Do you have to do cardiac angiography if you have coronary heart disease? Is there any other way?

Cardiography, to be precise, coronary angiography, is just an examination, the purpose of which is to find out whether there are atherosclerotic plaques on the wall of blood vessels (coronary arteries) that supply blood to the heart. If yes, how narrow the vascular lumen is, so as to judge whether there is coronary heart disease, which is also the gold standard for diagnosing coronary heart disease.

Is there any other way to diagnose coronary heart disease besides coronary angiography? What should I do if I dare not do it for various reasons or can't do coronary angiography because of renal failure?

We say that coronary angiography is the gold standard for diagnosing coronary heart disease, but it is not the only standard. There are also the following methods to help you judge whether you have coronary heart disease.

1. Symptoms

There is tension, pain and discomfort in the precordial area or middle chest related to activity, fatigue or emotional excitement, which is generally the size of the palm of your hand and lasts for several minutes. After rest, the symptoms gradually improve. This condition should be considered as angina pectoris of coronary heart disease, and it will not be relieved after more than 15-20 minutes. To be alert to acute myocardial infarction, you need to go to the hospital for further examination immediately.

2. ECG

For patients with chest tightness and chest pain for a few minutes, ordinary electrocardiogram is likely to be normal. It is necessary to do dynamic electrocardiogram or exercise test to judge whether there is coronary heart disease.

Dynamic electrocardiogram examination: Do this examination, never lie down and rest. Exercise as usual, even need to climb stairs deliberately, inducing chest tightness and chest pain discomfort. At this time, the electrocardiogram will be recorded, and you should stop and rest immediately after the attack. After 24 hours, the doctor will analyze your 24-hour ECG changes. If you have ECG changes of myocardial ischemia during chest tightness and chest pain, but the ECG is normal when there are no symptoms, then it is very likely to diagnose coronary heart disease.

Exercise test: Walking fast on a treadmill-like device can adjust the speed from slow to fast. At the same time, the patient is attached with an electrode sheet, which is connected with an electrocardiogram machine. Chest tightness, chest pain and discomfort occurred during exercise, and ECG showed ischemic changes. After stopping exercise, the subjects' symptoms gradually eased and their electrocardiogram returned to normal, that is, the exercise test was positive, so it is very likely that coronary heart disease will be considered.

3. Coronary CTA

Put a indwelling needle on the arm, and when doing ct examination, inject the contrast agent quickly, and the contrast agent will flow into the heart blood vessels, and then perform CT scanning. Finally, the coronary artery is imaged in the background to see if there is coronary artery stenosis and judge the degree of stenosis. However, due to the influence of coordination, heart rate, breathing and other factors, the accuracy is not as good as that of coronary angiography. And the dosage of contrast agent is more than that of coronary angiography. In order to prevent contrast-induced nephropathy, drink plenty of water after examination and discharge contrast as soon as possible. Patients with abnormal renal function need to be evaluated by doctors before deciding whether they can be examined.

4. Blood test myocardial markers

Patients with chest tightness and chest pain lasting more than 15-20 minutes should be alert to acute myocardial infarction. Myocardial markers will increase in patients with acute myocardial infarction, but the specific cardiac marker troponin will generally increase after 4 hours, so the first examination of troponin is normal and needs reexamination.

Then, the above examination methods are highly suspicious of coronary heart disease. Is it necessary to do coronary angiography?

The word "certain" is too absolute, and it is necessary to seek the opinions of patients and their families. However, from the treatment point of view, Dr. Xu still suggested that the following patients should have coronary angiography.

Patients with acute myocardial infarction and unstable angina pectoris, including patients with initial angina pectoris, aggravated angina pectoris and angina pectoris with poor drug treatment, all have unstable plaques in their bodies. Coronary angiography helps to find them. A lot of evidence shows that interventional therapy for these patients is helpful to reduce myocardial infarction, cardiovascular death and improve prognosis.

For patients with fatigue angina pectoris whose condition is very stable, the drug treatment effect is very good. Studies have shown that compared with drug therapy, interventional therapy can not bring further benefits to such patients, so coronary angiography and interventional therapy are not needed.

I hope the above answers are helpful to everyone!

The wife of Mr. Huang of a company said near the clinic, doctor, can you take an X-ray for me? We are not short of money!

I said: Why are you uncomfortable? Electrocardiogram, color Doppler ultrasound and other examinations are not routine examinations, but invasive examinations, which are risky.

Mr. Huang: Isn't angiography the best way to check the heart?

