coronary angioplasty, patient education and procedure guide
TRANSCRIPT
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8/20/2019 Coronary Angioplasty, Patient Education and Procedure Guide
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ORON RY
NGIOPL STY
© 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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© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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2
3
4
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
© 2002 Empowered Medical (www.EmpoweredMedical.com)
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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ORON RY
NGIOPL STY
Patient Education and Procedure Guide
NOTES