Coronary Angioplasty

1) What is an angioplasty? Angioplasty is a medical procedure that opens up blocked or narrowed blood vessels without surgery. During angioplasty, the interventional cardiologist inserts a very small balloon attached to a thin tube (a catheter) into a blood vessel through a very small incision in the skin, about the size of a pencil tip. The catheter is threaded under X-ray guidance to the site of the blocked artery. When the balloon is in the area of the blockage, it is inflated to open the artery, improving blood flow through the area.

2. Why do I need angioplasty?

The most common reason for angioplasty is to relieve a blockage of an artery caused by atherosclerosis (hardening of the arteries). Atherosclerosis is a gradual process in which cholesterol builds up inside the artery, forming a substance called “plaque” that clogs the artery.
Arteries are like tubes; they carry blood and oxygen to the tissue in your body. When an artery becomes narrowed or blocked, the tissue supplied by that artery does not get enough oxygen. The symptoms you feel depend on which artery is blocked. Some blockages are best treated with surgery, while others are best treated with angioplasty.

3. What is an angioplasty like? Will it hurt?

If you have not had an angiogram (an X-ray examination of your arteries), the interventional cardiologist will perform that procedure before proceeding with your angioplasty. An angioplasty has three major steps:

  • placement of the angioplasty catheter into the blocked artery
  • inflation of the balloon to open the blocked artery
  • removal of the catheter.

4. How do I prepare for my angioplasty?

Most hospitals follow a set routine. Before you come to hospital, your physician will ask you to get few tests done that will help him take better decisions about you. These may include blood tests, an electrocardiogram (ECG),an exercise test and a chest X-ray.
You may be admitted to hospital the night before your coronary angiogram, but most people are admitted the same morning. In most hospitals, people are admitted and discharged from hospital on the same day. You may be asked not to have anything to eat or drink for four to six hours prior to the procedure.
When you are admitted to hospital, your physician will explain the coronary angiography procedure to you, give you a brief physical examination, and answer any questions that you or your family may have. You will be asked to sign a form consenting to the test. You will also be asked to remove any jewellery that you are wearing and to put on a hospital gown. You will then be shaved in the area where the catheter will be inserted. Sometimes you will be given a sedative about an hour before the test to help you to relax. However, you will be awake throughout the procedure
As a general rule the below mentioned points should be remembered. However we once again suggest that you talk to your physician in detail about it.
•Any medicines that you're taking should be informed to the physician and necessary discussion should be taken whether you should stop taking them before the test.
•If you have any other condition or diseases that may require taking extra steps during or after the test to avoid complications, then you should discuss this in depth with your physician. Eg: diabetes and kidney disease.
Follow the below mentioned instructions. However it is advisable to talk to your physician in detail about it.
• Eating. Do not eat any solid food after midnight on the night before your procedure. You may drink clear fluids.
• Medication. Most people can continue to take their prescribed medicines. If you are a diabetic and take insulin, ask your doctor about modifying your insulin dose for the day of your procedure. If you are taking the oral anti-diabetic medicine glucophage (Metformin), you will need to discontinue use for up to 48 hours prior to the procedure and 48 hours following the procedure. Consult with your doctor about blood sugar control during this period. If you take a blood thinner such as Coumadin, you must tell your doctor so that it can be stopped. Bring allyour medications with you.
• Allergies. If you are allergic to contrast (X-ray dye) or iodine, let your doctor know as soon as possible. If possible, let the interventional cardiologist know about your allergy a few days before your angioplasty procedure. Your doctors can then plan to take special precautions during the procedure or prescribe special medications prior to the procedure.
• Smoking. Do not smoke for at least 24 hours before your angioplasty. Blood tests are usually done the day before the angioplasty. Before your procedure, you will dress in a hospital gown and an intravenous (IV) line will be placed in one of your veins. You may need to remove your jewelry and any dentures or partials. The IV will be used to give you fluids and medicines during the procedure and will stay in place until after your angioplasty is completed.

