What is coronary angioplasty (percutaneous coronary intervention)?

Coronary Angioplasty (Percutaneous Coronary Intervention)
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Coronary Angioplasty: Before Your Procedure

How can you care for yourself after a coronary angioplasty?

Activity

  • If the doctor gave you a sedative:
    • For 24 hours, don't do anything that requires attention to detail, such as going to work, making important decisions, or signing any legal documents. It takes time for the medicine's effects to completely wear off.
    • For your safety, do not drive or operate any machinery that could be dangerous. Wait until the medicine wears off and you can think clearly and react easily.
  • Do not do strenuous exercise and do not lift, pull, or push anything heavy until your doctor says it is okay. This may be for several days. You can walk around the house and do light activity, such as cooking.
  • If the catheter was placed in your groin, try not to walk up stairs for the first couple of days.
  • If the catheter was placed in your arm near your wrist, do not bend your wrist deeply for the first couple of days. Be careful using your hand to get into and out of a chair or bed.
  • Carry your stent identification card with you at all times.
  • If your doctor recommends it, get more exercise. Walking is a good choice. Bit by bit, increase the amount you walk every day. Try for at least 30 minutes on most days of the week.
  • If you haven't been set up with a cardiac rehab program, talk to your doctor about whether rehab is right for you. Cardiac rehab includes supervised exercise. It also includes help with diet and lifestyle changes and emotional support.

Diet

  • Drink plenty of fluids to help your body flush out the dye. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
  • Keep eating a heart-healthy diet that has lots of fruits, vegetables, and whole grains. If you have not been eating this way, talk to your doctor. You also may want to talk to a dietitian. This expert can help you to learn about healthy foods and plan meals.

Medicines

  • Your doctor will tell you if and when you can restart your medicines. Your doctor will also give you instructions about taking any new medicines.
  • If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
  • You will take medicine that prevents blood clots. You may take aspirin plus another antiplatelet. It is very important that you take these medicines exactly as directed. These medicines help keep the coronary artery open and reduce your risk of a heart attack.
  • Call your doctor if you think you are having a problem with your medicine.

Care of the catheter site

  • For 1 or 2 days, keep a bandage over the spot where the catheter was inserted. The bandage probably will fall off in this time.
  • Put ice or a cold pack on the area for 10 to 20 minutes at a time to help with soreness or swelling. Put a thin cloth between the ice and your skin.
  • You may shower 24 to 48 hours after the procedure, if your doctor okays it. Pat the incision dry.
  • Do not soak the catheter site until it is healed. Don't take a bath for 1 week, or until your doctor tells you it is okay.
  • Watch for bleeding from the site. A small amount of blood (up to the size of a quarter) on the bandage can be normal.
  • If you are bleeding, lie down and press on the area for 15 minutes to try to make it stop. If the bleeding does not stop, call your doctor or seek immediate medical care.

How well does a coronary angioplasty work?

Heart attack

Angioplasty works well to open a blocked artery after a heart attack. This helps blood to flow more normally to the heart muscle. Angioplasty can help lower the risk of death and complications from the heart attack.

Stable angina

Angioplasty can improve your angina symptoms. It can also improve your quality of life. If your symptoms happen a lot, you are more likely to have a better quality of life after the procedure.

Angioplasty might not relieve all of your symptoms. But you might not need to take angina medicines anymore. Or you might not need to take as much.

There are some things that angioplasty can't do. In people who have stable angina:

  • It does not prevent a heart attack.
  • It does not help you live longer.

It may be hard to understand why angioplasty does not lower your risk of a heart attack or help you live longer. It's because of how coronary artery disease and plaque happen in your arteries.

Even if you get a stent, you still may have other places in your arteries where a heart attack can happen. During the procedure, your doctor finds and treats the places where plaque narrows the artery and limits blood flow. But smaller plaques can build up in other places in your arteries. They don't limit blood flow much or cause symptoms. But if one ruptures, it can cause a heart attack. This type of plaque is treated with medicines and a heart-healthy lifestyle.

How do you prepare for a coronary angioplasty?

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

  • Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
  • Understand exactly what procedure is planned, along with the risks, benefits, and other options.
  • If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
  • Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
  • Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

What are the risks of a coronary angioplasty?

Angioplasty has some risks. They include:

  • The need for emergency bypass surgery during the procedure.
  • Heart attack.
  • Stroke.
  • Death.

