriculography.
Coronary angiography.
Taking tests.

An important procedure is coronary angiography. With its help, the condition of the vessels saturating the myocardium is determined and the degree of damage is revealed. How is the procedure carried out? The patient is injected with a contrast agent into the vessels and examined using X-rays.

Since the normal functioning of the heart is disrupted, myocardial infarction is dangerous; the operation is performed according to certain indications. If you want to urgent intervention, then the patient is given emergency surgery. In the absence of serious violations, it is necessary elective surgery. They begin to prepare the patient for it.

The preoperative period lasts 12 hours. During this time, the patient has excess chest hair removed, tests are taken and the necessary examinations are carried out. Before the operation, the blood type and Rh factor are determined.

Surgical intervention includes:

patient preparation;
anesthesia;
operating period;
intensive therapy.

It is important to monitor the patient’s condition on the first day postoperative period. Therefore, the patient is in intensive care, and doctors provide assistance if necessary. If the condition improves, he is transferred to a hospital for further therapy.

Types of surgery

Myocardial infarction often requires surgery. This dangerous disease can cause serious consequences; even drug treatment cannot cope with it. Therefore, to prolong life, surgical intervention is often required.

There are several types of surgery for myocardial infarction:

Coronary artery bypass surgery.
Transluminal balloon dilatation.
Excimer laser angioplasty.

If the coronary vessels are not able to provide normal blood supply to the myocardium, then a special shunt is installed. The procedure is simple and does not cause complications. However, the risk lies in the installation of artificial blood circulation and ventilation devices during the operation.

Also, general anesthesia can negatively affect people of retirement age and pregnant women. In some cases, this type of operation can be performed on a beating heart, it all depends on the extent of the damage and the condition of the patient.

Although this method is common, there are contraindications for heart bypass surgery:

diabetes;
lung diseases;
hepatitis;
damage to several arteries;
severe damage to the arteries.

After the operation, the patient requires long-term rehabilitation. If therapy and postoperative regimen are violated, there is a risk of secondary myocardial infarction.

Balloon angioplasty eliminates the need for stents. The balloon is inserted, it is deflated in the place where the stenosis occurred, and then it is removed. This operation is performed during coronary angiography. The patient's well-being is monitored for several days and then he is discharged. Usually this method does not cause complications. However, there is one drawback after a heart attack - the likelihood of a relapse.

After a heart attack and surgery, metabolism in the myocardium is normalized and the heartbeat is restored. The risk of repeated attacks of angina and myocardial infarction is also reduced.

A healthy lifestyle, taking medications and regularly visiting a doctor will help you quickly recover and prolong your life.

Ischemia of the heart muscle is a condition that is very dangerous for human life. Timely diagnosis of diseases that lead to circulatory disorders allows you to choose the most effective tactics treatment and improve the patient's quality of life. Experts recognize coronary angiography of the heart vessels as the most informative research method in this situation - it is with the help of it that the doctor learns about the location, degree and nature of the narrowing of the lumen of the artery carrying blood to the myocardium. You will learn about how coronary angiography is performed, indications, contraindications, preparation for the study, as well as its possible complications from our article.

Brief historical background

Almost a century ago - in 1929 - the German scientist W. Forrsmann, after lengthy experiments under fluoroscopy control, inserted a 65-centimeter long urinary catheter through the left cubital vein into the right atrium. Despite the fact that this experiment was criticized by the scientist’s colleagues at the time, today he can safely be considered the founder of coronary angiography.

11 years later - in 1940 - New York doctors A. Cournard and D. Richards provided the public with data from a study of hemodynamic parameters during cardiac catheterization in individuals with rheumatic valve disease. At the same time, these scientists created a diagnostic program that made it possible to use the method in clinical practice. In 1956, the authors of coronary angiography received the Nobel Prize in Physiology or Medicine.

Around the same time - in 1953 - Seldinger developed a low-traumatic method of cardiac catheterization, which facilitated diagnosis and reduced the risk of complications.

In 1958, M. Sones developed and performed selective coronary angiography, which is a variation of the method today.

The essence and types of coronary angiography

Angiography, in which only one of the coronary arteries is examined, is called selective.

So, coronary angiography is a method for studying the coronary (coronary) vessels of the heart, in which a contrast agent is injected into them and a series of X-rays are taken in different projections. It is the “gold standard” for diagnosing the condition of the heart vessels.

Depending on the indications, the study can be carried out in different volumes:

with general coronary angiography, all coronary arteries are subject to diagnosis;
during selective coronary angiography, contrast is injected into only a few vessels - those that need to be examined.

Today there is a technique for coronary angiography, which is performed using a multislice computed tomograph. In this case, a contrast agent is first injected into the patient’s body, and then it is placed in an MSCT machine. The advantages of CT coronary angiography are:

no need for hospitalization of the patient;
short diagnostic time;
its high information content.

usually higher cost than traditional coronary angiography;
quite low accessibility for certain segments of the population.

