Coronary Angiography

General Information

What is coronary artery disease?

Coronary artery disease is when your coronary arteries (the ones that supply blood to your heart muscle) become clogged with fatty material called 'plaque' or 'atheroma'. Plaque slowly builds up within the normally thin inner wall of your arteries, causing the arterial lumen to gradually become narrow. This process is called 'atherosclerosis'. It starts when you are young and can be quite advanced and widespread by middle age.

If the lumen (where blood flows) of your arteries becomes critically narrow (ie. 60%-70% narrow), then blood supply to your heart muscle is reduced and inefficient. This may lead to symptoms such as 'angina pectoris' (chest pain due to significantly narrowed coronary arteries), shortness of breath, and sometimes an irregular heart rhythm. Sometimes, even if there is not a significant narrowing within the coronary artery lumen, there can be a series of events that lead to a part of the plaque build-up to rupture, exposing the arterial wall to sticky platelets that normally flow within our bloodstream. This invariably leads to the sudden formation of a blood clot within the artery which quickly obstructs the normal flow of blood supply to a particular part of your heart. This is called 'myocardial infarction,' otherwise commonly known as a 'heart attack.'

What causes coronary artery disease?

Doctors and scientists are still unsure as to the exact cause of plaque build-up within the arterial walls. We believe there are probably numerous mechanisms responsible for this complex biological process that are inter-related, along with the normal aging process. However, we do know from large studies that there are certain population risk factors that significantly increase the chance of atherosclerosis in certain individuals. These are:

  • Smoking
  • High cholesterol
  • Diabetes
  • High blood pressure
  • Family history (especially first degree relatives)

Along with these factors, certain other states of health are also known to result in ordinarily silent plaque build-up in within the arteries becoming problematic, resulting in 'opportunistic' heart attacks. These tend to occur in at-risk individuals. These are usually related to the degree of inflammation within the body, such as during infections, inflammatory diseases (inflammatory arthritis), and sometimes during or just after surgery.

What is coronary angiography?

Coronary angiography is an important test, usually used when your doctor suspects, knows, or definitively needs to rule out that you have coronary artery disease.  Coronary angiography is when special types of real-time X-rays of your coronary arteries are taken. It shows your cardiologist if these arteries are narrowed or blocked.

Why do people need coronary angiography?

Your cardiologist may recommend that you undergo a coronary angiogram if:

  • you have chest pain that your doctor suspects is caused by narrowed coronary arteries
  • your cardiologist wants to assess the degree of narrowing in your coronary arteries to see if you could benefit from angioplasty or bypass surgery, to relieve your symptoms and reduce your risk of further heart problems
  • you have had a documented heart attack - or you have continuing chest pain, or the results of an exercise test indicate the need for further investigation, your doctor will need detailed information about your heart and arteries
  • as part of an overall work-up for a heart operation which may or may not involve concomitant by-pass surgery if your arteries are co-incidentally found to be narrowed (ie for heart valve surgery, it is always important to do an angiogram first)

Before your coronary angiogram, your cardiologist will discuss all the potential risks weighed up against the possible benefits. He or she will answer any questions that you or your family may have.

If you agree to have the procedure after discussing this with your cardiologist, you will be required to sign a consent form, which will be done either in the consulting rooms or in the recovery room just prior to your procedure.

  • Professor Sanders says...

    Atrial fibrillation is a consequence of several reversible risk factors - high blood pressure, diabetes, obesity, sleep apnoea, and excessive alcohol. Your management of atrial fibrillation must include strict control of these risk factors.