When is this exam indicated?
Coronarography allows to assess the state of patency of the heart coronary arteries; this examination, therefore, is useful in identifying narrowings (stenosis), occlusions and/or other abnormalities that may affect the arterial vessels supplying blood to the myocardium. Therefore, it is performed in acute cases for patients suffering from myocardial infarction, or alternatively for patients with angina pectoris at stress and/or at rest, or with evidence of ischemia inducible by functional tests (stress test, myocardial scintigraphy, echocardiography stress).
How is it performed?
A short 3-day hospitalization is required. While the patient is fasting, the heart and coronary arteries are reached with small catheters under local anesthesia in the groin. A contrast liquid is then injected, a substance that highlights the coronary arteries and any obstructions. If a narrowing exceeding in general 70% is confirmed (diagnosis of significant coronary stenosis), the most appropriate treatment can be proceeded through:
- medical therapy;
- coronary angioplasty (most frequent choice);
- aortocoronary bypass surgery (in case of multiple lesions involving several coronary branches, not favorable for angioplasty and for diabetic patients). A coronarography can take from 15 minutes to more than an hour, depending on its being followed or not by coronary angioplasty.
There are no absolute contraindications to coronarography, only relative ones; the latter, in particular, are:
- Severe hypertension;
- Ventricular arrhythmias;
- Severe anemia;
- Severe allergy to the contrast medium;
- Acute renal failure;
- Electrolyte abnormalities and imbalances (e.g., hypokalemia);
- Active gastrointestinal bleeding.