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RELIABILITY
OF
CORONARY
ANGIOGRAM
FOR
CORONARIES CHALLENGED
Coronary
angiogram (radiographic
demonstration
of
the status
of
the coro-
nary arteries supplying the heart)
has
always been hailed
as
the "gold
stan-
dard" for
diagnosing
coronaries
and
assessing the status of the coronary
arteries. Based
on
these
angiograms,
decisions on
PTCA (percutaneous
transluminal coronary angioplasty) or
"ballooning" of the coronaries, or,
if
required, CABG (coronary
artery
by-
pass
graft)
are made
accordingly.
Once,
a patient
had
typical chest
pain
attrib-
utable to
coronary
infarct but
coronary
angiograms
were
perfectly normal. He
was thus classified as "X
Syndrome",
as no
known
cause for his chest
pain
could
be documented.
lt
is now known
that the
risk of
subsequent coronaries
is not only based on the degree of nar-
rowing
of the
coronaries but,
more
importantly, also on
the stability
of the
atherosclerotic plaque on the diseased
vessel wall. Should unstable plaques
tear and
blood
clots
form, the whole
coronary artery would be blocked com-
pletely and
the
result
is
very
drastic
and,
often
disastrous. On
the other
hand,
some patients may
have
near-complete
blockage
of
coronary arteries,
yet,
there
are
no
symptoms of infarct,
nor is
the
heart function
de-compensated
in
any
way
-
their gradual development
of
coro-
naries allowed effective
establishment
of collaterals (natural diversions). Nev-
ertheless and despite all these short
comings, coronary angiogram
is
still
the
most important tool for coronaries.
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