Doctor, Do I Need Angiography Now?
Patient: Doctor, the cardiologist is saying I need an Angiography. I am a bit scared. Do I really need this procedure?
Doctor: I understand your worry. The word “Angiography” sounds serious because it involves the heart. But simply put, it is just a “dye test.” It is the gold standard method to see the exact condition of the blood vessels of your heart.
Patient: But is it absolutely necessary? Can’t you just treat me with ECG or Echo?
Doctor: Not always. An ECG or Echo gives us a clue, like seeing smoke from a distance. But Angiography takes us right to the source. We recommend it only when other tests (like TMT or Echo) strongly suggest a blockage, or if you have symptoms like unstable chest pain. It is not recommended for everyone.
Patient: What exactly happens during the procedure? Will they cut my chest open?
Doctor: No, absolutely not. It is not an open surgery. We insert a thin tube (catheter) usually through a blood vessel in your wrist (or sometimes the groin). It goes up to the heart, we inject a special dye called “contrast”, and take short X-ray movies. It usually takes just 15 to 20 minutes.
Patient: What are these coronary arteries you are checking?
Doctor: Think of your heart as an engine. The coronary arteries are the “fuel pipes” that supply petrol (blood) to the engine itself. If these pipes get blocked by cholesterol, the engine stops working properly. That is a heart attack.
Patient: Is it safe?
Doctor: It is generally a very safe procedure. It is performed under local anesthesia, so you will be awake and talking to us. However, like any procedure, there are minor risks like a bruise at the wrist or reaction to the dye. But in expert hands, serious complications are very rare.
Patient: What is the difference between Angiography and Angioplasty? Some people use these words as though they are the same.
Doctor: That is a very important difference. Angiography is just the test (taking the photo) to see if there is a block. Angioplasty is the treatment (to open the block). We do Angioplasty only if the Angiography shows a critical blockage that cannot be treated by medicines alone.
Patient: And what is a stunt?
Doctor: It’s a stent, not stunt. A stent is a small wire mesh tube. It is somewhat like the small spring inside a ball-point pen. It is inserted into the narrowed artery to push the blockage to the side and keep the “pipe” open for blood flow.
Patient: Thank you, that is clear. But I thought Angiography is needed only when there is chest pain. Is that correct?
Doctor: Chest pain is the most common reason, yes. But sometimes, people have “silent” symptoms, like sudden breathlessness on walking, or extreme fatigue. Some elderly patients and diabetics might not feel the pain at all, but the blockage could be severe.
Patient: One of my friends was advised Angiography as a part of a general check-up package. Is that good practice?
Doctor: No. Invasive Coronary Angiography is NOT a screening test like a blood sugar check or an Echocardiography. It is an invasive procedure. We should not do it just “to be safe” in a healthy person. For screening, we have non-invasive options like Coronary Calcium Score and CT Angiography, but even that needs a doctor’s advice, not a package deal.
Patient: I heard that the dye used in Angiography can cause kidney failure. Is that correct?
Doctor: That is a valid concern, especially for older patients. The dye can slightly stress the kidneys. However, we always check your creatinine levels before the procedure. If your kidneys are weak, we hydrate you well with fluids and use minimal dye to protect them. We take extra care in such cases.
Patient: So, how do I decide?
Doctor: If your cardiologist is recommending it, it means the risk of leaving a blockage unknown is much higher than the risk of the procedure. It is better to check the map before we plan the journey, right?
Patient: Thank you, Doctor. I was very confused between the test and the treatment. I feel much better now.
Doctor: You are welcome. Knowledge reduces fear.
Dr. Shashikiran Umakanth (MBBS, MD, FRCP Edin.) is the Professor & Head of Internal Medicine at Dr. TMA Pai Hospital, Udupi, under the Manipal Academy of Higher Education (MAHE). While he has contributed to nearly 100 scientific publications in the academic world, he writes on MEDiscuss out of a passion to simplify complex medical science for public awareness.
