Our heart works non-stop throughout our lives, pumping blood to all our organs. The heart muscle does not get tired, but it constantly needs clean, oxygen-rich blood. In order for the heart to work this way, it must be constantly supplied with clean blood. We call the vessels that feed the heart muscle Coronary Arteries. Atherosclerosis (arteriosclerosis) is an abnormal process that occurs with the accumulation of fatty particles in the vessel wall and blocks the space of the vessels, preventing normal blood flow. The disease caused by atherosclerosis in the coronary arteries is called Coronary Artery Disease. Personal and environmental factors play a role in the development of atherosclerosis, and personal factors include first-degree relatives with Coronary Artery Disease, Hypertension, High Cholesterol, Diabetes, age and unclarified genetic factors. Environmental or acquired risk factors are smoking, high cholesterol diet, stressful and passive lifestyle. Fat accumulations that develop in the heart vessels over time prevent the blood flow in the vessels, disrupt the nutrition of the heart muscle, and initiate the patient's complaints. The most common complaint is chest pain. Apart from this, it may also cause tightness, tightness and burning in the chest. If the narrowing of the coronary artery occurs suddenly and blood flow cannot be provided from another place, a heart attack (myocardial infarction) occurs. The accompanying rhythm disorder and the pump power of the heart may decrease significantly or even stop completely, and the patient may die if not intervened.
Coronary Angiography (also called cardiac catheterization or angiography) is a diagnostic method, not a treatment. It is based on imaging the heart chambers and coronary arteries during the administration of contrast material (a type of medical dye) and taking moving movies using "X" rays.
Spasm may occur in the artery during the withdrawal of the cannula in the arm. Most of these complications can be compensated with treatment. Depending on the drugs used during the procedure, especially iodinated contrast material, renal failure may develop. Although in most patients who develop renal failure, the deficiency improves, but rarely, the patient's life is worse. They may need to receive dialysis treatment. Although it is advantageous for the patient to get up and be discharged earlier, angiography and stent procedure in the arm may not always be as easy and quick for the operator as the procedure performed in the groin. Angiography and stenting in the arm; It may have negative aspects such as not being able to use thick catheters when necessary, the need to make repeated attempts due to difficulties in directing and fixing the catheters (long tubes) to the required positions, and therefore prolonged procedure time in some patients and, as a natural result, increased radiation exposure to the patient.
If cardiac catheterization and angiography are not performed, adequate information about the patient's disease will not be obtained, and therefore, necessary interventions and treatments may not be planned properly. Since it cannot be learned whether there is coronary artery disease (arteriosclerosis), the cause of the complaint will not be revealed. If you decide to have angiography later, you can come to the cardiology service and make an appointment and have your angiography done on the given date.
In parallel with the developments in technology, there are also great developments in heart-related imaging methods, and today it can replace cardiac catheterization and angiography. There are no non-invasive (bloodless) diagnostic methods (examinations with computerized tomography or magnetic resonance methods, etc.) that can give as accurate information as these methods. What are the other diagnostic options and possible risks? Each examination exhibits a different feature of the heart, that is, it looks at the heart from different angles. There is no single study that can answer all our questions. Coronary angiography is the only examination that will show whether there is a real problem in your veins, if so, in which heart vessels, at what points in these vessels and how serious it is. If there is still a need after tests such as stress test, ECHO, myocardial scintigraphy, tomography angiography, coronary angiography can be performed. However, if the patient's condition clearly indicates a cardiovascular problem that does not require these, and especially if there are signs that the situation is urgent, it is sometimes the best option to perform direct coronary angiography as quickly as possible and see the situation without delaying. nektir. In fact, in such a case, examinations such as stress tests, etc. may even be harmful. Tomography angiography actually gives information about the vessels of the heart by administering medication through the superficial veins in the arm and taking an image that is completed in a few seconds. It has brought great convenience to us, especially in cases where classical angiography is difficult and impossible due to some anatomical difficulties. However, this method has some disadvantages, at least today. In order to get a good image, the patient must be able to hold his breath for even a few seconds, have no rhythm disturbances, have a low pulse, and have no serious calcification in the vessels. Exaggerated results about the degree of stenosis and erroneous results may be obtained in cases of in-stent stenosis. The high radiation rate is another point that needs to be careful. On the other hand, when significant stenosis is found in the heart vessels with this method, it is necessary to undergo angiography again, this time with the classical method. Can or should balloon angioplasty and heart surgery, which is decided based on the results of cardiac catheterization and angiography, be performed immediately? It should be known that there may be a need for coronary therapeutic intervention (coronary balloon angioplasty, coronary stent applications, etc.) or emergency cardiac surgery in the same session due to a complication of the catheterization and angiography process or in case of detection of the need for urgent intervention for the underlying disease that caused the patient to be examined. Except for the emergencies mentioned above, a decision is made about the further examination or treatment method by evaluating the angiography, and the patient is informed about this and the necessary interventions and treatments are planned. However, if the patient gives consent and the physician deems it appropriate, coronary therapeutic intervention can be performed in the same session.
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