Investigations and Interventions

Investigations and Interventions

  1. Angiography
  2. Angioplasty (PCI)
  3. Bypass Surgery (CABG)
  4. Cardiac Catheterization
  5. Echocardiogram
  6. Exercise Tolerance Test (ETT)






This is a technique used to visualise the inside of vessels, in this case, those of the heart. 
It is basically used to assess the extent of anginaIt involves cardiac catheterisationOnce the catheter is in place, an iodine based dyeis injected into the coronary vessels, and the extent of narrowing (atheroma) can be asses by –x-ray.
  • The angiogram is actually recorded as a moving picture as many low-dose x-rays are taken in quick succession.


  • The patient will lie flat on a couch, with the x-ray machine above them. The catheter will be passed to the opening of the cardiac vessels from the aorta.
    • Patients may feel an occasional missed or extra heart beat during the procedure – this is normal.
  • Basically – its exactly the same as catheterisation! – except that a bit of dye is squirted in and x-rays taken.
  • The test normally lasts about 30 minutes.


  • Mortality is about 1%
  • May be some bruising at the entry site
  • Some patients may have stitches at the entry site to seal it up
  • May have a false aneurysm at the femoral artery if this was used as the entry site
  • May get angina-type pain during the procedure
  • May get an infection at the site of entry
  • May have a warm flushing feeling when the dye is injected
  • Stroke and MI are possible but rare
  • Also rarely, the coronary artery may be damaged and emergency bypass may need to be performed 


Angioplasty (PCI)


Angioplasty (percutaneous coronary intervention - PCI)

This is also sometimes called PTCA - Percutaneous Transluminal Coronary Angioplasty
This procedure is able to open partially closed vessels before they become totally occluded. The patient is awake during the procedure. They may experience short periods of pain (explained below), but generally should not feel too uncomfortable. They may be given a sedative if they feel anxious.
***ANGIOPLASTY DOES NOT IMPROVE LONG TERM OUTCOME – it does not prolong life*** - it is purely for symptom relief. On the other hand, CABG does reduce MI related mortality, and can prolong life.
It is a coronary revascularisation technique – the other one of these being CABG.


  • STEMI (ST elevation MIacute coronary syndrome – PCI is the preferred treatment – it is preferred over THROMBOLYSIS – however, many centres don’t offer PCI, thus thrombolysis may be used instead. It can also be used in STEMI when thrombolysis is contra-indicated.
  • Stable angina – should only be used in:
    • Single or double vessel disease – i.e. disease only involving 1 or 2 of the coronary arteries
    • Triple vessel disease who are not suitable for CABG


This does not involve major surgery.