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Coronary angioplasty is a procedure that opens blocked arteries and allows blood to flow to your heart muscle. Angioplasty is not surgery. It opens a clogged coronary artery by inflating a tiny balloon in it. This information sheet discusses what the procedure is, who needs it, how it is done, and recovery afterwards.
Angioplasty - series
| Coronary artery balloon angioplasty - series Normal anatomy: |
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The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart. |
| Coronary artery balloon angioplasty - series Indication: |
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Fat and cholesterol accumulates on the inside of arteries (atherosclerosis). The small arteries of the heart muscle (the coronary arteries) can be narrowed or blocked by this accumulation. If the narrowing is small, percutaneous transluminal coronary angioplasty, or PTCA for short, may be the course for treatment. PCTA is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. The indications for PCTA are:
• persistent chest pain (angina)
• blockage of only one or two coronary arteries |
| Coronary artery balloon angioplasty - seriesProcedure, part 1: |
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While the patient is awake and pain-free (local anesthesia), a catheter is inserted into an artery at the top of the leg (the femoral artery). The procedure begins with the doctor injecting some local anesthesia into the groin area and putting a needle into the femoral artery (the blood vessel that runs from the heart down the leg). Once the needle is inserted, a guide wire is placed through the needle, into the blood vessel. Following this step, the guide wire is left in the blood vessel and the needle is removed. A large needle called an introducer is then placed over the guide wire and the guide wire is removed. |
| Coronary artery balloon angioplasty – serie Normal anatomy: |
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Procedure, part 1: |
The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart. |
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Procedure, part 2: |
Next, a diagnostic catheter, which is a long narrow tube, is advanced through the introducer over a .035"guidewire, into the blood vessel. This catheter is then guided to the aorta and the guidewire is removed. Once the catheter is placed in the opening or ostium of one of the coronary arteries, the doctor injects dye and takes a series of X-rays (film of the images). |
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| Coronary artery balloon angioplasty - series Procedure, part 3: |
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The first catheter is exchanged out over the guidewire for a guiding catheter and the guidewire is removed. A smaller guidewire is advanced across the blocked section of the coronary artery and a balloon -tipped tube is positioned so the balloon part of the tube is beside the blockage. The balloon is then inflated for a few seconds to compress the blockage against the artery wall. Then the balloon is deflated. The doctor may repeat this a few times, each time pumping up the balloon a little more to widen the passage for the blood to flow through. This treatment may be repeated at each blocked site in the coronary arteries. |
| Coronary artery balloon angioplasty - series Procedure, part 4: |
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A device called a stent may be placed. A stent is a latticed, metal scaffold that is placed within the coronary artery to keep the vessel open. |
| Coronary artery balloon angioplasty - seriesProcedure, part 5: |
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Once the catheter has been positioned at the coronary artery origin, contrast media is injected and a series of X-rays (film) are taken to check for any change in the arteries. Following this, the catheter is removed and the procedure is completed. |
| Coronary artery balloon angioplasty - series Aftercare, part 1: |
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This procedure can greatly improve the blood flow through the coronary arteries and to the heart tissue in about 90% of patients and may eliminate the need for coronary artery bypass surgery. The outcome is relief from chest pain symptoms and an improved exercise capacity. In 2 out of 3 cases, the procedure is considered successful with complete elimination of the narrowing or blockage. This procedure treats the condition but does not eliminate the cause and recurrences happen in 1 out of 3 to 5 cases. Patients should consider diet, exercise, and stress reduction measures. If adequate widening of the narrowing is not accomplished, heart surgery (coronary artery bypass graft surgery, also called a CABG) may be recommended. |
| Coronary artery balloon angioplasty - seriesAftercare, part 2: |
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Immediately after the procedure, a ten-pound sandbag may be placed over the femoral artery puncture site in the leg and remain there for 6 hours. This is done to help the artery heal. |
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Blood supply of heart
A closer look inside your coronary arteries:
Your heart muscle needs to receive a good supply of blood at all times to function properly. Your heart muscle gets the blood it needs to do its job from the coronary arteries.
