WHAT IS PTCA OR CORONARY ANGIOPLASTY?
Percutaneous transluminal coronary angioplasty (PTCA)
Heart is supplied by three main major blood vessels known as the Coronary Arteries and its branches.
Angina is caused when there is insufficient blood supply to the heart muscle due to blocks known as plaques (made up of fat,cholesterol,calcium and other things found in blood) in the artery.
What is coronory angioplasty?
Coronary angioplasty is a procedure used to open blocked or narrowed coronary (heart) arteries. The procedure improves blood flow to the heart muscle.
Over time, a fatty substance called plaque can build up in your arteries, causing them to harden and narrow. This condition is called atherosclerosis.
Atherosclerosis can affect any artery in the body. When atherosclerosis affects the coronary arteries, the condition is called coronary heart disease (CHD) or coronary artery disease.
What are the uses and indications for coronary angioplasty?
Angioplasty can restore blood flow to the heart if the coronary arteries have become narrowed or blocked because of CHD.
Angioplasty is a common medical procedure. It may be used to:
- Improve symptoms of CHD, such as angina and shortness of breath. (Angina is chest pain or discomfort.)
- Reduce damage to the heart muscle caused by a heart attack. A heart attack occurs if blood flow through a coronary artery is completely blocked. The blockage usually is due to a blood clot that forms on the surface of plaque. During angioplasty, a small balloon is expanded inside the coronary artery to relieve the blockage.
- Reduce the risk of death in some patients.
What To Expect During Coronary Angioplasty?
Coronary angioplasty is done in a special part of the hospital called the cardiac catheterization laboratory. The "cath lab" has special video screens and x-ray machines.
Your doctor uses this equipment to see enlarged pictures of the blockages in your coronary arteries.
In the cath lab, you'll lie on a table. An intravenous (IV) line will be placed in your arm to give you fluids and medicines. The medicines will relax you and prevent blood clots from forming.
To prepare for the procedure, the area where your doctor will insert the catheter will be shaved. The catheter usually is inserted in your groin (upper thigh). The shaved area will be cleaned and then numbed. The numbing medicine may sting as it's going in.
During angioplasty, you'll be awake but sleepy.
Your doctor will use a needle to make a small hole in an artery in your arm or groin. A thin, flexible guide wire will be inserted into the artery through the small hole. The needle is then removed, and a tapered tube called a sheath is placed over the guide wire and into the artery.
Next, your doctor will put a long, thin, flexible tube called a guiding catheter through the sheath and slide it over the guide wire. The catheter is moved to the opening of a coronary artery, and the guide wire is removed.
Next, your doctor will inject a small amount of special dye through the catheter. This will help show the inside of the coronary artery and any blockages on an x-ray picture called an angiogram.
Another guide wire is then put through the catheter into the coronary artery and threaded past the blockage. A thin catheter with a balloon on its tip (a balloon catheter) is threaded over the wire and through the guiding catheter.
The balloon catheter is positioned in the blockage. The balloon is then inflated. This pushes the plaque against the artery wall, relieving the blockage and improving blood flow through the artery. Sometimes the balloon is inflated and deflated more than once to widen the artery. Afterward, the balloon catheter, guiding catheter, and guide wire are removed.
A drill-like device called a rotablator sometimes is used to remove very hard plaque from the artery.
Your doctor may put a stent (small mesh tube) in your artery to help keep it open. If so, the stent will be wrapped around the balloon catheter.
When your doctor inflates the balloon, the stent will expand against the wall of the artery. When the balloon is deflated and pulled out of the artery with the catheter, the stent remains in place in the artery
After the angioplasty is done, the hole in your artery where the sheath, guide wires, and catheters were inserted is sealed with a special device, or pressure is put on it until the blood vessel seals.
During angioplasty, strong anticlotting medicines are given through the IV line to prevent blood clots from forming in the artery or on the stent. These medicines make it less likely that your blood will clot. Some anticlotting medicines may be started before the angioplasty.
What To Expect After Coronary Angioplasty?After coronary angioplasty, you'll be moved to a special care unit. You'll stay there for a few hours or overnight. You must lie still for a few hours to allow the blood vessel in your arm or groin (upper thigh) to seal completely.
While you recover, nurses will check your heart rate and blood pressure. They also will check your arm or groin for bleeding. After a few hours, you'll be able to walk with help.
