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20 years
What is the concept of this test we lebanese commonly call "mil"? And why is it that sometimes the dr can't do this test?
Apr 28, 2015

Dr. Zakia Dimassi Pediatrics

The medical term for “mil’
or “temyil” is coronary angiography (coronary for coronary arteries or الشرايين التاجية, which are the arteries that provide blood
supply to the muscles of the heart). This test uses dye and special x-rays to show the insides of the
coronary arteries.

The primary use of this
test is for the detection of atherotic plaques, which are substances made up of
cholesterol and inflammatory cells that build up inside the coronary arteries,
eventually resulting in coronary artery disease (CAD). Over time, a plaque can
harden or rupture (break open). Hardened plaque narrows the caliber of the coronary
arteries and reduces the flow of blood to the heart. This can cause chest pain
or discomfort called angina. If the plaque ruptures, a blood clot can form on
its surface. If this blood clot acquires a large enough volume, it can cause
partial or complete block of the blood flow through a coronary artery. This is
the most common cause of heart attacks.

coronary angiography, a special dye is injected into the bloodstream to allow visualization
of the coronary arteries on x-ray films. In order to introduce this dye, a
procedure known as cardiac catheterization (short: cardiac cath), is performed.
It consists of inserting a thin, flexible tube called a catheter into a blood
vessel (usually in the left arm, groin, or neck). The tube is then slowly
driven upwards to reach the coronary arteries. At that point the dye is
released into the bloodstream, and X-ray pictures are taken simultaneously.

Indications for cardiac
catheterization include:

1- Evaluation of chest pain:
this is the most common indication for a cardiac cath; chest pain could result
from a narrowing in one or more of the coronary arteries by a plaque

2- Treatment
of a blocked coronary artery: a procedure called angioplasty, which is
basically done by inserting a balloon into a narrowed coronary artery in order
to widen it up, or by placing a stent (better known in lay man terms as “ressort”),
which is a small mesh tube that supports the inner artery wall.

3- Decide
on a plan of management: let’s say a patient did an EKG (electrocardiogram), or
stress test done, with results suggestive of heart disease. In such scenarios,
a cardiac cath is performed to rule out this possibility.

Relative (not absolute; weighing the pros and the cons of
the procedures and taking necessary precautions may affect these
contraindications) contraindications to cardiac catheterization

Renal disease: people with advanced renal disease
cannot tolerate the dye used in cardiac cath as this may inflict further damage
to their already diseased kidneys

Coagulopathy: or a problem in their bloods whereby
they tend to bleed too much

Fever: indicates infection, and since this is an
invasive procedure (major blood vessels are accessed), it cannot be performed fear
of spreading the infection

Systemic infection

Uncontrolled arrhythmia (problem in the heart
rhythm) or hypertension

Uncompensated heart failure: the patient’s heart is
too weak and cannot tolerate the procedure

Allergy to dye in patients who have not received
proper pre-medication: patients with known allergies to dye material must
receive a set of medications before the procedure to prevent a severe sometimes
fatal allergic reaction.