Coronary artery disease is the narrowing or blockage of the coronary arteries caused by atherosclerosis. Atherosclerosis (sometimes called “hardening” or “clogging” of the arteries) is the buildup of cholesterol and fatty deposits (called plaque) on the inner walls of the arteries that restricts blood flow to the heart. Without adequate blood, the heart becomes starved of oxygen and the vital nutrients it needs to work properly. This can cause chest pain called angina. When one or more of the coronary arteries are completely blocked, a heart attack (injury to the heart muscle) may occur.
A closer look at coronary artery disease:
 When fat builds up inside your arteries it causes slight injury to your blood vessel walls. In an attempt to heal the blood vessel walls, the cells release chemicals that make the blood vessel walls stickier. Other substances traveling through your blood stream, such as inflammatory cells, cellular waste products, proteins and calcium, begin to stick to the vessel walls. The fat and other substances combine to form a material called plaque.
 Over time, the inside of the arteries develop plaques of different sizes. Many of the plaque deposits are soft on the inside with a hard fibrous “cap” covering the outside. If the hard surface cracks or tears, the soft, fatty inside is exposed. Platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque.
If a blood clot totally blocks the blood supply to the heart muscle, called a coronary thrombus or coronary occlusion, the heart muscle becomes "starved" for oxygen and nutrients (called ischemia) in the region below the blockage. Within a short time, an acute coronary syndrome can occur. Acute Coronary Syndrome is a name given to three types of coronary artery disease that are associated with sudden rupture of plaque inside the coronary artery: unstable angina, Non-ST segment elevation myocardial infarction or heart attack (NSTEMI), or ST segment elevation myocardial infarction or heart attack (STEMI)
A heart attack can also occur less frequently by a spasm of a coronary artery. During coronary spasm, the coronary arteries constrict or spasm on and off, causing lack of blood supply to the heart muscle (ischemia). It may occur at rest and can even occur in people without significant corona ry artery disease. If coronary artery spasm occurs for a long period of time, a heart attack can occur.
Symptoms of a heart attack:
Sometimes the first indications of a heart attack come as warning signals.
The actual diagnosis of a heart attack must be made by a physician who has studied the results of several tests. Besides reviewing a patient's complete medical history and giving a physical examination, a doctor will use an electro- cardiogram (EKG) to discover any abnormalities caused by damage to the heart. Sometimes a blood test is used to detect abnormal levels of certain enzymes in the bloodstream.
treat heart attack:
When a heart attack occurs, it's critical to recognize the signals and respond immediately. About half of all heart attack victims wait two hours or longer before deciding to get help. This reduces their chance of survival, because most heart attack victims who die do so within two hours of when the signals begin. Time is critical. Anyone experiencing the warning signals of a heart attack should be taken immediately to the nearest hospital with 24-hour emergency cardiac care. People who become unconscious before reaching the emergency room may receive emergency cardiopulmonary resuscitation (CPR).
Most communities have an emergency cardiac care system that can quickly respond to an emergency. This prompt care for heart attack victims dramatically reduces damage to the heart. In fact, 80 percent of heart attack survivors can return to work within three months. Prompt care for heart attack victims isn't the only reason so many people recover so quickly, but it's an important one.
The importance of time cannot be overemphasized. When a coronary artery gets blocked, the heart muscle doesn't die instantaneously - damage increases the longer an artery remains blocked. If a victim gets to an emergency room fast enough, a form of reperfusion therapy (called thrombolysis) sometimes can be performed. lt involves injecting a thrombolytic (clot-dissolving) agent, such as streptokinase, urokinase or tPA (tissue plasminogen activator), to dissolve a clot in a coronary artery and restore some blood flow. These drugs must be used within a few (usually 1-3) hours of a heart attack for best effect. The sooner a drug is used, the more effective it's likely to be.
In the weeks following a heart attack, either PTCA or coronary artery bypass surgery may be performed to improve the blood supply to the heart muscle. Once part of the heart muscle dies, its function can't be restored. Function may be restored to areas with decreased blood flow, however.
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