The place where the catheters (tubes) were inserted may feel sore or tender for about a week.
Going HomeMost people go home the day after the procedure. When your doctor thinks you're ready to leave the hospital, you'll get instructions to follow at home, such as:
- How much activity or exercise you can do.
- When you should follow up with your doctor.
- What medicines you should take.
- What you should look for daily when checking for signs of infection around the area where the tube was inserted. Signs of infection may include redness, swelling, or drainage.
- When you should call your doctor. For example, you may need to call if you have shortness of breath; a fever; or signs of infection, pain, or bleeding where the tubes were inserted.
- When you should call emergency/ambulance (for example, if you have any chest pain).
Recovery and RecuperationMost people recover from angioplasty and return to work about 1 week after leaving the hospital. Your doctor will want to check your progress after you leave the hospital. During the followup visit, your doctor will examine you, make changes to your medicines (if needed), do any necessary tests, and check your overall recovery.
Use this time to ask questions you may have about activities, medicines, or lifestyle changes, or to talk about any other issues that concern you.
Although angioplasty can reduce the symptoms of coronary heart disease (CHD), it isn't a cure for CHD or the risk factors that led to it. Making healthy lifestyle changes can help treat CHD and maintain the good results from angioplasty.
Talk with your doctor about your risk factors for CHD and the lifestyle changes you'll need to make. For some people, these changes may be the only treatment needed.
Lifestyle changes may include changing your diet, quitting smoking, doing physical activity regularly, losing weight or maintaining a healthy weight, and reducing stress. You also should take all of your medicines exactly as your doctor prescribes.
Your doctor may recommend cardiac rehabilitation (rehab). Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.
Cardiac rehab includes exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life. Your doctor can tell you where to find a cardiac rehab program near your home.
WHAT IS CORONARY ARTERY STENT?
A coronary stent is stainless tube with slots. It is mounted on a balloon catheter in a "crimped" or collapsed state. When the balloon of is inflated, the stent expands or opens up and pushes itself against the inner wall of the coronary artery. This holds the artery open when the balloon is deflated and removed.
What Are the Risks of Coronary Angioplasty?
Coronary angioplasty is a common medical procedure. Serious complications don't occur often. However, they can happen no matter how careful your doctor is or how well he or she does the procedure. Serious complications include:
- Bleeding from the blood vessel where the catheters were inserted.
- Blood vessel damage from the catheters.
- An allergic reaction to the dye given during the angioplasty.
- An arrhythmia (irregular heartbeat).
- The need for emergency coronary artery bypass grafting during the procedure (2–4 percent of people). This may occur if an artery closes down instead of opening up.
- Damage to the kidneys caused by the dye used.
- Heart attack (3–5 percent of people).
- Stroke (less than 1 percent of people).
As with any procedure involving the heart, complications can sometimes, though rarely, cause death. Less than 2 percent of people die during angioplasty.
The risk of complications is higher in:
- People aged 75 and older
- People who have kidney disease or diabetes
- People who have poor pumping function in their hearts
- People who have extensive heart disease and blockages in their coronary (heart) arteries
Complications From Stents
RestenosisAfter angioplasty, the treated coronary artery can become narrowed or blocked again, often within 6 months of angioplasty. This is called restenosis. When a stent (small mesh tube) isn't used during angioplasty, 4 out of 10 people have restenosis.
The growth of scar tissue in and around a stent also can cause restenosis. When a stent is used, 2 out of 10 people have restenosis
Stents coated with medicine reduce the growth of scar tissue around the stent and lower the chance of restenosis even more. When these stents are used, about 1 in 10 people has restenosis.
Other treatments, such as radiation, can help prevent tissue growth within a stent. For this procedure, a wire is put through a catheter to where the stent is placed. The wire releases radiation to stop any tissue growth that may block the artery.
Blood ClotsStudies suggest that there's a higher risk of blood clots forming in medicine-coated stents compared to bare metal stents. However, no conclusive evidence shows that these stents increase the chances of having a heart attack or dying, if used as recommended.
When medicine-coated stents are used in people who have advanced CHD, there is a higher risk of blood clots, heart attack, and death. Researchers continue to study medicine-coated stents, including their use in people who have advanced CHD.
