The heart is like the most important machine that works the hardest in the body to pump blood to various parts. However, sometimes the coronary arteries, which are the main blood supply pipes, can become narrowed or blocked due to plaque buildup from fat, fibrous tissue, and calcium deposits that have accumulated over time.
Coronary artery disease often develops silently and can lead to acute myocardial infarction if not treated promptly and with modern methods. Currently, medical technology has developed highly effective diagnostic and treatment methods, namely Coronary Artery Angiography (CAG) and Percutaneous Coronary Intervention (PCI) with balloon dilation and stent placement, which precisely and quickly save patients’ lives.
What is Coronary Artery Angiography (CAG)?
Coronary Artery Angiography (CAG) is a medical procedure used for diagnosis to observe the structure and blood flow in the coronary arteries. The process begins by inserting a very small catheter, about 2 millimeters in diameter, through the radial artery at the wrist or femoral artery at the groin, up to the opening of the coronary arteries.
Then, the doctor injects a contrast dye while using real-time X-ray imaging to record moving images. The images help the doctor clearly see if there is any narrowing, blockage, or abnormalities in the arteries, providing higher accuracy than other preliminary screening methods.
Warning Signs and Risk Groups That Should Get Tested
Danger signs indicating that your heart is struggling include:
- Severe chest tightness Feeling like a heavy weight is pressing down, or pain radiating to the arm, shoulder, jaw, and back
- Dizziness and shortness of breath Difficulty breathing, excessive sweating, lightheadedness, or palpitations as if about to faint
- High-risk groups Especially those with diabetes, high blood pressure, high cholesterol, obesity, smokers, or a family history of heart disease
If these symptoms occur or abnormalities are detected from an electrocardiogram (ECG) or exercise stress test (EST), doctors usually recommend CAG to confirm the severity of the disease.
Preparation Before the Procedure
For maximum safety, patients should follow these instructions:
- Fasting from food and water For at least 4-6 hours (in some cases up to 8 hours as per doctor’s discretion)
- Kidney function test Doctors will check BUN/Creatinine levels because the contrast dye is excreted through urine
- Medication adjustment For diabetic patients, doctors may advise stopping certain medications such as Metformin 24-48 hours before the test to prevent kidney complications
- Circulation test If the catheter is inserted via the wrist, doctors will perform an Allen’s test to ensure adequate blood flow to the hand during the procedure
- During the procedure Minimal pain, patient remains conscious throughout
During the procedure, the patient will remain conscious and does not require general anesthesia; only local anesthesia is used. The diagnostic angiography (CAG) usually takes only 30-60 minutes.
Advantages of Continuous Treatment
If the angiography shows a suitable blockage, the doctor can immediately proceed with treatment using balloon dilation and stent placement (PCI), which takes an additional 45 minutes to 1 hour. This method reduces the risk of major surgery and allows blood to flow back to the heart immediately, lowering the chance of death from myocardial ischemia.
Post-Procedure Care and Self-Care
Post-procedure care depends on the catheter insertion site:
- Via the groin The patient must lie flat and avoid bending the leg for 4-6 hours to prevent bleeding
- Via the wrist Patients feel more comfortable as they do not need to lie flat and can walk sooner, with a special wristband applied to compress and stop bleeding for about 2-4 hours
Recommendations for recovery at home
- Drink plenty of water About 8 glasses per day (unless otherwise advised by a doctor) to help the kidneys flush out the contrast dye
- Avoid heavy lifting Avoid lifting more than 2-3 kilograms and refrain from strenuous activities for 1 week
- Monitor the wound If the wound is swollen, red, oozing blood, or has a hard lump, see a doctor immediately
Coronary Artery Angiography (CAG) and balloon treatment (PCI) are innovations that turn a critical condition into a survival opportunity because the sooner the treatment, the less heart damage occurs.