EverythingYou Need To Know About Cardiac Catheterization And

Transcription

Everything You Need To Know
♥ About Cardiac Catheterization
And Coronary Intervention
♥
A Patient’s Guide
♥
A Patient’s Guide
Author
David Brill, MD
Director, Cardiac Catheterization Laboratory
Washington Adventist Hospital
7600 Carroll Avenue
Takoma Park, Maryland 20912
Editor
Susan Brill Kay, B.S.N, RN, CVNS
Copyright© 2004 Kay-McKenna Enterprises, Inc.
Copyright© 1996 All rights reserved.
9935 Potomac Manors Drive
Potomac, Maryland 20854
Phone and/or Fax Number: (301) 983-4733
www.kmheart.com
Table of Contents
♥
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Cardiac Catheterization—What is it and Why is it done? . . . . . . . . . . . . .1
How Your Heart Works
The Heart—A Muscular Pump . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
The Heart’s Blood Supply: Coronary Arteries . . . . . . . . . . . . . . . . . . . .3
Diseases of the Heart
Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4
Plaque Rupture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Myocardial Infarction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Valvular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
Congestive Heart Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Congenital Heart Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Cardiac Catheterization
What to do to Prepare for a Cardiac Catheterization . . . . . . . . . . . . . .8
Where is Your Catheterization Performed? . . . . . . . . . . . . . . . . . . . . . .9
What Happens Before Your Catheterization? . . . . . . . . . . . . . . . . . . . .10
How Does Catheterization Work? . . . . . . . . . . . . . . . . . . . . . . . . . . .10-11
What Happens During Catheterization? . . . . . . . . . . . . . . . . . . . . . . . .11
What is Angiography? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
After the Catheterization: Sheath Removal/Closure Devices . . . . . .13
At Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
When to Call Your Doctor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14
Risks Involved with Cardiac Catheterization . . . . . . . . . . . . . . . . . . . .15
Angioplasty/Stent
The Reasons for Intervention/Angioplasty . . . . . . . . . . . . . . . . . . . . .16
How Angioplasty Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17-18
Stents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19-20
Drug-eluting or Drug-coated Stents . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Other Methods of Intervention
Rotational Atherectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21
Directional Atherectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Thrombectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Laser Angioplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22
Cutting Balloon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Radiation Therapy or Brachytherapy . . . . . . . . . . . . . . . . . . . . . . . . . .23
Embolization Prevention Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
After Coronary Intervention
Recurrence or Restenosis after Angioplasty . . . . . . . . . . . . . . . . . . . . .25
Coronary Intervention: Success and Complication Rates . . . . . . . . . .26
Sheath Removal/Closure Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27
Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28
Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29
Your Care after Your Interventional Procedure
What is Normal after Intervention? . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
What You Should Report to Your Doctor . . . . . . . . . . . . . . . . . . . . . . .30
Ten Rules for Taking Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32-36
What You Can do to Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .37
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39-40
INTRODUCTION
1
ardiac catheterization and coronary intervention
(angioplasty) are two wonders of medical technology which have improved the lives of millions
of patients. Your doctor has recommended that you
should undergo a cardiac catheterization or an
interventional procedure. Do not be intimidated or
frightened by these procedures. They are safely and
comfortably performed in thousands of hospitals on a
daily basis. The information in this booklet will help
you understand how your heart works, how cardiac
catheterization helps to diagnose problems with your
heart, and how intervention (angioplasty) can successfully treat problems with your heart’s blood supply.
If you have any special concerns or questions after
reading this booklet, please discuss them promptly
with your doctor. Your doctor wants you to be wellinformed and comfortable with the catheterization or
interventional procedure. That is why your doctor
gave this booklet to you!
C
CARDIAC CATHETERIZATION—WHAT IS IT
AND WHY IS IT DONE?
Cardiac catheterization, also called an angiogram, is a
test that uses long, thin, hollow tubes called catheters
to make x-ray pictures of your heart and its blood
vessels. The test also determines how well your
heart muscle and its valves are performing. Cardiac
catheterization helps your physician to diagnose
diseases of your heart—clogged arteries, heart valve
defects, or heart muscle damage. Sometimes, a
cardiac catheterization confirms that the heart is
normal and provides reassurance that symptoms are
not related to the heart. If problems are identified by
the catheterization procedure, the test will help your
physician develop a treatment plan. To better understand why the test is being performed, you need to
know the basic workings of the heart and understand
the diseases that can affect and threaten your heart.
❦
2
HOW YOUR HEART WORKS
THE HEART—A MUSCULAR PUMP
The heart is actually two muscular
pumps or ventricles located side by
side in the center and left half of your
chest. These muscles circulate the blood
through your body. The right side of the
heart receives blood from your veins
and pumps it into the blood vessels of
your lungs. There, the blood picks up
oxygen and releases carbon dioxide, a
waste product. The left side of the heart
receives the blood with fresh oxygen
To the body
Pulmonary
artery
from the lungs and pumps the oxygenated
blood to your vital organs (brain, kidneys,
gut) and skeletal muscles. Once it has
traveled through your body, the blood
returns to the right side of your heart to
repeat its cycle of exchanging carbon
dioxide for oxygen. There are antechambers/small chambers on top of
the ventricles called atria that fill with
blood and then empty into the ventricles
to fill them completely before each heart
beat. The heart also has four valves that
keep the blood moving in only one direction
as it pumps the blood.
Aorta
Pulmonary artery (blood To the lungs)
Pulmonary veins
(blood from lungs
to the heart)
Pulmonary
veins
Left atrium
Right
atrium
Left ventricle
Blood from
veins to the heart
Right
ventricle
❦
HOW YOUR HEART WORKS
3
THE HEART’S BLOOD SUPPLY: CORONARY ARTERIES
To provide enough energy to keep its
pumping action going, the heart needs
an excellent blood supply. Blood is
supplied to the heart muscle through
the coronary arteries, tubular blood
vessels that divide into smaller and
smaller branches like the branches of a
tree. The large trunk arteries and major
Aorta
branches run on the outer surface of
the heart muscle. The smaller branches
penetrate deep into the heart delivering
fresh, oxygenated blood to the muscle.
There are two main coronary arteries
that originate from the base of the
aorta, the left coronary artery and the
right coronary artery. The left coronary
artery divides almost immediately into
two branches. The left anterior descending coronary artery supplies the front
side of the heart with blood and the
circumflex artery supplies the
left outer wall and back side of
the heart with blood. The right
Left main
coronary artery supplies the
coronary
right side and under surface
artery
of the heart with blood.
Left circumflex coronary artery
Left anterior descending
coronary artery
Right coronary artery
❦
4
DISEASES OF THE HEART
CORONARY ARTERY DISEASE: ATHEROSCLEROSIS
Atherosclerosis is a build-up of cholesterol, scar tissue, blood clot and fatty
material in the walls of your arteries.
As this material builds up in the walls
of the arteries it narrows the channel of
an artery and forms a plaque.
Coronary artery disease refers to atherosclerosis or cholesterol obstruction in
the coronary arteries. Coronary artery
disease is the most common problem
leading to a recommendation for a
cardiac catheterization. The conditions
that increase the risk of developing
plaques are called coronary risk factors.
Plaque
You are susceptible to developing
cholesterol plaques if:
• You have high blood
pressure.
• You have diabetes.
• You have a cigarette
smoking habit.
• You have high blood
cholesterol level and a low
HDL (the good cholesterol).
• You have a family history
of early-onset coronary
artery disease.