Dr. Wang: No, there are many kinds of heart diseases. It is good to choose the one that suits the patient. This is not the best angiography. And the most important thing in angiography is to check the blood vessels of the heart, that is, to see if there is coronary heart disease. It is impossible to detect all heart diseases after angiography!

Mr. Huang: Then make one. Anyway, nothing!

Dr. Wang: Of course, because filming is risky.

1, bleeding or hematoma:

Invasive examination is to enter the human body. Electrocardiogram needs to put a tube at the puncture site (wrist or femoral root artery). Connecting the outside world with blood vessels through this connecting tube, also called sheath tube, may cause local bleeding, systemic bleeding, hematoma at puncture point, vasospasm, damage to the inner wall of blood vessels, pseudoaneurysm and arteriovenous fistula, arterial occlusion and so on.

2, contrast nephropathy:

Since it is radiography, contrast agent must be used, and the contrast agent needs to be metabolized by the kidney, especially diabetes, renal insufficiency and the elderly are more prone to contrast-induced nephropathy.

3. The risk is minimal:

Complications such as guide wire breakage, catheter breakage, catheter guide wire knotting, angina pectoris attack, acute myocardial infarction, acute vasospasm, coronary artery dissection, coronary artery perforation, various arrhythmias and various embolism.

After listening to Mr. Huang, he immediately said that he would quit!

I told him not to do it because it was dangerous, but because it was unnecessary. Because you don't have typical coronary heart disease, there is no need to take risks.

But if it is necessary to do angiography, do it even if it is risky!

Electrocardiogram (ECG) is a common examination of cardiovascular system and a common method for diagnosis and treatment of coronary heart disease. To some extent, it is the "gold standard" for diagnosing coronary heart disease. In other words, whether you have coronary heart disease or cardiovascular stenosis, just do an angiography!

Now coronary angiography is becoming more and more popular, and medical institutions of all sizes can complete this examination, but the control of indications is becoming less and less strict. Today, let's talk about what kind of people should do!

These seven conditions require cardiac angiography: 1, acute myocardial infarction:

I won't say this, I have to do it, I have to do it, the sooner the better! Don't hesitate, because only when you finish the angiography immediately, see where it is blocked, and immediately open the blood vessels, can you save lives!

2, clear angina pectoris, especially angina pectoris that drugs can't control:

Drug treatment is definitely the first choice for fatigue angina pectoris; For unstable angina pectoris, coronary angiography is recommended for further examination. Of course, fatigue angina pectoris may also develop into aggravated fatigue angina pectoris, so it is necessary to decide whether to do angiography according to the specific situation.

3. Sudden left bundle branch block:

This is an ECG change, and sometimes an ECG abnormality is found, complete left bundle branch block; The most important thing is that the electrocardiogram is normal at ordinary times, and this kind of complete left bundle branch block suddenly appears. Angiography is also needed to rule out the left cardiac end caused by myocardial ischemia; The guideline clearly points out that sudden left bundle branch is necessary to improve coronary angiography.

4. Unexplained cardiac insufficiency:

The first symptom of some patients is heart failure, but the cause is unknown. It is suggested that coronary angiography should be improved first to make clear the coronary vessels. Because some people have atypical angina pectoris, they will have heart failure as soon as they have symptoms; Of course, it is necessary to exclude definite heart failure such as hypertensive heart failure, rheumatic heart failure, cor pulmonale heart failure, valvular heart failure, cardiomyopathy heart failure and so on.

5, sudden ventricular arrhythmia can't clear the reason:

Sudden ventricular arrhythmia, eliminating electrolyte disorder, heart failure and heart structural problems; In order to find out whether it is arrhythmia caused by coronary heart disease. Do a coronary angiography.

6. Survive from sudden death:

Sudden syncope, loss of consciousness, etc. After active rescue and elimination of brain-derived and malignant arrhythmia, it is suggested to improve coronary angiography. Because sudden cardiac death accounts for the vast majority, and cardiovascular disease is the most sudden cardiac death.

7. Angina recurrence after stent implantation:

This really needs to be done, one is to see if there is stent restenosis, the other is to look at other blood vessels, and it is best to combine the results of the last angiography.

Under normal circumstances, it is not the patient who wants to do angiography, nor is it the doctor who casually asks the patient to do angiography.

We must grasp the indications of cardiac angiography and do it again, instead of being a radiologist and letting patients do it when they meet patients. This is not the same as a machine.