Your doctor can help you know your chance of problems. Several things, including age and health, can raise your risk of problems. For example, older people or those with heart failure or kidney disease have a higher risk of problems.

The risks of problems where the catheter was placed include:

  • Bleeding.
  • Damage to blood vessels.
  • Pain.
  • Swelling.
  • Bruising.
  • Tenderness.

Over time, there is a chance that blood vessels with stents can close. There also is a chance that you'll need to decide whether or not to have another angioplasty or a bypass surgery.

Radiation: There is always a slight risk of damage to cells or tissues from being exposed to any radiation. This includes the low levels of X-ray used for this procedure. But the risk of damage from the X-rays is usually very low compared with the possible benefits of the procedure.

What is a coronary angioplasty?

Coronary angioplasty is a procedure that uses a thin tube called a catheter to open a blocked or narrowed coronary artery. Coronary arteries are the blood vessels that bring oxygen to the heart muscle. Angioplasty also may be called percutaneous coronary intervention (PCI).

Angioplasty can widen an artery that has been narrowed by fatty buildup (plaque) or blocked by a blood clot. The procedure helps blood flow more normally to the heart muscle.

Coronary angioplasty: What happens when you come out of the procedure?

The catheter will be removed. Pressure may be applied to the area where the catheter was put into your blood vessel. This will help prevent bleeding. A small device may also be used to close the blood vessel. You may have a bandage or a compression device on the catheter site. After the procedure, you will be taken to a room where the catheter site and your heart rate, blood pressure, and temperature will be checked several times. If the catheter was put in your groin, you will need to lie still and keep your leg straight for up to a few hours. If the catheter was put in your wrist, you may need to keep your arm still for at least 2 hours.

You may go home the same day. Or you may stay at least 1 night in the hospital. When you go home, you will get instructions from your doctor to help you recover well and prevent problems.

Make sure to drink plenty of fluids (unless your doctor tells you not to) for several hours after the procedure. This will help flush the dye out of your body.

What can you expect as you recover from a coronary angioplasty?

After a coronary angioplasty, you will be moved to a recovery room or to the coronary care unit. Your heart rate and blood pressure will be closely monitored. The catheter insertion site will be checked for bleeding. You may have a bandage or a compression device on your groin or wrist at the catheter insertion site. This is to prevent bleeding. You may go home the same day. Or you may stay at least 1 night in the hospital.

Do not do strenuous exercise and do not lift anything heavy until your doctor says it is okay. This may be for several days.

You will take medicine to prevent blood clots. This medicine helps prevent a heart attack. If you get a stent, you may take aspirin plus another blood thinner. If you get a drug-eluting stent, you may take both of these medicines for at least 6 months. If you get a bare-metal stent, you may take both medicines for at least 1 month. If you had a heart attack, you may take both medicines for at least 1 year. Then you will likely continue to take one of the medicines. If you have a high risk of bleeding, your doctor may shorten the time you take these medicines. You can work with your doctor to decide how long you will take both of these medicines. This decision may depend on your risk of a heart attack, your risk of bleeding, and your preferences about taking medicine.

After your procedure, you might attend a cardiac rehabilitation (rehab) program. In cardiac rehab, a team of health professionals provides education and support to help you recover and start new, healthy habits, such as eating healthy and getting more exercise. Making these changes is just as important as getting treatment if you want to keep your heart healthy and your arteries open. If your doctor hasn't already suggested it, ask if cardiac rehab is right for you.

After coronary angioplasty: When to call

Call 911 anytime you think you may need emergency care. For example, call if:

  • You passed out (lost consciousness).
  • You have severe trouble breathing.
  • You have sudden chest pain and shortness of breath, or you cough up blood.
  • You have symptoms of a heart attack, such as:
    • Chest pain or pressure.
    • Sweating.
    • Shortness of breath.
    • Nausea or vomiting.
    • Pain that spreads from the chest to the neck, jaw, or one or both shoulders or arms.
    • Dizziness or lightheadedness.
    • A fast or uneven pulse.
    After calling 911, chew 1 adult-strength aspirin. Wait for an ambulance. Do not try to drive yourself.
  • You have been diagnosed with angina, and you have angina symptoms that do not go away with rest or are not getting better within 5 minutes after you take one dose of nitroglycerin.

