Angiogram versus Echocardiogram

Angiogram and echocardiogram are the most important diagnostic tools in evaluating heart conditions like coronary artery disease, myocardial infarction, and heart failure. Modern cardiac care relies heavily on them.

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Our heart works continuously throughout our lifetime, and cardiac diseases often develop during this period. Several advanced imaging techniques help healthcare professionals assess heart function and detect abnormalities. They are echocardiography, angiography, nuclear imaging, cardiac CT, and MRI.

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Angiography and echocardiography are two of the most commonly performed tests, and Gauze explains here how they differ from each other.

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Heart conditions that require investigation

The common indications for heart diagnostic tests, their signs, and symptoms are

• Coronary artery disease: A narrowing or blockage in the arteries that supply blood to the heart causes chest pain, shortness of breath, and fatigue.
• Heart valve disease: damage and malfunction in the valves cause typical symptoms of heart disease.
• Congenital heart defects: Structural abnormalities at birth present themselves as poor growth, fatigue, and shortness of breath.
• Heart failure: Edema of legs, tiredness, and shortness of breath are caused when the body’s demands are not met by the blood pumped from the heart.

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Common types of heart and diagnostic tests

The most commonly done test to diagnose heart conditions is

• An electrocardiogram (ECG) is the first line of test, which measures the heart's electrical activity.
• Echocardiogram: Sound waves are used to create images of the heart, helping doctors visualize its structure and function.
• An angiogram involves injecting a special dye into the bloodstream and taking an X-ray of the heart and blood vessels. It helps identify blockages and other problems in the arteries supplying blood to the heart.
• Nuclear stress test: A small amount of radioactive material is injected into the bloodstream, and images of the heart are taken before and after exercise.
• Magnetic Resonance Imaging MRI: The test uses powerful magnets and radio signals to provide pictures of the heart and blood vessels, diagnose muscle problems, heart valve problems, and congenital heart defects.

What is Coronary Angiography?

Cardiovascular diseases are a leading cause of mortality worldwide and contribute significantly to the global health burden. Angiography is used to assess the inside of blood vessels and organs. Coronary angiography is a procedure used to evaluate the heart, arteries, and veins, assess blood flow, and identify diseases.

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Applications of angiography

It is a non-invasive alternative for assessing coronary arteries in patients who are unsuitable for invasive tests. It helps to evaluate

• Acute coronary syndrome
• Coronary artery disease
• Evaluating outcomes post-surgery
• Evaluating the effectiveness of medical management of coronary intervention

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Procedure for angiogram

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Before the test

• Do not eat anything for 8 hours before the test
• You will need to change into a hospital gown and sign the consent form before the test.
• You must inform your healthcare provider if you have had reactions to contrast materials in the past.
• You must inform healthcare providers if you are taking medication or are pregnant.
• A mild sedative helps you relax

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The procedure

• Your arms or groin are cleaned and numbed with local anesthesia
• Cardiologists use the radial artery if access is taken from the arms, and the femoral artery if access is through the groin
• A catheter, a hollow tube, is passed through an artery and moved up into the heart by the cardiologist
• The X-ray images help to place the catheter.
• A contrast dye is injected into the catheter, causing a warm, flushing sensation.
• X-ray images are then taken as the dye moves through the artery
• The dye highlights any blockages in the blood flow
• The procedure lasts 30 to 60 minutes

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After the test

• The catheter is removed, and firm pressure is applied at the insertion site to prevent bleeding.
• If a catheter is placed in your groin, you must lie flat on your back for a few hours to prevent bleeding. It may cause some mild back discomfort.
• All normal activities can be resumed 8 to 12 hours after the test, along with a normal dietary intake.

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How is cardiac catheterization a useful tool for physicians?

It is used for diagnostic and therapeutic purposes.

