Peering into the Pipes: Coronary Angiography

Coronary angiography serves as a critical diagnostic tool for identifying and localizing obstructions within the coronary vasculature, functioning much like a sewer inspection camera for the heart. The procedure involves catheter insertion—typically via the radial or femoral artery—to assess vessel patency through contrast injection. Clinical assessment requires a thorough history and physical examination to distinguish ischemic chest pain from non-cardiac causes, supported by 12-lead ECG interpretation to identify ST-elevation myocardial infarction (STEMI) criteria. While angiography guides urgent revascularization in unstable patients, the 2019 ISCHEMIA trial highlights that for stable coronary artery disease, initial revascularization may not offer mortality benefits over medical therapy alone. Successful management post-intervention necessitates careful consideration of dual antiplatelet therapy (DAPT) duration to prevent stent thrombosis, balancing the risks of bleeding against the necessity of maintaining vessel patency.