by Elizabeth Peterson, MFA
Anatomy and Physiology
The heart is the muscle responsible for pumping blood throughout your body. It is made up of four chambers: the right and left atria, and the right and left ventricles.
Your heart must have a steady supply of oxygen and other nutrients to function properly. Normally, your heart receives all the oxygen and nutrients it needs from the blood passing through your coronary arteries. Two sets of coronary arteries emerge from the right and left side of the aorta.
In some people, cholesterol and other substances build up inside the coronary arteries over time. This build up, known as plaque, can become large enough to narrow or block the arteries. This may prevent enough oxygen and nutrients from reaching the heart muscle.
Reasons for Procedure
Insufficient oxygen reaching the heart muscle often causes a type of intermittent chest pain called angina. Many patients with coronary artery disease experience angina when they exert themselves. Sometimes angina pain can be felt in other locations, such as the right arm, jaw, or back.
If a plaque ruptures, a clot may form that blocks off all blood flow to a portion of the heart muscle. If this occurs, the muscle quickly dies, a condition known as a heart attack or myocardial infarction.
Heart attack sufferers often experience severe, persistent chest pain. Other symptoms may include: shortness of breath, sweating, nausea, weakness and/or lightheadedness.
Treatment options for coronary artery disease include: lifestyle changes, such as diet and exercise, medications that can reduce the narrowing in the arteries or prevent it from getting worse, medications that prevent or treat angina, invasive cardiac procedures that restore blood flow inside the coronary arteries through the use of balloons, surgical procedures that bypass blockages in the coronary arteries.
A coronary angioplasty is an invasive procedure designed to restore the flow of blood through coronary arteries that are narrowed or clogged by atherosclerotic plaques or blood clots. This procedure is designed to take the place of a coronary artery bypass graft, which usually requires opening the chest and using a heart-lung bypass machine.
In the days leading up to your procedure: arrange for a ride to and from the hospital and for some help at home afterwards. The night before, eat a light meal, and do not eat or drink anything after midnight. If you regularly take medications, herbs, or dietary supplements, ask your doctor if you need to temporarily discontinue them. Do not start taking any new medications, herbs, or dietary supplements before consulting your doctor. You may be asked to shower using special antibacterial soap the morning of your procedure.
Most coronary angioplasties last between one and three hours. You will remain awake for the procedure, but may be offered a sedative to help you relax. To begin the procedure, you will be placed on a table equipped with a fluoroscope. The fluoroscope will x-ray your heart and coronary arteries from many angles.
Your doctor will numb the skin in your groin area and insert a needle into your femoral artery. In rare cases, a brachial artery at the elbow may be used instead.
Your doctor will then pass a wire through the needle and guide it up to your heart. He or she will slip a soft, flexible catheter over the wire.
To examine the coronary arteries, your doctor will remove the guide wire, position the tip of the catheter just inside each artery one at a time, and inject a special dye. This dye allows the fluoroscope to take x-ray images, called angiograms, and identify any blockages inside your arteries.
To treat a blockage, your doctor will reinsert a guide wire into the artery and then advance a balloon-tipped catheter into position at the site of the blockage.By rapidly inflating and deflating the balloon, your doctor will be able to push the plaque and vessel wall out, partially reestablishing blood flow. This procedure will be repeated for each blockage.
Your doctor may recommend a coronary stent, which is a wire mesh that remains in the artery to hold it open. To perform this procedure, your doctor will place a collapsed stent over a deflated balloon and move it into position. When the balloon is inflated, the stent expands and locks into place.
At the end of the procedure, your doctor will remove the wires and catheter through the original insertion site in the groin.
Risks and Benefits
The risks of coronary angioplasty depend on: the severity of your coronary artery disease, how well your heart is pumping, and your general state of health.Possible complications of coronary angioplasty include: narrowing of the artery once again, although this is less likely if a stent is used, clotting within the stent, the need for emergency surgery to re-open a clogged coronary artery or repair a torn coronary artery, heart attack, stroke, allergic reaction to the dye, abnormal heart rhythms, infection, accumulation of blood at the insertion site in the groin, and/or accumulation of fluid around the heart.
Benefits of coronary angioplasty include: improved blood flow to the heart muscle, most likely resulting in less chest pain and an increased tolerance for exercise; far shorter recovery period and lower risk of complications compared with a traditional coronary artery bypass graft, which usually requires opening the chest and using a heart-lung bypass machine.In coronary angioplasty, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether itâ€™s the most appropriate treatment choice for you.
After the Procedure
After the procedure, you will be: monitored closely for bleeding, chest pain, and changes in your heart rhythm or blood pressure; asked to lie on your back for several hours, with a pressure bandage overlying the groin area; this is to insure there is no bleeding from the femoral artery; asked to keep your arm straight using an arm board, if the catheter was inserted in your arm.
Most patients are discharged from the hospital on the same day or after an overnight stay.After being discharged, you should contact your doctor if you experience: chest pain, swelling, tingling, numbness, pain, bruising, or discoloration of your leg, redness, swelling, increasing pain, excessive bleeding, or discharge from the insertion site in the groin or arm, cough, shortness of breath, chest pain, or severe nausea or vomiting, signs of infection, including fever or chills.
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Available at: http://www.americanheart.org/presenter.jhtml?identifier=4721.
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Accessed July 24, 2003.
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Available at:http://www.americanheart.org/downloadable/heart/1046795664928WhatIsCoronaryAngioplasty.pdf. Accessed July 24, 2003.
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