Coronary Angioplasty - A Guide for Patients

What is Coronary Angioplasty or PTCA?
Coronary Angioplasty (PTCA) is a procedure used to widen (dilate) the narrowing in your coronary artery without having surgery. PTCA stands for Percutaneous Transluminal Coronary Angioplasty. You and your doctor have decided that this is the best treatment for you.

How does Angioplasty work?

The basic idea of Angioplasty (PTCA) is to position a special catheter with a small balloon on the end within the narrowed section of the coronary artery. The balloon is then inflated and deflated several times to try to stretch the artery and flatten the deposits against the walls of the artery. Once the artery is opened, blood can then flow more easily to feed the heart muscle.

Can everyone who has chest pain have PTCA?
No, whether you are a candidate for this procedure depends on a number of things. Among them are the overall functioning of your heart, how long you have had angina, how many of your vessels are narrowed or blocked, where the narrowing or blockage is and how severe it is. Only a doctor who is familiar with your case, can determine the best form of treatment for you.

What should my doctor know?

Be sure to tell your doctor what medications you are currently taking. You should also tell your doctor about any allergies you have, especially to x-ray dye or iodine. These allergies may require additional medication before the PTCA. It is also important to let your doctor know if you cannot take aspirin, since this and other medications are usually begun prior to PTCA and continued for several months afterwards.

What preparation will I have to do?
You will be booked for your test through the Consulting Clinic Unit Receptionist or Ward Unit Receptionist. At that time, a deposit will be requested to confirm your appointment for the procedure. This deposit is non-refundable. If you are unable to come for your PTCA for any reason on the day of your admission, please call the Cardiac Catheterisation Laboratory at telephone: 92 21 486 1401, or the Consulting Clinic at 92 21 486 1011.

Special instructions:

• Pack a bag for an over-night stay.
• The medication tablets that you take at home should be taken in the morning as usual with a sip of water.
• Bring all your medications with you to the Hospital.
• Do not bring any valuables or jewellery.
• Special parking facilities are available at AKUH.
• Arrange a ride home from the Hospital after discharge. You should not drive yourself home.

What can I expect before the Angioplasty?
The Angioplasty (PTCA) preparation is very much like your previous coronary angiogram. You can expect to be admitted to the Hospital the day before or the same day of your procedure, provided your tests have been completed ahead of time.

From the admission office you will be directed to your room or the Coronary Care Unit. An ECG, chest x-ray (if not done within the last three months) and blood tests may be performed. On the evening before the procedure, both groins will be shaved and cleaned carefully. You will not receive anything to eat or drink for twelve hours before the PTCA, although you will continue taking your medications with sips of water. An intravenous (IV) will be started in he morning before the PTCA and you will be given a pill to help you relax.

What can I expect during the procedure?
A coronary Angioplasty is similar to a coronary Angiogram procedure. Therefore, the equipment used and the preparations are the same. You will remain awake through out the procedure and should feel free to ask questions, and describe any unusual sensations you might have.

The doctor or nurse may ask you to do several things such as move your head, move your arms behind your head, cough or lake deep breaths. It is important that you listen carefully and follow the instructions for which the nurse will assist you.

A local anaesthetic will be injected into the groin area and the Cardiologist will insert a catheter into an artery in the groin. He will then attempt to direct the balloon into the involved artery and through the narrowed segment. Once the balloon is positioned in the narrowing of the artery, it is inflated for several seconds upto several minutes depending on the nature of the blockage. The balloon may be inflated and deflated several times in order to press the plaque back against the wall of the artery. Some people feel chest discomfort that is similar to the angina they have experienced. This happens because the balloon is temporarily blocking off the blood supply to a small area of the heart muscle. Be sure to let the doctor or nurse know immediately if you begin to have any discomfort.