People who shouldn't do angiography, if they do angiography, can only increase the risk and harm; People who have to do angiography are worth it even if there are risks, because angiography can help us solve problems.

I hope that patients will seek medical treatment in time if they have problems, follow the process, have more trust and less doubt.

After all, we are professionals!

I hope those radiologists don't say, "Let's do an angiogram!" " When they see a doctor, they don't care.

After all, we are all parents and children. Do to others what you don't want them to do to you! After all, people are doing it, and the sky is watching!

Coronary angiography is one of the core examinations of coronary heart disease, but it is not necessary!

What is coronary angiography? Coronary angiography is the gold standard for the diagnosis of coronary heart disease, and it is also an invasive examination, which is harmful to patients. Therefore, unlike other examinations, it generally requires the judgment of a professional doctor.

All patients were awake after coronary angiography, and the operation time could be completed within 10 minutes (all went well). If the patient's blood vessels are thin and difficult to find, it may be extended for a period of time, but generally it is a minor surgical examination.

1, the doctor will puncture the patient's right hand artery and put a sheath tube, which is the basis of everything.

2. Send the contrast catheter into the heart through the sheath.

3. Inject the contrast agent through the contrast catheter and observe it from the outside through X-ray.

Therefore, coronary angiography is an invasive examination. No doctor dares to say that angiography is necessary. Angiography needs to consider many conditions.

Coronary angiography is accurate, but it is not the only way! First of all, I need to remind everyone: don't just say that you have coronary heart disease. Maybe you have chest tightness, chest pain and other symptoms, but that doesn't mean you have coronary heart disease. I didn't mean to attack anyone, but at present, there are indeed many doctors who assert that they are "coronary heart disease" as soon as they hear chest pain and chest tightness without detailed inquiry and examination. This kind of consultation is not reliable.

Angiography is necessary, but it should be the last step in the diagnosis of coronary heart disease. A patient suspected of coronary heart disease needs a comprehensive examination, such as the most basic electrocardiogram, which can give some basic information, such as arrhythmia and myocardial ischemia. And then exercise test (dynamic electrocardiogram) to see whether the myocardial blood supply is normal during exercise. If the situation is not optimistic at this time, don't worry about angiography. You can also choose coronary CTA, although the accuracy is not as high as angiography, but you can roughly find out whether there is coronary artery stenosis, and then doctors can basically find the problem through symptoms, medical history and examination. At this point, angiography should be considered for final clarification.

Is coronary angiography necessary for coronary heart disease? This is indeed a question in many people's minds. It can be said that any cardiologist will encounter the problem of patient consultation. Today, dr. zhang will focus on explaining this problem for everyone. Try to let you know what you need for angiography after reading it. Let's look down!

First of all, nothing in the world is necessary and absolute. Even patients with coronary heart disease cannot say that coronary angiography is absolutely necessary. So, who needs coronary angiography and who doesn't?

First of all, use a famous saying of Sones, a world-class cardiologist, to illustrate this problem. Sones said: "As long as surgeons are qualified, well-equipped and acceptable to patients, coronary angiography can solve clinical problems, and everyone can do coronary angiography." This sentence seems simple, but it is still difficult for the public to understand.

In fact, for different purposes, coronary angiography can be divided into two categories:

First, coronary angiography diagnosed the disease 1, atypical chest pain, it is difficult to diagnose angina pectoris clinically, and coronary angiography is likely to be needed.

2. Unexplained cardiac enlargement, arrhythmia and cardiac function decline also need coronary angiography to see if the coronary artery is blocked.

3. After the successful rescue of cardiac arrest and cardiopulmonary resuscitation, coronary angiography was performed to see the coronary artery.

4. Patients with ECG abnormalities such as bundle branch block and abnormal T wave may need coronary angiography when the cause needs to be clarified.

5. Some special occupations (airplane pilots, aerial workers) need to know the coronary artery in advance, and coronary angiography may be needed.

Second, coronary angiography is used to treat 1 patients with diseases and clinically diagnosed coronary heart disease. At the same time, if the symptoms of myocardial ischemia are aggravated, such as chest pain, chest tightness and other definite symptoms of myocardial ischemia are more frequent than before, it is likely that coronary angiography is needed as soon as possible. Of course, for those patients with acute myocardial infarction or acute coronary syndrome, it is more necessary to have a coronary angiography. In these cases, coronary angiography is probably for the next treatment.

2, old myocardial infarction, if you want further treatment, you must also do coronary angiography.

