Before the Procedure

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure. 
• You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear. 
• Notify your doctor if you have ever had a reaction to any contrast dye, or if you are allergic to iodine or seafood. 
• Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general). 
• You will need to fast for a certain period of time prior to the procedure. Your doctor will notify you how long to fast, whether for a few hours or overnight. 
• If you are pregnant or suspect that you may be pregnant, you should notify your doctor. 
• Notify your doctor if you have any body piercings on your chest and/or abdomen. 
• Notify your doctor of all medications (prescription and over-the-counter) and herbal supplements that you are taking. 
• Notify your doctor if you have heart valve disease, as you may need to receive an antibiotic prior to the procedure. 
• Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop some of these medications prior to the procedure.
• Your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot. Other blood tests may be done as well. 
• Notify your doctor if you have a pacemaker. 
• You may receive a sedative prior to the procedure to help you relax. 
• The area around the catheter insertion (groin area) may be shaved. 
• Based upon your medical condition, your doctor may request other specific preparation.

During the Procedure

An angioplasty may be performed as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices

Generally, an angioplasty follows this process:

1. You will be asked to remove any jewelry or other objects that may interfere with the procedure.
2. You may wear your dentures or hearing aid if you use either of these. 
3. You will be asked to remove clothing and will be given a gown to wear.
4. You will be asked to empty your bladder prior to the procedure.
5. An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed. 
6. You will be placed in a supine (on your back) position on the procedure table. 
7. You will be connected to an ECG monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes.
8. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure. 
9. There will be several monitor screens in the room, showing your vital signs, the images of the catheter being moved through the body into the heart, and the structures of the heart as the dye is injected. 
10. You will receive a sedative medication in your IV before the procedure to help you relax. However, you will likely remain awake during the procedure.
11. Once the local anesthetic has taken effect, a sheath, or introducer, will be inserted into the blood vessel. This is a plastic tube through which the catheter will be inserted into the blood vessel and advanced into the heart.
12. The angioplasty catheter will be inserted through the sheath into the blood vessel. The doctor will advance the catheter through the aorta into the heart. Fluoroscopy will be used to assist in advancing the catheter to the heart.
13. The catheter will be advanced into the coronary arteries. Once the catheter is in place, contrast dye will be injected through the catheter into your coronary arteries in order to see the narrowed area(s). 
14. You should notify the physician if you feel any breathing difficulties, sweating, numbness, itching, nausea and/or vomiting, chills, or heart palpitations.
15. After the contrast dye is injected, a series of rapid, sequential x-ray images of the heart and coronary arteries will be made. You may be instructed to take in a deep breath and hold it for a few seconds during this time.
16. When the physician locates the narrowed artery, the catheter will be advanced to that location and the balloon will be inflated to open the artery. It is possible to experience some chest pain or discomfort at this point as a result of blood flow being temporarily blocked by the inflated balloon. Any chest discomfort or pain should go away when the balloon is deflated. However, if you notice any continued discomfort or pain, such as chest pain, neck or jaw pain, back pain, arm pain, shortness of breath, or breathing difficulty, tell your physician immediately. 
17. The physician may inflate and deflate the balloon several times. The decision may be made at this point to insert a stent in order to maintain the artery's opening. In some cases, the stent may be inserted into the artery before the balloon is inflated. The inflation of the balloon will open the artery and fully expand the stent.
18. The physician will take measurements after the artery has been opened. Once it has been determined that the artery is opened sufficiently, the angioplasty catheter will be removed.
19. The insertion site may be closed with a closure device that uses collagen to seal the opening in the artery, by the use of sutures, or by applying manual pressure over the area to keep the blood vessel from bleeding. Your physician will determine which method is appropriate for your condition.
20. If a closure device is used, a sterile dressing will be applied to the site. If manual pressure is used, the physician (or an assistant) will hold pressure on the insertion site so that a clot will form. Once the bleeding has stopped, a very tight bandage will be placed on the site. A small sandbag or other type of weight may be placed on top of the bandage for additional pressure on the site, especially if the site is in the groin.
21. Your physician may decide not to remove the sheath, or introducer from the insertion site for approximately four to six hours, in order to allow the effects of blood-thinning medication given during the procedure to wear off.
22. You will be assisted to slide from the table onto a stretcher so that you can be taken to the recovery area. NOTE: If the insertion was in the groin, you will not be allowed to bend your leg for several hours. To help you remember to keep your leg straight, the knee of the affected leg may be covered with a sheet and the ends tucked under the mattress on both sides of the bed to form a type of loose restraint. If the insertion site was in the arm, your arm will be kept elevated on pillows and kept straight by placing your arm in an arm guard (a plastic arm board designed to immobilize the elbow joint). In addition, a plastic band (works like a belt around the waist) may be secured around the arm near the insertion site. The band will be loosened at given intervals and then removed at the appropriate time determined by your physician.

After the Procedure

In the Hospital

After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. You will remain flat in bed for several hours after the procedure. A nurse will monitor your vital signs, the insertion site, and circulation/sensation in the affected leg or arm.

You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site in your leg or arm.

Bedrest may vary from two to six hours depending on your specific condition. If your doctor placed a closure device, your bedrest may be of shorter duration.

In some cases, the sheath or introducer may be left in the insertion site. If so, the period of bedrest will be prolonged until the sheath is removed. After the sheath is removed, you may be given a light meal.

You may feel the urge to urinate frequently because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bedrest so that your affected leg or arm will not be bent.

After the specified period of bed rest has been completed, you may get out of bed. The nurse will assist you the first time you get up, and will check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the long period of bedrest.

You may be given pain medication for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.

You will be encouraged to drink water and other fluids to help flush the contrast dye from your body. You may resume your usual diet after the procedure, unless your doctor decides otherwise.

You will most likely spend the night in the hospital after your procedure. Depending on your condition and the results of your procedure, your stay may be longer. You will receive detailed instructions for your discharge and recovery period.

At Home

Once at home, you should monitor the insertion site for bleeding, unusual pain, swelling, and abnormal discoloration or temperature change at or near the insertion site. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small dressing, notify your doctor.

If your doctor used a closure device for your insertion site, you will be given specific information regarding the type of closure device that was used and how to take care of the insertion site. There will be a small knot, or lump, under the skin, where the insertion site was.

This is normal. The knot should gradually disappear over a few weeks.

It will be important to keep the insertion site clean and dry. Your doctor will give you specific bathing instructions.

You may be advised not to participate in any strenuous activities. Your doctor will instruct you about when you can return to work and resume normal activities.

Notify your doctor to report any of the following:

• Fever and/or chills
  
• Increased pain, redness, swelling, or bleeding or other drainage from the insertion site
• Coolness, numbness and/or tingling, or other changes in the affected extremity
• Chest pain/pressure, nausea and/or vomiting, profuse sweating, dizziness, and/or fainting

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.