Coronary Angiography in Ahmedabad

Being advised to have an angiography can bring several questions: Is there a blockage? Will it hurt? Will I need a stent immediately? Who will perform the test?

Coronary angiography, also called CAG, is a diagnostic test that records moving X-ray images of the arteries supplying your heart. A thin tube called a catheter delivers contrast dye into these arteries, allowing the team to see where they are narrowed or blocked.

Dr. Kulin Sheth personally performs coronary angiography at Apollo CVHF Hospital, Bodakdev, Ahmedabad. If you have been referred from Sheth Heart Clinic, Bopal, the hospital admission is for the test in the catheterisation laboratory. Dr. Kulin remains involved in your care, supported by the hospital team.

Angiography is a test. Angioplasty or stenting is a separate treatment. Agreeing to angiography does not automatically mean that you will need a stent.

The purpose is to answer a specific question about your coronary arteries and help decide what care you need. The recommendation depends on your symptoms, earlier reports, response to treatment and overall risk.

In a planned assessment, angiography may be considered when symptoms remain troublesome despite treatment, earlier tests suggest higher-risk disease, or uncertainty needs to be resolved before a treatment decision. An abnormal test does not automatically mean that everyone needs invasive angiography. Equally, a normal resting ECG or echo does not rule out coronary narrowing.

Your doctor should explain why angiography is appropriate for you and whether another investigation could answer the question. The cardiac tests used to investigate symptoms provide different kinds of information; they are not interchangeable.

Planned and Unplanned Angiography

Planned angiography is arranged after consultation. There is time to review reports, explain alternatives, discuss medicines and prepare for admission.

Unplanned or urgent angiography may be advised during an unexpected admission with concerning symptoms or a heart attack. Its timing depends on the clinical findings. Some patients need immediate treatment; others undergo assessment and angiography during their hospital stay. The chest pain and heart attack assessment helps establish that urgency.

For a heart attack requiring emergency angioplasty, angiography identifies the artery that needs treatment. Do not delay emergency care to arrange an outpatient appointment or second opinion.

CT coronary angiography can be appropriate in selected planned investigations. It does not replace catheter angiography in every situation. The choice depends on the clinical question, previous findings and urgency.

The angiogram shows the inner channel of the main coronary arteries. It helps identify the location, extent and pattern of narrowing. The images are interpreted alongside your symptoms and other findings.

The appearance of a narrowing does not always tell us how much it limits blood flow. For selected intermediate narrowings, pressure-wire measurements such as FFR or iFR can help assess whether treatment is needed. IVUS and OCT are different tools: they provide images from inside an artery and may help clarify its structure or guide treatment. These additional assessments are used selectively.

A report showing no major obstructive blockage does not mean that persistent symptoms should be dismissed. Small-vessel dysfunction or coronary spasm can require further assessment; other causes of chest discomfort also need consideration.

You are awake during routine coronary angiography. Local anaesthesia numbs the entry site. Light sedation may be used if needed, but general anaesthesia is not normally required. You can speak to the team and tell them if you feel uncomfortable.

The usual steps are:

1. The team monitors your heart rhythm, blood pressure and oxygen level, and cleans the wrist or groin area.
2. Local anaesthesia is given. A small tube is placed in the artery, through which the catheter is guided towards the coronary arteries using X-ray guidance.
3. Contrast dye is injected and moving X-ray images are recorded from different angles.
4. The catheter is removed. Pressure, a wrist compression band or an appropriate closure method controls bleeding at the entry site.

The wrist or groin route is chosen according to your circulation, clinical circumstances and procedure requirements.

It Is a Video Map of Your Coronary Arteries

An angiogram is a sequence of moving images showing contrast flowing through the arteries. This helps Dr. Kulin assess the findings from several views.

You will receive a written report and a CD containing your CAG video. Keep both safely. The recording is useful when reviewing treatment options, planning follow-up or obtaining a second opinion.

Do I Need to Fast?

For routine planned CAG under Dr. Kulin’s care, patients are generally asked to remain non-fasted. You do not need to assume that an overnight fast is necessary simply because angiography has been advised. Follow the eating and drinking instructions given by the team, including any individual exceptions.