Symptoms or problems develop when
plaque partially or completely blocks
the channel of a coronary artery. If an
artery is partially blocked, there can be
a reduction in blood flow to your heart
muscle. This reduction in blood flow
may create problems when the heart is
stressed by physical exertion or emotional upsets. Inadequate blood flow
through the partially obstructed artery
can cause discomfort in the chest called
angina pectoris. Angina is a warning
sign or symptom that the blood flow to
the heart muscle through an obstructed
artery is not sufficient.
Cholesterol plaque obstructing
blood flow in a coronary artery
❦
PLAQUE RUPTURE
The cholesterol plaque in a coronary artery can undergo rapid
transformation with sudden
narrowing of the channel of the
artery. The cholesterol plaque in
the wall of the coronary artery can
trigger a reaction from the body’s
immune system resulting in
inflammation. This inflammatory
reaction can weaken the inner lining of the artery, causing the lining
to tear and expose the cholesterol
plaque directly to the blood inside
the artery. This process is referred
to as plaque rupture and can cause
rapid accumulation of blood clot
material on the exposed plaque.
The sudden build-up of clot at a
plaque rupture can narrow an
artery to the point of causing a
heart attack or a prolonged bout
of chest pain (unstable angina).
Endothelium
5
MYOCARDIAL INFARCTION/
HEART ATTACK
When an artery is completely obstructed, a
heart attack may occur. A total obstruction
of a coronary artery typically occurs when
a clot (thrombus) closes off a segment in
an artery that is already narrowed with a
plaque. A heart attack occurs when part of
the heart muscle (myocardium) has no blood
flowing to it for a half hour or longer. The
heart muscle supplied by that particular
artery becomes damaged and is turned
into scar tissue.
Occasionally, if an artery narrows gradually
over time, your body can compensate by
growing auxiliary, small blood vessels
around the obstructed segment of the artery.
These small blood vessels are called collaterals
and may protect the heart from damage if
an artery closes off.
Complete obstruction of an artery resulting in
damage (heart attack)
Plaque
Plaque
Clot
❦
6
VALVULAR DISEASE
When the heart circulates the blood, its
valves must open and close fully to
allow the proper flow of blood through
the heart’s pumping chambers. When a
valve does not open completely, this
condition is called stenosis. The opposite problem, regurgitation, occurs
when a valve leaks, causing blood to
flow in the reverse direction. In adults,
the two valves most commonly affected
by these problems are the valves in the
left side of the heart, the aortic and
mitral valves. When a valve has severe
stenosis or regurgitation, the heart can
Tricuspid
valve
Pulmonary valve
be weakened and its pumping function
impaired. Aortic stenosis obstructs
blood flow out of the left ventricle. This
occurs mostly in older patients. This
condition can weaken the heart and
may require heart surgery for treatment. Mitral regurgitation results in
blood flowing backward from the left
ventricle (main pumping chamber) into
the left atrium and the blood vessels of
the lungs. Mitral regurgitation can also
reduce the pumping function of the
heart and is sometimes due to a “floppy”
valve (mitral valve prolapse) or damage
to the valve attachment from a heart
attack.
Mitral
valve
Aortic valve
Normal valves
Aortic stenosis
❦
Mitral
regurgitation
7
CONGESTIVE HEART FAILURE
Congestive heart failure is a condition
that occurs when the heart has become
weakened and cannot pump enough
blood to meet your body’s needs.
When the heart does not circulate
the blood vigorously enough, fluid
can back up into your lungs or legs.
The symptoms of congestive heart
failure are breathlessness, fatigue
and swollen ankles.
The most common causes of
congestive heart failure are:
1) heart attacks that damage the heart
muscle
2) high blood pressure that hinders the
heart from filling and pumping the
blood forward.
Occasionally, congestive heart failure
results from excess thickness and stiffness of your heart muscle. In
this case, the pumping chamber of the
heart muscle has difficulty filling with
blood between heart beats.
This condition is called diastolic
dysfunction.
Septal
defect
CONGENITAL HEART PROBLEMS
Cardiac catheterization can also be
useful in diagnosing congenital heart
problems that are present at birth.
Septal defects are “holes in the heart”
that allow the blood to move abnormally
from the left side of the heart to the right
side (or vice versa). Valve problems can
also be congenital.
❦
8
CARDIAC CATHETERIZATION
CARDIAC CATHETERIZATION: HOW IT IS DONE AND WHAT TO EXPECT
he catheterization procedure is performed by a cardiologist, an expert in the diagnosis and treatment of heart disease. Your cardiologist wants your catheterization procedure to be safe, comfortable, and easy for you. You can help by getting
yourself ready ahead of time and by understanding the procedure. A well-prepared
patient is a calm, informed patient who expects a successful procedure.
T
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WHAT TO DO TO PREPAR
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CARDIAC CATHETERIZAT
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❦
9
WHERE IS YOUR CATHETERIZATION PERFORMED?
You will go to the catheterization laboratory to have your procedure. The catheterization laboratory is a specially designed room with an x-ray camera and monitor ( a TV
screen) which will display pictures of your heart and blood vessels. There is a padded
table for you to lie on during the procedure.
❦
10
WHAT HAPPENS BEFORE YOUR
CATHETERIZATION?
HOW DOES CATHETERIZATION
WORK?
• Before the procedure— sometimes
earlier that day or several days in
advance—you will need to have
blood tests to check your blood
count, kidney function, and blood’s
ability to clot.
Your doctor will use a catheter to perform your heart examination. The
catheter is a long, thin, flexible hollow
plastic tube. Your cardiologist will
insert the catheter into a blood vessel
(artery) in the groin area or the arm.
The catheter then follows the course of
the blood vessels to reach the heart.
The movement of a catheter inside a
blood vessel cannot be felt by a patient
and is therefore painless. The size of
the catheter is relatively small compared to the size of the blood vessel
into which it is introduced.
• You are also asked to fast on the day
of the procedure.
• An IV line is inserted into a vein in
your arm so that you can be given
fluids and medications easily.
• You will receive enough medication
to feel relaxed and comfortable.
• You will be awake enough during
the procedure to communicate with
the physician and the staff.
• If you become nervous before or during the procedure, additional medicine to help you relax can be given
through the intravenous line.
Most commonly, the blood vessels in
the right groin area are used for insertion of the catheters to the heart. The
femoral artery and vein are located in
the skin fold in the groin area that is
formed by bending the hip. In the arm,
on the inside of the elbow or wrist are
two arteries (brachial and radial arteries) that can also be used for catheter
insertion.
A special needle to puncture the
femoral (or radial) artery or vein is
used, and through this needle a thin
metallic guidewire is threaded into the
blood vessel. An introducer sheath is
then inserted over the guidewire into
the artery or vein. The sheath has a
special rubber valve through which a
catheter can be introduced into the
blood vessel. An x-ray camera is used
to guide the catheter from the groin (or
arm) area to your heart. When the
catheter is positioned at your heart, a
❦
special dye that shows up during x-ray
procedures is injected through the
catheter. Your cardiologist observes
this dye making its way through the
coronary arteries and the heart by
viewing the x-ray monitor. The
catheter can also be used to measure
the pressures in the various chambers
of your heart and to examine the
function of your heart valves. This
procedure helps your physician identify
clogged arteries, heart valve defects or
heart muscle damage.
11
WHAT HAPPENS DURING
CATHETERIZATION?
Once you are adequately medicated
and at ease, your cardiologist will:
1.
