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Percutaneous Coronary intervention(Coronary angioplasty/ stenting)
Cardiac Procedures Unit
What every patient needs to know
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This guide has been prepared by William Osler Health System to help you
understand heart disease, angioplasty and how you can improve your heart
health.
Acknowledgements
Hamilton Health Sciences
Trillium Health Centre
Disclaimer
This guide does not replace professional health care advice, medical diagnoses
or treatment. It will help you understand your cardiac procedure. If you have
any questions or concerns, ask a health care professional. William Osler
Health System does not guarantee the quality accuracy, completeness,
timeliness, appropriateness, usefulness or suitability of the information in thisguide.
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TABLE OF CONTENTS
Part I – Angina and Heart Attacks 3
What is coronary artery disease? 3
Progress of coronary artery disease 3
What is angina? 4
How do you know if you have angina? 4
How do you test for angina? 5
How do you treat angina? 5 What is a heart attack? 6
What are the signs of a heart attack? 6
Part II - Coronary Angioplasty 7
What is an angiogram? 7
What is angioplasty? 7 What is a stent? 7
Preparing for your angioplasty 8
What happens during your angioplasty? 8
How is an angioplasty done? 9
What happens after the angioplasty? 10
Going home after your angioplasty 10
What to watch for after your angioplasty 11
PART III – Cardiac Rehabilitation Program 12
William Osler Heart Smart Cardiac Rehabilitation Program 12
Quit smoking 12
Learn more about Healthy Heart Habits 13
PART IV – Frequently Asked Questions about Angioplasty 13
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PART I – ANGINA AND HEART ATTACKS
What is coronary artery disease?
Coronary artery disease is a build up of fat and other materials including
cholesterol and calcium inside
the arteries called atherosclerosis.
The artery walls become thick,
narrowing the blood flow. Blood
carrying oxygen to the heartcannot flow through these
arteries well.
Normal artery - The blood flows througheasily
Damaged artery - Plaque starts to build
up and narrow the artery.
Narrowed artery - Blood flow becomes
partially blocked because of the build up
of plaque. This decreases the amount of
oxygen your heart gets during activity.
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Aorta
Right coronaryartery
Left maincoronary artery
Circumflexartery
Left anteriordescending artery
Your Heart
Artery
Smooth blood flow
Plaque build up
Progress of coronary artery disease
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Blocked Artery
Over time, the flow of blood becomes
sluggish and causes blood clots which
block the artery. A heart attack happens
when oxygen cannot reach your heart
due to a blocked artery.
What is angina?
Angina is chest pain. It occurs when your heart does not get enough blood oroxygen. Your arteries may be plugged with plaque, cholesterol or fatty build
up. When this happens less blood flows to your heart. Angina is a warning
sign that your heart is under stress and needs help.
How do you know if you have angina?
You may have any of these signs Pain in your chest which moves to your neck, jaw, back, shoulders and
arms
Chest pressure tightness or heaviness
Squeezing or burning in your chest
Sharp pain or cramping in your chest/back
Numbness in your arms Nausea or vomiting
Trouble breathing or shortness of breath
Women may have less typical symptoms
*Please note that these signs and symptoms may vary from person to
person
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ClotNo blood flow
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How do you test for angina?
Your doctor may send you for these tests
ECG: helps to find problems with heart rhythm
Stress Test: exercise or medication will stress your heart. Your ECG, heart
rate and blood pressure will be monitored for changes
Chest X-ray: shows your lungs, heart and larger blood vessels
Nuclear Scanning: shows areas of heart that are unhealthy
Echocardiogram: creates sound waves to create a picture of your heart. It
tells us how well your heart pumps and can also check your heart valves
Cardiac Catheterization: checks for blockage in the arteries and also
measures how the heart and valves work
Blood Work: checks for elevated cholesterol levels and diabetes
How do you treat angina?
Based on test results your doctor may1. Treat you with medication
Nitroglycerin: relaxes and widens your blood vessels allowing more blood
to flow to your heart.
Beta Blockers: reduce blood pressure, slow your heart rate and reduce the
workload of the heart.
Calcium Channel Blockers: lower blood pressure and relax the blood
vessels. Also may slow your heart rate.
Ace Inhibitors: help relax blood vessels, lower blood pressure and
strengthen heart muscle.
Antiplatelets: medication to stop platelets from clumping together. They
reduce the risk of heart attack and stroke by preventing clots from
forming.
Diuretics: remove excess fluid from your body and decrease blood
pressure.
Statins: lower blood cholesterol which may over time decrease the
blockage in your arteries. It may also stabilize existing cholesterol plaques.
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2. Recommend lifestyle changes: These will reduce your risk factors for heart
disease and control chest pain. Your heart health depends on the lifestyle
changes you make.
