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  • Coronary angiography is considered the gold standard for visualization of the coronary anatomy in clinical settings.
    medical angiography coronary
  • The ultimate goal of coronary angiography is to define the coronary anatomy and to quantify or characterize the severity of coronary stenoses.
    medical angiography stenoses
  • Most indications for coronary angiography in the United States are for patients presenting with acute coronary syndrome or angina pectoris.
    medical indications syndrome
  • Elective coronary angiography is usually performed after an initial cardiac workup of chest pain is abnormal, requiring more definitive diagnostic testing.
    medical elective diagnosis
  • Coronary angiography is performed in a catheterization laboratory, which includes a patient table, x-ray source, image intensifier, and monitor display.
    medical angiography laboratory
  • The left main coronary artery bifurcates into the left anterior descending (LAD) artery and the left circumflex (LCX) artery.
    anatomy coronary artery
  • The LAD artery generally supplies the anterior/anterolateral walls and the interventricular septum.
    anatomy coronary supply
  • The right coronary artery (RCA) supplies the right ventricle (RV) and gives rise to the posterior descending artery (PDA) in 85% of the population.
    anatomy coronary rca
  • Anatomically, right or left dominance is determined by the artery that gives off the PDA.
    anatomy dominance pda
  • To effectively interpret coronary angiograms, one must understand that the heart is situated on an oblique axis in the chest cavity.
    anatomy angiography interpretation
  • Oblique views involve turning the patient's right or left shoulder toward the image intensifier.
    imaging anatomy oblique
  • Cranial and caudal angulations are obtained by rotating the image intensifier along the patient's long axis.
    imaging anatomy angulations
  • In the right anterior oblique (RAO) view at about 30 degrees, the interventricular septal plane and the atrioventricular plane are perpendicular to each other.
    imaging anatomy rao
  • The left main coronary artery arises from below the sinotubular junction of the aorta and bifurcates into the LAD and LCX.
    cardiology coronary anatomy
  • The LAD is best seen in the cranial angulation, extending downward to the apex and giving off septal branches.
    cardiology lad anatomy
  • The LCX is best visualized in the caudal angulation, traversing posteriorly and giving off obtuse marginal branches.
    cardiology lcx anatomy
  • The RCA usually arises from the right aortic sinus and is best seen in the left anterior oblique view.
    cardiology rca anatomy
  • The PDA can be identified in the cranial angulation, giving off septal perforating branches.
    cardiology pda anatomy
  • In the RAO cranial projection, the LAD artery shows a shadow cast by the diaphragm.
    imaging lad diaphragm
  • In the RAO caudal projection, the LCX artery shows NO diaphragmatic shadow.
    imaging lcx diaphragm
  • The spine location helps distinguish between RAO and LAO angles; if the spine is on the right side of the patient, it is an RAO angle, while if it is on the left side, it is an LAO angle.
    angiography views anatomy
  • In the LAO caudal view, there is no prominent diaphragmatic shadow.
    angiography views anatomy
  • In cranial views, the LAD is seen in full length traveling downward, while the LCX appears to be traversing upward; the opposite is true in caudal views.
    angiography views anatomy
  • The LAO angle tends to splay out the thoracic aorta and is a good angle to view the origin of the great arteries.
    angiography views anatomy