Taking medicine as prescribed by your doctor can lower your risk of blood clots. People who have medicine-coated stents usually are advised to take anticlotting medicines, such as clopidogrel and aspirin, for months to years to lower the risk of blood clots.
As with all procedures, it's important to talk with your doctor about your treatment options, including the risks and benefits.
- Coronary angioplasty is a procedure used to open blocked or narrowed coronary (heart) arteries. The procedure improves blood flow to the heart muscle.
- Over time, a fatty substance called plaque can build up in your arteries, causing them to harden and narrow. When plaque builds up in the coronary arteries, the condition is called coronary heart disease (CHD).
- Angioplasty can restore blood flow to the heart if the coronary arteries have become narrowed or blocked because of CHD. The procedure can improve symptoms of CHD, reduce damage to the heart muscle caused by a heart attack, and reduce the risk of death in some patients.
- Angioplasty is less invasive than surgery. General anesthesia isn't needed. You'll be given medicines to help you relax, but you'll be awake during the procedure.
- Before angioplasty is done, your doctor will need to know the location and extent of blockages in your coronary arteries. To find this information, your doctor will use coronary angiography. This test uses dye and special x rays to show the insides of your coronary arteries.
- Angioplasty is done in a special part of the hospital called the cardiac catheterization laboratory.
- During angioplasty, your doctor will use a thin, flexible tube called a catheter with a balloon at the end. He or she will thread the balloon catheter through an artery in your arm or groin (upper thigh) to the blockage in your coronary artery. Your doctor will then inflate the balloon. This pushes the plaque against the artery wall, relieving the blockage and improving blood flow.
- A small mesh tube called a stent usually is placed in the newly widened part of the artery. The stent helps prevent the artery from becoming narrowed or blocked again. The stent remains in place after the procedure.
- After the procedure, you'll be moved to a special care unit. While you recover, nurses will check your heart rate and blood pressure. Most people go home the day after having angioplasty.
- Your doctor may recommend lifestyle changes after angioplasty to improve CHD and to prevent arteries from becoming narrowed or blocked again. Lifestyle changes may include changing your diet, quitting smoking, doing physical activity regularly, losing weight or maintaining a healthy weight, and reducing stress. You also should take all of your medicines exactly as your doctor prescribes.
- Angioplasty is a common medical procedure. Serious complications don't occur often. However, they can happen no matter how careful your doctor is or how well he or she does the procedure. Complications may include bleeding, renarrowing of the artery, blood clots, and more.
- Research on angioplasty is ongoing to make it safer and more effective, to prevent treated arteries from closing again, and to make the procedure an option for more people.
CABG / BYPASS SURGERY
CABG-CORONARY ARTERY BYPASS GRAFTING
This is a Open heart surgery performed to improve the blood supply to the heart.
CABG is recommended if other treatments, such as lifestyle changes or medicines, haven't worked.It is also recommended , if you have severe blockages in the large coronary (heart) arteries that supply a major part of the heart muscle with blood—especially if your heart's pumping action has already been weakened.
CABG also may be a treatment option if you have blockages in the heart that can't be treated with angioplasty.
Indications for a CABG-
- The presence and severity of CHD symptoms
- The severity and location of blockages in your coronary arteries
- Your response to other treatments
- Your quality of life
- Any other medical problems you have
What To Expect During Coronary Artery Bypass Grafting?
Coronary artery bypass grafting (CABG) requires a team of experts. A cardiothoracic surgeon does the surgery with support from an anesthesiologist, perfusionist (heart-lung bypass machine specialist), other surgeons, and nurses.
There are several types of CABG. They range from traditional surgery in which the chest is opened to reach the heart, to nontraditional surgery in which small incisions (cuts) are made to bypass the blocked or narrowed artery.
Traditional Coronary Artery Bypass GraftingThis type of surgery usually lasts 3 to 5 hours, depending on the number of arteries being bypassed. Numerous steps take place during traditional CABG.
You'll be under general anesthesia for the surgery. The term "anesthesia" refers to a loss of feeling and awareness. General anesthesia temporarily puts you to sleep.
During the surgery, the anesthesiologist checks your heartbeat, blood pressure, oxygen levels, and breathing. A breathing tube is placed in your lungs through your throat. The tube is connected to a ventilator (a machine that helps you breathe).
An incision is made down the center of your chest. The chest bone is then cut and your ribcage is opened so that the surgeon can get to your heart.