Once the doctor is satisfied that your artery has opened, the balloon will be removed and some final pictures taken. A small tube called a "sheath", will be secured and left in the groin for several hours following the procedure. The entire Angioplasty procedure will take one to two hours longer than the coronary Angiogram procedure. A lot depends on how easily the balloon catheter moves into the desired position and how many coronary arteries are involved.

Is PTCA a painful procedure?
You will feel very little or no discomfort during the PTCA. Before starting the procedure, your doctor will inject a local anaesthetic where the catheters will be inserted. You may feel a stinging sensation as he does this. However, after the medication takes effect, you should only feel dull pressure where he is working with the catheters. If you do feel pain, please tell your doctor so he can give you additional medications.

What can I expect after the procedure?
At the end of the procedure, the decision will be made whether or not the artery has been adequately opened by PTCA. The cardiologist will look for improvement in the appearance of the artery and the flow of blood through it.

You will be brought to the Coronary Care Unit (CCU) or a special care area, where you will be monitored for approximately 24 hours. The nurse will regularly check your blood pressure, heart rate, pulses in your feet and puncture spot. ECGs, blood tests and IV medication therapy are routinely done following PTCA.

Once the "sheath" in your groin is removed, firm pressure will be applied to the puncture spot by hand or by a clamp for 20-30 minutes until bleeding stops. A pressure bandage or sand bag will cover the groin area and will remain in place for several hours. You will remain flat on your back for four hours, keeping the affected leg straight after pressure of the clamp is removed. It is very important that you do not bend the knee or the hip of the side that was used during the procedure as movement may cause bleeding from the puncture spot. If you feel the need to cough or sneeze, press firmly on the bandage with your fingers. Be sure to notify the nurse immediately if you feel sharp pain or a wet warm sensation under the bandage, or if you experience any chest, arm or jaw discomfort.

You will urinate often because your kidneys will be getting rid of the x-ray dye that was injected into your coronary arteries. You will need to use a bedpan or urinal. You will receive only clear fluids to drink to help decrease the possibility of nausea while the "sheath" is in your groin and given extra fluids to help get rid of the dye. Your first meal will be a light one and will be given after the "sheath" is removed.

What if PTCA fails?
The possibility of failure will be discussed with you before the procedure and an alternate plan of action will be developed. In some cases, the failure of PTCA will lead to open heart surgery. Usually, this will be done immediately after the unsuccessful PTCA.

What about complications?
Since PTCA is a specialised form of coronary Angiography, it shares the same risks relating to insertion of the catheter in the groin and passage of the catheter within the heart and blood vessels. PTCA has the additional risk that the artery under treatment may become more narrowed or even close off completely during the procedure. Should this occur, it may be possible to re-open the artery with the balloon catheter. Otherwise, immediate bypass surgery may be necessary to restore blood flow to the heart. There is a possibility that widening your narrowed arteries with the balloon catheter may not be possible. If this happens, bypass surgery may be recommended later.

When can I go home?
You are likely to go home one or two days after your PTCA, unless some other treatment is needed. You should arrange to have someone take you home rather than driving yourself.

Before leaving the Hospital, make sure the nurse gives you a copy of the "Discharge Instructions for Coronary Angioplasty/PTCA". You will need to follow the instructions carefully.

After Coronary Angioplasty/PTCA (it does not matter where it was done), there is a 20 per cent - 30 per cent chance of your artery(ies) re-blocking. This can occur suddenly or gradually. Angina (chest, arm or jaw discomfort with or without shortness of breath, light headedness or nausea) is the most common indication that re-blocking has occurred and is usually a sensation which is similar to that you experienced before angioplasty.

IF YOU EXPERIENCE THESE SYMPTOMS YOU MUST NOTIFY YOUR DOCTOR
Early detection of re-blocking is the key to successful treatment. Usually it may require a second angioplasty.

Aga Khan University Hospital, Karachi
P.O Box 3500, Stadium Road, Karachi-74800, Pakistan.
Telephone: 92 21 486 1011 and 486 4701
Fax: 92 21 493 4294, 493 2095
email: cardiology@aku.edu