Numb your groin (or arm/
wrist) by using a small needle
to inject lidocaine, a local
anesthetic under your skin.
2.
Puncture the femoral (or
radial) artery or vein with
a needle specially designed
to allow entry of the catheter.
3.
Insert the catheter through a
sheath that is threaded into
the artery over a guidewire
passed through the needle.
4.
5.
Guide the catheter from the
groin (or arm) to your heart.
Radial artery
6.
Catheter in the
Femoral artery
Inject through the catheter a
special dye that visualizes
your heart’s blood vessels
and pumping chamber.
Use the catheter to measure
the pressure in the chambers
of your heart.
❦
12
ANGIOGRAPHY — X-RAY
PICTURES OF YOUR ARTERIES
An angiogram is a picture of your
blood vessels or arteries. A coronary
angiogram (or arteriogram) is an x-ray
picture of the arteries of your heart that
demonstrates any obstructions or
plaques narrowing the coronary arteries. The x-ray picture is made by injecting x-ray dye into the blood vessels. Xray dye (radiographic contrast agent) is
a clear liquid, containing iodine, that
shows up on x-ray pictures. When the
dye is injected and the x-ray beam passes through the heart, your arteries
appear on the x-ray image as a silhouette in black against a background of
white. The x-ray image is recorded as a
digital image or is recorded on 35 mm
film. The digital image can be stored
on a CD-rom format.
Most people do not feel the small injections of x-ray dye into the arteries of
the heart. However, a few experience
minor chest discomfort which lasts only
a few seconds. A few patients may
note a mild sensation of nausea or
lightheadedness at times during the
angiogram.
Another picture of your heart is made
by injecting x-ray dye into the main
pumping chamber of your heart and
observing the pumping action of the
heart muscle as it beats. This procedure
may produce a hot and flushed sensation. This feeling lasts for 10 seconds
and is not painful.
Narrowing of coronary artery
❦
13
AFTER THE CATHETERIZATION: SHEATH REMOVAL/CLOSURE DEVICES
The angiogram part of the catheterization procedure takes between 15 and 45
minutes. After the procedure, you are
taken to a holding area to recover. A
short tube, called a sheath, is removed
from the groin area (or arm area). The
sheath is the plastic tube through which
the catheters were inserted into the
blood vessel.
As soon as the sheath is taken out:
• Pressure is applied to the insertion
site for about 20 minutes to prevent
bleeding.
• When the pressure is released, the
insertion site is inspected very carefully to be certain there is no oozing
or bleeding.
• Then, a dressing is applied to
the skin and a 10 pound weight
(sandbag) may be placed over the
insertion site.
• In order to prevent bleeding, it is
very important for you to lie still and
neither bend your leg nor raise your
head, if the catheter was inserted in
the groin.
• Most patients need to lie still for 2 to
6 hours after a sheath is removed.
• Some physicians use closure devices
to close up or seal the arterial puncture. Biologic materials that promote
rapid clot formation at the puncture
hole are used, such as collagen or
thrombin (a clot forming enzyme).
Some closure devices close the puncture hole with suture material.
Immediately after the procedure, your
physician will have some information
available about your condition. More
information will be forthcoming after
your physician has had a chance to
review the x-ray pictures and study
the data in more detail. Coronary
intervention (angioplasty or stent
procedure) is occasionally performed
immediately after the angiogram.
Interventional procedures are described
later in this booklet.
Sandbag
❦
14
AT HOME
Once you are home, in the hours and
days following a catheterization, you
may notice a small bruise in the area
where the catheter was inserted.
Bruising is caused by a small amount
of blood that escapes from the blood
vessels under the skin during or after
the test. In a few cases a larger bruise
will develop that can extend many inches
beyond the insertion site. In a few
patients a hard swelling (hematoma)
may appear in the groin area.
WHEN TO CALL YOUR DOCTOR
Please report to your doctor any of the
following:
• Swelling in the calf or thigh that
occurs days after the procedure.
• Painful swelling at the catheter
insertion site that gets worse
rather than better.
• Fever of 101 or higher.
• Bleeding from the insertion site.
• Drainage of pus from the
insertion site.
• Numbness or weakness of the
extremity into which the catheter
was inserted.
You do not need to report to your doctor if there is skin discoloration around
the insertion site, even if it is relatively
large. The discolored bruise is caused
by the leakage of blood from the artery
after the procedure. This old blood
works its way to the surface over a
period of days. The discolored area
may enlarge over time, but will resolve
in 1 to 3 weeks.
❦
15
RISKS INVOLVED WITH CARDIAC CATHETERIZATION
Cardiac catheterization is a safe
procedure but as with any procedure
there are risks involved:
risk. It is very rare for x-ray dye to
produce serious or permanent injury
to the kidneys, especially if kidney
function is normal beforehand.
• In very rare cases—one in 1,000
patients—a stroke or heart attack
can occur. Although it is possible
that either of these two serious complications could occur, the likelihood
is very, very rare.
• Finally, the insertion of the catheter
into a blood vessel can sometimes
result in injury to the vessel or significant bleeding around the artery.
On rare occasions, the blood vessel
does not seal properly or a blood
clot forms in the vessel. A minor
procedure can repair the blood
vessel in these cases.
• In addition, some patients are allergic to the x-ray dye. It is very important to inform your doctor immediately if you have this kind of allergy.
Medications can prevent most allergic
reactions if they are given before the
procedure. Some allergic reactions
cannot be anticipated and may occur
for the first time only after the x-ray
dye is injected. The most common
reactions are minor such as skin rashes
and itching. The chance of a lifethreatening allergic reaction is very,
very small—one in 10,000 or less.
• Patients with weak kidney function,
especially as a result of diabetes or
high blood pressure, have an
increased risk of further weakening
kidney function from a toxic effect of
the x-ray dye. However, this deterioration in kidney function is usually
only a temporary problem. Special
precautions are taken to reduce this
❦
16
ANGIOPLASTY
CORONARY INTERVENTIONS/ ANGIOPLASTY:
A NON-SURGICAL TREATMENT FOR BLOCKED ARTERIES
Coronary interventions are treatments or procedures that open up
blockages in the blood vessels.
Angioplasty is a type of coronary
intervention that uses a catheter
with a balloon affixed to it to
open up a blocked artery. The
term angioplasty also will be
used as a general term
indicating any type of
intervention.
Angioplasty
balloon
catheter
Guide catheter
The majority of patients
have a stent (see page 19)
implanted during the
angioplasty procedure.
Angioplasty balloon
catheter inflated
THE REASONS FOR INTERVENTION/ANGIOPLASTY
When a build-up of plaque significantly narrows a coronary artery, patients can
experience chest pain (angina) or have a heart attack if the artery becomes completely
obstructed. Angioplasty is a treatment that can relieve chest pain, reduce the likelihood of a heart attack in the future, and can stop a heart attack if rapidly performed
during a heart attack.
For the majority of patients, the procedure permanently eliminates the severe blockage.
Angioplasty and related procedures are the only techniques that actually reduce an
obstruction and “fix” the artery.
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ANGIOPLASTY
17
HOW ANGIOPLASTY WORKS
The angioplasty procedure is similar to
cardiac catheterization.
• In both procedures, your cardiologist
inserts a catheter in the femoral
artery in your groin (or an arm
artery) and directs it to your heart.
• With angioplasty, the catheter which
extends from your groin (or arm)
area to the heart is called the guiding
catheter.
