Unfortunately, cardiovascular diseases today are characteristic not only of elderly people, but also of middle-aged people, and even young people. Everyone knows about their danger. We also know that any disease is easier to prevent than to cure. As for the pathologies of this spectrum, they are quite effectively detected at the very early stage by a modern diagnostic method - CT-coronarography. What are its features, what are the indications and contraindications for conducting, how the event is held - these are all the topics of our today's article.
What is coronarography?
CT coronary angiography will be one of the branches of a fairly common study in modern medicine. CT scan means computed tomography.
Coronarography in general terms is an X-ray examination of large blood vessels leading to the heart. They are filled with a special contrast agent, after which they take the necessary pictures on medical equipment.
The introduction of contrast often scares patients. However, it is this substance that helps the specialist in the picture to consider the gaps of the vessels, the state of their walls. Without it, it is impossible to achieve clear frames that will make it possible to make the correct diagnosis. In most cases, a contrast agent is a solution of urographin.
Coronarography is a fairly easy procedure to implement. First, the aforementioned contrast is introduced to the patient, then the x-ray machine takes pictures of blood vessels on a special film. However, some modern devices already do without it.
After the contrast medium fills the blood vessels, effective frames are made, which will be the basis for the diagnosis. On them not only narrowing of the gaps, but also the formed blood clots are clearly visible.
Types of coronary angiography
So far we have only talked about computed tomography - CT-coronarography (its types depend on the accuracy of the apparatus - 32- or 64-slice). The types of the main procedure are as follows:
- The total.
- Selective
- Conducted using a computer tomograph - CT coronary angiography.
Let's briefly talk about each.
Coronary angiography
The simplest survey of all presented. A contrast agent is injected directly into the coronary vessels by a specialist. After that, the necessary pictures are taken on the x-ray machine. But even such a traditional method helps to determine a large number of cardiac, vascular pathologies.
Selective coronarography
What is special about this method? In fact, this is a modernized version of the above. During the examination, the doctor does not examine all the vessels, but concentrates on several or even one. Such a selective (selective) approach was reflected in the name.
The procedure requires the installation of a special catheter for the patient - it is through him that the contrast agent is delivered. A special wish for the event is a good film for an x-ray machine. Its poor quality may affect the resulting image. If it is fuzzy, vague, then on its basis the doctor will not be able to make an accurate diagnosis.
A significant plus of the selective method is that it does not require the introduction of large volumes of a contrasting drug. Another feature is the quick passage of the procedure. Moreover, in a short period of time, a specialist can get pictures of vessels that are diverse in locations.
However, selective coronarography also has a significant minus - the procedure cannot be performed on the same probes. Their replacement is required, and this measure can lead to atrial fibrillation. The disadvantage of the method is the fact that the selective variety of coronary angiography is carried out only with the help of sophisticated equipment - such that it is capable of making a large number of frames per minute. It is important to pay attention to the quality of the probes for examination.
MSCT coronarography
The full name of CT coronary angiography is multispiral computed tomography aimed at examining coronary vessels. However, this procedure also helps to examine other important elements of the cardiovascular system - for example, the valves of the main muscle of the body.
The disadvantage of CT coronary angiography of the blood vessels of the heart can be called the fact that not every medical clinic performs the procedure. It is connected with the fact that a high-speed multispiral computed tomograph is needed for the examination. Another condition is that the device must be at least 32-slice so that coronary angiography is possible. Such a specific technique has a corresponding cost.
How is a CT coronary angiography of the heart vessels performed? The beginning of the event is standard - the specialist fills the patient's test vessels with a contrast agent. In the vast majority of cases, they are various iodine solutions. Then the patient rests on the couch under the tomograph, and the doctor takes the necessary pictures with the help of the apparatus.
As you can see, the study is extremely simple and quick, requiring no specific preparation or hospitalization. If the pictures are relatively good results, then after the procedure, the patient can go home, return to normal life. Because of this, many people prefer computed tomography to the methods listed above.
The main advantages of the procedure
Now we know what it is - CT coronary angiography. We highlight its important advantages that patients note in their reviews:
- Almost complete absence of invasiveness - procedures associated with any medical penetration through the protective barriers of the body - mucous membranes, skin integuments.
- The ability to conduct a comprehensive detailed examination of the coronary vessels without hospitalization.
- Relatively fast procedure.
- The ability to identify hidden pathologies. Such, for example, as a vascular stenosis.
- The ability to determine the type of atherosclerotic plaques at an early stage in the development of pathology is soft or calcified formations.
- Evaluation of the correctness of the imposition of shunts, walls, control over them after some time after the operation.
It is noted that CT coronary angiography of the heart is periodically prescribed to specialists whose work is associated with constant nervous overvoltages, loads on the heart - without consequences for their health. In addition, this event is not prohibited to carry out even with an acute form of myocardial infarction.
Indications for the procedure
What is CT coronary angiography? Diagnosis, which is indicated for many diseases of the cardiovascular sphere. We will present a list of those pathologies, the study of which is recommended mainly in this way:
- An attack of angina pectoris, which manifested itself in the treatment of myocardial infarction.