Research, including the SCOFF randomised trial, supports a non-fasting approach for the catheter-laboratory procedures studied, including procedures performed with conscious sedation.

For an unplanned admission, follow the treating team’s instructions. If you develop possible heart attack symptoms after eating, seek emergency care immediately; do not wait until you have an empty stomach.

Do I Need to Stop My Routine Medicines?

You can generally continue your routine medicines unless the team specifically advises a change. Do not stop them yourself because you are coming for CAG.

Bring your prescription and tell the team everything you take. Anticoagulants, insulin and other diabetes medicines may need individual instructions. Kidney function and the procedure plan can also affect those instructions. If anything is unclear, check with the team before admission rather than guessing which tablets to omit.

What Should I Bring or Tell the Team?

• Previous ECGs, echo and stress-test reports, blood tests, discharge summaries and any previous angiography report and recording.
• Your current medicine list, including non-prescription medicines and supplements.
• Details of kidney disease, dialysis, bleeding problems or a previous reaction to contrast.
• Any possibility of pregnancy.

Arrange for an adult to accompany you home. The team will advise which blood tests are needed, including assessment of kidney function. Your procedure preparation instructions should be followed alongside the advice specific to your admission.

Kidney disease does not automatically prevent angiography, but it changes the preparation and risk discussion. Bring recent creatinine results and earlier reports so the team can assess both your estimated kidney filtration, or eGFR, and whether it is stable.

Patients with significant or worsening kidney dysfunction may need a nephrologist’s assessment before planned CAG. The cardiology and kidney teams can coordinate preparation and follow-up. This assessment helps manage risk; it cannot guarantee that kidney function will remain unchanged.

The plan may include carefully prescribed intravenous fluids, limiting contrast and arranging repeat kidney blood tests. Fluid treatment must be individualised, particularly if you have heart failure or fluid restrictions. Do not try to protect your kidneys by drinking excessive water without advice.

Preparation may require a longer stay than routine day-care admission. In an emergency, the team weighs kidney risk against the danger of delaying necessary heart treatment.

“But Sir, Is Angiography Risky?”

It is understandable to ask this even after agreeing to the test. Most planned diagnostic angiograms are completed without a serious complication, but the test is invasive and is not risk-free.

Bruising and soreness at the wrist or groin are more common than serious problems. Other risks include bleeding, damage to the access artery, contrast reactions and kidney dysfunction. Uncommon serious complications include heart attack, stroke, a dangerous rhythm disturbance or death.

Your risk depends on your health and the circumstances of the procedure. A stable person having a planned test has a different risk profile from someone with a heart attack, low blood pressure or advanced kidney disease. Dr. Kulin and the team will discuss the relevant risks and expected benefit with you before the procedure. X-rays are used, so radiation exposure is also considered.

Can the Dye Affect My Kidneys? Understanding Contrast Induced Nephropathy

Contrast can contribute to an acute deterioration in kidney function, traditionally called contrast-induced nephropathy, or CIN. The change is detected through kidney blood tests in the days after the procedure and may occur without obvious symptoms.

Risk is lower when kidney function is preserved and the patient is clinically stable. It rises with existing kidney dysfunction, dehydration, low blood pressure, heart failure and greater contrast exposure. Diabetes is particularly relevant when kidney disease is also present.

Kidney dysfunction after angiography is not always caused by contrast alone. The acute illness, circulation and other medicines can contribute. Doctors therefore also use the term contrast-associated acute kidney injury when a deterioration follows contrast exposure without proving that contrast caused it.

The deterioration may be temporary, but persistent loss of kidney function and, in severe cases, dialysis are possible. The team assesses risk, plans preventive measures and arranges repeat creatinine testing when appropriate, often within 48–72 hours in patients at increased risk. Feeling well on discharge does not replace a blood test that has been advised.

“Sir, angiography karavie etle stent mukavo j pade?”

Does having an angiogram mean I must have a stent?

No. Finding a blockage does not automatically mean that a stent is the right treatment.

After reviewing the angiogram, Dr. Kulin personally comes out of the cath lab to explain the findings to your family or accompanying person. He also discusses the findings with you, explains the options and answers questions before a decision about further treatment. An emergency requiring immediate action to protect you is the exception.