• Local anesthesia is always used so
that the insertion of the catheter is
painless. After the guiding catheter
is positioned at the opening of your
coronary artery, x-ray dye is injected
to make pictures of the artery that
needs angioplasty.
• Inside the guiding catheter, the
angioplasty device, called a balloon
catheter, is then inserted. This
balloon catheter is a long, very thin,
delicate plastic tube that is equipped
with a small plastic balloon at its
end. When the balloon is deflated,
the tube is very thin and can be
squeezed across an obstructed
segment of an artery. The balloon
part of the catheter is used to open
up the blockage in your artery.
• The narrowed segment of the artery
must first be crossed with a
guidewire. A guidewire is a thin,
delicate, hair-like strand of metal.
The thickness of the guidewire is
usually fourteen thousandths of
an inch (0.014”).
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18
ANGIOPLASTY
• After the guidewire is successfully
passed through the blocked area, the
balloon catheter slides over the
guidewire like a train on a rail. The
guidewire allows the balloon
catheter to safely follow twists and
bends in the artery.
• The balloon segment of the angioplasty catheter is then positioned
across the blockage. The balloon is
inflated with a mixture of water and
x-ray dye.
• When the balloon is fully expanded,
the obstructive plaque is pushed off
to the side. The procedure works by
stretching the wall of the artery and
compressing the plaque. There is
some minor tearing and cracking of
the plaque that extends into the wall
of the artery. This is a normal part
of the procedure and is necessary for
success.
• During the brief balloon inflations,
blood flow through your artery
stops. When the balloon is inflated,
many patients experience brief
discomfort in the chest that is
similar to angina. If any significant
discomfort occurs, pain medication is
given immediately.
• After the balloon has been inflated
and deflated, x-ray pictures are again
taken to be certain that the obstruction has been eliminated. The
balloon catheter is then removed
and final x-ray pictures are made.
• The patients are observed after the
procedure to be certain that delayed
problems do not occur.
Artery after angioplasty
Narrowing of coronary
artery before angioplasty
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STENTS
19
STENTS
Stents are small metal strands that are
woven or fashioned into a tubular
shape. Most stents are made of thin
strips of stainless steel and look like a
minature tube of chicken wire. Stents
are used to improve upon angioplasty
results and provide a more durable
treatment of the cholesterol blockage.
Stents can reduce the likelihood of
recurrent blockage (restenosis) by at
least 10% when compared to balloon
angioplasty. Some types of blockages
are not well suited to stent implantation
and are best treated with simple angioplasty or other techniques. Small arteries, very stiff and calcified arteries, and
arteries with blockages involving major
branch points may not yield good
results with stents. Usually, stenting
achieves an excellent result even in
complex blockages.
Stent on angioplasty
balloon before
expansion in the
artery
The majority of patients (at least 80%)
now receive a stent implant during a
coronary intervention:
• A stent is first loaded onto an angioplasty balloon catheter by crimping
and compressing the tubular piece of
metal firmly against the plastic balloon material.
• The stent-angioplasty balloon unit
can then be inserted into the coronary artery using standard angioplasty techniques.
• The metal structure of the stent has a
“memory” and will retain the shape
that the expanded balloon catheter
forces on the stent.
• Many times a blockage is first
stretched open with an angioplasty
balloon to allow sufficient room for
the catheter with the stent to pass
through the obstructed segment.
Stent on angioplasty
balloon expanding
in the artery
Stent opened in the artery
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20
STENTS
Stents may also be helpful in opening
up blocked arteries on an emergency
basis during a heart attack. Stents can
be implanted into diseased bypass
grafts and can reopen an artery that
has developed a delayed narrowing
after angioplasty (restenosis). Also,
when an artery is forced open by the
stretching action of an angioplasty balloon, rough surfaces or “flaps” frequently are created on the inside of the
artery. Stents “tack up” and press
together these jagged inner edges of
the artery and therefore are useful for
fixing an initially unsatisfactory angioplasty result.
After a stent is inserted, there is a tendency for blood to try to form a clot on
the metallic surface inside the artery.
Special care is needed to prevent a clot
from forming and cutting off blood
flow through the stented vessel. All
patients are treated with antiplatelet
agents, medications that keep platelets
(small clotting cell fragments in the
blood stream) from adhering to the
stent. Failure to take the antiplatelet
medications (such as aspirin, Plavix,
and/or Ticlid) can cause the stent to
clot and provoke a heart attack. If a
patient properly takes the antiplatelet
medications, the likelihood of a serious
clotting event occurring is 1 in 200.
Drugs being slowly
released from stent
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Stents are a great technologic improvement in the angioplasty procedure.
Their increased use among cardiologists
is due to the extra safety, reliability, and
durability that they add to the coronary
intervention.
Drug-eluting or drug-coated stents:
New stents are being developed that
are coated with drugs that are slowly
released from the stent and that can
block the body's ability to form scar
tissue at the site of the stent implant.
These new stents slowly release the drug
into the wall of the coronary artery. The
drugs are targeted to stop the ingrowth
of smooth muscle tissue from the blood
vessel wall. These drug-coated stents
have lowered dramatically the recurrence rate after stenting. The most
promising drug so far tested appears
to be sirolimus (rapamycin), although
other agents are being tested and
demonstrate effectiveness in early
trials. A stent coated with sirolimus
(Cypher stent) is available. There is
strong evidence that this type of stent
dramatically lowers the risks of recurrent
blockage and reduces the likelihood of
needing a repeat procedure to keep the
treated artery open.
OTHER METHODS OF INTERVENTION
21
ROTATIONAL ATHERECTOMY
Rotational atherectomy is performed with
the Rotablator, a long metallic catheter with
an olive-shaped burr at its tip. This device
is useful for treating blockages that are very
hard with calcium deposits or resistant to
stretching with an angioplasty balloon
catheter. The Rotablator can be used to
remove obstructive scar tissue that can form
inside stents. The Rotablator spins rapidly at
approximately 150,000 to 180,000 RPM. The
burr is coated with tiny diamond fragments
that abrade and pulverize plaque as the burr
spins against the plaque material. The microscopic debris generated by the Rotablator
harmlessly washes out of your coronary
arteries and is absorbed by your body. In
a small number of patients, the microscopic
debris can slow down blood flow in the
treated artery.
Rotablator burr
ROTO
ROTATOR
Plaque
Rotational atherectomy
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22
DIRECTIONAL ATHERECTOMY
THROMBECTOMY
Directional atherectomy is a technique
that allows your physician to remove
the plaque from the artery using a special device known as an atherectomy
catheter. When the atherectomy
catheter is positioned over the plaque, a
rotating cutting blade advances
through the cutting chamber in the
catheter and slices off thin slivers of the
plaque. The plaque material is collected in a conical chamber in the front of
the catheter and then removed from the
body. The cholesterol material therefore is not allowed to break off or to
obstruct the artery. Like angioplasty,
the atherectomy catheter is inserted
through a larger guiding catheter from
the groin and is passed over a guidewire in the artery. Atherectomy is
performed less frequently than balloon
angioplasty or stenting, because only
certain types of blockages are best suited for this procedure. Atherectomy is
recommended for blockages in the
beginning and middle segments of
large arteries, blockages at branch
points, and blockages with complex
configurations.
Thrombectomy devices such as the
Angiojet can remove blood clots from
the arteries. The Angiojet device aspirates clot by “sucking” clot into a high
speed jet of salt water sprayed from the
tip of the device into a collection chamber in the shaft of the instrument. The
Transluminal Extraction Catheter (TEC)
is a device with rotating cutting blades
attached to a suction line. The TEC
device also can be used to remove
clot or soft cholesterol material.
