Coronary Angioplasty, Patient Education and Procedure Guide

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© 2002 Empowered Medical (www.EmpoweredMedical.com)

Patient Education and Procedure Guide

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Provided Exclusively for thepatients of the

Your CommunityHospital


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The Purpose of this GuidePatient Education and Procedure Guide

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This guide is not intended to be instructionalfor medical diagnosis or treatment, or for the

practice of medicine, and it should not be

used as a substitute for the user's health-

care provider. Only your doctor can diag-

nose medical conditions and perform any

treatment.

The information contained within this Patient

Education and Procedure Guide has been

verified by a board of physicians for its med-

ical accuracy. However Empowered Medical

cannot be held responsible for any inaccura-

cies or misuse of its contents. Empowered

Medical does not make any representationsto its completeness or appropriateness for a

particular purpose.

Empowered Medical is neither responsible

nor liable for any claim, loss or damage

resulting from use of information in this

guide.


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The Heart

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The heart is a muscular organ that pumps

blood to every part of the body. It is made

up of 4 chambers.

The right atrium collects

blood from the body

The right ventricle pumps

blood to the lungs

The left atrium collects

blood from the lungsThe left ventricle then

pumps the blood to the

body through the aorta

The heart is roughly

the size of a closed

fist and weighs about

10 ounces.

The heart's muscle,

called cardiac muscle,

contracts and relaxes

about 70 to 80 times

every minute.

Over a normal life-time, the heart will

beat 2.5 billion times

without pausing once.


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The Coronary Arteries

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The AORTA is the

biggest artery in the

body

The RIGHT

CORONARY

ARTERY supplies

blood to the front

and back of theright side of the

heart

The left main artery isthe first part of the

LEFT CORONARY

ARTERY

The LEFT ANTERIOR

DESCENDING artery

supplies blood to the

left front side of the

heart

The LEFT

CIRCUMFLEX artery

supplies blood to the

left side and back of

the heart

The coronary arteries are the vessels that provide the blood sup-

ply to the heart tissue. These are blood vessels that branch off the

aorta and wrap around the heart. These coronary arteries branch

off into smaller arteries, which supply oxygen-rich blood to theentire heart muscle.

There are 4 major coronary arteries.

Blockages in the coronary arteries are the cause of most of the

heart disease in this country. Angina, a heart attack, heart failure,

and sudden death all can occur from the obstructions in these four

arteries.


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Coronary Artery Disease

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C R O S S S E C T I O N O F B L O C K A G E I N A R T E R Y

10% blockage isquite common and

will not cause any

pain in the chest.

These coronary arteries may become blocked with deposits of

cholesterol and other fatty substances called plaque. This will

cause the channel to become narrow and hence the flow of blood

is slowed. This condition is known as a 'hardening of the arteries'or arteriosclerosis.

50% blockagecauses a blood flow

problem during

exertion. This will

cause angina, a

pain that goes

away after a few

minutes rest.

90% blockagecauses a problem

even at rest. This

is arteriosclerosis

and will need to be

treated.

100% blockagegenerally leads to

a heart attack.

This will cause

chest pain that will

not go away, even

after resting.

Stenosis means constriction or

narrowing. A coronary artery that

is constricted or narrowed is

called stenosed.

Plaque usually takes a long timeto build up and can slowly block

an artery. This will eventually

result in chest pain during exer-

tion. This is angina and is a sign

of the start of coronary heart dis-

ease (CHD).


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How is Coronary Heart Disease Diagnosed?

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There is no definite method of diagnosing atherosclerosis by exter-

nal examination alone. Your doctor will perform certain stress tests

to see how well your heart is functioning under exertion. If your

doctor then thinks there may be a blockage in one or more of your

coronary arteries, you will go for a procedure called cardiac

catheterization.

The purpose of this procedure is to find the position and severity

of any possible blockages. The procedure is usually done on an

outpatient basis and you will be released at the end of the day, aslong as there are no complications.

• No food or drink is allowed on the day of your procedure.