Medicines are used to stop your heart, which allows the surgeon to operate on it while it's not beating. You're also given medicines to protect your heart function during the time that it's not beating.
A heart-lung bypass machine keeps oxygen-rich blood moving throughout your body during the surgery.
An artery or vein is taken from your body—for example, from your chest or leg—and prepared to be used as a graft for the bypass. In surgery with several bypasses, both artery and vein grafts are commonly used.
- Artery grafts. These grafts are much less likely than vein grafts to become blocked over time. The left internal mammary artery most often is used for an artery graft. It's located inside the chest, close to the heart. Arteries from the arm or other places in the body are sometimes used as well.
- Vein grafts. Although veins are commonly used as grafts, they're more likely than artery grafts to develop plaque and become blocked over time. The saphenous vein—a long vein running along the inner side of the leg—is typically used.
The surgeon uses wires to close your chest bone (much like how a broken bone is repaired). The wires stay in your body permanently. After your chest bone heals, it will be as strong as it was before the surgery.
Stitches or staples are used to close the skin incision. The breathing tube is removed when you're able to breathe without it.
Nontraditional Coronary Artery Bypass GraftingNontraditional CABG includes off-pump CABG and minimally invasive CABG.
Off-Pump Coronary Artery Bypass GraftingThis type of surgery can be used to bypass any of the coronary (heart) arteries. Off-pump CABG also is called beating heart bypass grafting because the heart isn't stopped and a heart-lung bypass machine isn't used. Instead, the part of the heart where grafting is being done is steadied with a mechanical device.
Minimally Invasive Direct Coronary Artery Bypass GraftingThere are several types of minimally invasive direct coronary artery bypass (MIDCAB) grafting. These types of surgery differ from traditional bypass surgery. They only require small incisions rather than opening the chest bone to get to the heart. These procedures sometimes use a heart-lung bypass machine.
MIDCAB procedure. This procedure is used when only one or two coronary arteries need to be bypassed. A series of small incisions is made between your ribs on the left side of your chest, directly over the artery to be bypassed.
The incisions usually are about 3 inches long. (The incision made in traditional CABG is at least 6 to 8 inches long.) The left internal mammary artery most often is used for the graft. A heart-lung bypass machine isn't used during this procedure.
Port-access coronary artery bypass procedure. This procedure is done through small incisions (ports) made in your chest. Artery or vein grafts are used. A heart-lung bypass machine is used during this procedure.
Robot-assisted technique. This type of procedure allows for even smaller, keyhole-sized incisions. A small video camera is inserted in one incision to show the heart, while the surgeon uses remote-controlled surgical instruments to do the surgery. A heart-lung bypass machine is sometimes used during this procedure.
What To Expect After Coronary Artery Bypass Grafting
Recovery in the HospitalAfter surgery, you'll typically spend 1 or 2 days in an intensive care unit (ICU). Your heart rate, blood pressure, and oxygen levels will be checked regularly during this time.
An intravenous line (IV) will likely be inserted into a vein in your arm. Through the IV line, you may get medicines to control blood circulation and blood pressure. You also will likely have a tube in your bladder to drain urine and a tube to drain fluid from your chest.
You may receive oxygen therapy (oxygen given through nasal prongs or a mask) and a temporary pacemaker while in the ICU. A pacemaker is a small device that's placed in the chest or abdomen to help control abnormal heart rhythms.
Your doctor may recommend that you wear compression stockings on your legs as well. These stockings are tight at the ankle and become looser as they go up the leg. This creates gentle pressure up the leg. The pressure keeps blood from pooling and clotting.
While in the ICU, you'll also have bandages on your chest incision (cut) and on the areas where an artery or vein was removed for grafting.
After you leave the ICU, you'll be moved to a less intensive care area of the hospital for 3 to 5 days before going home.
Recovery at HomeYour doctor will give you specific instructions for recovering at home, especially concerning:
- How to care for your healing incisions
- How to recognize signs of infection or other complications
- When to call the doctor right away
- When to make followup appointments
- Discomfort or itching from healing incisions
- Swelling of the area where an artery or vein was removed for grafting
- Muscle pain or tightness in the shoulders and upper back
- Fatigue (tiredness), mood swings, or depression
- Problems sleeping or loss of appetite
- Chest pain around the site of the chest bone incision (more frequent with traditional CABG)
Your doctor will tell you when you can start physical activity again. It varies from person to person, but there are some typical timeframes. Most people can resume sexual activity within about 4 weeks and driving after 3 to 8 weeks.