Cutting blades
Plaque
Conical collection
chamber
Directional atherectomy
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LASER ANGIOPLASTY
Excimer laser angioplasty is a technique
that opens up obstructed arteries using
laser fibers in a catheter. The laser
energy at the catheter tip cuts through
the plaque and converts the cholesterol
material and any adherent clot to water
vapor and carbon dioxide. Laser angioplasty may be recommended to treat
complex blockages or to remove
obstructive material that can block
stents.
Laser
catheter
Plaque
Laser angioplasty
23
CUTTING BALLOON
The cutting balloon is a balloon catheter with 3 sharp, very short cutting blades
attached to the balloon material. As the balloon inflates, the cutting blades shallowly
incise the plaque resulting in a more complete and precise opening of the artery.
The cutting balloon may be useful for blockages that form inside stents or for
plaques that resist stretching properly with an angioplasty balloon catheter.
RADIATION THERAPY OR BRACHYTHERAPY
The scar tissue or tissue proliferation after coronary intervention can negate the beneficial effects of an intervention. The growth of scar tissue can be blocked by applying
very low doses of radiation directly to the inside of the treated artery at the time of
the angioplasty or interventional procedure. The direct application of radiation to an
artery is referred to as brachytherapy. Brachytherapy is a new treatment that is very
effective for treating restenosis that has occurred at a site previously treated with a
stent. The radiation source is applied to the blocked stent for a period of several
minutes and then removed. The obstructed stent is usually first treated with angioplasty or atherectomy to reopen the blocked channel.
At the present time, brachytherapy is the most
effective treatment for blocked stents.
Brachytherapy may also prove to be
Radioactive “seeds”
useful in preventing restenosis in
patients with blockages that are
anticipated to have a high
recurrence rate at the time of
the first procedure.
Radiation brachytherapy
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24
EMBOLIZATION PREVENTION DEVICES
Blood vessels with large amounts of
clot (thrombus) at the site of the blockage are more likely to develop complications with coronary interventions.
The clot can travel down the blood
vessel and obstruct smaller branches
near the termination of the artery. This
process is referred to as embolization
and may result in heart attack damage
(myocardial infarction). Intervention
performed on vein grafts implanted at
the time of the bypass operation can
also be complicated by embolization,
but the material embolized is frequently
cholesterol plaque that is poorly adherent
to the vein graft wall. Fortunately, new
devices have been developed and are
being developed to trap embolic material
during these complicated interventions.
The only approved device so far is the
Percusurge Guardwire which captures
embolic debris behind a soft retaining
balloon mounted on a guidewire. The
debris then is aspirated with a special
catheter after the intervention. The final
step is the deflation of the retaining
balloon to allow restoration of normal
blood flow. The Guardwire has been
demonstrated to reduce the complication
rate in patients undergoing intervention
on vein graft blockages. Other filter
type devices are being developed to
capture dislodged debris during
interventions.
Clot breaking off in endothelium
Debris
Retaining ballon
Embolization device for
capturing debris
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AFTER CORONARY INTERVENTION
RECURRENCE OR RESTENOSIS
AFTER ANGIOPLASTY
In a minority of patients who undergo a
successful angioplasty procedure, the
blockage recurs:
• This recurrence, called restenosis, usually is caused by the build up of scar
tissue at the site of the original angioplasty or stent procedure. Restenosis is
not due to a reaccumulation of cholesterol or plaque at the treatment site.
• Other causes of restenosis are recoil of
the artery wall and negative remodeling (“shrinkage” of the vessel wall).
Recoil means that the artery wall reassumes its original narrowed configuration because the vessel wall is very
elastic like a rubber band. Negative
remodeling refers to contraction and
actual shrinkage of the entire artery as
it heals and scars after angioplasty.
These processes occur only after
balloon angioplasty and are not
involved in restenosis after stenting.
Restenosis occurs in 10 to 35% of patients
(1 in 10 patients to 1 in 3 patients), usually
between two and six months after angioplasty or stenting. It is unlikely to occur
in the first month or beyond one year
after the procedure. Restenosis is suspected when symptoms return or if a
stress test to evaluate the result of an
intervention is abnormal. Restenosis
can occur after any of the intervention
procedures previously described.
25
the original blockage. If the patient has
minimal or no symptoms, a mild
restenosis is not treated with repeat
intervention and instead is managed
with medication. When a restenosis is
severe or is associated with severe
symptoms, the intervention can be
repeated. If a stent was not originally
implanted, a stent is frequently used to
treat restenosis after balloon angioplasty.
A restenosis in a stent is due to scar tissue build-up occurring through the open
space between the metal “struts” of the
stent. In-stent restenosis is more difficult
to treat than a restenosis after balloon
angioplasty and may require an atherectomy device to remove the scar tissue
or treatment with radiation (brachytherapy). A small number of patients
experience repetitive restenosis and do
not have long lasting symptom relief
with coronary intervention. The likelihood of repetitive restenosis is less
than or equal to one out of six patients.
Some patients require bypass surgery
to treat repetitive restenosis.
Restenosis of artery
In some patients, the narrowing that
recurs with restenosis is not as severe as
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26
CORONARY INTERVENTION: SUCCESS AND COMPLICATION RATES
Coronary intervention and angioplasty
have a very high success rate. It is very
likely that your physician will be able to
open up the obstructed artery during the
procedure. Angioplasty is successful in
95% to 98% of patients. This means that in
a group of 100 patients, 95 to 98 patients
have a successful outcome. The high success rate of coronary interventions is
responsible for its popular use as a treatment and is attributable to the technologically advanced equipment used, especially
stents, and newer medications that have
reduced complications. The success rate is
less for arteries that have been obstructed
for several months or longer.
The major complications of coronary
intervention include:
• Acute closure of the artery or one of its
branches. Acute closure can be due to a
portion of the cholesterol plaque or artery
wall protruding into the channel of the
blood vessel. Acute closure can damage
the heart and cause a heart attack, but can
usually be corrected by implanting a stent.
Rarely, a stent can clot off causing the procedure to fail.
• Clot formation or embolization (the
breaking off of a fragment of clot that
obstructs smaller branches of an artery).
Clot formation can be treated with powerful antiplatelet medications (IIbIIIa platelet
inhibitors) and clot dissolving medications
(thrombolytics) or a thrombectomy device.
• Even with the best equipment and the
most experienced hands, a very small
number of patients will require emergency
❦
open heart surgery (bypass operation) to
treat complications resulting from a failed
intervention. The likelihood of this occurring varies according to the type of blockage, its severity, complexity, and location
in the artery. The occurrence of emergency bypass surgery now averages less
than one in two hundred patients (<0.5%).
• Bleeding from the catheter insertion site
can also occur due to the anticoagulant
medications administered during the procedure. These medications prevent clots
from forming on the equipment or in the
artery. Bleeding around the sheath or
catheter insertion site is usually controllable and not dangerous. Rarely, bleeding
can be severe at the catheter insertion site
or can develop internally. Your cardiologist is an expert who can manage bleeding
difficulties by adjusting medications or in
very rare cases referring you to a surgeon
who can repair the artery into which the
catheter was placed.
• Because angioplasty and intervention
are a type of cardiac catheterization, the
complications detailed in the first part of
this booklet for the angiogram also apply
to angioplasty. They include allergy,
stroke, kidney injury, blood vessel damage
and nerve damage.
