Image Description:
Angiocardiography - Frontal view of the trunk from neck to groin with the heart, abdominal aorta and branching femoral arteries. A catheter is shown as being inserted in the right femoral artery, passing through the abdominal aorta, and entering the heart's left ventricle.
Click to see ImageAngiocardiography is examination of the blood vessels or chambers of the heart. It is performed by tracing, via x-ray or nuclear medicine, the course of a contrast dye or radionuclide that has been injected into the bloodstream. These pictures are called angiograms. The left ventricle, heart valves, coronary arteries, aorta, and pulmonary arteries are the structures most often examined with this technique.
In traditional angiocardiography, a contrast material or dye is injected into the coronary arteries. The contrast material absorbs x-rays differently than do the surrounding blood vessels and soft tissue, allowing heart structures to be more clearly visualized on film. Once the contrast material is injected, large x-ray films are exposed in two planes at right angles to each other, which permits the simultaneous recording of two different views (bi-plane angiocardiography). Angiocardiography is part of what is traditionally called “cardiac catheterization” and is usually restricted to the left side of the heart. During cardiac catheterization, pressure and oxygenation measurements, flow measurements, and an injection of contrast into the left ventricle are also performed, in addition to the angiogram (pictures) of the coronary arteries.
Because it is classified as an invasive procedure, angiocardiography must be performed in a hospital setting under strict controls. Recent advances in echocardiography, which is not invasive and does not use radioactive material, as well as 128 slice CT angiography, can replace angiocardiographic evaluations for some individuals (Cullen).
Radionuclide angiography is becoming an outdated technique. Synonyms include radionuclide ventriculography (RVG), radionuclide cine angiography (RNCA), and multiple gated cardiac blood pool imaging (MUGA). Radionuclide angiocardiography uses red blood cells that have been tagged with a low-level radioactive substance so that their path through the circulatory system can be tracked. Several variations of radionuclide angiocardiography are used, including first-pass radionuclide angiocardiography, which examines only one pass of the substance through the heart, and equilibrium radionuclide angiocardiography or gated equilibrium radionuclide angiocardiography, which follows passage of the radionuclide through hundreds of cycles and looks at specific phases of heart function. This imaging provides information about heart chamber size and contractility, but provides little information about coronary artery flow (patency), despite some of the names used to describe it. As echocardiography has improved, this procedure is being used less. |
Source: Medical Disability Advisor
Angiocardiography can provide both structural (anatomic) and functional (hemodynamic) information about the heart and its vessels. It may reveal anatomical abnormalities such as aneurysms, narrowed or obstructed coronary arteries, or heart chamber enlargement. Angiocardiography can also demonstrate leaky heart valves or the failure of a valve to close that result in a regurgitation of blood.
Imaging of the ventricle helps evaluate the heart's performance. Another, more accurate measurement of how the heart is functioning is the ejection fraction (the percentage of the heart's maximum blood volume that is ejected into the aorta in a single heart beat). This measurement correlates well with the individual's prognosis and is widely used as an index of ventricular performance.
Ventricular function can also be assessed by radionuclide ventriculography.
Individuals should not have angiocardiography if they have a history of allergic reaction to contrast material. |
Source: Medical Disability Advisor
Angiocardiography is an invasive procedure done under sedation/anesthesia. Although the actual procedure only takes about 1 hour, preparation and recovery are an all-day process, and some individuals may need to remain in the hospital overnight.
The procedure is performed by inserting a long narrow tube (cardiac catheter) into a blood vessel, usually in the groin or arm, and then advancing it toward the heart. The catheter is placed into a vein to visualize the right side of the heart and into an artery to examine the aorta, coronary arteries, and left side of the heart. After the catheter tip has been guided into the appropriate chamber or vessel, contrast medium is injected through the catheter. The contrast medium mixes with the blood and moves through the circulation, with the movement observed and the image recorded. |
Source: Medical Disability Advisor
| The outcome from the procedure itself is expected to be uneventful. The risk of major complications during the procedure is 1% to 2%, and the death rate from the procedure is about 0.11% (Garcia-Borbolla). The test, in general, gives accurate indications of heart and blood vessel structure and function. |
Source: Medical Disability Advisor
- Cardiologist, Cardiovascular Physician
- Nuclear Medicine Specialist
|
|
Source: Medical Disability Advisor
| No rehabilitation is necessary after cardiac catheterization. |
Source: Medical Disability Advisor
Source: Medical Disability Advisor
Serious reactions to the contrast material may occur, despite continued efforts to develop less harmful materials. Allergic reactions may include hives (urticaria) and inflammation of eye and eyelid tissues (conjunctivitis). Lung spasms (bronchospasm), swelling of the throat (laryngeal edema), and difficulty breathing (dyspnea) are rare reactions.
Major complications such as cardiac arrest, bleeding, infection, a blood clot in a vessel, muscle contractions and capillary dilation (anaphylactic reactions), shock, convulsions, blue skin (cyanosis), and kidney (renal) toxicity from the injected contrast agent are rare. Should a blood clot become loosened, it could damage other parts of the body and result in very serious disability or, in rare cases, death. In very rare cases, perforation of a coronary artery occurs, necessitating emergency cardiac surgery.
Abnormal ventricular rhythms (arrhythmias) are common if the catheter tip contacts the wall of the ventricle. |
Source: Medical Disability Advisor
| Disability may be influenced by factors such as the site of insertion of the catheter, the setting (inpatient or outpatient), and any complications. |
Source: Medical Disability Advisor
| The underlying condition for which the angiocardiography was performed may require adjustments in work requirements. In terms of the procedure itself, nonstrenuous work may resume within a few days following the procedure. Strenuous physical activity or exercise should be temporarily avoided. Risk: Risk of the procedure is low. The greater risk consideration is the underlying reason for the procedure, usually for Coronary Artery Disease. Capacity: The procedure may greatly improve capacity if it is associated with an intervention of stenting. Exercise stress testing remains the method of choice for evaluation of cardiac capacity. Tolerance: There would be no expected effect on tolerance. |
Source: Medical Disability Advisor
Source: Medical Disability Advisor
| CitedCullen, M. W. , and P. A. Pellikka. "Recent advances in stress echocardiography." Current Opinion on Cardiology 26 (5) (2011): 379-384.Garcia-Borbolla, Mariano, Rafael Garcia-Borbolla, and Begona Balboa. "Complications of CardiacCatetherization." Advances in the Diagnosis of Coronary Atherosclerosis. Ed. Suna Kirac. InTech, 2011. |
| GeneralKern, M. J. Cardiac Catheterization Handbook: Expert Consult. 5th ed. Philadelphia: Elsevier Saunders, 2011. |
Source: Medical Disability Advisor