Depending on the findings, the next step may be:

• Medicines and risk-factor treatment, with follow-up.
• Further assessment when the importance of a narrowing is uncertain.
• Coronary angioplasty, when catheter-based treatment is appropriate.
• Bypass surgery evaluation, sometimes through a Heart Team discussion, when the pattern of disease and your circumstances favour surgery.

The decision considers your symptoms, the arteries involved, disease complexity, heart function, other illnesses and preferences. It should explain the expected benefit of treatment in your situation. The management of coronary artery disease continues whether or not a procedure is needed.

Can Angioplasty Be Done in the Same Sitting?

Sometimes, yes. Before angiography, Dr. Kulin discusses this possibility when it is relevant, including consent and alternatives. Coronary angioplasty remains a separate treatment decision.

When it is clinically safe, you can take time to consider the findings, involve your family or seek a second opinion. Certain symptoms or high-risk findings may require prompt treatment even without an ongoing heart attack. If waiting is unsafe, the team will explain why.

Planned diagnostic coronary angiography is usually a day-care procedure. If you are admitted in the morning, need no further intervention or inpatient treatment, and recover satisfactorily, you can usually go home by evening.

The team checks your blood pressure, pulse and entry site before discharge. Observation and mobilisation depend partly on whether the wrist or groin was used. An acute admission, kidney-protection plan, complication or additional treatment can require a longer stay.

Before leaving, make sure you understand:

• Your results and the next treatment or follow-up decision.
• Which medicines to take and whether any changes are temporary.
• Entry-site care and when you can resume driving, work, lifting and exercise.
• Whether you need repeat blood tests and whom to contact with concerns.

Follow the instructions given for your own procedure. Recovery after diagnostic CAG differs from recovery after angioplasty or a heart attack. Keep your written report and CD, and bring them to your recovery and follow-up appointment.

When Should I Seek Urgent Help Afterwards?

Seek emergency care for new or persistent chest pain, severe breathlessness, collapse, stroke symptoms, a cold or numb hand or foot on the procedure side, or heavy bleeding or rapidly increasing swelling at the entry site.

If the entry site bleeds, apply firm pressure and seek urgent help if bleeding is heavy or does not stop. Do not drive yourself to emergency care.

Contact the treating team promptly for increasing wound pain, redness, discharge, fever or a noticeable reduction in urine. Follow any scheduled kidney blood tests even if you feel well.

You may want to understand why angiography has been advised, what your report means, or whether medicines, a stent or bypass surgery best fits your situation.

Dr. Kulin Sheth personally reviews existing reports and angiography images when providing a second opinion, before deciding whether further assessment is appropriate. Bring the written report and video CD, together with your medicine list and other relevant records. A previous angiogram does not automatically need to be repeated for a review.

You can arrange a cardiologist consultation at Sheth Heart Clinic, Bopal to discuss these decisions. For urgent symptoms or a time-sensitive recommendation, speak to your treating team immediately rather than postponing care for an elective appointment.

References

• 2024 ESC Guidelines for the Management of Chronic Coronary Syndromes: investigation choices, coronary physiology and symptoms without obstructive coronary disease.
• 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Acute Coronary Syndromes: urgent assessment and treatment pathways.
• 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: shared decisions and selection of PCI or bypass surgery.
• SCOFF Trial: Fasting Versus No Fasting Before Catheterization Laboratory Procedures: randomised evidence on non-fasting care.
• SCAI: Quality Initiatives for Prevention of Contrast-Induced Acute Kidney Injury: kidney-risk assessment and prevention.
• ESUR Contrast Media Safety Committee: Post-Contrast Acute Kidney Injury, Part 1: terminology, causation and risk factors.
• ESUR Guidelines: Renal Adverse Reactions to Contrast Media: individualised hydration and follow-up kidney testing.
• Cardiological Society of India Practice Guidelines for Angiography in Patients with Renal Dysfunction: assessment and preparation in patients with kidney disease.
• Guy’s and St Thomas’ NHS Foundation Trust: Having a Coronary Angiogram: procedure experience and individual medicine instructions.
• NHLBI: Coronary Angiography and Other Heart Tests: test information and procedural risks.
• NHLBI: Recovery After Cardiac Catheterization: follow-up and warning signs.