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Q. What is the risk of avoiding or postponing angiography?

Answered by
Dr. Muhammad M. Hanif Md.
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 29, 2017 and last reviewed on: Nov 05, 2021

Hi doctor,

I am a 45 year old male. My height is 184 cm and weight is 97 kg. I have breathlessness on exertion. I get some pain in my throat while walking, but not always. I had a TMT test which was positive. I did TMT for 6.3 minutes and stopped due to breathlessness. The ECG showed ST depression of 2.5 to 3 mm in inferolateral leads. My father, who is now 80 years old, had some ischemic issues and is on medication for about two decades. My echo was normal with mild LVH. ECG showed ST depression and T-wave inversion first; later the T-wave inversion went away and again came back. Similarly, it showed LVH with strain earlier and now it does not. I suffer from severe sleep apnea (AHI index 62) and oxygen desaturation up to 50% while sleeping. I am unable to use CPAP machine due to discomfort while using. My LDL was 153 and with medicine it is 90 now. My HDL 39, triglycerides 129 and lipoprotein (a) 68. I never had diabetes all these years, but in my last blood test the HbA1c was 6.2 that is prediabetes. My recent blood work also shows changes in MCV (106), MCHC (27.9), RDW-SD (64.4), RDW-CV (16.7) as well as SGOT (38.1) and SGPT (48.6). I have been advised Sorbitrate, Ecosprin AV, Dilzem and Deriphyllin by one cardiologist. He asked me to try out these before taking further tests. Other cardiologist advised an early angiography. Do I need angiography immediately? I would like to avoid invasive procedures. What is the risk of doing angio? What is the risk of avoiding it or postponing it for several months? My ECG showed ischemia earlier, but then it seems to have gone away. Does this indicate that the medicines have cured it? Similarly, earlier I had RBBB and not now. The same with LVH. Is it possible that a block in artery can cause constriction in throat? Could my TMT be false positive? Should I repeat it? Please help.

#

Hi,

Welcome to icliniq.com.

I welcome you and want to assure you do not worry as everything is going to be fine if proper care and treatment is opted in for. I have thoroughly gone through your case and can well understand your genuine health concerns.


The Probable causes:

I feel sorry for the issues you have with your health. But, do not get panic as there is a solution to every health issue you have. I will come to your queries one by one in the order you asked.

1. Yes, you need an angiography immediately as per your medical record suggests (attachment removed to protect patient identity). Please do not get worried about angiography as you will feel only one single prick of the injection of a normal gauge needle which you already have been taken many times in life. The rest of the procedure is painless. You will be conscious, no general anesthesia needed. You will be listening to the doctors and watching your heart's blood vessels on the screen too. So, it will rather be a pleasant procedure.

2. Risks are associated with everything in life, so are with angio. There are no major risks in most cases. But, some minor chances are there for heart attack, injury to the artery of manipulation, irregular heartbeats, stroke, torn artery or a chamber of heart, an allergic reaction to the dye used for angiogram, radiation exposure is also a risk from x-rays used, kidney problems, bleeding and post angiography infection.

3. Postponing the angiography may have no serious problem or may lead to sudden cardiac event that may be fatal and may have serious life-threatening consequences such as heart attack and death before reaching the hospital. I advise you to go for angio and do not postpone it.

4. The change in ECG (electrocardiogram) sometime happens with variation of results but rarely happens to complete cure with medication. Especially, you got LVH (left ventricular hypertrophy) although to a lesser extent now, that may come back and further deteriorate if not dealt with in a timely manner.

5. Constriction in neck and breathlessness or shortness of breath is the major sign of the partial blockage in vessels of heart and that is over there; you or your reports deny it or accept it. You have issues with sleeping too. That is also a major sign of coronary artery disease and the LVH. It may lead to congestive heart failure in near future if not treated timely.

6. When your body needs more oxygen in the time of increased demand due to some activity or emotional imbalance, it leads to the increased heart beats and forceful pumping so as to fulfill the demand. This increased workload on heart muscles demand more blood and oxygen to the heart muscles too. But, there is partial obstruction and heart's own blood supply is not met with leading to decreased cardiac output in that specific time of body's increased need and the symptoms appear like neck and throat constriction and shortness of breath.