It is important to remember that complications from angioplasty occur infrequently.
Your cardiologist has recommended a
coronary intervention because the likelihood of success is very high and the risk
of a complication is small. In other
words, the benefits of the procedure outweigh the risks.
27
AFTER CORONARY INTERVENTION:
SHEATH REMOVAL/CLOSURE DEVICES
After the angioplasty procedure:
• You will be taken to your room or to a holding area.
• Usually, you will still have the sheath in the groin (or arm) artery.
• In many patients, the sheath is removed several hours after the procedure.
• Sometimes, a closure device such as a collagen plug system, collagen-thrombin
system, or suture device is used to close the artery in the catheterization laboratory
immediately after the procedure.
• You are given pain medicines and sedatives so that the sheaths can be removed
without causing discomfort.
• Once the sheath is removed, a sandbag is sometimes applied to the groin area to
help prevent bleeding.
• You will be asked to lie still for several hours.
• You should not bend your leg or raise your head. These restrictions are necessary
to allow the insertion site to seal and to prevent bleeding.
• For patients who have had the catheter inserted into the radial or brachial artery,
a compressive dressing is applied to the puncture site after sheath removal.
There is less confinement to bedrest after a radial procedure.
Sandbag
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28
ACTIVITY
ost patients are discharged from the
hospital 12 to 24 hours after the
sheath is removed. You are able to
walk, climb stairs, perform routine daily
activities and take care of your personal
hygiene. You should try to minimize physical activities for one to two days after the
coronary intervention.
M
• Restrict yourself to light activity for
the first five days after angioplasty.
• Do not do any heavy lifting or very
strenuous physical exertion for
at least 3-4 weeks after the
angioplasty.
• Do not push yourself to the point
of significant fatigue, shortness of
breath or chest pain.
• Walking is an excellent activity.
• You can resume moderate activities five
days after the coronary intervention.
• You should not engage in strenuous
activity or manual labor until a stress
test has been performed or you have
been given clearance by your doctor.
• Always follow your doctor’s specific
instructions for activities.
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29
TESTING
• A treadmill exercise test, or stress test, is occasionally
performed 3-6 weeks after the intervention. Generally, the
results of this test are favorable and help to guide your
doctors in prescribing an activity level for you.
• An additional stress test may be done 6 months
after the intervention to be certain that you have not
experienced a recurrence (restenosis).
• For some patients, after the first stress test, your physician
may recommend that you enroll in a regular exercise
program. Supervised exercise can be provided through
a cardiac rehabilitation program. Please ask your doctor
about this if you are interested in cardiac rehabilitation.
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30
YOUR CARE AFTER YOUR INTERVENTIONAL PROCEDURE
YOUR CARE AFTER YOUR
INTERVENTIONAL PROCEDURE:
Now that you have had a successful intervention, you and your physician need to
keep a watchful eye on your heart to be sure that your good results last. The following
is what to expect after your procedure and what to report to your physician.
WHAT IS NORMAL AFTER
INTERVENTION?
WHAT YOU SHOULD REPORT TO
YOUR DOCTOR
• Bruising or discoloration in your
groin area where your catheters were
inserted. The bruise (“black and
blue”) may extend along the inner
thigh and up toward the abdomen.
The bruise will disappear in 1-3
weeks.
• Chest pain or discomfort that is similar to what you felt before the intervention or similar to the discomfort
that you may have felt when the
balloon catheter was inflated in your
artery during the procedure. Very
brief, fleeting chest discomfort that
lasts for a few seconds is probably
not from the heart. Brief pains that
last for 1-2 seconds usually are muscular in origin. Most patients when
questioned about this type of pain
will observe that it is different from
the discomfort that they felt during
the intervention or that they felt with
their typical attacks of angina.
• A small lump where the catheter was
inserted. The lump should not
expand in size.
• Soreness over the catheter insertion
site when you apply pressure there.
• Slight oozing of thin yellow or pink
liquid from the catheter hole in the
first day following the intervention.
The amount of oozing should only be
a drop or two at most.
• Tiredness and fatigue that lasts for
one or two days after the procedure.
You have been through a lot! You are
entitled to be tired. If your intervention was performed in the first two
weeks after a heart attack, you may
have more fatigue. This added tiredness is from the effects of the heart
attack. It takes 6 weeks for the heart
to heal and “remodel” after a heart
attack.
❦
• A lump in the groin area that increases
in size and/or is painful when no
pressure is applied. Such a lump
may indicate that the puncture hole
in the artery in the groin has not
sealed properly or has leaked blood.
• Fever or drainage of pus (thick
yellow-brown material) from the
puncture site; redness of the skin
around the puncture site.
• Swelling, with or without pain, in
the thigh or calf of the leg in which
the catheters were inserted.
Ten Rules For
Taking Medication
31
1. Know the name, purpose, dosage, and precautions
of all medications you are taking. Take only medications that have been prescribed for you at the time of
discharge. If you were on other medications before
your procedure, discuss them with your cardiologist
before leaving the hospital.
2. Do not take any over-the-counter drugs or previously
prescribed medications without checking with your
physician. These drugs may interact or interfere with
one another.
3. Take the medicine at the same time each day and in
the amount prescribed. This is necessary to ensure a
consistent amount of medicine in your blood stream.
4. Do not skip a dose, stop the medicine, or take an
extra dose without first consulting your physician.
5. Do not give your medicine to anyone, even though
he/she may seem to have the same medical problem.
6. Some medications may produce an allergic or
unanticipated reaction such as rash, fever, vomiting,
bruising, or diarrhea. Report any such problems to
your physician.
7. Keep all medicines out of the reach of children.
8. Outdated medications can become ineffective. If
the medicine is more than several months old, ask
the pharmacist if it is still safe and effective.
9. Do not remove medicines from their original bottles
or mix different kinds in the same container. The
color and material of the containers are designed
to protect the medications from sunlight and other
hazardous conditions. Switching to a different container might decrease the medicine’s effectiveness.
10. Carry a card with you with the names of your
medicines and their dosages written on it.
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ACE INHIBITORS:
Purpose: ACE inhibitors
(captopril/Capoten, enalapril/Vasotec,
Prinivil/Zestril, Lotensin, Monopril,
ramipril/Altace, etc.) and angiotensin
receptor blockers (Cozaar, Avapro,
Diovan, etc.) block the effects of
angiotensin, a hormone that raises the
blood pressure and constricts blood
vessels. The actions of angiotensin are
sometimes harmful in patients with
weakened hearts, especially after heart
attacks. ACE inhibitors are frequently
prescribed after heart attacks.
How Taken: Take the medication as prescribed by your physician and do not
stop taking it unless your physician
instructs you to do so.
Major Side Effect: ACE inhibitors can
cause a dry cough; angiotensin receptor
blockers do not tend to cause a dry
cough as a side effect.
CALCIUM CHANNEL
BLOCKING DRUGS:
Purpose: Calcium channel blocking
drugs (diltiazem/Cardizem/Dilacor/
Cartia, verapamil, nifedipine/
Procardia/Adalat, amlodipine/Norvasc)
are medications that prevent spasm of
the blood vessel wall at the angioplasty
site. They also control high blood pressure. Calcium channel blocking drugs
are occasionally administered after
interventions.
35
scribed by your physician and do not
stop taking it unless your physician
instructs you to do so.
Major Side Effects: Some patients
may develop flushing headaches or
constipation with certain calcium
channel blocking drugs.
