This overview is a sample of the type of information available to you at Griffin Hospital's Community Health Resource Center. It is not intended to replace your physician's instructions in the management of your health problems, but to better inform you about a particular illness and alert you to the availability of other materials. If you have a question about any piece of information presented in theses fact sheets, please call your physician, or stop by the Community Health Resource Center at your convenience.

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA) OR CORONARY ANGIOPLASTY

Coronary angioplasty or PTCA is a procedure similar to cardiac catherization. PTCA is used to widen the narrowing in your coronary arteries (the arteries which supply the blood to your heart), by using a small balloon to push any plaque (fatty material) against the wall of the coronary artery, and improve blood flow to the heart.

Coronary angioplasty is done with a procedure called coronary angiography. This involves the injection of a dye through a catheter. This dye will show up in x-rays and enable your cardiologist to have a closer look at your coronary arteries, and determine where the blockage(s) are.

WHAT IS THE PURPOSE OF THIS PROCEDURE?

A coronary angioplasty is often done if you have coronary artery disease (a condition where blood vessels that supply blood to your heart are narrowed or blocked by plaque). The blocked artery may have caused your current symptoms, which might include: chest pain (angina); pressure; shortness of breath; palpitations, fainting or dizziness.

Angioplasty is often done before open heart surgery is considered. If the angioplasty is not successful, then you may need to undergo open heart surgery. Treatment options should be discussed with your doctor.

WHAT CAN I EXPECT BEFORE THE EXAM?

Once your doctor has explained the procedure to you, you will be requested to sign two consent forms. The first consent form will be for Coronary Angiography and Angioplasty. The second consent form is for stand-by open heart surgery in case any complications arise while you are undergoing the angioplasty.

Only sign these forms if you understand the procedure and the complications associated with it. If you have any concerns, please share these with your doctor or nurse; they will be more than happy to answer any concerns or questions you may have.

Your nurse will then ask you if you have any allergies to any medications or to iodine, fish, or shellfish since these substances are found in the dye that is used during your test. If the test is scheduled for the next day, you will be instructed not to eat or drink anything after midnight. If the test is scheduled for later in the day, then you may have clear liquids (jello, soup, tea, etc.) for breakfast.

Blood tests and an electrocardiogram (EKG) will be done prior to the test, and an intravenous (IV) line will be started in your arm. This IV line is available in case you need intravenous medication during your procedure, or for fluid replacement.

You may receive a visit from a cardiac surgeon and an anesthesiologist who are members of a stand-by team for open heart surgery. This team is always on stand-by when an angioplasty is done, in case an emergency situation arises.

Fifteen or thirty minutes prior to your procedure, your nurse (following your doctor’s orders) will give you medication to relax you. This medication may be in the form of a pill or an injection. Be prepared for the dryness in your mouth, since this is a common side-effect of the medication. Before your procedure, your nurse will ask you to keep your hospital gown on, but to remove your underwear, jewelry, and any other personal belongings. If you wear glasses, you can continue to wear them. Your nurse will also ask you to urinate so that you are as comfortable as possible for your procedure.

WHAT DO I EXPECT DURING THE EXAM?

Your procedure is done in the catherization lab. Once inside the procedure room, your will be transferred from a gurney to an examining table. At this time, you will be shaved on the part of your body where the catheter will be placed (most likely your groin). This allows the doctor a clear view of your skin for catheter placement.

You will notice what looks like a television above your examining table. This allows the doctor to view where he or she will guide the catheter. This screen will also show pictures of your heart and vessels when your doctor injects the dye.

Before inserting the catheter, your doctor will inject medicine that will help numb the area so that the insertion of the catheter is as comfortable as possible for you.

Your cardiologist first inserts an "introducing sheath," then follows with a guiding catheter. Once it reaches the blocked artery, your doctor will inject the dye and an x-ray picture of your heart vessels will be taken to show your doctor where the narrowing of your artery is. When the dye is injected, you may feel a warm sensation in your chest. This is a normal reaction. After the pictures are taken, the doctor may also ask you to cough. This is done to clear the dye from your arteries.

Your doctor may also ask you to take a deep breath during the procedure. This is done to lower your diaphragm so that it does not show on the x-ray pictures, and gives a clear view of your coronary arteries.

Once your doctor has determined where the blockage is, he or she will insert a guide wire through the guiding catheter and move it to the narrowed artery. This is continuously monitored on the television.

