How arterial blockages of the heart are detected: from angio-CT to coronary angiography

Chest pain, shortness of breath, or fatigue brought on by minimal exertion can be warning signs of ischaemic coronary artery disease, particularly in people with cardiovascular risk factors. When such symptoms arise, a doctor may recommend investigations to determine whether the heart's arteries are narrowed or blocked.

Non-invasive investigations and coronary angiography

Depending on the symptoms and the patient's risk profile, a doctor may initially recommend a non-invasive imaging investigation, such as coronary CT angiography, which can reveal atherosclerotic plaques, calcifications, and narrowing of the coronary arteries. When there is suspicion of more serious disease, or when other tests indicate a possible problem with blood flow to the heart, the doctor may recommend coronary angiography.

Coronary angiography is an interventional cardiology procedure that uses contrast dye and X-rays to visualise the coronary arteries. It is important to note that this investigation is carried out only on the recommendation of a cardiologist — it is not available on demand and is not used as a routine check-up.

When coronary angiography is indicated

A cardiologist may recommend coronary angiography in a number of situations:

• when a patient has symptoms that suggest significant coronary artery disease;
• when non-invasive tests indicate significant ischaemia;
• when acute coronary syndrome is suspected, such as unstable angina or myocardial infarction;
• in certain cases of heart failure or valvular heart disease, where evaluation of the coronary arteries is required.

Patients who receive a referral for coronary angiography should not delay having the investigation. It can confirm the presence of narrowings or blockages that reduce blood supply to the heart and provides essential information for determining the most appropriate course of treatment.

What the investigation reveals and what treatments may follow

Coronary angiography not only confirms the presence of coronary lesions, but also shows how severe they are and where they are located. Based on this information, treatment may vary: some patients require only medication and monitoring, whilst others need coronary angioplasty with stent placement.

Angioplasty with stenting is an endovascular procedure through which an interventional cardiologist restores normal blood flow in the coronary arteries. If a significant stenosis is identified and there is an indication for treatment, angioplasty may be performed during the same session as the coronary angiography or at a later date, depending on the individual case.

For complex cases, coronary artery bypass surgery may be recommended. The treatment decision is made based on what the doctor observes during the investigation, the patient's overall condition, their symptoms, and the results of other tests.

The role of coronary angiography in chronic disease versus acute myocardial infarction

In chronic coronary artery disease, coronary angiography is recommended selectively, following a cardiological assessment — particularly when symptoms persist, tests suggest significant ischaemia, or the findings are likely to influence the treatment decision. In acute myocardial infarction, however, coronary angiography plays a major role: it can identify the blocked artery and enable prompt treatment through interventional procedures, where indicated.

How the procedure is performed

For coronary angiography, the doctor inserts a thin catheter through a blood vessel — usually at the wrist or the groin — and injects a contrast dye. This allows the heart's arteries to be visualised using X-rays, enabling the identification of any narrowings or blockages affecting blood flow to the heart.

How the investigation is performed at SANADOR Clinical Hospital

At SANADOR Clinical Hospital, coronary angiography is performed in the Catheterisation Laboratory, which is equipped with state-of-the-art technology, including two Philips Azurion 7 angiography systems. Where necessary, coronary angiography can be followed directly by angioplasty with stenting. After the procedure, patients are monitored in the Advanced Cardiac Patient Surveillance and Treatment Unit (USTACC).

The SANADOR heart team includes specialists from all disciplines involved in the diagnosis and treatment of cardiovascular conditions: cardiology, interventional cardiology, cardiovascular surgery, vascular surgery, cardiovascular anaesthesia and intensive care, radiology and medical imaging, nuclear medicine, emergency medicine, and physical medicine and rehabilitation. This ensures that patients benefit from a multidisciplinary approach to both diagnosis and personalised treatment, tailored to each individual case.