3. After coronary stent implantation or coronary artery bypass grafting, myocardial ischemia symptoms appear, or the prognosis of the operation needs to be reviewed and evaluated, and coronary angiography may be needed.

4. Patients with valvular heart disease need coronary angiography before valve replacement surgery.

5, congenital heart disease is likely to require coronary angiography before surgery.

6. Coronary angiography needs to be improved before radiofrequency ablation of hypertrophic cardiomyopathy.

The above is the case that coronary angiography may be needed, and the summary here may be incomplete. At the same time, due to the development of multi-slice spiral CT in recent years, many cases can also be solved by coronary CTA, so coronary angiography is not necessary for some of the above cases.

In short, whether to do coronary angiography or not depends on the advice of the competent doctor, and it is necessary to do it resolutely when it is necessary, and it is not necessary to do it when it is not necessary.

Not all coronary heart diseases need angiography, and not all non-coronary heart diseases don't need angiography. We need to understand these two problems. What is the purpose of our angiography?

1. Does coronary heart disease need angiography?

Of course not. If all coronary heart diseases need angiography, then cardiology is definitely a great burden for 300 million patients with cardiovascular diseases. The purpose of angiography is to evaluate the pathological changes of patients and guide the treatment, and the second is to further reconstruct the blood image. Of course, there is another situation that is to identify whether the patient is coronary heart disease, differential diagnosis and understand the situation! Therefore, for some stable coronary heart disease, we already know the possible risks. If we have a certain degree of certainty about its prognosis in the future, then it is completely unnecessary to do angiography.

Second, if it's not coronary heart disease, don't you need angiography?

Of course not. As we just said, sometimes coronary heart disease is to identify whether you are coronary heart disease or not, so angiography is very necessary for a patient who is not coronary heart disease but has very similar clinical symptoms, which makes doctors highly suspect coronary heart disease.

Thirdly, angiography depends on many factors.

Whether angiography is necessary depends on many factors, not just the diagnosis of patients. We must understand that angiography is only an examination, a way to understand our blood vessels, not the only way, nor the inevitable choice of coronary heart disease.

But if our coronary heart disease changes, such as instability, angina pectoris, acute myocardial infarction and so on. Or other situations that require angiography, then you must do angiography as soon as possible, instead of hesitating to do it!

Coronary heart disease, as the most common heart disease, is high in middle-aged and elderly people. Electrocardiogram, also known as coronary angiography, is the "gold standard" for the diagnosis of coronary heart disease. However, because coronary angiography is an invasive examination, many patients are worried about this examination.

Do you have to do cardiac angiography if you have coronary heart disease? Is there any other way? The pathological change of coronary heart disease is coronary artery stenosis caused by the formation of coronary atherosclerotic plaque. Generally speaking, coronary heart disease can be diagnosed if the coronary artery stenosis exceeds 50%. Coronary CT and coronary angiography can diagnose the degree of coronary artery stenosis, and ECG can be used as an auxiliary examination of myocardial ischemia. Among them, coronary angiography, as the "gold standard" for the diagnosis of coronary heart disease, has higher accuracy. However, because coronary angiography is an invasive examination, it is risky and expensive, and many patients reject it.

So, if you have coronary heart disease, is it necessary to do coronary angiography? In fact, whether coronary angiography is necessary needs to consider many factors. Generally speaking, for patients with coronary heart disease, if angina pectoris is typical, it can be diagnosed according to clinical experience. If it is predicted that coronary artery stenosis is serious, stent treatment is likely to be needed. It is recommended to do coronary angiography as soon as possible to clarify the condition. At this time, coronary CT is unnecessary and will only delay the illness. However, if it is predicted that the coronary artery stenosis is mild and the symptoms of angina pectoris are mild, you can actually choose not to do coronary angiography according to the patient's wishes.

Generally speaking, coronary angiography is mainly used for patients with angina pectoris with atypical symptoms or difficult clinical diagnosis. Especially for patients who still can't be diagnosed by ECG and coronary CT, or patients who have no obvious effect after routine medication. Moreover, not everyone can do coronary angiography, and it is impossible for patients with paroxysmal severe ventricular arrhythmia and severe cardiac insufficiency to do coronary angiography.

