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Coronary Balloon Angioplasty

Percutaneous transluminal coronary angioplasty (PTCA) or coronary angioplasty, is a non-surgical method of improving blood flow to the heart by widening the openings in narrowed coronary arteries.

Coronary arteries are blood vessels which bring oxygen-rich blood to the heart muscle. Sometimes cholesterol and other materials build up on the interior walls of these arteries, and form a hard substance called, "plaque". Plaque narrows the lumen (opening) where the blood flows through the arteries. The more plaque there is, the narrower the opening.

If blood flow in a coronary artery is blocked, there will be inadequate delivery of oxygen to the heart muscle. This may interfere with the functioning of the heart muscle. Partial blockage of blood flow in a coronary artery may cause shortness of breath and angina (pain). Most often the pain is felt in the chest, but you can experience angina in your neck, jaw, arm or fingertips. Some people describe the feeling as a dull ache or pressure. Others say it resembles heartburn or indigestion.

If an artery is totally blocked, part of the heart will be completely deprived of oxygen, and a heart attack may occur.

During coronary angioplasty, a balloon-tipped catheter is inserted into the narrowed artery. When the balloon is inflated, it compresses some of the plaque against the interior arterial wall. The plaque remains compressed against the arterial wall after the balloon is deflated and removed. This process widens the lumen of the artery.

Why has my doctor ordered this procedure for me?
You might have complained of angina to your physician. You might have undergone diagnostic testing such as: an exercise stress test, echocardiograms, and cardiac catheterization. Based upon the results, your doctor has formed a diagnosis of coronary artery disease, and decided with you that angioplasty would be beneficial.

Although coronary angioplasty does not cure coronary artery disease, it is a relatively safe procedure which can improve blood flow to the heart and relieve angina.

Are there any risks associated with coronary angioplasty?
The risks associated with coronary angioplasty include: rupturing of an artery, heart attack, stroke or death. These events are rare. Sometimes during angioplasty, the lining of an artery can tear and block the flow of blood.. This is a rare, but serious event which can cause a heart attack. Sometimes this can be fixed in the catheterization laboratory. If not, a surgical team is on hand to perform immediate coronary artery bypass surgery if necessary.

Are there alternative forms of treatment?
Certain medicines can also improve blood flow and reduce angina. These medicines fall into the broad categories of Beta Blockers, Vasodilators, and Calcium Channel Blockers.

These medicines do one or more of the following: decrease the heart rate, reduce the heart's demand for oxygen, or open or widen the coronary arteries.

Coronary artery bypass surgery also reduces the symptoms of angina, but it has more risks associated with it, and a longer recovery period, than does angioplasty.

What preparations should I make before the procedure?
Discuss your current medications with your physician. She may ask you to discontinue certain medicines, such as anticoagulants, prior to the coronary angioplasty. If you are taking insulin, your doctor will most likely recommend that you take a half dose prior to the procedure.

Shower the night before. Do not eat or drink after midnight. If you have diabetes, consult your physician about eating. You may take approved medications with small sips of water.

Leave all valuables and money at home or with a relative. Do not wear any jewelry to the hospital. You may be allowed to wear eyeglasses, hearing aids, dentures or dental bridges. This varies from place to place.

If it is allowed, bring reading material with you. There may be periods of waiting before the actual procedure commences.

How long does the procedure take?
The procedure takes from one to three hours

Does the procedure hurt?
You may feel a twinge in your chest when the balloon is inflated. The pain should discontinue when the balloon is deflated. Some people feel nauseated or have a headache during the procedure.

What happens on the day of the procedure?
Before the coronary angioplasty, a heart doctor (cardiologist), will examine you and review your medical history and diagnostic tests. He will explain the procedure and its risks and benefits. You will have to sign a consent form. Do not hesitate to ask questions and voice your concerns. Tell the doctor if you are pregnant or think you may be.

The doctor will ask if you have any allergies, particularly to certain food, dyes and materials. If you have allergic reactions to shellfish, and/or iodine-containing x-ray contrast, you may be given medication to prevent an allergic reaction during the procedure. He will also want to know if you are allergic to latex or rubber products such as gloves or balloons.