• Routine tests will be conducted, they may include a heartstress test, chest X-RAY, EKG and blood analysis.

• The area where the catheter will be inserted will be shavedand cleaned to help prevent infection. This is usually in your groin area.

• An intravenous line is inserted into a vein into your arm so

that medications can be put directly into your bloodstream.• A list of all medications and allergies has to be submitted to

your doctor.

To prepare for your procedure:


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The Cath Lab

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Cardiac catheterization is done in a special type of facility called

a cath lab.

The table, that you lay upon, is actually part of a special x-ray

machine. The X-RAY camera can move into different positions and

take images of your heart. The doctor can then see each of the

main coronary arteries, by moving the X-RAY camera into differ-

ent positions.

There is a series of monitors that measure your vital signs during

the procedure.

There will be a team

of people in the cath

lab. These will include

the cardiologist, anassistant, nurses and

one or more technolo-

gists.

You will be awake during the procedure

and be able to speak to the staff.


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What is a Catheter?

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A catheter is a thin, flexible tube, made

of plastic and it is hollow in the middle. Itis used to gather information about the

heart and/or to carry out treatment pro-

cedures. You will feel some discomfort

from the movement of a catheter through

your body.

The catheter is usually inserted

into a large artery in your groin

region.

A local anaesthetic is injected

into the skin to numb the area.This may cause a stinging sen-

sation.

A small incision is made in theskin and a needle is used topuncture the artery.


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How is a Catheter Inserted?

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1. A thin, flexible guidewire is inserted into

the artery.

2. A sheath is placed

over the guide wire.

3. A guiding

catheter is then

threaded through

the sheath.

4. The guiding

catheter then goes

through the aorta

and to the heart.


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How a Blockage is Located

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5. The catheter is

guided to the opening

of the coronary artery.

In this case, the left

main coronary artery.

6. X-RAY contrast dyeis pumped directly

into the coronary

artery.

7. The contrast dye

outlines the coronary

artery on an X-RAY.

8. This is an example

of how a blockage

may show up on the

X-RAY film.


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The Angioplasty Procedure

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The next step is to open the blocked artery to allow an ade-

quate amount of blood to flow through it once again. This

procedure takes about one to two hours to complete.

A balloon catheter is then guided,

through the guiding catheter, to

the site of the blockage.

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The balloon is inflated which

pushes aside the blockage

and the artery is opened.The balloon is then deflated and

the catheter is withdrawn.

This allows an adequate amount of

blood to flow through the artery and

nourish the heart muscle.


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Alternative Treatments

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Once the cardiac catheterization procedure has been performed,

there are several options as to the course of your treatment.

These may include MEDICATIONS, STENT IMPLANTATION or

BYPASS SURGERY.

MEDICATIONS

There are medications available that may reduce your symptoms

of coronary artery disease. These drugs will only increase the

blood flow to the heart tissue or reduce the demand of the heart

muscle and hence ease your chest pain somewhat. However,

there is no drug that can remove a specific blockage in any of your coronary arteries.

STENT IMPLANTS

One of the biggest problems with Balloon Angioplasty is when the

artery will not remain open and closes once again, usually within

six months. This happens in one third of cases. This process is

called restenosis. A stent is a metal device that acts like a retain-ing wall and keeps the artery propped open. The stent remains in

place after the procedure but you will not feel its presence.

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The stent is guided to

the blockage.The catheter is retracted,

leaving the stent in

place, and the blood

flows through the artery

once more.

The balloon inflates,

pushing the plaque

aside.


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Alternative Treatments

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BYPASS SURGERY If there are too many blockages, in two

or three major coronary arteries, andyour heart has been weakened and is not

pumping properly, then bypass surgery

may be an option. This requires open

heart surgery with several days in a hos-

pital and a three month recovery period.

In this case, a vein is grafted from a

blood vessel from your own thigh and isused to literally bypass a blockage in the

coronary artery, as shown below.

Vein bypassing the

blockages in the rightcoronary artery.


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The Risks

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The risk from Angioplasty is minimal, and deaths are very rare.