There are a number of indications for each of the methods; each of them has both advantages and disadvantages in relation to the others. The type of coronary angiography required by the patient is determined by the doctor based on the clinical situation.

Also, during this study, if necessary, some additional manipulations can be performed to clarify the extent and nature of damage to the coronary arteries. These include:

left-sided ventriculography (with the help of which the doctor evaluates the contractility of the left ventricle, the nature of the movement of its walls, and diagnoses insufficiency mitral valve, if any);
aortography (arteriography of the aorta) – allows you to detect aortic valve insufficiency and assess the condition of the walls of different parts of the aorta, the nature of damage to it and the large arteries extending from it;
coronary bypass grafting (performed after CABG surgery to determine the patency of the shunts).

Indications

Coronary angiography is prescribed for people suffering coronary disease hearts that have a high risk of developing complications of this pathology or if previous therapy has not shown a positive result.

So, the indications for this study are as follows:

first appeared;
unstable (progressive) angina;
angina pectoris that does not respond to traditional drug treatment;
post-infarction angina (which occurred immediately after);
myocardial infarction itself (the study must be carried out urgently - within the first 12 hours from the onset of the disease);
signs of insufficient blood supply (ischemia) to the heart muscle, detected on or through daily ECG monitoring;
samples from physical activity(bicycle ergometry, treadmill, transesophageal electrical stimulation), in which myocardial ischemia was detected;
heavy;
the need for differential diagnosis with heart diseases of a different (non-ischemic) nature;
some chest injuries;
hypertrophic cardiomyopathy;

In addition, coronary angiography is performed in preparation for heart surgery, heart, lung, kidney or liver transplantation, and sometimes to determine the condition of the coronary bed in people from risk-related professions - pilots, drivers of certain types of transport, astronauts and others.

Contraindications

Coronary angiography can be performed on patients of any age and in any condition, even severe ones. The value of this research method in a number of clinical situations is so great that it has no absolute contraindications - those in which diagnostics are absolutely impossible to perform. There are relative contraindications, which include:

patient intolerance to a specific X-ray contrast agent;
in which it is very difficult to reduce blood pressure with medications (uncontrolled);
decreased concentration of potassium in the blood (hypokalemia);
severe, uncontrolled ventricular arrhythmia;
disorders of the blood coagulation system;
decompensated;
acute infectious disease;
severe renal failure;
ONMK ();
severe anemia;
chronic infectious disease in the acute stage;
active bleeding of any nature (uterine and others).

If the patient has one or more of the diseases listed above, coronary angiography is postponed until his condition stabilizes. If an emergency examination is necessary, the doctor can conduct it even despite the presence of relative contraindications (of course, the risk of complications in this situation is significantly increased, but sometimes this is the only way to save the patient’s life).

Is preparation necessary for coronary angiography?

Coronary angiography is a serious study that requires certain preparation for it.

First of all, the patient should be maximally informed about the essence of the study, the goals pursued by the doctor when prescribing it, and about possible complications. In addition, the patient is pre-examined. He may be assigned:

blood test for group and Rh factor;
biochemical blood test (renal tests, electrolytes);
blood test for coagulation (coagulogram);
blood test for infections (hepatitis B, C, HIV, syphilis, and so on);
electrocardiography;
(echocardiography);
stress ECG testing;
daily ECG monitoring;
consultations with specialized specialists and examinations recommended by them (if the patient has a concomitant pathology).

It is important that the patient warns the doctor about allergic reactions that he has ever had (especially allergies to medications), talks about all chronic diseases and lists what medications he takes on a regular basis. If these medications can affect the information content of coronary angiography, the doctor may recommend discontinuing them or take into account the fact of their use when assessing the result of the study.

Coronary angiography is performed depending on the clinical situation:

planned or emergency;
outpatient or in the cardiac surgery department.

The study is carried out on an empty stomach - the last meal should be no later than 8 hours before it.

The patient toilets the area where the vessel puncture will be performed and removes it from this area of the body. hairline. Also, before the start of coronary angiography, he needs to take medications if prescribed by the doctor.

Research methodology

With CT coronary angiography, the doctor observes an image of the coronary vessels of the heart on a monitor screen.

Coronary angiography is an invasive study. During the entire duration of the procedure, the patient’s condition is monitored by an anesthesiologist and a cardiac resuscitator.

First of all, the cardiac surgeon performs local anesthesia at the puncture site - injecting lidocaine, ultracaine or another local anesthetic layer by layer. During the examination, the patient is conscious.
Next, the doctor performs a puncture of the artery - brachial, axillary, radial or femoral (at the doctor’s discretion and depending on the available equipment), installs an introducer, inserts a catheter into the lumen of the needle, and then removes the puncture needle.
To avoid blood clotting, the system is washed with a mixture of heparin and saline solution.
Under the control of an ultrasound machine or fluoroscope, the catheter is advanced along the artery in the direction of the heart up to the ascending aorta.
When the catheter reaches the aorta, under the control of blood pressure it is moved into the common trunk or into any of the branches (left, right or their branches) of the coronary arteries.
A contrast agent is injected into the catheter, which spreads through the bloodstream and, reaching the coronary arteries, fills them.
A series of x-rays are taken in different projections, the results are digitized, recorded on a computer, and subsequently issued to the patient on electronic media along with a report, and can also be printed.

