Editors

HelenaKervinen

Diagnostic Coronary Angiography

Coronary angiography is used to investigate the anatomy of the coronary arteries and to assess the number, location and severity of possible coronary stenoses.
In the case that a significant stenosis is found it is possible at the same time to perform a therapeutic intervention, i.e. balloon angioplasty (also using a drug-eluting balloon) and, if needed, insertion of a metal mesh (bare-metal or drug-eluting stent) to secure the patency of the vessel.

The way to proceed can be agreed upon in a regional care pathway, but a cardiologist's assessment is often needed concerning the indication http://www.dynamed.com/evaluation/diagnostic-cardiac-catheterization-and-coronary-angiography#GUID-C5E4163D-5255-4E07-B4BA-CEA0E0FBA0AF of the procedure. The suitability of the patient for potential invasive treatment interventions (PCI or CABG) and for the necessary pharmacotherapy should be assessed beforehand.
Exercise-related angina pectoris symptoms (chest pain, dyspnoea, fatigue) during medication and a very high pretest probability of CHD (> 85%): consider either coronary angiography or other type of diagnostic imaging.
Exercise-related symptoms that repeatedly disturb the life of the patient despite optimal medication, when the pretest probability of CHD is 15-85% and the patient has findings suggestive of ischaemia either in an exercise stress test or in another diagnostic imaging study.
Exercise-related angina pectoris symptoms (chest pain, dyspnoea, fatigue) during medication, when the pretest probability of CHD is HASH(0x304aee0) 15% and the patient has some other finding suggestive of ischaemia (reduced left ventricular function or a local wall motion disturbance, arrhythmias).

ST elevation myocardial infarction (STEMI): coronary angiography should be performed as soon as possible; see Acute coronary syndrome and myocardial infarction Acute Coronary Syndrome and Myocardial Infarction.
Non-ST segment elevation myocardial infarction (NSTEMI): coronary angiography is performed according to the clinical situation, nonetheless within 2-72 hours; see Acute coronary syndrome and myocardial infarction Acute Coronary Syndrome and Myocardial Infarction.

Heart failure of unknown aetiology or wall motion disturbance: search for the cause
As further investigation in a patient surviving resuscitation after ventricular fibrillation
Assessment of invasive management of a valvular heart disease
Assessment prior to heart transplantation