冠状动脉造影

定义

冠状动脉造影 is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart.

选择的名字

Cardiac angiography; Angiography - heart; Angiogram - coronary; Coronary artery disease - angiography; CAD - angiography; Angina - angiography; Heart disease - angiography

如何执行测试

冠状动脉造影 is sometimes performed with 心导管检查. This is a procedure that measures pressures in the heart chambers.

Before the test starts, you will be given a mild sedative to help you relax.

An area of your body (the arm or groin) is cleaned and numbed with a local numbing medicine (anesthetic). 心脏病专家通过一根细空心管, 叫做导管, through an artery and carefully moves it up into the heart. X-ray images help the doctor position the catheter.

Once the catheter is in place, dye (contrast material) is injected into the catheter. X-ray images are taken to see how the dye moves through the artery. The dye helps highlight any blockages in blood flow.

这个过程通常持续30到60分钟.

如何准备考试

You should not eat or drink anything for 8 hours before the test starts.

你要穿病号服. 你必须在测试前签署一份同意书. Your health care provider will explain the procedure and its risks.

如果你:

• Are allergic to any medicines or if you have had a bad reaction to contrast material in the past
• 正在服用西地那非(伟哥), 伐地那非(血管扩张药), tadalafil (Cialis) or other medicines from this class
• 可能怀孕了

考试的感觉如何

在大多数情况下，你会在测试过程中保持清醒. You may feel some pressure at the site where the catheter is placed.

You may feel a flushing or warm sensation after the dye is injected.

测试结束后，取出导管. You might feel a firm pressure being applied at the insertion site to prevent bleeding. 如果导管放在腹股沟, you will be asked to lie flat on your back for a few hours to several hours after the test to avoid bleeding. 这可能会引起轻微的背部不适.

为什么要进行测试

在下列情况下可进行冠状动脉造影:

• 你第一次得了心绞痛.
• 你的心绞痛越来越严重, 不会消失, 发生的频率更高, 或在休息时发生(称为 不稳定性心绞痛).
• 你有 主动脉瓣狭窄 或者另一个阀门问题.
• 你有 atypical chest pain, when other tests are normal.
• 你的心脏压力测试不正常.
• You are going to have surgery on your heart and you are at high risk for coronary artery disease.
• 你有 心脏衰竭.
• 你被诊断为心脏病发作.

正常的结果

There is a normal supply of blood to the heart and no blockages.

异常结果意味着什么

An abnormal result may mean you have a blocked artery. The test can show how many coronary arteries are blocked, 它们被阻塞的地方, 以及堵塞的严重程度.

风险

Cardiac catheterization carries a slightly increased risk when compared with other heart tests. However, the test is very safe when performed by an experienced team.

Generally, the risk for serious complications ranges from 1 in 1,000 to 1 in 500. 手术的风险包括:

• 心脏压塞
• 不规则的心跳
• 心脏动脉受伤
• 低血压
• Allergic reaction to contrast dye or a medicine administered during the exam
• 中风
• 心脏病

注意事项 associated with any type of catheterization include the following:

• In general, there is a risk for bleeding, infection, and pain at the IV or catheter site.
• There is always a very small risk that the soft plastic catheters could damage the blood vessels or surrounding structures.
• Blood clots could form on the catheters and later block blood vessels elsewhere in the body.
• The contrast dye could damage the kidneys (particularly in people with diabetes or prior kidney problems).

注意事项

如果发现堵塞, your provider may perform a percutaneous coronary intervention (PCI) to open the blockage. This can be done during the same procedure, but may be delayed for various reasons.

参考文献

Dangas GD, Mehran R. 冠状动脉造影和血管内成像. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12日艾德. Philadelphia, PA: Elsevier; 2022:chap 21.

Fihn SD, Blankenship JC, Alexander KP，等. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, 预防心血管护士协会, Society for Cardiovascular Angiography and Interventions, 和胸外科学会. 我是科尔·卡迪诺. 2014;64(18):1929-1949. PMID: 25077860 pubmed.ncbi.nlm.国家卫生研究院.gov / 25077860.

Kern MJ, Kirtane AJ. 导管和血管造影. 参见:Goldman L, Schafer AI主编. Goldman-Cecil医学. 26日艾德. Philadelphia, PA: Elsevier; 2020:chap 51.

Werns年代. Acute coronary syndromes and acute myocardial infarction. 见:Parrillo JE, Dellinger RP，编. Critical Care Medicine: Principles of Diagnosis and Management in the Adult. 5日艾德. Philadelphia, PA: Elsevier; 2019:chap 29.