1. It helps to identify aneurysms in the aorta in the chest and abdomen

2. In diagnosing atherosclerosis, plaque formation in the carotid artery of the neck limits the blood flow to the brain and causes a stroke

3. To identify arteriovenous malformations

4. To detect narrowing of arteries in the legs due to plaque formation

5. Accessing arteries in the kidneys for blood flow to help prepare for a kidney transplant

6. Helping in implanting stents and evaluating them after implantation

7. Following trauma, detecting injuries to the neck, chest, abdomen, pelvis, or limb arteries

8. Evaluating arteries supplying a tumor before surgery or other procedures

9. Performing a coronary bypass and stenting

10. To detect pulmonary embolism

11. Evaluating stenosis and obstruction of blood vessels

12. Identifying congenital abnormalities

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Benefits /risks.

The benefits of angiography include:-

• Eliminating the need for surgery.
• Catheter angiography provides a detailed and clear picture of the blood vessels, surpassing the clarity of any other non-invasive procedure.
• It can be used for both diagnostic and therapeutic purposes, in a single procedure.

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Risks of angiography include:-

• A small chance of having cancer because of excessive radiation exposure.
• An allergy to X-ray contrast materials.
• Pregnancy
• Breastfeeding mothers should avoid feeding for 24 to 48 hours after receiving contrast material.
• A small risk that a blood clot will form at the tip of the catheter, blocking the artery and making it necessary to reopen the vessel.
• Contrast material can damage the kidneys in individuals with diabetes or kidney disease.
• In rare cases, the catheter may puncture the artery, causing internal bleeding. Another possibility is that the catheter tip may dislodge part of the clot from the inner lining of the artery, resulting in a blockage in the downstream blood vessel.

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What is echocardiography?

Echocardiography is a non-invasive technique that uses sound waves to create images of the heart. Echo provides detailed images of the heart muscle, valves, and blood flow. It is the ideal test for evaluating heart function, wall motion abnormalities, atrial fibrillation, and pulmonary embolism.

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Types of echocardiography and their uses

• Transthoracic echocardiogram: It is the most commonly performed echo, is non-invasive, and provides detailed images of the heart's structure and function.
• Transesophageal echocardiogram: Using thin ultrasound probes placed in the esophagus. It provides clear images of the left ventricle and nearby structures.
• Stress echocardiogram: The test combines imaging with a stress test to help detect an impending ischemic heart disease.

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Echocardiogram Procedure

An echocardiogram (echo) is a non-invasive procedure that does not breach the skin. To record an electrocardiogram, sound waves are transmitted through a transducer with an ultrasound frequency.

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The transducer is a handheld device that, when placed on the chest at specific locations and angles, emits and receives sound waves to display heart structures. These sound waves are then transmitted to a computer, where they are converted into images.

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Angiogram versus echocardiogram

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Diagnostic accuracy and performance

Angiogram and echocardiogram have high diagnostic accuracy. Angiography is an excellent tool for detecting coronary artery stenosis and performing coronary interventions.

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Echocardiography provides a complete assessment of the heart structure and function.

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Coronary CT and CT angiography are techniques that bridge the gap between echocardiogram and angiogram.

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Clinical applications and outcomes

Angiogram or echocardiogram depends on the patient’s

• Clinical symptoms
• Medical history.

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Acute symptoms, such as chest pain suggestive of myocardial infarction, require coronary angiography. The test confirms coronary disease, identifies blockages, and supports immediate decisions, including bypass surgery.

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Echocardiography is suitable for evaluating chronic conditions, such as heart failure and valve dysfunction, as well as low-risk problems.

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Advances in cardiac imaging

Technology is revolutionizing the field of cardiac imaging, and coronary CT angiography has emerged as a powerful non-invasive testing procedure. It gives diagnostic accuracy with minimal radiation exposure.

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Integrating CT and Echocardiography for patients with chest pain provides faster and more accurate diagnosis.

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Conclusion

Angiogram and echocardiogram are the most useful tests in cardiology. Angiography helps to diagnose coronary artery disease and aids in coronary intervention procedures. Echocardiography offers a comprehensive evaluation of cardiac function.