This page describes a non-surgical procedure known as angioplasty. The procedure may also be called percutaneous transluminal coronary angioplasty or PTCA. If you or a family member have additional questions, please feel free to discuss them with your doctor or nurse at any time.

The Purpose Of Cardiac Angioplasty

Your doctor has recommended that you have an angioplasty because you have coronary artery disease, also called atherosclerosis. The purpose of cardiac angioplasty is to open arteries that have become partially blocked by a build-up of plaque (a combination of cholesterol and other fats, calcium, and other elements in blood). When plaque accumulates, the opening in the arteries becomes more narrow and less blood, and therefore less oxygen, reaches the heart. This can cause chest pain (angina) or even a heart attack (myocardial infarction).

Angioplasty is a treatment, not a cure. After your procedure, it is important to reduce your any risk factors you may have for coronary artery disease by following your doctor's instructions and by participating in a cardiac rehabilitation program if ordered by your doctor.

Words You Should Know:

Anesthetic: a medicine applied to an area to numb it

Angina: chest pain

Antiseptic: a disinfectant used to kill germs

Atherosclerosis: the slow buildup of fatty deposits inside the walls of arteries which causes angina and can lead to a heart attack

Atherectomy: a tool that cuts or shaves the fatty deposits from the side of the artery

Catheter: a small, thin, flexible tube

Coronary: referring to the heart

Electrocardiogram or ECG: computerized recording of electrical activity of the heart

Myocardial Infarction or MI: a heart attack

IV: intravenous needle and fluid drip

Sheaths: plastic tubes

TESTING INSTRUCTIONS: DO NOT EAT OR DRINK AFTER MIDNIGHT THE DAY OF THE PROCEDURE UNTIL THE PROCEDURE IS COMPLETED.

Take all medications as prescribed with a small sip of water unless directed otherwise by your doctor.

Be sure to tell your doctor if:

• You have an allergy to seafood, x-ray dye or iodine
• You know or suspect that you are pregnant
• You are taking blood thinners
• You have a history of bleeding problems
• You are diabetic

Prior to your procedure, blood tests, x-rays and an electrocardiogram (ECG) will be ordered by your doctor. Family members will be taken to a waiting room where your doctor will speak with them after your procedure.

THE ANGIOPLASTY PROCEDURE

You will be awake during the entire procedure, and your doctor and nurses will explain each step as it occurs. You will wear a hospital gown, and you may wear your glasses, hearing aid and dentures. At the start of the procedure, a nurse will give you a sedative to help you relax. If you don't already have an intravenous needle (IV), one will be started. Your blood pressure and electrocardiogram (ECG) will be monitored throughout the procedure. In some cases, an angioplasty is done immediately when a cardiac catheterization procedure shows that you have narrowed coronary arteries.

The procedure begins by administration of an anesthetic in the groin area. You may feel a slight "stinging" sensation during the injection. During the procedure, the doctor will insert a plastic tube (sometimes called a sheath), into an artery in the groin. Then, a thin, flexible tube (catheter) is carefully guided into the coronary artery that is narrowed. A special dye is injected that allows the doctor to follow the progress of the catheter while watching the procedure on an x-ray.

Since blood vessels do not have nerves, you should experience no pain while the catheter is threaded into your artery. A very small balloon at the end of the catheter is then inflated for 1-3 minutes (this may be done several times). The pressure from the inflated balloon causes the hardened deposits (plaque) in the artery to be pressed into the wall of the vessel. This opens the artery and allows blood flow to the heart. While the balloon is inflated, it is normal to feel some chest pain. In many cases, a small, expandable stainless-steel tube, or stent, may be placed in the artery to help hold it open permanently after the catheter is removed.

Because you will be awake during the procedure, you should report any pain or angina symptoms to your doctor as soon as you feel them. The procedure usually takes 60 minutes. After the procedure, the catheter and sheath will be removed.

POSSIBLE COMPLICATIONS:

Complications of an angioplasty are rare, but may include: bleeding that results from a puncture of a large blood vessel; blood clots in a catheterized blood vessel; collapse or tear in a blood vessel; and restenosis, or excess scar tissue in an artery that may cause more blockage. The doctors and nursing staff are highly skilled and are prepared to act immediately in the event of any complication.

Complications:

Complications from angioplasty occur infrequently but may include:

• Sudden closure of the artery
• You may require emergency bypass surgery
• Heart attack
• Death. The risk of death is higher when more than one artery is involved.

What to expect following surgery

You will be transferred to the recovery room or to the Coronary Care unit where you will be closely monitored by the nursing staff. You will remain in bed with the head of the bed slightly raised until your doctor determines that it's okay for you to get up. You will usually start walking within 12 to 24 hours after the procedure. Your doctor will decide when you will be able to drink liquids and eat solid food.

It is not uncommon to have swelling, bruising and a small lump where the catheter was inserted. The leg below the catheter insertion site will be monitored to check for bleeding. Movement of your leg will be restricted for several hours. When the sheaths are taken out, the nurses may apply pressure to reduce swelling and prevent bleeding. Please tell your nurse if you experience any pain or discomfort. Your doctor will decide, based on your concerns, whether you will be discharged to your home or transferred to another unit in the hospital. Discharge usually takes place within 24 hours of the procedure. Exercise and driving may usually resume after 1 to 2 days with permission from your doctor.

What to do and expect once you go home

• Avoid heavy activity for 1 to 2 days, including pushing or pulling heavy objects or lifting more than 10 pounds.
• Stop exercising before you become tired or short of breath. If you experience chest pain during exercise, stop immediately, call your doctor and follow all instructions given. If you cannot reach your doctor and are still in pain, call 911.
• Avoid rubbing the lump at the catheter insertion site.
• Avoid driving for two days after the procedure.
• Keep all follow-up appointments with your doctor.

Keep all follow-up appointments with your doctor. You may return to your normal sexual activity after your groin heals. Don't smoke. Angioplasty will not remain successful if you smoke.

Plan a diet that is healthy, tastes good and is low in fat and cholesterol. Too much weight is hard on your heart and blood vessels. If you need to lose weight, ask your doctor for help. Learn to manage stress. Discuss any emotional problems you may have with your doctor or nurse.

Returning to work: The type of work you do determines how quickly you will be able to return to work. Your doctor will discuss this with you to see what's best for you.

CALL YOUR DOCTOR IF:

Your arm or leg becomes numb or painful, or if there is redness or a yellow discharge.

You have pain or numbness below the catheter insertion site (leg, toes, arm, fingers).

The catheter insertion site swells or bleeds. If this happens, lie down immediately on a firm surface and have someone apply pressure to the catheter insertion site for 10 minutes by pressing the heels of both hands over the lump and pushing down. If the swelling and/or bleeding does not stop, call your doctor or go to the emergency room while continuing to hold pressure on the site. Seek emergency medical care immediately if you have chest pain like the pain before or during your angioplasty.

MEDICATIONS:
You may be placed on medications following your angioplasty to prevent blood clots from forming. Report all side effects from medications to your doctor. DO NOT stop taking any medicine unless directed by your doctor.

This information should not be considered specific medical advice and is not meant to replace professional medical services. Please speak to your physician regarding symptoms, diagnosis, treatment, and any other pertinent questions regarding pacemakers.