However, as with any invasive procedure, there are inherent risks.

• Excessive bleeding at your incision point

• Allergic reaction to the dye

• Infection

• Blood clot formation

• A rupture of a blood vessel

• Heart attacks and/or strokes

These risks include:

The balloon may damage the artery wall when it

is inflated and this may cause bleeding. Tiny

blood clots form and close the artery in about

10% of all cases.

The artery itself may also be damaged by the

metal stent, and this may also lead to an

inflammatory response.

Stents are made of metal and the body will try to

reject it as a foreign object. This is called an

inflammatory response.

Immune cells then gather around the stent

and this might lead to a re-closing or re-

stenosis of the artery.


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The Potential Benefits

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80% of patients are still free of blockages 6 months after having

the angioplasty procedure, and having a stent implanted.

No overnight stay is normally required and patients go home

after a few hours of observation.

Additional benefits wouldinclude, a decrease in chest

pains during physical exer-

tion and a general increase

in level of activity and well-

being.

The most important bene-

fit would be the avoidance

of a heart attack. As the

plaque continues to buildup inside the coronary

artery over time, it will ulti-

mately restrict or even cut

off the blood supply to a

part of the heart's tissue.

A blockage in the coronary artery herecan cause future damage to heart tis-

sue downstream from the obstruction.

Once the blood supply is cut off, the

part of the heart that depends on that

vessel for its nutrients will die and be

replaced by scar tissue. Notice the

dark area, below the green circle. This

will effect the way the heart beats and

may severely weaken its performance.This is a heart attack, and can be mild

or severe, depending upon the extent

of the damage to the heart’s tissue.

The purpose of the procedure is to

prevent this kind of extensive dam-

age from happening in the future.


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After The Procedure

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Once the procedure is finished, you will be taken to another roomfor observation and recovery. There, your vital signs will be moni-

tored (usually pulse and blood pressure) and you will need to

remain still for several hours. Also, drink plenty of fluids to flush the

X-RAY contrast dye out of your body.

The IV is removed and the sheath is taken out. However, the small

incision in the skin and the puncture hole in the artery will need tobe sealed. This is done by you applying pressure to the site for

about 30 minutes. Sometimes a surgical compression clamp will be

used and the doctor may close the puncture in the artery with a vas-

cular closure device.

If there are no complications, you will be allowed to go home after a

few hours, or the next morning, depending upon the doctor’s recom-mendation. Since you have been given sedatives, to help you relax

during the procedure, do not drive yourself home.


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After Care: The First 72 Hours

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You Should Call Your Doctor

• If you feel chest pains, pressure in your chest or any symptoms of your

angina pain.

• If there is bleeding at the site of your incision.

• If the bruising and swelling, around the incision point, get worse . (The

bruise should normally diminish over time.)

• If the area of the incision feels painful, or you have pain/numbness in

any part of your leg.

• If you develop a fever.

• Do not drive or operate any kind of heavy machinery.

• Do not exercise or do any strenuous activity.

• Do not drink any alcoholic beverages.

• Do not take any medication or drugs, other than those prescribed by

your doctor.

• Call your physician for an appointment. You may require a stress test

within the next 6 weeks, to determine how well your heart is functioning.

• Eat a healthy diet, low in cholesterol.

• Get plenty of rest and relaxation. Avoid stressful situations.

• Stair climbing should be limited.

• When you cough or sneeze, press lightly on the incision site.

• Once you can climb two flights of stairs, without getting breathless or

feeling any pain or discomfort, then you can resume your sexual activity.

General Guidelines When You Go Home


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Long Term Care

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Stress management. Learn to deal with

daily stress and pressure in a constructive

manner. This may include relaxation tech-

niques (such as progressive muscle relax-

ation), meditation, breathing exercise or

anything that will help to reduce the level of

stress in the course of your day.

Getting regular check-ups. Make sure

you get regular and thorough check-ups

from your physician to monitor how your

heart is functioning.

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Patient Education and Procedure Guide

NOTES

Coronary Angioplasty, Patient Education and Procedure Guide

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