Returning to work after 6 weeks is common unless your job involves specific and demanding physical activity. Some people may need to find less physically demanding types of work or work a reduced schedule at first.
Ongoing CareCare after surgery may include periodic checkups with doctors. During these visits, tests may be done to see how your heart is working. Tests may include ECG(electrocardiogram), stress testing, echocardiography, and cardiac CT.
CABG is not a cure for coronary heart disease (CHD). You and your doctor may develop a treatment plan that includes lifestyle changes to help you stay healthy and reduce the chance of CHD getting worse.
Lifestyle changes may include making changes to your diet, quitting smoking, doing physical activity regularly, and lowering and managing stress.
Your doctor also may refer you to cardiac rehabilitation (rehab). Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.
Rehab programs include exercise training, education on heart healthy living, and counseling to reduce stress and help you return to an active life. Doctors supervise these programs, which may be offered in hospitals and other community facilities. Talk to your doctor about whether cardiac rehab might benefit you.
Taking medicines as prescribed also is an important part of care after surgery. Your doctor may prescribe medicines to manage pain during recovery; lower cholesterol and blood pressure; reduce the risk of blood clots forming; manage diabetes; or treat depression.
What Are the Risks of Coronary Artery Bypass Grafting?Although complications from coronary artery bypass grafting (CABG) are uncommon, the risks include:
- Wound infection and bleeding
- Reactions to anesthesia
- Stroke, heart attack, or even death
This complication sometimes is seen 1 to 6 weeks after surgeries that involve cutting through the pericardium (the outer covering of the heart). This reaction usually is mild. However, some patients may develop fluid buildup around the heart that requires treatment.
Memory loss and other changes, such as problems concentrating or thinking clearly, may occur in some people.
These changes are more likely to occur in people who are older, who have high blood pressure or lung disease, or who drink excessive amounts of alcohol. These side effects often improve several months after surgery.
Use of a heart-lung bypass machine increases the risk of blood clots forming in your blood vessels. Clots can travel to the brain or other parts of the body and block the flow of blood, which may cause a stroke or other problems. Recent technical improvements in heart-lung bypass machines are helping reduce the risk of blood clots forming.
In general, the risk of complications is higher if CABG is done in an emergency situation (for example, during a heart attack), if you're older than 70, or if you have a history of smoking.
Your risk also is higher if you have other diseases or conditions, such as diabetes, kidney disease, lung disease, or peripheral arterial disease.
- Coronary artery bypass grafting (CABG) is surgery used to improve blood flow to the heart. It's used for people who have severe coronary heart disease (CHD).
- During CABG, a healthy artery or vein from the body is connected, or grafted, to a blocked coronary (heart) artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This improves the flow of blood and oxygen to your heart muscle.
- CABG is one treatment for CHD. Not everyone who has CHD needs CABG. In people who are candidates for the surgery, the results usually are excellent. Following CABG, 85 percent of people have significantly reduced symptoms, less risk of future heart attacks, and a decreased chance of dying within 10 years.
- Your doctor will decide whether you're a candidate for CABG based on a number of factors, including the presence and severity of CHD. Nonsurgical treatments, such as medicines and angioplasty, may be tried first. During angioplasty, a small mesh tube called a stent may be placed in an artery to help keep it open.
- Although CABG usually is done on an elective (scheduled) basis, it may need to be done in an emergency, such as during a heart attack.
- There are several types of CABG that range from traditional surgery in which the chest is opened to reach the heart, to nontraditional surgery in which small incisions (cuts) are made to bypass the blocked or narrowed artery.
- After surgery, you'll typically spend 1 or 2 days in an intensive care unit. You'll then be moved to a less intensive care area of the hospital for 3 to
5 daysbefore you go home. Recovery may take 6 to 12 weeks or more.
- Ongoing care after surgery may include followup visits with doctors, lifestyle changes to prevent CHD from getting worse, cardiac rehabilitation, and taking medicines as prescribed.
- Although complications are rare, the risks of CABG include infection at the incision site, bleeding, reactions to anesthesia, fever and pain, stroke, heart attack, or even death.