Call your doctor now or seek immediate medical care if:

  • You are bleeding from the area where the catheter was put in your artery.
  • You have a fast-growing, painful lump at the catheter site.
  • You have signs of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the catheter site.
    • Pus draining from the catheter site.
    • A fever.
  • Your leg or hand is painful, looks blue, or feels cold, numb, or tingly.

Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.

After a coronary angioplasty: Overview

Coronary angioplasty is a procedure that is used to open a narrowed or blocked coronary artery. It may also be called a percutaneous coronary intervention (PCI). The doctor opened your narrowed or blocked artery by putting a thin tube, called a catheter, into your heart through a blood vessel. The catheter was inserted into the blood vessel in your groin or wrist. The doctor may have placed a small tube, called a stent, in the artery.

Your groin or wrist may have a bruise and feel sore for a few days after the procedure. You can do light activities around the house. But don't do anything strenuous until your doctor says it is okay. This may be for several days.

Why is a coronary angioplasty done?

Coronary angioplasty is done to widen a blocked or narrowed coronary artery and improve blood flow to the heart muscle. It may be done to treat a heart attack or relieve symptoms of stable angina.

Heart attack

Emergency angioplasty may be the first choice of treatment for a heart attack.

Doctors try to do angioplasty as soon as possible after a heart attack. But angioplasty is not available in all hospitals. If you are at a hospital that does not do angioplasty, you might be moved to another hospital where angioplasty can be done.

Stable angina

Although many things are involved, angioplasty might be done for stable angina if you:

  • Have frequent or severe angina that is not responding to medicine and lifestyle changes.
  • Had a test that showed severely reduced blood flow (ischemia) to an area of heart muscle caused by one narrowed coronary artery.
  • Have an artery that is likely to be treated successfully with angioplasty.
  • Are in good enough health to have the procedure.

Angioplasty may not be a reasonable treatment option when:

  • There is no evidence of reduced blood flow to the heart muscle.
  • You do not have angina symptoms, or you feel that you can live well with your symptoms.
  • You are at risk of complications or dying during angioplasty due to other health problems.
  • The anatomy of the artery makes angioplasty or stenting too risky or will interfere with the success of the procedure.

What happens on the day of your coronary angioplasty?

  • Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.
  • Take a bath or shower before you come in for your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
  • Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

  • Bring a picture ID.
  • You will be kept comfortable and safe by your anesthesia provider. You may get medicine that relaxes you or puts you in a light sleep. The area being worked on will be numb.
  • The procedure will take 30 to 90 minutes.
  • After the procedure, pressure may be applied to the area where the catheter was put into your blood vessel. This will help prevent bleeding. A small device may also be used to close the blood vessel. You may have a bandage or a compression device on the catheter site.
  • Nurses will check your heart rate and blood pressure. The nurse also will check the catheter site for bleeding.
  • If the catheter was put in your groin, you will need to lie still and keep your leg straight for up to a few hours. The nurse may put a weighted bag on your leg to help you keep it still.
  • If the catheter was put in your wrist, you may be able to sit up right away. But you may need to keep your arm still for at least 2 hours.

How is a coronary angioplasty done?

Coronary angioplasty is done in a cardiac catheterization laboratory ("cath lab"). It is done by a heart specialist called a cardiologist. The whole procedure may take 1½ to 3 hours.

You lie on a table under a large X-ray machine. You will get medicine through an I.V. in one of your veins. It helps you relax and not feel pain. You will be awake during the procedure. But you may not be able to remember much about it.

The doctor will inject some medicine into your wrist or groin to numb the skin. You will feel a small needle poke you. It's like having a blood test. You may feel some pressure when the doctor puts in the catheter. But you will not feel pain.

The doctor will look at X-ray pictures on a monitor (like a TV screen) to move the catheter to your heart. The doctor then puts a dye into the catheter. This makes your heart's arteries show up on a screen. The doctor can then see any arteries that are blocked or narrowed. You may feel warm or flushed for a short time when the doctor injects dye into your artery.

If you have a blocked or narrow artery, the doctor uses a catheter with a tiny balloon at the tip. The doctor puts it into the blocked or narrow area and inflates it. The balloon presses the fatty buildup against the walls of the artery. This buildup is called plaque. This creates more room for blood to flow. In most cases, the doctor then puts a stent in the artery. A stent is a small, expandable tube. It presses against the walls of the artery. The stent is left in the artery to keep the artery open. This helps blood flow. The catheter is removed from your body.

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