You Failed a Stress Test — Now What? Explaining Coronary Angiograms

doctor talking with male patient

A cardiac stress test is most people’s introduction to screening their heart for potential problems. Exercising makes the heart work harder and pump faster and can help your doctor diagnose cardiovascular disease. But what happens after you fail a stress test?

Oftentimes, the next step for people who fail a stress test, and who have risk factors for or symptoms of cardiovascular disease, is an imaging test called a coronary angiography. Your doctor may call it a cardiac catheterization, or “cath” for short.

What is a coronary angiogram?

A coronary angiogram is a diagnostic scan that allows you and your doctor to see, in detail, how your body moves blood through the arteries near the heart.

Arun Kumar, MD
Arun Kumar, MD

“A coronary angiogram is used to get a lay of the land,” said Arun Kumar, MD, an interventional cardiologist at MU Health Care. “We check to see if there are any artery blockages, how severe they are, and what needs to be treated and what can be left alone with good lifestyle choices.”

In addition to failed stress tests, your doctor may recommend one if you have chest pain, also called angina. Because chest pain can have many causes, a coronary angiogram is used to see if your heart and arteries are the source of the pain.

The exam takes less than an hour, is minimally invasive, and uses moderate sedation rather than full anesthesia. Your cardiologist inserts a small catheter in your wrist or your leg, guides it close to your heart and injects a harmless dye that shows up clearly on an X-ray.

Because the test uses moderate sedation, doctors can have full conversations with patients during the exam and show them the results in real time.

What does a coronary angiogram show?

The dye will show your cardiologist how much plaque buildup you have. Plaque restricts your heart’s ability to efficiently pump blood, which makes your body work harder and places strain on your heart. Plaque buildup and heart strain are often risk factors for developing more serious cardiovascular diseases.

“The main thing we're looking for on a coronary angiogram is severe narrowing of the heart arteries,” Dr. Kumar said. "Any blockage that is 70% or more, meaning the artery is narrowed due to plaque buildup, would be something that we would target with therapy.”

What happens after a coronary angiogram?

People fail stress tests for many reasons. Your angiogram test results may not show any issues with your arteries, which is a good thing.

If your coronary angiogram does show narrowed arteries, your cardiovascular team will discuss a range of treatment options with you based on your personal medical history and the results of the coronary angiogram. These may include:

  • Changes in diet, exercise and smoking habits
  • Cardiac rehabilitation
  • Medication
  • Stents
  • Heart surgery

“We tailor our therapies, whether it be medical therapy, stents or surgery, based on the individual patient,” Dr. Kumar said.

How can I prevent heart issues and arterial blockages?

Prevention is the top priority right now in interventional cardiology. Regular exercise and making changes to your diet and smoking habit can all help you avoid heart problems. It’s also important to manage conditions like diabetes or high cholesterol if you have them or take steps to prevent those diseases if you are at risk.

Poor sleep and high stress levels can contribute to heart issues, too, while good hygiene can help.

“Cardiac health is overall health,” said Dr. Kumar. “It’s never too late, but it’s also never too early, to focus on taking care of your heart.”

A closer look at the procedure

In this video, Dr. Kumar describes the process of a coronary angiography, including what to expect if you’re a patient and what doctors are looking for.


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