During the diagnostic process, devices record ECG, pressure in the aorta and heart chambers.

During coronary angiography, the patient feels mild pain during puncture of the artery and during local anesthesia, a feeling of heat from the administration of a contrast agent, and sometimes pain characteristic of an angina attack.

At the end of the study, the doctor removes the catheter from the patient’s bloodstream and applies a special sterile pressure bandage to the puncture site to stop the bleeding. After 30 minutes, replace this bandage with a regular one, which is removed after 24 hours.

If during coronary angiography changes are detected that can be eliminated by surgical interventions - stenting, CABG, balloon angioplasty, they can be performed immediately after the diagnosis is completed.

Time spent by the patient under observation medical personnel depends on the access through which the catheter was inserted, as well as on its general condition:

If coronary angiography was performed through radial artery, the examinee can leave the department within a few hours, provided that he follows a gentle regimen for the arm whose artery was punctured.
Other approaches require the patient to stay in the hospital for 24 hours after the study.

To speed up the removal of the contrast agent and at the same time facilitate the functioning of the kidneys, the patient should drink more fluid, and if symptoms of coronary angiography complications occur (more about them below), consult a doctor immediately.

What the study shows

By filling the lumen of the coronary arteries, the contrast agent allows the doctor to assess the condition of the entire arterial system of the heart and the adequacy of the blood supply to these myocardial vessels. Thus, pathological changes are detected in the arteries, areas and the degree of their narrowing, and the reaction to contraction of the heart muscle.

The type and degree of narrowing (stenosis) is the main parameter that interests the doctor when performing coronary angiography.

If the lumen of the vessel is narrowed by less than 50%, the blood supply to the myocardium is not impaired, which means that the risk of developing ischemic complications is low. However, with progression pathological process(for example, the growth of an atherosclerotic plaque or the formation of a parietal thrombus), the lumen of the vessel will decrease - the prognosis will become unfavorable.
If the lumen of the vessel is narrowed by 50% or more, the myocardium experiences oxygen deficiency. This condition requires the rapid restoration of normal blood supply, since a delay can lead to a heart attack. The patient is recommended such types of interventions as coronary artery bypass grafting, balloon angioplasty or stent installation.

Stenosis and stenosis are different. There are several types of them, characterized by different prognosis for the patient:

local stenosis is the most favorable option, since it affects a small area of the vessel;
diffuse stenosis covers a long section of the vessel, with areas of narrowing and normal lumen of the vessel replacing each other;
uncomplicated stenosis - with even, smooth walls;
complicated stenosis - at the site of narrowing there is an atherosclerotic plaque with ulcerations or parietal thrombi; it is dangerous due to the high probability of progression of the process.

In addition to stenosis, coronary angiography can detect areas of occlusion (blockage) of the lumen of the vessel and atherosclerosis of varying severity.

When the study is completed, the doctor tells the patient about its results, answers questions and makes recommendations regarding treatment.

Complications

As a rule, if the patient follows all the recommendations and the doctor makes the diagnosis correctly, complications of coronary angiography practically do not occur. Sometimes the following complications may occur:

bleeding from the puncture site (occurs in 1 patient out of 1000);
hematoma (popularly - bruise), swelling at the puncture site;
formation of a pseudoaneurysm at the access site;
allergic reaction to contrast (as a rule, iodine-containing drugs are used, which are quite allergenic);
heart rhythm disturbances;
coronary thrombosis;
autonomic reactions (arterial hypotension, cold sweat and others);
ischemic stroke;
myocardial infarction;
damage to the artery through which the catheter was inserted until it ruptured;
contrast-induced nephropathy (kidney damage caused by a contrast agent);
death of the patient (less than 1 case per 1000 examinations).

The risk of complications is higher in the following categories of patients:

children and elderly/senile (65 years or more) people;
persons with heart defects;
persons with insufficiency of left ventricular function (EF less than 35%);
there is a narrowing of the left coronary artery;
persons with concomitant chronic pathology in the stage of decompensation (renal, liver failure, diabetes mellitus and others).

Conclusion

If necessary, after diagnostic coronary angiography, surgical intervention (bypass surgery, stenting, or other) can be performed.

Coronary angiography is a method for studying the condition of the coronary arteries of the heart, which involves the introduction of a contrast agent into them and the subsequent taking of a series of x-rays in different projections. This is a highly informative diagnostic method that allows you to determine the location and degree of narrowing (stenosis) of the artery in a patient with different forms of coronary artery disease, assess the risk of complications and develop the most effective treatment tactics.