ANTICOAGULANT
(BLOOD THINNER):
Purpose: Coumadin (warfarin) is a
powerful “blood thinner” that inhibits
or slows clotting. Your blood will still
be able to clot if you are on this medication, but the time that it takes for a clot
to form will be longer.
How Taken: Coumadin should be
taken at the same time each day. Your
blood will need to be tested regularly
(up to twice a week in the beginning
and then every 2 to 4 weeks) in order to
regulate the dosage of the medication
to a safe and effective level.
Major Side Effect: This medication can
be associated with internal bleeding.
Call your doctor immediately if you
notice excess bruising or bleeding,
black tarry stool, blood in the stool or
urine, or vomiting of blood or coffeeground appearing material.
Do not use Coumadin with arthritis
medications. Coumadin can be taken
with aspirin, but a patient should be
monitored very closely for bleeding.
How Taken: Take the medication as pre-
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32
MEDICATIONS:
PLAVIX AND TICLID
You may be asked to take one or
more of these medications,
depending on your situation.
Purpose: Plavix is an antiplatelet agent
that has a different mechanism of action
as compared to aspirin. Plavix is always
combined with aspirin to prevent clot
formation in a stented artery.
ANTIPLATELET MEDICATIONS:
How Taken: This medication is
prescribed usually for 4 weeks after
intervention. It should be taken in
combination with aspirn unless you
are instructed otherwise. Failure to
take these medications can increase the
chance of a dangerous clot in the stent
(subacute stent thrombosis). Occasionally,
you may receive instructions from the
pharmacist to not take both aspirin and
Plavix; these instructions usually should
not be applied to patients with stents.
Always check with your cardiologist if
you are given conflicting instructions.
Your cardiologist may instruct you to
take Plavix for a longer period of time,
up to one year after your procedure.
ASPIRIN
Purpose: Aspirin is an antiplatelet
agent, a medication that prevents
platelets from sticking together and
from sticking to the inside of the artery
at the angioplasty or stent site.
Platelets are small cell fragments that
bind to tears or areas of trauma in
blood vessels. Platelets help form clots
that stop bleeding. Aspirin prevents
platelets from forming harmful clots at
the site of the intervention on your
heart’s artery.
How Taken: Aspirin should be taken
indefinitely after an intervention unless
you are instructed otherwise. Aspirin is
available in low dose strength (81 mg),
adult strength (325 mg), and in an
enteric coated variety to help protect
the stomach lining from bleeding.
Major Side Effects: The major possible
side effect from aspirin is bleeding.
Another side effect can be gastrointestinal distress.
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There is evidence that Plavix can prevent vascular events such as heart
attacks if taken on a regular basis.
Ticlid is an alternative antiplatelet agent
that can be substituted for Plavix.
Major Side Effects: Ticlid can cause the
white blood cell count to drop below the
normal level; patients on Ticlid should
have a CBC blood test 2 to 4 weeks after
starting this medication.
With both these medications it is
important to know that it will take
longer to stop bleeding if you cut
yourself. All your physicians and
dentist should be aware that you are
taking these medications.
33
CHOLESTEROL-LOWERING MEDICATIONS:
Purpose: Cholesterol-lowering medications are vital to prevent additional cholesterol
build-up in your arteries. Statins, such as Pravachol, Zocor, or Lipitor may also prevent
inflammation in your heart’s arteries where cholesterol plaque has formed. This
inflammation-quieting effect may prevent clot formation and future problems with
chest pain or heart attacks in patients with coronary artery disease, even if their
cholesterol level is not very high.
Fibric acid derivatives, such as gemfibrozil/Lopid and Tricor, have a greater effect
on elevated triglyceride levels. Niacin is used in some patients to raise the HDL
cholesterol (“good cholesterol”) level.
How Taken: The statins are usually well tolerated and are given once a day at bedtime.
Lopid is usually given twice a day, thirty minutes before the morning and evening
meals. Tricor is usually given once a day. Niacin should be taken ½ hour after aspirin.
Any of these drugs should be taken as prescribed by your physician.
Major Side Effects: These drugs infrequently can cause aching of the muscles.
Patients on cholesterol-lowering medications should have blood tests done to monitor
the function of their liver. Niacin can cause flushing, headache, or stomach upset.
Fibric acid derivatives, such as gemfibrozil/Lopid and Tricor, should not be used while
taking any Statin drugs (Pravachol, Zocor, Lipitor) because of the possibility of serious side effects.
Foods high in cholesterol.
❦
34
BETA BLOCKER DRUGS:
Purpose: Beta blocker drugs (metoprolol/Toprol, atenolol/Tenormin,
propanolol/Inderal, nadolol/Corgard)
slow the pulse and lower the blood
pressure. These medications reduce
the workload of the heart, control high
blood pressure, and reduce the risk of
death and other problems after heart
attacks. Some beta blockers (carvedilol/
Coreg, metoprolol, bisoprolol) are useful in patients with weakened hearts.
How Taken: These medications should
be taken as prescribed by your physician. They should be taken at the same
time each day.
Major Side Effect: Beta blockers can
cause fatigue or breathing problems,
including asthma or wheezing.
❦
NITROGLYCERIN-TYPE
MEDICATIONS:
Purpose: Nitroglycerin-type medications (nitroglycerin patch, isosorbide
dinitrate, isosorbide mononitrate/
Imdur/Ismo) prevent spasm of the
arteries of your heart and reduce the
work of your heart.
How Taken: There are many nitroglycerin medications and they should be
taken as prescribed by your physician.
Major Side Effect: Some patients note
headaches with these medications.
The headaches usually improve or
disappear over time and frequently
respond to Tylenol.
36
ANTISECRETORY
MEDICATIONS:
Purpose: Antisecretory medications
such as Prilosec, Prevacid, Protonix,
Pepcid, ranitidine/Zantac, Axid,
cimetidine/Tagamet reduce the
stomach’s output of acid and can
lower the risk of bleeding from
antiplatelet agents like aspirin or
Plavix and anticoagulants like
Coumadin.
How Taken: These medications are
usually taken once or twice a day.
Major Side Effects: Some people
may develop a headache, constipation, and abdominal discomfort
or pain.
NITROGLYCERIN TABLETS:
Purpose: Nitroglycerin tablets are used for
chest discomfort that is from your heart.
How Taken: Nitroglycerin should be placed
under the tongue and allowed to dissolve.
Nitroglycerin is rapidly absorbed from
under the tongue and can provide very
quick relief from angina pain. You should
lie down or at least sit when you take
nitroglycerin. A second or even third nitroglycerin can be taken, if you wait 5 to 15
minutes between each tablet and understand that more doses of nitroglycerin can
produce significant lightheadedness by
lowering your blood pressure.
Major Side Effect: This medication can
cause lightheadedness and can make you
faint if you stand up quickly after taking a
tablet. Nitroglycerin usually produces a
brief headache.
You should call 911, go to the hospital, and call your physician if you
have any prolonged episodes of chest discomfort (greater than 15 to 20 minutes).
If you are unsure how to respond to an episode of chest discomfort, it is always
appropriate to come to an emergency room and to call your physician.
