Lets decode medical verbatim first. Below are few commonly used terms and their meaning.
Cardiac: related to heart
Coronary artery: blood vessels that supply blood to heart. When blocked, these vessels are responsible for heart attack and other related issues.
Angiography: process of looking at coronary arteries
Angioplasty: process of fixing a blocked or damaged coronary artery.
Your doctor may recommend for angiography if there's reasonable suspicion that your coronary arteries may be blocked. Doctors make such decision based on your symptoms, and available test results like ECG, echocardiogram, or stress tests. Angiography is the best test available to know for sure if coronary arteries have any blockages or not. Sometimes if clinical situation is urgent (if ongoing heart attack is suspected), an emergency angiography may be recommended which should typically be done as soon as possible.
Angiography involves inserting thin flexible tubes (catheters) from the wrist or groin. Catheter is then taken up to the heart and pictures of coronary arteries are taken under xray. In a typical scenario, diagnosis can be made in real time. A routine angiography takes about 15 minutes. Patients typically spend less than one hour total inside cardiac cath lab (place where angiography is performed).
For centers well versed with cardiovascular services, coronary angiography is a routine procedure with most high volume centers doing at least a few of those daily. Enormous operational experience exists among cardiology community, making this one of the safest procedures done. Although there is always risk of disasters happening (like death, stroke/paralysis) when catheters are inserted in the body, particularly around heart, fortunately such incidents are extremely rare. The procedure itself is virtually pain free (this is not 100% since all of us have different pain threshold and some perceive significantly higher pain for any given stimulus). Other complications listed in textbooks like infection, medication reaction etc. are also very uncommon. Two issues worth listing are follows: bleeding and kidney damage. Bleeding occurs typically in people who are predisposed to it to begin with like patients taking blood thinners, elderly population etc. Kidney damage is more common in patients who have underlying kidney disease and in such patients, angiography should be considered weighing risks and benefit.
Angioplasty on the face of it looks similar to angiography. Since it involves fixing a problem (like a blockage), it is more time taking than angiography. The procedure uses special catheters, wires, balloons, and stents as needed. After completion of cardiology training (DM), certain cardiologists opt for additional training dedicated towards coronary angioplasty and other cardiac interventions to master this skill set. You will always find cardiologist with such dedicated training around you.
Because angiography or angioplasty is an invasive procedure, a certain level of preparation is required prior to the procedure. Patients are instructed to report to the hospital in a fasting state (meaning nothing to eat or drink after dinner the night before). Patients should take their routine medications as scheduled, except diabetes medicines which should be held on the morning of the procedure. Blood thinners (Warfarin, Acitrom, Rivaroxaban, Epixaban etc.) should be stopped a few days prior. Patients who are sick due to other illness should report to their doctors. Pre-procedure evaluation may involve blood tests, xray, and/or echocardiogram. Only when doctor is satisfied with the available information, he/she will approve for the procedure. Once the procedure is done, results are typically available instantaneously. Please ask for a CD of the procedure for your records. Be prepared to spend most of that day in the hospital. Driving is not recommended after the procedure, so one should have a designated driver, or take a taxi back home. In cases of angioplasty, patients are typically kept in the hospital for 1-2 days for observation.
When introduced in 1970-80s, angiography and angioplasty was one of the most novel procedures. With experience and updated technologies, it is now considered a routine procedure with excellent safety and efficacy. When performed in urgent/emergent situation, it not only saves lives, but also provides quality of life (compared to medications alone). While an elective (non-urgent) procedure merits a detailed analysis before decision to go for coronary angiography is made, urgent cases should go for this life saving procedure without any time delay. At the time of heart attack, there is ongoing irreversible damage to heart muscle, and one should save every minute possible.
I am sure I haven't addressed all routine queries related to angiography and angioplasty in this article. Feel free to write to me any unanswered question and I will be happy to help.
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