Indications for cardiac catheterization and coronary arteriography in the adult

R. O. Brandenburg, V. Fuster, R. Giuliani

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


At the present time reasonable indications for coronary angiography are: 1. The patient with stable angina which causes him to be disabled despite a vigorous medical program. 2. Unstable angina responding poorly to medical treatment. 3. Postinfarction patients who have persisting angina or develop significant angina following the infarct. 4. Patients who on treadmill testing develop significant symptoms and ischemic electrocardiographic changes at heart rates of 110 per minute or less. 5. Selected patients with valvular heart disease (see above). 6. Postinfarction patients with persistent rhythm disturbances or marked dyspnea suggesting left ventricular aneurysm, ruptured ventricular septum, or mitral insufficiency. 7. Selected postcoronary-surgical-bypass patients who have again developed angina. The above examples would all be potential surgical candidates, while the following two represent diagnostic problems. 8. Patients in whom the character of chest pain and the treadmill test leave doubt as to the presence of significant coronary disease. 9. Patients in positions of responsibility for the lives of others, e.g., pilots and bus drivers, in whom there is suspicion of coronary heart disease from history, treadmill testing, or resting electrocardiograms. Indications for cardiac catheterization in the common congenital heart diseases are mentioned here for the sake of completeness. These include: 1. Tetralogy of Fallot: a. Patients under 3 years of age. b. The presence of a continuous murmur (suggesting open ductus, bronchial collaterals, or peripheral pulmonary stenosis). c. Patients with a previous thoractomy. 2. Atrial septal defect a. Patients with findings suggesting the presence of pulmonary hypertension. b. Patients in whom the diagnosis is unclear, because of pectus excavatum, straight back, etc. 3. Ventricular septal defect. a. The presence of associated pulmonary hypertension. b. Selected instances of difficulty differentiating a small ventricular septal defect from mild pulmonic valve stenosis or mitral incompetence. c. Ventricular septal defect associated with aortic valve incompetence. 4. Patent ductus arteriosus a. Patients with a continuous murmur not heard maximally in the left intraclavicular area, i.e. to rule out ruptured sinus of Valsalva, coronary artery fistula, and pulmonary arteriovenous fistulas. b. Patients suspected of having complicating pulmonary hypertension. 5. Coarctation of aorta. a. Symptomatic infants (because of probabiity of associated lesion). b. Patients without hypertension because of excellent collateral circulation. c. Patients with coarctation of the abdominal aorta (absence of collaterals or rib notching). d. Selected patients with pseudocoarctation of the aorta. We recognize that these recommendations can serve only as guidelines because the variations in individual manifestations of each cardiac lesion are legion. New and improved technical advances in echocardiography and nuclear myocardial imaging may well modify current recommendations in the near future.

Original languageEnglish
Pages (from-to)83-88
Number of pages6
JournalCardiovascular Clinics
Issue number3
StatePublished - 1980
Externally publishedYes


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