Is it necessary to do a cardiac angiography if you feel uncomfortable in your heart? How to choose whether to do it or not? Are there any alternative methods?

Yesterday I met a family member who was too "filial":

The patient was an 85-year-old lady who came to the hospital for a checkup because of palpitations. The electrocardiogram showed: arrhythmia and atrial fibrillation. The doctor recommended a complete cardiac ultrasound and 24-hour dynamic electrocardiogram to evaluate the condition.

Unexpectedly, the family members were very "active": "Doctor, when can we do a cardiac angiography? Let's see what's wrong with the heart?"

The doctor rejected the family's idea and explained, "The patient is not suitable for cardiac angiography. First, the patient has arrhythmia, and angiography is to check myocardial ischemia, not a disease. Second, the patient is old, and the risk of angiography is too high. Try not to take this risk unless it is absolutely necessary."

Should I undergo cardiac angiography if I feel uncomfortable in my heart? What are the pros and cons of cardiac angiography? Let's hear what the doctor says:

1. The use of cardiac angiography

Cardiac angiography can determine the degree of stenosis of the coronary arteries and is used to diagnose coronary heart diseases such as angina pectoris and myocardial infarction. If the degree of stenosis is greater than 75%-80%, interventional treatments such as stent implantation can be performed directly during angiography.

However, cardiac angiography has no diagnostic value for rheumatic heart disease, cardiomyopathy, valvular heart disease, arrhythmia and other diseases, so it is not a routine examination item. Cardiac angiography is only performed when the doctor needs to exclude whether the patient has myocardial ischemia that affects the condition.

2. In what situations should angiography be performed with caution?

1. Uncontrolled heart failure

Cardiac angiography requires the injection of iodinated contrast agents into blood vessels to make them visible. However, a large amount of contrast agents entering the human body in a short period of time will increase the burden on the heart and may worsen heart failure.

2. Renal insufficiency

The contrast agent is excreted from the body through the kidneys. However, the contrast agent will affect the blood and oxygen supply to the kidneys and has a certain cytotoxic effect, which may aggravate renal insufficiency.

3. Elderly and weak people

Although cardiac angiography is a minimally invasive surgery, the surgical instruments are transported through the arteries. For elderly and weak patients, there is a greater risk of arterial damage, hematoma, and even bleeding. In addition, the iodine in the contrast agent will aggravate the condition of patients with hyperthyroidism, so it is not suitable for examination.

3. Are there any alternative methods?

1. If the patient has typical symptoms of myocardial ischemia and has no contraindications to surgery, cardiac angiography is recommended and stents can be directly implanted if necessary.

2. For patients with atypical symptoms but multiple risk factors who need to exclude coronary heart disease, coronary artery CTA or dynamic electrocardiogram examination can be performed. If there is evidence of lesions, cardiac angiography can be performed.

3. Cardiac MRI can assess the degree of coronary artery stenosis and myocardial ischemia, but the accuracy of the test results is greatly affected by the level of the hospital and needs further development.

I am Dr. Zhang from the Department of Cardiology. If you like my popular science articles, please like them! Follow me to learn more about heart disease! You can also share this article with friends in need!