“All you need to know about Angioplasty”
— Get Well in India
It is a non-surgical procedure which opens the narrowed or blocked coronary arteries and restores blood flow into the heart. “Angio” means, relating to a blood vessel and “plasty” means repair. Angioplasty is also used in other parts of the body, usually to treat peripheral artery disease.
The heart is mainly made of muscles which pumps blood into blood vessels (called arteries) which supply blood to other parts of the body. Heart needs a good blood supply. The heart (coronary) arteries take blood to the heart muscle. The coronary arteries are the first arteries to branch off the aorta. The aorta is the large artery which takes blood from the left ventricle of the heart to the body.
Angioplasty surgery generally involves using a balloon to stretch open a narrowed or blocked artery. Modern procedures also involve inserting a stent, into the artery and place it permanently to allow blood to flow more freely.
Plaque build-up overtime on the inner artery walls which can result in clogged arteries. The blocked arteries will not widen enough to let the blood flow properly. This can result in a condition called Coronary Atherosclerosis. This leads to chest pain also known as angina, a stroke or heart failure.
Angioplasty can improve symptoms of blocked arteries, such as chest pain and shortness of breath. It can also be used during a heart attack to quickly open a blocked artery and reduce the amount of damage to your heart.
Angina can often be treated with medication. A coronary angioplasty cannot be treated with medication and a surgery may be required to restore the blood supply to the heart. Coronary angioplasties are also often used as an emergency treatment after a heart attack.
Many people find their symptoms get significantly better after angioplasty as blood starts flowing freely through the coronary arteries. After a heart attack, an angioplasty can increase your chances of surviving more and also reduce your chances of having another heart attack in the future.
Dr. Jamshed Dalal
The following symptoms indicate that a person may need to undergo the Angioplasty:
- Chest pain
- Heaviness in arms
- Shortness of breath
- Swelling in hands and feet
- Heavy Indigestion
- Abnormal heart rhythms
- Heart attack
Your doctor will do a detailed investigation and suggest various tests such as:
Blood tests to check the levels of electrolytes, blood cells, clotting factors and hormones in the blood and presence of specific enzymes and proteins.
Electrocardiogram (ECG): It records the electrical activity of the heart when at rest. This shows changes that indicate the heart muscle is not receiving enough oxygen. Electrical activity of the heart will be recorded using electrodes placed on the arms, legs and chest.
Exercise ECG/ Exercise Tolerance Test (ETT): It is meant to evaluate the heart’s response to exercise and stress. It includes walking on an exercise treadmill or riding an exercise bike for a few minutes. Continuous ECG and blood pressure and symptoms of coronary artery disease such as shortness of breath, and pain in the chest, jaw or arm are noted.
Echocardiography: It uses ultrasound waves to capture movements of the heart as it beats. It measure the dimensions of the heart, views the structures of the heart and assess damage to heart muscle.
Stress Echocardiography: This test involves inserting medications into the bloodstream through a drip while the echocardiogram is being performed. These medications stimulate the heart and mimic the effect of exercise.
Angiogram: This is a diagnostic test. It involves inserting a catheter into an artery in the wrist or groin. The catheter is threaded up through the artery, into the aorta and is positioned at the entrance to the coronary arteries. An x-ray dye containing iodine is injected through the catheter. The dye is visible on an x-ray screen and produces an outline of any narrowing or blockages in the arteries. Heart function and efficiency can also be assessed during this test.
CT Angiography: It is also called as computerised x-ray technology. It uses several cross sectional x-ray images to create three-dimensional images of the heart. A contrast dye is injected through a vein in the arm and x-rays are taken. The three-dimensional images can indicate narrowings, fat deposits and calcium in arteries.
Myocardial Biopsy: In this, a small amount of tissue is removed from the internal lining of the heart to diagnose and treat heart muscle disorders. A catheter, a tube like structure, is inserted into a vein and threaded up into the heart. The doctor will watch its movements on a monitor showing an X-ray image of the area, and will then take several tiny snips of muscle for microscopic examination.
Stages & Treatment Details
There are five steps the Angioplasty Procedure, it is as follows;
- Step 1: Patient preparation: You will be given local anaesthetics, your vitals such as your blood pressure, body temperature, pulse rate, respiration will be monitored time to time.
- Step 2: Catheter Insertion: A thin flexible tube called a catheter is inserted into one of the arteries through an incision in the groin, wrist or arm. This is guided to the affected coronary artery using an X-ray video.
- Step 3: Locating the arterial block: The path of the catheter will be monitored through X-rays. The catheter is pushed till the coronary arteries, where the radio-opaque dye (also known as radiocontrast dye) is injected. The injected dye then flows freely through the artery, exposing the exact site of narrowing or blockage. Your doctor will then try to reach the site of arterial block through the catheter, to remove the same.
- Step 4: Removing the arterial block: After locating the block, your doctor will insert a thin wire into it in order to guide a second catheter, which is also called the balloon catheter. A balloon catheter is designed in such a way that it can be inflated inside the arterial lumen. The balloon will be inflated for about 1 to 2 minutes and then deflated. This step may be repeated intermittently as blood flows during deflation. The inflated balloon will press and squeeze the plaque against the arterial wall, clearing the lumen. Once the block is cleared, normal blood flow will soon resume.
- Step 5: Placing the stent: In order to keep the cleared artery intact, your doctor will place a stent at the repaired site. Stents are wire mesh tubes that are designed to be retained inside the vessels.
Your doctor will gradually pull the catheter out from the site of insertion, the surgical wound would then be covered. After the procedure is completed, you will be put under observation and your vitals will be monitored for a few hours. An angioplasty might take anywhere between 30 minutes and 3 hours, depending on the status of the individual and other complications.
After undergoing an angioplasty procedure you need to take care of the following factors:
- You need to take your medicines on time, especially the medicines given for anti-clotting.
- One week after the procedure you need to go for a general physical check-up, get an ECG done, get your blood pressure checked and undergo some laboratory tests.
- You should avoid any strenuous work or lifting objects heavier than 6 kgs for at least 4 weeks after the procedure.
- Avoid any strenuous exercises, jerking, pulling, hiking, bicycle rides or swimming for about two weeks after the procedure.
- You need to avoid driving for two weeks after the procedure.
- You need to report to the doctor immediately if you experience pain in the chest or in the leg or wrist, allergic reaction to medications, experience dizziness and weakness, shivering, fever, and chills
- You can opt for a cardiac rehabilitation programme offered in many major hospitals of India. Cardiac rehabilitation programmes can be of twelve weeks.
- Take healthy diet. Keep hydrated and avoid smoking and drinking.
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