Angiogram vs angioplasty.

In most cases you stay awake. Local anaesthetic is used at the wrist or groin, so that area is numb, and the catheters are usually not felt inside the arteries. Mild sedation is given in some cases. You may feel pressure at the start and a brief warm flush when the dye is injected. Full anaesthesia is not usual for a simple angiogram, but the plan can differ if you are very unwell or if another procedure is being done at the same sitting. Tell the team at once if you feel chest pain, breathlessness, or any discomfort.

You will usually be asked not to eat for a few hours before, though sips of water are often allowed. Do not stop any medicine on your own. Most heart tablets are continued, but blood thinners, diabetes tablets and insulin often need adjusting, so tell the team exactly what you take and bring the strips with you. Also tell them if you have kidney problems or asthma, or if you have ever reacted to X-ray dye or to any medicine. Fasting instructions differ between hospitals and between patients, so follow the instructions you are given.

Either is possible, and the choice is made by the operator on the day. The wrist route is commonly used and usually allows you to sit up and walk sooner. The groin may be preferred if the wrist artery is small, the pulse is weak, or a larger catheter is needed. Sometimes the route has to be changed during the procedure, for example if the artery is small or goes into spasm. That is usually a practical decision rather than a sign that something has gone wrong, and the team will tell you what was done.

Sometimes angioplasty is done in the same sitting. Sometimes the angiogram is completed and the treatment decision is made later, once the findings have been explained to you and your family. It depends on how significant the narrowing is, whether it explains your symptoms, and whether medicines or bypass surgery may suit you better. This is why the consent form usually covers both. If you want the decision discussed with your family before anything is treated, say so before the procedure starts. In an emergency, such as an ongoing heart attack, treatment may have to be done straight away.

Any procedure carries some risk, and a coronary angiogram is generally considered a low-risk test in experienced hands. Bruising or bleeding where the catheter enters is the commonest problem. Less often the artery at the wrist or groin can be damaged, and the dye can affect the kidneys or cause an allergic reaction. Serious complications such as heart attack, stroke, or rhythm disturbance are uncommon but possible. Your own risk depends on your heart, your kidneys, and your other illnesses, so ask your cardiologist to explain it for your situation before you consent.

After a straightforward angiogram many people go home the same day or the next morning. After angioplasty the stay is usually longer, and the exact timing depends on how the procedure went and on your other medical problems. Avoid heavy lifting and straining with the arm or leg that was used for a few days. Driving and return to work depend on what was done and on your job, so ask your doctor before you resume. If you had a stent, do not stop the blood-thinning tablets you are discharged on, even for a dental or minor procedure, without asking your cardiologist first. If the access site bleeds, press firmly over it and get emergency help. Also get emergency care for swelling that grows quickly, a hand or leg that becomes cold, pale, or numb, or any chest pain or breathlessness.