Risk factors you cannot change
Your age and gender
Your family history
Your race
Past disease problems
Risk factors you can change
Stop smoking
Lower your blood pressure
Watch your cholesterol levels
Control your weight
Manage your diabetes
Begin exercising
Limit your stress
3. Treat you with angioplasty or heart bypass surgery.
What is a heart attack?
A heart attack occurs where your blood doesn’t get to an area of your heart.
When this happens, you will have chest plain. If the blood flow is not re-
started in time, the heart can be damaged forever.
What are the signs of a heart attack?
Chest pain:
That does not go away with rest
Reaches your neck, jaw, back and arms
Feels like pressure, burning, squeezing, heaviness or tightness
Trouble breathing
Nausea or vomiting
Sweating, or feeling cool and clammy
Feeling anxious
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PART II - CORONARY ANGIOPLASTY
What is an angiogram?
An angiogram is a test that takes X-Ray pictures of the coronary arteries and
the vessels that supply blood to the heart. The test gives doctors valuable
information about the condition of the coronary arteries and helps them to
decide your treatment options. During an angiogram, a special dye is released
into the coronary arteries from a catheter inserted in a blood vessel. This dye
makes the blood vessels visible when an X-ray is taken of them. What is angioplasty?
An angioplasty is a procedure to open up blocked arteries found during your
angiogram.
During an angioplasty, a catheter with a
special balloon goes into the blocked artery.The balloon is inflated (blown up). This
pushes the material known as “plaque”
against the walls of the artery and expands
the artery. Another balloon, covered with a
wire mesh (called a stent), is then put into
the artery. The stent expands and locks into
place. This holds the artery open.
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What is a stent?
A stent is a small wire mesh tube that
looks like a spring. A stent
Stays permanently in the artery
Improves the blood flow through
the arteries and to the heart muscle
Your cardiologist will decide which
stent will work best for you.
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Preparing for your angioplasty
Read your procedure booklet. The
instructions for the appointment
are on the envelope of Osler’s
“Cardiac Procedure Package”
Get your ECG (electrocardiogram)
or any blood tests your doctor
ordered done before the
angioplasty. If you have had reaction to x-
ray dye, tell your doctor prior
to this test
You will need someone to stay with
you for 24 hours after your
angioplasty . If you cannot find
someone to stay with you, tell your
doctor. Your angioplasty can be rescheduled
What happens during your angioplasty?
Prior to going to the Cardiac Catheterization Lab
A nurse will start an intravenous in your arm.
An intravenous is a needle attached to a tubethat brings fluids into your body.
A nurse will clip the hair at the insertion site. This could be your arm or groin.
The cardiologist doing the angioplasty will explain what is about to
happen and tell you about the risks and benefits.
You will need to sign a consent form. This is the form that lets the doctor
do this procedure. Make sure you understand the information before you
sign the form.
The nurse will give you a medication to relax, but you will be awake
during the procedure so that you can follow instructions.
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Radialartery
Possible Cardiac Catheter Access Sites
Brachialartery
Femoralartery
access site
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How is an angioplasty done?
A nurse will wash your groin or arm with antiseptic solution and cover the
area with sterile sheets. The doctor will freeze your groin or arm. A small
tube, known as a sheath, will be inserted into your coronary artery. A small
catheter with a tiny deflated balloon at its tip is inserted through the sheath.
It is advanced into the narrowed part of an artery.
The balloon is then inflated. This balloon presses the plaque against the
artery walls so that blood will flow more easily through the centre of the
artery.
Blood thinners are given during the procedure to prevent blood clots from
forming. The balloon is then deflated and removed.
If you have pain or discomfort in your chest or have trouble breathing, tell
your doctor or nurse. In most cases balloon angioplasty is followed by theplacement of a stent.
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Deflated balloon
catheter
Inflated ballooncatheter
Compressed
plaque
Smooth bloodflow
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What happens after the angioplasty?
You will need to remain in bed for two to eight hours after your procedure,
depending on the access site used (arm or groin).
If the tube is in your groin, it will remain for two to four hours. After that time,
the nurse will remove the tube, applying pressure to the site for about 20 minutes.
The cardiologist will decide how long you will be in the hospital.
Discharge:1. If you go home on the day you have your angioplasty, you need to have
someone take you home and stay with you for 24 hours.
2. If you are an inpatient from another hospital, you will go back there.
3. If you go home the next day you will be discharged at 6 a.m. A family
member needs to come to the unit to pick you up.
Going home after your angioplasty
During your angioplasty, the doctor places a tube in your artery. This area can
start bleeding after you leave the hospital. If this happens, you need someone
with you who can
Call “911”
Help stop the bleeding by putting pressure on the area
Do not stop taking your antiplatelet medication unless your Cardiologist
tells you to stop. If you stop this medication before your doctor tells you to
do so, it can result in the formation of clots in your stent.
