Invasive Cardiac Diagnostic Procedures

Coronary arteriography and ventriculography provide valuable information about the presence and severity of CHD and about ventricular function. These techniques can indicate the specific areas of coronary artery stenosis or occlusion, the number of involved vessels, the ventricular systolic and diastolic volumes, the ejection fraction, and regional wall-motion abnormalities. Multiple gated acquisition (MUGA) scans can also be performed for these purposes. This information helps the cardiologist and cardiac surgeon plan appropriate treatment for the patient. Intravascular ultrasound imaging is an evolving invasive modality for studying the intraluminal coronary anatomy and may be particularly useful in evaluating the effects of stents or angioplasty.

Coronary artery stenosis is hemodynamically significant when the arterial lumen diameter is narrowed by more than 50%, or the cross-sectional area is reduced by more than 75%. Common indications for coronary arteriography are ACS, post-MI angina, stable angina unresponsive to medical therapy or revascularization, a markedly positive exercise stress test result, and a recent MI in a patient younger than 40 years. The technique may also be useful in evaluating valvular heart disease, ventricular septal defect, papillary muscle dysfunction, cardiomyopathy of unknown cause, or unexplained ventricular arrhythmias.

Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.