Once this is done, the next step is to insert the balloon-tipped catheter through the guiding catheter and thread it over the guide wire. When the catheter is in place within the narrowed artery, the balloon is inflated and deflated several times so as to compress the plaque against the arterial wall. This will open up the blood flow in that area.

During inflation, it is normal to feel some chest pain – please tell your doctor if you do feel any. Your doctor will ask you to rate this pain on a scale from 1 to 10, 1 being the least amount of pain you have ever felt and 10 being the most extreme amount of pain you have ever felt.

Once the plaque is compressed, the balloon is deflated. The guide wire and catheters are removed, but the introducing sheath remains in place for several hours or overnight to prevent bleeding and to allow your doctor to check the treated artery.

WHAT SHOULD I EXPECT AFTER THE ANGIOPLASTY?

Once your procedure is over, you will be returned to your hospital room for your recovery period. It is important to keep the area where your introducing sheath is placed flat. If the sheath is in your groin, you should not place the head of your bed higher than a 30 degree angle. The reason for this position is so that you do not bend the catheter, causing bleeding to start. The nurse will also ask you to keep your leg straight. This position needs to be kept for several hours until your doctor decides to remove the sheath. You may bend the leg that is not involved in this procedure to ease any back discomfort you may experience during this time. Your nurse will try and make you as comfortable as possible during these hours. Your nurse will continue to monitor your blood pressure and pulse rate.

It is important to let your nurse know if you experience any discomfort such as chest or back pain, catheter site pain, shortness of breath, itching, numbness, or coolness of your arms and legs.

After your procedure, it is important to drink lots of fluids, such as water and juices, so as to flush the dye from your body. You will be able to eat your regular diet when you feel like doing so.

After several hours or the next morning, your doctor may request that the introducing sheath in your groin or arm be removed. Your nurse will apply pressure to the site either by the nurse’s hand or a special clamp (called a C-clamp) for at least 30 minutes, or until bleeding has stopped from the insertion site.

Once the bleeding has stopped, the nurse may place a pressure dressing with a sandbag on the site to help prevent further bleeding. Once this procedure is over, your nurse will ask you again to remain in a flat position and not to move your leg or arm for about six hours. Your nurse will continue to take your blood pressure and pulse rate. It is important to let your nurse know if you experience any chest pain. In addition, it is important to let your nurse know if you feel anything running down your leg or arm, or have a feeling of "wetness" from the catheter site, or a lump growing under the skin. This may be an indication of bleeding. Your nurse will instruct you on how to apply pressure to your catheter site, should you suddenly cough, sneeze, or laugh, since this may also cause the site to bleed.

After six hours, you will be able to get out of bed and walk around the unit. Your nurse should be present when you first get out of bed, since you may feel dizzy from lying flat for so long. If the catheter site was your groin, you may notice that your leg feels stiff and sore for a few days after the procedure and you might notice some bruising.

Your cardiologist will inform you before the next day of the results of your angioplasty.

After your doctor has determined that your condition is stable, and that your EKG and blood tests are normal, you will be discharged home. Your doctor will let you know what medications, if any, that you need to take and when to make a follow-up appointment to see him or her.

BEFORE YOU LEAVE THE HOSPITAL

Arrange for someone to drive you home from the hospital. Your doctor or nurse will give you information about any medications or diet you need to follow. Be sure to ask when you can return to normal daily activities.

REDUCING YOUR RISK FACTORS

It is important to realize that angioplasty is a treatment, not a cure for Coronary Artery Disease (CAD). CAD is a progressive disease and the best way to slow the progress and reduce risk of further disease is to practice maintaining healthy heart living. This can be done by quitting smoking, eating less cholesterol, maintaining a low fat diet, and controlling your blood pressure, as well as getting regular exercise.

Please note that this information is intended to give you a general overview of the topic. It is not intended to replace advice or instruction of a health professional. We recommend that you consult your physician, nurse, or qualified health professional regarding the information in this publication. © 1994 Planetree, Inc. Reproduction of this material in any form is limited to license agreement.

Planetree Health Fact Sheets are developed by Planetree, Inc., a non-profit consumer health organization, founded in 1978. The Planetree Alliance includes hospitals and libraries which, among many other patient-centered concepts, promote the importance of access to health information for patients, families, and community. For more information regarding affiliation with the international Planetree Alliance, call (203) 732-1365 or visit Planetree, Inc. at www.planetree.org.