You should not drive for 48 hours after your angioplasty.
Take showers instead of baths for one week after your angioplasty.
Do not go swimming or get into a hot tub for one week after your
angioplasty.
You can restart sexual activities two days after your angioplasty.
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What to watch for after your angioplasty
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Watch for: How to get help:
Sudden bleeding that soaks through
your clothes
Sudden swelling at the puncture site
Changes in your speech or eye sight
Call 911
If you are bleeding have someone
apply firm pressure over the
puncture site.
Bad pain at your puncture site
Weakness or numbness or coolness
in your arm of leg
Too much pain in your arm or leg
Call your nearest doctor or go to the
nearest Emergency Department.
Redness, warmth or other signs of
infection at your puncture site
See your family doctor.
Chest pain Follow the usual steps you take when
you have angina
Take one nitroglycerin every five
minutes If the pain does not go away
after three doses of nitroglycerin,
call 911 or go to the nearest
Emergency Department
Skin rash Call your doctor. Your rash might becaused by your medication or a dye
reaction.
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PART III – CARDIAC REHABILITATION PROGRAM
Now that you’ve had your angioplasty procedure, you’ll begin a program of
cardiac rehabilitation. This program will help you modify or change some ofthe risk factors that led to your coronary artery disease.
At this program you will be guided to:
Quit smoking
Control your diabetes
Control your blood pressure
Choose healthy foods low in fat and cholesterol Maintain a healthy body weight
Exercise
Avoid excessive alcohol consumption
All these life style modifications will prevent your coronary arteries from
getting blocked
William Osler Heart Smart Cardiac Rehabilitation Program
Individualized counselling, group exercise and education to get your heart in
shape and put your mind at ease, twice a week for six months at our state-of-
the-art rehab facility at Brampton Civic Hospital. The Cardiac Rehabilitation
phone number is (905) 494-6479.
Take charge and manage your own heart health
Build your self-confidence as you get heart smart Improve your physical strength, endurance and energy levels
Improve your blood pressure and cholesterol levels
Adopt healthy eating habits
Reduce your stress levels
Lose weight if needed
Quit smoking
Register for Osler’s Kick it! Quit Smoking Program.
Download useful Quit Smoking information and kits from the Canadian
Cancer Society, www.cancer.ca
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Learn more about Healthy Heart Habits
Visit the Heart and Stroke Foundation web site at www.heartandstroke.ca.
PART IV – FREQUENTLY ASKED QUESTIONS ABOUT
ANGIOPLASTY
1. Can I wear jewellery during the procedure?
You should not bring or wear rings, earrings, a watch or other items that
could get lost. Please leave your valuables at home.
2. Can I eat after the angioplasty procedure?
Yes. The nurse will give you a snack after the procedure. You may choose
to bring your own snack.
3. Can I have a visitor immediately following the angioplasty procedure?
You can have one visitor while you are resting after the procedure. Please
talk to the nurse before your procedure about where you will be restingafter the procedure so you can inform your visitor. Please note that
visitors are not allowed to stay in the recovery area.
4. How long will I be in the hospital after the angioplasty?
Your doctor will decide if you can go home the same day or whether you
will stay in the hospital overnight. If you stay overnight, you will go home
at 6:00 a.m. the next morning.
5. Do I take my antiplatelet medication with a stent?
Continue taking your antiplatelet medication unless your Cardiologist
tells you to stop. If you stop this medication before your Cardiologist tells
you to, it can result in the formation of clots in your stent.
6. Can I take herbal medications and/or vitamin supplements with astent?
Tell your cardiologist about any herbal medications and/or vitamin
supplements you are taking. He or she will tell you whether to continue or
to stop taking them.
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7. Can I have an MRI (Magnetic Resonance Imaging) with a stent?
You should wait six weeks after your stent procedure before having an
MRI. In case of emergency, the emergency doctor will decide what to do.
8. Will my stent affect or be affected by airport security?
No, your stent will not trigger alarms at security checkpoints. Metal
detectors will not harm your stent.
9. Can I go an a vacation or fly?
There may be certain restrictions to driving or flying based on the adviceof your doctor.
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William Osler Health System is a hospital system ‘Accredited with Exemplary Standing’
that serves 1.3 million residents of Brampton, Etobicoke, and surrounding communities
within the Central West Local Health Integration Network. Osler’s emergency
departments are among the busiest in Ontario and its labour and delivery program is one
of the largest in Canada. William Osler Health System Foundation builds and fostersrelationships in order to raise funds to support William Osler Health System’s capital,
education and research priorities at Brampton Civic Hospital, Etobicoke General
Hospital and Peel Memorial Centre for Integrated Health & Wellness (targeted for
completion in 2015-16).