Specifically, the following people need coronary angiography: patients who need definite diagnosis, patients with angina pectoris suspected of coronary heart disease, patients with undiagnosed cardiac insufficiency and arrhythmia, etc. Patients who need further examination, such as abnormal electrocardiogram and coronary CT examination, suggest severe coronary stenosis; Patients with a history of heart disease include patients who have been previously diagnosed with coronary heart disease and recurrent angina pectoris after myocardial infarction, or patients who have recurrent angina pectoris after stent implantation. In addition, for some elderly patients who need major surgery, or patients with heart disease who need surgery, coronary angiography is also needed when necessary.

I am pharmacist Wang, and I insist on popularizing the knowledge of cardiovascular and cerebrovascular diseases in easy-to-understand language, so as to contribute my meager strength to healthy China. If you think my answer is helpful to you, please leave a comment! In addition, if you have any questions about coronary angiography, please leave a message and we will discuss it together. Coronary angiography is the gold index for the diagnosis of coronary heart disease. In addition to the diagnostic function, it can also guide the treatment, especially when interventional therapy is needed.

First of all, for patients suspected of coronary heart disease, if there are predisposing factors of coronary heart disease (such as hypertension, hyperlipidemia, diabetes, etc.). ), if chest tightness and chest pain related to activities occur, they can be relieved after a few minutes to ten minutes' rest, which can be clinically diagnosed as coronary heart disease, but coronary angiography is needed for the final diagnosis. Coronary angiography is an invasive examination that requires hospitalization. Contrast agent has certain influence on human body (such as contrast agent allergy), so some patients are unwilling to do it.

At this time, these patients can choose coronary CTA examination, that is, just like lung enhanced CT, insert a indwelling needle in their arms, push some contrast media, and then do CT of cardiac vessels. Coronary CTA clinic can be used for patients who are afraid of coronary angiography without puncturing the artery and sending the guide wire catheter to the heart. The negative predictive value of coronary CTA was good (89. 1%), and the positive predictive value was 82.4%. Sometimes the results of coronary CTA are heavier than the actual ones.

If you are a patient who is ready to put a stent or acute myocardial infarction, coronary angiography should be done before putting a stent, regardless of the results of coronary CTA. In fact, coronary angiography is very mature, and skilled doctors can complete the operation in ten minutes. Generally, the probability of serious complications is also very low, so don't be too afraid. What should be checked is still to be done.

Hello, I'm Wang Dafu Jr., a physician in a 3A hospital. My answer to this question is as follows, I hope it will help you.

George W. Wang Dafu often heard such complaints:

Got coronary heart disease, why do you want to do so many tests? Take a few tubes of blood at will, and do ECG, echocardiography and even coronary CT scan. What are these tests for? Can you do less?

Today, Wang Dafu Jr. will take you to know about coronary heart disease-related examinations!

What tests should patients with coronary heart disease do? Coronary heart disease needs to be examined in three categories:

1. Laboratory examination: some samples need to be taken for examination, such as blood drawing and urine test;

2. Non-invasive examination: including ECG, ambulatory blood pressure monitoring, chest radiograph, echocardiography and other non-invasive ECG records or imaging examinations, which are non-invasive and have no harm or little impact on human body;

3. Invasive examination: for example, coronary angiography requires invasive operations, such as puncturing arteries and inserting catheters.

Different examination methods observe diseases from different angles:

1. Laboratory inspection:

Generally speaking, aiming at liver and kidney function, blood lipid, blood sugar and other indicators, it helps doctors to understand whether patients have risk factors and control effects.

2. Non-invasive inspection:

The degree of illness can be indirectly judged by ECG examination or non-invasive images. For example, ECG can show whether there is arrhythmia, angina pectoris or myocardial infarction;

Dynamic electrocardiogram and dynamic blood pressure monitoring can observe the changes of electrocardiogram and blood pressure within 24 hours;

Chest X-ray can show the size of the heart and so on.

3. Invasive inspection:

It is more intuitive than the first two examinations, and can "see" the dynamic image of the lesion, such as coronary angiography, and can see whether the coronary artery is narrow, which is the main means to determine the next treatment strategy.

Summary:

Only through proper examination can doctors get evidence from the results and choose the most effective treatment for diseases.

Thank you for reading!

First of all, we should change our eating habits and living habits, eat more vegetables and miscellaneous grains, eat less meat and exercise moderately. It is best to see Chinese medicine treatment, not necessarily to do cardiac angiography.

Do a 24-hour ambulatory electrocardiogram first. If there is no problem, it is most important to look at the ejection coefficient when doing color ultrasound. Finally, if there are no problems above, you don't need too many coronary arteries, and you may not succeed! [Ross] [wit] Get well soon! [Smiles]