Evidence Brief: Coronary Computed Tomography Angiography ...
Coronary Angiography What I should Know?. A specialised test to find out detailed information about...
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Transcript of Coronary Angiography What I should Know?. A specialised test to find out detailed information about...
Coronary Angiography
What I should Know?
• A specialised test to find out detailed information about the arteries of your heart.
Coronary arteries do not show up on a plain X-ray. With coronary angiography, dye is injected down the
coronary arteries. The arteries and their smaller branches then show up clearly 'like a road map'
What is it???
Heart Disease: Blockage of the vessels
• Failure of oxygen delivery caused by a decrease in blood flow in front of increased oxygen demand of the heart
Pain/Angina Heart Attack
WHY I Need to Know State of my coronary Arteries
coronary angiography can show the exact site and severity of any narrowing of the coronary arteries
THEN(5-6 years from now)• It is mainly used if you have angina , to assess the extent
and severity of the angina.
Now It is used to know if your heart is healthy or has the disease
started & to assess the extent & severity.
ANGIOGRAPHY
• Before the day of the test you may need a blood test and an ECG to make sure you are OK to have the procedure.
• If you take a 'blood thinning' drug (anticoagulant), then you are likely to need to stop this for 2-3 days before the test. (This prevents excessive bleeding from the site of the catheter insertion.)
• You may be asked to stop eating and drinking for a few hours before the test.
• A blood test to check your Kidneys are fine
• You may be asked to shave both groins before the test.• You will have to sign a consent form at some point before the test to
confirm that you understand the procedure, understand the possible complications and agree to the procedure being done
How do I prepare for the procedure
Complications!! Oh My God!
What are these??
A bruise, which may form under the skin where the catheter was inserted (usually the groin). This is not serious, but it may be sore for a few days.
You may need to have few stitches at the groin if a small cut has been made.
• There May be risk of Excessive Bleeding or Bleeding may not stop all together• May lead to balooning of vessel–Aneurysm formation
• The small wound where the catheter is inserted sometimes becomes infected. Tell your Doc if the wound becomes red and tender. A short course of antibiotics will usually deal with this if it occurs.
some people have had a stroke or a heart attack (myocardial infarction) during the procedure.
rarely, the catheter may damage a coronary artery.
some people have even died during this procedure.
Serious Complications
DO I Have an Alternative
•
Really
CT CORONARY
ANGIOGRAPHY
Now What is It??
Same Procedure to see artery of the heart
But Without any need to insert the catheter
How is this performed
• With the help of an Ultrafast CT Scan Machine
Can All CT Machines perform this test
• No• Only multidetector CT Scan with atleast 64 slice /detectors• Other machines : 128 detectors CT , 256
Detector CT and best of all Dual Source CT(DSCT)
SOMATOM Definition DSCT-Dual Source CT Scanner The World’s First Dual Source CT
Two X-Ray sources and two detectors at the same time
Is Dual Source CT and Dual Slice CT one n the same thing
• Not at all• Dual Slice CT is capable of only taking 2 Images
/rotation and is a basic entry level CT machine only
• A 64 Slice CT can take upto 192 images /sec• Where as a Dual Source CT (the best one and
the fastest) can take upto 776 images/sec
64 slice CT : is it sufficient for CTA• Maybe. • It would require to give you medicines to lower
your heart rate to less than 60/minute to achieve the diagnostic quality images and heart beet needs to be very regular. Otherwise , we may not be able to perform angiography on 64 Slice CT
Presently- it is considered outdated machine to perform a CT Heart Angiography
DSCT ANGIO- No Need To Reduce Heart Rate
• Dual Source CT is independent of heart rate and is capable of imaging any beating heart
Experience with CT Angio
• Just Walk in and Walk Out
Any preparation needed
• Simply 2-3 hrs Fasting prior to the test• A blood test to check your Kidneys are fine
Why Kidney test
• The dye used in Angiography is excreted by kidney
• If Kidney is not functioning properly then this dye can act like poison
• We have a better but costlier option which can also be used instead
Visipaque– Renal safe contrast agent when kidney functioning
is compromised & test must be performed.
‘Because we care’...
Do I need hospital care
• In less than half an hour u r free to resume your daily routine
• No Hospitalisation• No admission• No Drugs to reduce ur heart rate• No pains & all Gains
Who can get this test done
• Anyone who wants to know the state of his heart
• Person with – Diabetes– History of heart disease in family– Hypertension– Bad Cholesterol levels
Other modifiable risk factors
Smoking
Obesity
Bad eating habits
Lack of exercise or sedentary life style
Who else
• A person who has not very high pretest probability of severe heart disease i.e A person who has not had angina but effort intolerance is there.Other test such as Echo and TMT are normal. ECG is normal.
Is it for heart patients too
• It is advisable that a cardiac patient who has had Heart attack should ideally go in for Conventional Invasive catheter Angiography as it can even lead to Angioplasty at same time
BUTIf a patient is afraid or evading an angiography This is definite answer to persuade the patient
If I already am diagnosed and treated for the Heart disease- can it help me
• Definitely
• For Stent patients- followup for stent patency or recurrance of disease in any other vessel or any other cause of symptoms
• For Post CABG/Bypass surgery; to look for graft occlusion.
Is this test as effective to diagnose disease as routine angiography
yes & No
• If it is 64 slice CT it depends on your heart rate• If Dual source CT then as effective and
sometimes better as it can also tell about plaque character – whether soft or hard
How is a CT Angiography done
This is how ordinary single source machine with high heart rate show heart
•