❦
37
HELP:
WHAT YOU CAN DO TO
deposits to
ing causes cholesterol
ok
sm
tte
re
ga
Ci
.
ely
immediat
t’s arteries. This allows
ar
he
e
th
• If you smoke, stop
of
g
in
lin
e
th
Smoking
s by damaging
build up in the arterie
the wall of the artery.
to
in
am
tre
ds
oo
bl
e
th
also
e from
t attack survivors and
ar
he
the cholesterol to mov
in
ck
ta
at
t
ar
he
of a second
ss surgery.
increases the likelihood
ts closing off after bypa
af
gr
ss
pa
by
of
s
ce
an
l
increases the ch
te intake is also harmfu
ra
yd
oh
rb
ca
ss
ce
Ex
.
struct you
esterol, low-fat diet
your physician can in
or
st
• Consume a low-chol
ni
tio
tri
nu
A
el.
yceride lev
and can raise the trigl
diet.
further on the correct
d. You
d sugar well controlle
oo
bl
ur
yo
ep
ke
d
an
el. If this
stick to your diet
a hemoglobin A1C lev
• If you are diabetic,
ith
w
ed
ss
se
as
l
ro
nt
etic co
your diabetes.
should have your diab
doing enough to treat
t
no
e
ar
u
yo
d,
te
va
fer you
level is significantly ele
physician who may re
re
ca
y
ar
im
pr
ur
yo
lp
Consult with
etes expert, who can he
ab
di
a
,
ist
og
ol
in
cr
do
l.
to an en
e your diabetes contro
ov
pr
im
to
ns
tio
ica
ed
adjust your m
ht loss will
are overweight. Weig
• Lose weight if you
, improve
cholesterol metabolism
’s
dy
bo
ur
yo
e
ov
pr
im
, and help
es (if you are diabetic)
your control of diabet
sure.
lower your blood pres
robic exercises
ed by your doctor. Ae
ib
cr
es
pr
as
e
cis
er
help
Ex
•
running, bicycling, etc)
g,
in
m
im
sw
g,
in
alk
w
(brisk
cise can help
d blood vessels. Exer
A cardiac
condition the heart an
re and cholesterol level.
su
es
pr
d
oo
bl
ur
exercise
yo
l
contro
ul to help you learn to
ef
us
be
ay
m
m
ra
og
pr
cle strength,
rehabilitation
training can build mus
ht
eig
w
us
io
ut
Ca
.
safely and effectively
t.
rect benefit to the hear
but probably has no di
hol
t in moderation. Alco
bu
,
ed
um
ns
co
be
ay
• Alcohol m
avoided in
e level and should be
id
er
yc
gl
tri
e
th
ise
ra
n
ca
yceride levels.
patients with high trigl
s.
self and your symptom
• Pay attention to your
ctor.
do
ur
e symptoms to yo
Report any questionabl
s ask!
when in doubt, alway
t
bu
t,
ac
-re
er
ov
to
t
Try no
❦
38
CONCLUSION
ow that you have finished this booklet,
you should be more confident about
undergoing your heart procedure.
Although the technology appears to be
complicated, most procedures are much
simpler and easier than you imagine.
N
Hopefully, this booklet has helped to increase
your understanding and has answered your
questions about cardiac catheterization
and interventions. Of course, your
doctor can answer any questions that
this booklet did not address.
If your doctor’s instructions differ from
some of the statements in this booklet,
always follow your doctor’s instructions.
Remember, stay calm!
Success and safety are what
your doctor expects and what
you should focus upon.
❦
GLOSSARY
Glossary
Angina pectoris is inadequate blood
flow through the partially obstructed
artery causing chest discomfort. P.4
Angiogram is an x-ray picture of the
coronary arteries. P.12
Angioplasty is a type of coronary intervention that uses a catheter with a
balloon affixed to it to open up a
blocked artery. P.16
Aortic stenosis obstructs the blood flow
out of the left ventricle. P.6
Aortic valve is the valve between the left
ventricle and the aorta which allows
the blood to be pumped out to the rest
of the body. P.6
Atherosclerosis is a build-up of cholesterol, scar tissue, blood clot and fatty
material in the walls of arteries. P.4
Atria are the two small chambers located
on top of the ventricles that fill with
blood and then empty into the ventricles to completely fill them before each
heart beat. P.2
Brachytherapy is a treatment using
radiation to treat restenosis of a stent.
P.23
Cardiac catheterization or angiogram is a
test that uses catheters, (long, thin hollow tubes) to take x-ray pictures of the
heart and its blood vessels (coronary
arteries). P.1
Catheterization laboratory is a specially
designed room with an x-ray camera
and monitor which will display pictures of the heart and blood vessels
that is used to perform the catheterization procedure. P.9
Catheters are long, thin, flexible, hollow
plastic tubes that are used to perform
the catheterization. P.10
Collaterals are auxiliary small blood
vessels that develop over time to
compensate for narrowed or obstructed
vessels. P.5
Congenital heart problems are heart
problems that are present at birth. P.7
Congestive heart failure occurs when the
heart has become weakened and cannot
pump enough blood to meet the body’s
needs. P.7
Coronary arteries are tubular blood vessels that divide into smaller branches
like branches of a tree and supply the
heart muscle with oxygenated blood.
P.3
Coronary risk factors are those conditions
that increase the risk of developing
plaques. P.4
Directional atherectomy is a technique
that removes plaque from the artery
by using rotating cutting blades on the
catheter that slices off thin slivers of
the plaque when advanced through
the artery. P.22
(continued on next page)
39
40
GLOSSARY
Drug-eluting or drug-coated stents are
stents that are coated with a drug that
stops the ingrowth of smooth muscle
tissue from the blood vessel wall. P.20
Femoral artery is commonly used for the
catheterization and is located in the
skin fold in the groin area. P.10, 11
Plaque rupture occurs when there is a
rapid accumulation of blood clot material on the exposed plaque. P.5
Heart is two muscular pumps or ventricles that are located side by side in the
center and left half of the chest. P.2
Radial and brachial arteries are two
arteries located in the wrist and the
antecubital space that are also used for
the catheterization. P.10, 11
Heart attack occurs when part of the
heart muscle has no blood flowing to it
for a half hour or longer. P.5
Recurrence or restenosis is a build up of
scar tissue at the site of the original
angioplasty or stent procedure. P.25
Heart valves allow the blood to flow
through the chambers of the heart in
one direction. P.6
Rotational atherectomy is a procedure
that uses a long metallic catheter with
an olive-shaped burr at its tip to shave
fatty deposits and plaque from the
walls of the artery. P.21
Mitral regurgitation results in blood flowing backward from the left ventricle
(main pumping chamber) into the left
atrium and the blood vessels of the
lungs. P.6
Mitral valve is the valve between the left
atrium (upper chamber) and the left
ventricle (lower chamber) of the heart.
P.6
Myocardium is the middle muscular
layer of the heart wall. P.5
❦
Plaque is formed from the build-up of the
atherosclerotic material and narrows the
channel of the coronary artery. P.4
Stents are small metal strands that are
woven or fashioned into a tubular
shape and are used to improve angioplasty results and to provide a more
durable treatment of the cholesterol
blockage. P.19
Thrombus is a clot of blood that is
formed within a blood vessel. P.5
Valvular disease occurs when a valve
does not open or close properly. P.6
A Patient’s Guide
To order copies of this book,
write or call:
Kay-McKenna Enterprises, Inc.
9935 Potomac Manors Drive
Potomac, Maryland 20854
Phone and/or Fax Number:
(301) 983-4733
www.kmheart.com
Credits:
Illustrator
Joyce Hurwitz
(301) 365-0340
[email protected]
Designer
Design Central, Inc.
Silver Spring, MD
(301) 588-6994
[email protected]
♥

EverythingYou Need To Know About Cardiac Catheterization And

Transcription

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