The doctor will question you about your current medications. Make sure to tell him if you are taking nitroglycerin medicine. If you bring your medications with you, the doctor can ascertain the exact dosages you are taking.

Usually, you will have blood tests, an electrocardiogram, urinalysis, and a chest x-ray taken prior to the procedure. Sometimes these tests are performed within a week to ten days before the procedure.

What happens before the procedure?
You may be given a mild sedative to help you relax. You will stay awake throughout the procedure, and will be asked to perform some simple tasks such as: taking a deep breath, coughing, turning your head to one side, or refraining from speaking for a few minutes.

What happens during the procedure?
The procedure will take place in a cardiac catheterization laboratory, which is usually cold and dimly lit. You will lie on a bed under an x-ray camera.

Electrodes will be applied to your chest and back to monitor your heart rhythm at all times. A blood pressure cuff will be placed on your arm to monitor your blood pressure. You will be shaved and cleansed with antiseptic solution in your groin where the catheter will be inserted. These steps are taken to prevent infection.

An intravenous line will be started in your arm to allow for the administration of medication during the procedure.

A local anesthetic will be injected into the skin to numb the insertion site. This stings a little bit. Then a small incision will be made in the skin. The doctors will use a special needle to puncture the artery into which the catheter will be introduced. Usually, this procedure is performed from the groin, but it can also be is done by inserting catheters in the arm or wrist. You will feel some pressure. If you feel pain, let the doctor know, so that more numbing medication can be given to you.

An introducing sheath is placed in the artery. A cardiologist will insert a guiding catheter (a thin tube) into the introducing sheath, and then he will thread it carefully into the narrowed coronary artery. Contrast fluid (dye) will be injected through the catheter into the artery. This creates angiograms (x-ray movies) which enable the doctor to see inside your artery to confirm the areas of blockage. The doctor may ask you to hold your breath briefly during this process. You may feel a warm sensation as the contrast fluid flows through your blood vessel.

Then a guide wire is inserted through the guiding catheter and moved through the narrowed area in your artery. The doctor can watch the movement of the wire on the television screen.

A balloon-tipped catheter will be inserted into the first catheter and then threaded over the guide wire.. The balloon will be inflated and deflated a number of times until the plaque is compressed against the arterial walls. The lumen are thus widened. Then the balloon is removed. This procedure may be repeated with additional arteries.

What happens after the procedure?
The sheath of the guiding catheter may be removed shortly after the procedure or may be left in place for a few hours or overnight. Pressure will be applied to the site for 10 to 20 minutes when it is removed. A small dressing is applied and sometimes a five pound sandbag will be placed on top of the bandages for 4 to 6 hours. This additional pressure helps prevent bleeding.

You will leave the catheterization laboratory and go to another room where you will have bed rest. You must lie straight, but you may raise your head slightly. You should not bend your knee. You may wiggle your foot and toes to prevent stiffness.

You will remain connected to a heart monitor and an intravenous line while you rest.

A nurse will check your insertion site and vital signs. If you are in pain, ask her for medicine to relieve it. You may feel drowsy. Notify the nurse if you experience a sudden pain at the insertion site or if you have a warm, sticky or wet feeling around the site.

It's a good idea to drink a lot of fluids. This will hasten the removal of the contrast fluid from your body.

How long will I stay in the hospital?
Usually there is an overnight stay following this procedure. Arrange in advance for someone to drive you home from the hospital.

What happens before I'm discharged from the hospital?
Your doctor will discuss the results of the procedure with you and advise you as to exercise, diet, and care of your insertion site.

Your doctor may prescribe medications to prevent the formation of blood clots. He may want you to continue taking medicine for angina.

What should I do when I get home?
Continue to drink fluids. Do not drive, shower, bathe, or smoke for 24 hours. .Call your doctor if you experience angina, or if the insertion site is red, bleeding, swollen or draining. Also notify your physician if you have a fever or if the site is cold.

Are there follow-up visits/procedures?
You will have regular check-ups which may include diagnostic testing. such as an exercise stress test.

Sometimes the coronary arteries narrow again. This is known as "restenosis". Sometimes blockages recur. If they do, it usually happens within the first few months following angioplasty. Your physician may recommend a repeat coronary angioplasty.


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