5. What happens after my angioplasty?Can I go home?

After coronary angioplasty procedure is done, the patient is moved to a special area called the Intensive Care Unit in the hospital that is constantly manned by physicians and nurses. It is here that the patient is carefully observed for several hours or overnight. During this time, the patient is asked to limit his/her movement to avoid bleeding from the site where the catheter was inserted. The nurses check heart rate and blood pressure regularly. They’ll also watch for any bleeding at the catheter insertion site.

The patient may develop a small bruise on your arm, groin (upper thigh), or neck at the catheter insertion site. It is advised to talk to your physician if any such thing is observed. At times, Unusual pain, swelling, redness, or other signs of infection at or near the catheter insertion site may be seen. Again it is advisable to let your physician  know about this.
Post procedure certain activities should be avoided such as heavy lifting, for a short time after the test.In most cases, you will stay in the hospital after the angioplasty is completed.
After you go home:
• DO resume taking routine medicine as advised by your physician
• DO relax and take it easy for 24 hours.
• DO drink plenty of fluids.
• DO resume your regular diet.
• DO keep a bandage on the catheter insertion site for a day. Put on a dry, clean bandage after bathing.
• DO NOT drive or run machinery for at least 24 hours.
• DO NOT do any strenuous exercise or lifting forat least two days.
• DO NOT take a hot bath or shower for at least 12 hours.
• DO NOT smoke for at least 24 hours.

6.  What are the risks of having angioplasty?

With modern techniques, angioplasty is safer than surgery, and complications are infrequent. However, because the procedure involves stretching one of your arteries, and includes the use of catheters and contrast injection, there is some risk.
Placing a catheter in your artery can damage the artery and may result in bleeding. Even when the artery has not been damaged, you may have a bruise or a small lump where the catheter was inserted. The bruise or lump may be sore, but will go away in a few days to a week. Because everyone is different, there may be risks associated with your angioplasty that are not mentioned here. The exact risks of your angioplasty will be discussed with you in more detail by your physician.
Angioplasty complications can include:
•Discomfort and bleeding at the catheter insertion site.
•Blood vessel damage from the catheters.
•An allergic reaction to the dye used during the angioplasty.
•An arrhythmia (irregular heartbeat).
•The need for emergency coronary artery bypass grafting during the procedure (less than 3 percent of people). This may occur if an artery closes down instead of opening up.
•Kidney damage caused by the dye used during the angioplasty. 
•Heart attack (3–5 percent of people).
•Stroke (less than 1 percent of people).
Sometimes chest pain can occur during angioplasty because the balloon briefly blocks blood supply to the heart.As with any procedure involving the heart, complications can sometimes be fatal. However, this is rare with coronary angioplasty. Less than 2 percent of people die during the procedure.
The risk of complications is higher in:
•People aged 65 and older
•People who have chronic kidney disease
•People who are in shock
•People who have extensive heart disease and blockages in their coronary (heart) arteries
Research on angioplasty is ongoing to make it safer and more effective and to prevent treated arteries from narrowing again.

7. What changes do I need to bring about in myself post procedure?

Most people recover from angioplasty and return to work within a week of leaving the hospital. Lifestyle Changes
Although angioplasty can reduce the symptoms of coronary heart disease (CHD), it isn't a cure for CHD or the risk factors that led to it. Making healthy lifestyle changes can help treat CHD and maintain the good results from angioplasty. Talk with your doctor about your risk factors for CHD and the lifestyle changes you should make. Lifestyle changes might include changing your diet, quitting smoking, being physically active, losing weight or maintaining a healthy weight, and reducing stress.
Cardiac Rehabilitation
Your doctor may recommend cardiac rehabilitation (rehab). Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems. Cardiac rehab includes exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life. Your doctor can tell you where to find a cardiac rehab program near your home