A coronary angiogram, also called cardiac catheterization, is a procedure in which contrast material is injected through a catheter to see the size and location of plaque that may have built up in your coronary arteries. Consider the following when making your decision:

• The American Heart Association recommends a coronary angiogram when:
  • Tests, such as cardiac stress test, suggest severe coronary artery disease, especially if several risk factors are present. A stress test compares your electrocardiogram (EKG, ECG) while you rest to your EKG during the time and after your heart has been stressed.
  • You have severe symptoms, such as chest pain (angina), at rest or with minimal exertion.
  • You have an occupation involving the safety of others (pilots, bus drivers, etc.) and are considered at risk for heart attack.
• A coronary angiogram may not be recommended when you:
  • Absolutely do not want OR your health problems make it impossible to have coronary artery bypass surgery, surgery to improve blood flow to your heart muscle, or angioplasty, a procedure which opens up blocked coronary arteries.
  • Can control your chest pain and other symptoms with medicines or other methods.
• You may not want to have a coronary angiogram if you do not want to or feel that you cannot quit smoking, because you may not receive the full benefit from subsequent treatment.

What is a coronary angiogram?

A coronary angiogram can determine whether your heart arteries are narrowed, to what degree, and the location of the problem. During angiography, a thin flexible tube (catheter) is threaded through an artery of an arm or leg up into the heart and a dye is then injected into the catheter. The doctor can then see whether your coronary arteries are blocked and how your heart is beating on a TV screen. If an artery appears narrowed or blocked, angioplasty with stent placement may be done during the angiogram to open the artery, or at a later time.

What is coronary artery disease?

Coronary artery disease occurs when the coronary arteries, the blood vessels that supply oxygen-rich blood to your heart muscle, gradually become narrowed or blocked by plaque deposits. The plaque deposits decrease the space through which blood can flow. Poor blood flow can "starve" the heart muscle and lead to chest pain and weakened heart muscle.

A heart attack can result when blood flow is completely blocked, usually by a blood clot forming over a ruptured plaque.

How will I know if I have coronary artery disease?

Unfortunately, symptoms of coronary artery disease often develop only after the disease has progressed to an advanced stage. These symptoms include angina and shortness of breath and can indicate that your heart muscle is not getting enough oxygen-rich blood.

If you do not have symptoms of coronary artery disease, your doctor may suspect you have the disease if you are at high risk for developing it. Risk factors that contribute to coronary artery disease include smoking, high cholesterol, high blood pressure, and diabetes.

How will my doctor diagnose coronary artery disease?

Your doctor will ask you about your risk factors and symptoms and perform a complete physical exam. If coronary artery disease is suspected, you may have additional tests to determine the diagnosis. The most common initial tests are an electrocardiogram (EKG or ECG), chest X-ray, routine blood tests, an exercise electrocardiogram (also called a "stress test"), or a stress thallium test.

If these tests indicate you have coronary artery disease or you have severe symptoms, your doctor may recommend a coronary angiogram to evaluate the severity of coronary artery disease and the exact location of any narrowing or blockages.

How is coronary artery disease treated?

Your doctor will strongly advise that you make lifestyle changes such as quitting smoking, following a heart-healthy diet, and exercising. With these measures, you may be able to halt the progression of the disease and improve the quality and length of your life. However, many people must take medicines for the rest of their lives, and a smaller portion require further treatment.

If lifestyle changes and medicines do not work well enough, you may need angioplasty with stent placement or coronary artery bypass surgery.

For more information, see the topic Coronary Artery Disease.

Your choices are:

• Do not have an angiogram and continue to treat your coronary artery disease with lifestyle changes and, if necessary, medicine.
• Have an angiogram to help determine whether angioplasty or surgery is needed.

The decision about whether to have an angiogram takes into account your personal feelings and the medical facts.

Deciding about an angiogram

Reasons to have an angiogram

Reasons not to have an angiogram

An angiogram will help confirm the diagnosis of coronary artery disease. Your symptoms are not controlled with medicine, have reduced your ability to move around without getting chest pain or short of breath, and have affected your daily life. An angiogram will help determine whether coronary artery bypass surgery or angioplasty are suitable for you. You have an occupation involving the safety of others and need to know your risk of heart attack. Are there other reasons you might want to have an angiogram?

An angiogram carries rare complications, such as an allergic reaction and bleeding. An angiogram is an expensive test and is not available in all communities. An angiogram is probably not necessary if you can control your angina and other symptoms with medicines or other methods. Health problems make it impossible to have coronary artery bypass surgery or angioplastyor you are opposed to having further treatment. You smoke. Studies show that quality of life improves less for people who continue to smoke and the risk of death is higher after coronary artery bypass surgery or angioplasty than for those who do not smoke. 1 Are there other reasons you might not want to have an angiogram?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about angiography. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

My doctor is unsure whether or not I have angina.	Yes	No	Unsure
My chest pain is affecting the quality of my life.	Yes	No	Unsure
For the most part, medicines are controlling my symptoms.	Yes	No	Unsure
I am concerned that my heart disease could go undiagnosed and I could have a heart attack sometime in the future.	Yes	No	Unsure
I am concerned about the cost of an angiogram.	Yes	No	Unsure
I smoke and do not plan on quitting, so I probably will not reap the full benefit of further treatment.	Yes	No	NA*
I do not want to have surgery or angioplasty for coronary artery disease.	Yes	No	Unsure
I am a pilot, so I need to know my risk of heart attack.	Yes	No	NA*

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have an angiogram.

Check the box below that represents your overall impression about your decision.

Leaning toward having an angiogram

Leaning toward NOT having an angiogram

• Coronary Artery Disease
• Angiogram

Citations

1. Taira DA, et al. (2000). The impact of smoking on health-related quality of life following percutaneous coronary revascularization. Circulation, 102(12): 1369–1374.

Author	Robin Parks, MS
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer	Robert A. Kloner, MD, PhD - Cardiology
Specialist Medical Reviewer	Ruth Schneider, MPH, RD - Diet and Nutrition
Last Updated	May 29, 2008