- Comprehensive diagnosis before surgery on the coronary vessels, heart.
- Suspicion of endocarditis of an infectious form.
- Kawasaki disease.
- Examination before any type of surgical operation that is carried out in relation to a patient who has had a heart attack.
- Congestive heart failure.
- The failure of therapy with a malignant form of arrhythmia.
- The lack of effect of highly effective medications prescribed for angina pectoris.
- Comprehensive examination of the heart, coronary vessels before transplantation to the patient of any tissues or organs.
- A history of heart failure for a reason unknown to doctors.
- A dull chest injury in a recent medical history.
- Cardiomyopathy is hypertrophic.
- Pathological processes affecting the aorta, coronary vessels.
- Deviations in the work of the heart with ischemic disease, etc.
Preventive examination
We have examined the above cases in which computed tomography of the coronary vessels of the heart is mandatory. For example, for making an accurate diagnosis, assessing the patientโs condition, eliminating the fact of pathogenic changes, planning a specific treatment.
However, there are a number of cases where this procedure is not required, but is advised in the form of effective prevention of serious diseases. After all, the fact is that this examination is able to determine the pathology at an early stage, when it can be completely cured without harm to the body.
CT coronarography in this case is shown to patients, which belong to the so-called risk groups:
- According to the age. Men over 40 years old, women over 45 years old.
- In the way of life. Obesity, weight problems, poor diet, constant emotional stress, nervous strain, hard (physically, emotionally, mentally) work, smoking, addiction to alcohol.
- For diseases in the medical history. Stroke, consistently high blood pressure, diabetes mellitus, high levels of "bad" cholesterol, vascular disease, hereditary predisposition to cardiac pathologies.
Absolute contraindications to the procedure
Although CT coronary angiography of the heart (in Izhevsk and other cities is carried out in a number of diagnostic centers) is the safest procedure among its kind, it also has a number of contraindications.
Here is a list of those for which the survey is strictly prohibited:
- Pregnancy at any stage - both waves and contrast are harmful to the baby.
- Calcification affecting the coronary vessels.
- Individual intolerance to iodine - the main component of a contrast medium.
- Hepatic, renal failure.
- Severe stage of diabetes.
- Arrhythmia.
- Tachycardia.
- A number of thyroid diseases.
Relative contraindications to the procedure
Now letโs talk about the relative contraindications to CT coronary angiography (we examined the evidence above). The following are situations in which the procedure is undesirable, but possible after normalization of the patientโs condition, with the permission of the attending doctor:
- Ventricular arrhythmia of an uncontrolled type. A specialist allows CT to be performed only when the disease is transferred to the category of controlled ones.
- A history of cardiac glycoside intoxication.
- Hypokalemia of an uncontrolled form.
- High body temperature.
- Uncontrolled hypertension.
- Endocarditis is an infectious form.
- Pathological processes associated with poor blood coagulation.
- Some diseases of the internal organs.
- Decompensated heart failure.
Examination preparation
High-quality equipment and contrast medium are the main conditions for successful CT-coronography of blood vessels. However, special preparation of the patient for the procedure is no less important.
Judging by the reviews of CT coronary angiography, these are completely uncomplicated events:
- A blood test taken no earlier than two weeks before the date of the CT scan. The doctor needs indicators for creatinine and urea to determine the possibility of using a contrast medium.
- The CT procedure itself takes place on an empty stomach.
- Before the examination, the patient must remove all metal objects - jewelry, clothing items, piercings, etc.
- If he takes any medications, it is necessary to notify a specialist about this before the procedure.
- If the heart rate exceeds 60 ular / min, then medication will be required, which will slow it down. Otherwise, this fact will be a serious obstacle to conducting a qualitative study.
- Although CT coronary angiography in most cases is a fairly complete procedure for planning heart treatment, other examination results may still be required. For example, ultrasound, magnetic resonance imaging of an organ.
How is the procedure performed?
Thus, non-invasive computed tomography of the coronary arteries can be performed in any medical clinic with 32-slice (for more accurate results, of course, better with 64-slice) equipment.
The approximate sequence is as follows:
- One hour before the event, the patient takes a drug that will somewhat slow down his heart rate. This is necessary to obtain more accurate pictures.
- The patient is given an intravenous catheter through which a contrast agent is injected.
- A man on a couch is placed under the examination area of โโa computer tomograph.
- At a time called diastole (a relaxed state of the heart muscles), the equipment takes the necessary pictures. The period necessary for this is monitored using an electrocardiogram.
- During the examination, the patient must clearly comply with the recommendations of a specialist, because this method is extremely sensitive to the frequency of heart contractions.
- At the end of the procedure, the patient is given a disc with pictures recorded on it. The specialist gives advice on pathologies identified during the diagnosis.
- With a conclusion on the procedure, a disc with recorded information should contact your doctor.
Thus, CT coronary angiography is today the most comprehensive, safe and fastest method among such diagnostic methods. Another plus is the ability to detect cardiac, vascular pathologies at an early stage. The disadvantage of the procedure will be the non-proliferation of the necessary equipment in clinics, the price is from 8,000 to 25,000 rubles.