CT Coronary Angiograph

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CT Coronary Angiograph

CT Coronary Angiography (CTCA) is a non-invasive imaging test that uses CT scanning and intravenous contrast to visualize the coronary arteries.

Purpose

CTCA is used to:

• Detect coronary artery disease (CAD)
• Identify atherosclerotic plaques (calcified and non-calcified)
• Assess coronary artery stenosis
• Rule out CAD in patients with chest pain
• Evaluate congenital coronary anomalies
• Assess coronary stents or bypass grafts (selected cases)

Advantages

• Non-invasive (no catheter insertion into arteries)
• High diagnostic accuracy
• Quick procedure (usually < 15 minutes)

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2. How CTCA is Performed (Radiology Perspective)

Step-by-Step Procedure

1. Patient Positioning
   • Patient lies supine on the CT table
   • ECG leads attached for cardiac gating
   • Arms raised above the head
2. Heart Rate Control
   • Ideal heart rate: ≤ 60 beats/min
   • Beta blockers may be administered if heart rate is high
3. IV Contrast Injection
   • Non-ionic iodinated contrast injected via 18–20G cannula
   • Usually placed in antecubital vein
   • Injection rate: 4–6 ml/sec using a power injector
4. Breath-Holding
   • Patient instructed to hold breath for 5–10 seconds
   • Motion-free imaging is essential
5. ECG-Gated CT Scan
   • Images acquired during specific phases of the cardiac cycle
   • Scanner synchronizes with ECG to reduce motion artifacts
6. Image Reconstruction
   • Images reconstructed in multiple planes
   • Coronary arteries evaluated for:
     • Stenosis
     • Plaque type
     • Vessel course

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3. Nursing Preparation for CTCA

A. Pre-Procedure Nursing Preparation

1. Patient Assessment

• Check:
  • History of contrast allergy
  • Asthma
  • Renal function (serum creatinine, eGFR)
  • Pregnancy status
• Review medications:
  • Beta blockers
  • Metformin (may need temporary withholding)

2. Patient Instructions

• NPO for 4–6 hours before scan
• Avoid:
  • Caffeine (24 hours)
  • Smoking
• Explain procedure to reduce anxiety

3. IV Access

• Insert large bore IV cannula (18–20G)
• Ensure good vein patency

4. Heart Rate Control

• Administer oral or IV beta blockers as prescribed
• Monitor:
  • Blood pressure
  • Heart rate
• Contraindications for beta blockers:
  • Severe asthma
  • Bradycardia
  • Hypotension
  • Heart block

5. Nitroglycerin (If Ordered)

• Sublingual nitroglycerin given just before scan
• Purpose: Dilates coronary arteries
• Monitor BP closely

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B. Intra-Procedure Nursing Role

• Monitor:
  • ECG
  • Blood pressure
  • Patient comfort
• Reassure patient during breath-holding
• Watch for contrast reactions

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C. Post-Procedure Nursing Care

• Observe patient for 15–30 minutes
• Monitor for:
  • Contrast reactions
  • Dizziness or hypotension
• Encourage oral hydration
• Resume normal diet unless contraindicated
• Educate patient to report:
  • Rash
  • Shortness of breath
  • Chest discomfort

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4. Contraindications to CTCA

• Severe renal impairment
• Known iodinated contrast allergy
• Uncontrolled arrhythmias
• Very high heart rate not controllable
• Pregnancy (relative)

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5. Summary (Quick Recall)

Aspect	Key Point
CTCA	Non-invasive coronary artery imaging
Contrast	IV iodinated contrast
Heart Rate	Ideally ≤ 60 bpm
Nursing Prep	NPO, IV line, HR control
Scan Time	Very short

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