Coronary Angioplasty, Patient Education and Procedure Guide

Patient Education and Procedure Guide

Provided Exclusively for the patients of the

Your Community Hospital

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Patient Education and Procedure Guide The Purpose of this Guide

This guide is not intended to be instructional for medical diagnosis or treatment, or for the practice of medicine, and it should not be used as a substitute for the user's healthcare provider. provider. Only your your doctor doctor can diagnose 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 medical accuracy. accuracy. However Empowered Medical cannot be held responsible for any inaccuracies or misuse of its contents. Empowered Medical does not make any representations to 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 The heart is a muscular organ that pumps blood to every part of the body. It is made up of 4 chambers.

The heart is roughly the size of a closed fist and weighs about 10 ounces.

The right atrium collects blood from the body

The right ventricle pumps blood to the lungs

The left atrium collects blood from the lungs

The left ventricle then pumps the blood to the body through the aorta

The heart's muscle, called cardiac muscle, contracts and relaxes about 70 to 80 times every minute. Over a normal lifetime, the heart will beat 2.5 billion times without pausing once.

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The Coronary Arteries The coronary arteries are the vessels that provide the blood supply 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 the entire heart muscle. There are 4 major coronary arteries. The AORTA is the biggest artery in the body

The left main artery is the first part of the LEFT CORONARY ARTERY

The RIGHT CORONARY ARTERY supplies blood to the front and back of the right side of the heart

The LEFT CIRCUMFLEX artery supplies blood to the left side and back of  the heart The LEFT ANTERIOR DESCENDING artery supplies blood to the left front side of the heart

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. © 2002 Empowered Medical (www.EmpoweredMedical.com) -4-

Coronary Artery Disease 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. Stenosis means constriction or  narrowing. A coronary artery that is constricted or narrowed is called stenosed. Plaque usually takes a long time to build up and can slowly block an artery. This will eventually result in chest pain during exertion. This is angina and is a sign of the start of coronary heart disease (CHD). CROSS

10% blockage is quite common and will not cause any pain in the chest.

SECTION

OF

BLOCKAGE

50% blockage causes a blood flow problem during exertion. This will cause angina, a pain that goes away after a few minutes rest.

IN

ARTERY

90% blockage causes a problem even at rest. This is arteriosclerosis and will need to be treated.

100% blockage generally leads to a heart attack. This will cause chest pain that will not go away, even after resting.

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How is Coronary Heart Disease Diagnosed? There is no definite method of diagnosing atherosclerosis by external 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, as long as there are no complications. To prepare for your procedure: • No food or drink is allowed on the day of your procedure. • Routine tests will be conducted, they may include a heart stress test, chest X-RAY, EKG and blood analysis. • The area where the catheter will be inserted will be shaved and 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.

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The Cath Lab 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 different 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, an assistant, nurses and one or more technologists.

You will be awake during the procedure and be able to speak to the staff.

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What is a Catheter?  A catheter is a thin, flexible tube, made of plastic and it is hollow in the middle. It is used to gather information about the heart and/or to carry out treatment procedures. 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 sensation.  A small incision is made in the skin and a needle is used to puncture the artery.

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How is a Catheter Inserted?

1. A thin, flexible guide wire 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

5. The catheter is guided to the opening of the coronary artery. In this case, the left main coronary artery.

6. X-RAY contrast dye is 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 The next step is to open the blocked artery to allow an adequate amount of blood to flow through it once again. This procedure takes about one to two hours to complete. 1

 A balloon catheter is then guided, through the guiding catheter, to the site of the blockage.

2

This allows an adequate amount of  blood to flow through the artery and nourish the heart muscle.

3

4

The balloon is then deflated and the catheter is withdrawn.

The balloon is inflated which pushes aside the blockage and the artery is opened.

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Alternative Treatments 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 retaining wall and keeps the artery propped open. The stent remains in place after the procedure but you will not feel its presence. 1

2

The stent is guided to the blockage.

3

The balloon inflates, pushing the plaque aside.

The catheter is retracted, leaving the stent in place, and the blood flows through the artery once more.

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Alternative Treatments

BYPASS SURGERY

If there are too many blockages, in two or three major coronary arteries, and your 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 hospital and a three month recovery period. In this case, a vein is grafted from a blood vessel from your own thigh and is used to literally bypass a blockage in the coronary artery, as shown below.

Vein bypassing the blockages in the right coronary artery.

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The Risks The risk from Angioplasty is minimal, and deaths are very rare. However, as with any invasive procedure, there are inherent risks. These risks include: • 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 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. 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 restenosis of the artery. The artery itself may also be damaged by the metal stent, and this may also lead to an inflammatory response. © 2002 Empowered Medical (www.EmpoweredMedical.com) - 14 -

The Potential Benefits 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.

 A blockage in the coronary artery here can cause future damage to heart tissue 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 damage from happening in the future.

The most important benefit would be the avoidance of a heart attack. As the plaque continues to build up inside the coronary artery over time, it will ultimately restrict or even cut off the blood supply to a part of the heart's tissue.  Additional benefits would include, a decrease in chest pains during physical exertion and a general increase in level of activity and wellbeing.

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After The Procedure

Once the procedure is finished, you will be taken to another room for observation and recovery. There, your vital signs will be monitored (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 to be 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 vascular 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 recommendation. 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 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. General Guidelines When You Go Home

• 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. © 2002 Empowered Medical (www.EmpoweredMedical.com) - 17 -

Long Term Care Long term benefits of Coronary Angioplasty is only possible with a change in lifestyle. These changes need to include; A regular exercise program. Studies have shown that even 30 minutes of walking a day will greatly enhance your physical health and substantially reduce the risk of coronary artery disease and a heart attack in the future. Every 10lbs of excess weight adds 10% more work for  your heart. And if you smoke, find a way to stop. Management of one’s cholesterol level. Regular check-ups for cholesterol are very important and the levels should be monitored. The desirable cholesterol level is less than 200 mg/dl.

Eating a healthy, nutritious diet. This should include plenty of fruits and vegetables and whole grain products. These foods are loaded with vitamins and have little or no fat. Avoid foods that are high in saturated fats such as bacon, sausage, ham, butter, whole milk, cream-cheese, peanut butter, bologna, coconut oil and ice cream. Also, limit your salt intake. © 2002 Empowered Medical (www.EmpoweredMedical.com) - 18 -

Long Term Care 4

5

Stress management. Learn to deal with daily stress and pressure in a constructive manner. This may include relaxation techniques (such as progressive muscle relaxation), 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

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