7. You have chest pain that is unrelated to exertion. This is more dangerous and serious. Pain on exertion means less coronary artery lumen obstruction. Pain at walking or at rest means there is more obstruction. There is no need to repeat your exercise stress testing.

Investigations to be done:

Angiography. If found positive you may need angioplasty then and there in the same procedure. That will be good as in a single procedure all will be handled.

Regarding follow up:

For further information consult a cardiologist online.---> https://www.icliniq.com/ask-a-doctor-online/cardiologist

Hi doctor,

Thanks a lot for your detailed and step by step answer. It is great to see an expert spend so much time in allaying the fears of a patient. I propose to have the angio in a week or fortnight's time. Meanwhile, I seek your guidance on another couple of queries. My cardiologist proposed to do it through the radial artery in the wrist. When my father had angio sometime back it was through the femoral artery (groin). How does the radial approach compare with femoral in terms of pain and safety? Is there any chance of artery getting ruptured by the catheter? Is there any specific precaution to take until angio is done? Will a CT angio (256 slice) be of any help? How to lower my lipoprotein (a) which is high and is said to be a risk factor for cardiac disease? Thank you for your valuable time and I am grateful for your clear answers.

#

Hi,

Welcome back to icliniq.com.


The Probable causes:

1. It is very common to get scared of the cardiac issues especially when it comes to catheterization. There is no difference in both the techniques (femoral and radial) as far as the complications are concerned.

2. Not much specifics needed to get angio, but avoid strenuous exercise or workout. Do not do running or other thing, which may lead to pain in chest.

3. Yes, of course CT angio has novel potential clinical implications in challenging cases of coronary artery angiography. It gives a wide range of images through wide range detectors and even 4-dimensional CT subtraction angiography images and there are least artifacts during the whole heartbeat.

4. This scanner holds a great deal of confidence in giving speedy and best quality 'triple-rule-out' test result (TRO), without the need to inject a contrast dye at higher volume loads. So, we may image the heart's blood supply as a whole at a single point of time without any stairstep artifacts which are a problem with 4-detector row systems.

5. Yes, lipoproteins and other derangement in lipid profile is a risk factor to heart's blood vessels and other diseases of heart. Exercise, diet, and lifestyle modification is the best way to keep lipids normal. But in your case, you are not advised to do exercise as that may make your heart overburden.

Investigations to be done:

Coronary angiography.

Treatment plan:

1. Keep a good control on your diet. No added salts and sugars.
2. No fatty meals or fried and spicy fast foods. Avoid beverages, tea, coffee and energy drinks.
3. Take fish, vegetables, salads and fruits.
Ask your cardiologist to add medication if the above mentioned measures fail to make the lipid profile better.

Regarding follow up:

For further information consult a cardiologist online.---> https://www.icliniq.com/ask-a-doctor-online/cardiologist

Hi doctor,

I have scheduled angiogram. In case a block is found in the angio, can it be treated later in a separate procedure? Based on my medical reports what are the chances that a block will be found? Based on my reports do you feel that it is likely to have a block?

#

Hi,

Welcome back to icliniq.com.


The Probable causes:

1. It is difficult to comment, because I have not seen you in office for physical evaluation. But yes, I think there may be a need for angioplasty due to the coronary artery disease.

2. Yes, you may go for angiography any time later too, if it is needed. It is not mandatory that you get angioplasty in the same visit along with angiography.

3. If blockage needs angiography, they will guide you for that. May be you have very mild disease and need only medication. If patients have got triple vessel disease, they may also need to go for a coronary artery grafting surgery, generally known as CABG or bypass surgery. It all depends on what is going on inside there.

Regarding follow up:

For further information consult a cardiologist online.---> https://www.icliniq.com/ask-a-doctor-online/cardiologist

Hi doctor,

Thank you for the prompt response.

#

Hi,

Welcome back to icliniq.com.

I am so happy to help you further. If any need arise revert back to me.

For further information consult a cardiologist online --> https://www.icliniq.com/ask-a-doctor-online/cardiologist


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