Coronary Angioplasty

What is coronary angioplasty?
Coronary angioplasty – or PCI and PTCA – is a technique for treating coronary heart disease and angina. It helps improve your blood supply to the heart muscle and can help to relieve angina symptoms. You might also have angioplasty if you’ve already had a coronary bypass but your angina has returned.

You’ll usually have an angiogram before your angioplasty, but sometimes this is carried out at the same time. Angioplasty is sometimes used as an emergency treatment for people that have had a heart attack or unstable angina (angina that comes on with less and less physical activity or even while you are resting).

What can an echocardiogram show?

The start of the procedure is the same as an angiogram. A catheter – a fine, flexible, hollow tube – with a small inflatable balloon at its tip will be passed into an artery in either your groin or your arm. The operator then uses X-ray screening to direct the catheter into a coronary artery until its tip reaches a narrow or blocked section.

The balloon will then be gently inflated so that it squashes the fatty tissue in the narrowed artery, allowing the blood to flow more easily. The catheter contains a stent - a small tube of stainless steel mesh. As the balloon is inflated, the stent expands so that it holds open the narrowed blood vessel. The balloon is let down and removed, leaving the stent in place.

If you have a stent, you’ll need to take certain anti-platelet drugs to help reduce the risk of blood clots forming round the stent.
Angina usually feels like a heaviness or tightness in your chest which may spread to your arms, neck, jaw, back or stomach. Symptoms usually subsides after a few minutes and while some patients report a severe tightness, others say it’s more like a dull ache. It’s often brought on by physical activity or an emotional upset, cold weather and after a meal. If your angina pattern changes in any way, you should speak to your doctor immediately.

What happens after the procedure?

When the test is over, the catheters are removed. Sometimes there might be a small amount of bleeding when they are taken out. A nurse or doctor will press on the area for a short while or they may put in a plug called an angioseal to stop any bleeding. After the procedure, you’ll need to stay in bed for a while.

Most people can go home the same day or the next day, but if you’ve had an emergency angioplasty it’s likely you’ll need to stay in hospital for longer.

When you get home, check your groin area. Expect to have some bruising, but if you get any redness, swelling or if the bruising worsens, contact your doctor.

Before you leave hospital, you will be told what you can and can’t do when you get home. It’s best to avoid doing any demanding activities, such as heavy lifting for a week or so. Most people find that they’re back to normal after a few days. However if you’ve also had a heart attack, it will take longer to recover.

You shouldn’t drive for at least a week after having angioplasty – longer if you also had a heart attack.

You might be invited to go on a cardiac rehabilitation programme.

What should I do if I get chest pain after I go home?

If you have not been diagnosed with heart disease and you get chest pain, you should call 999 immediately for an ambulance.

The information below is for people who already have coronary heart disease and are being treated for it with GTN (glyceryl trinitrate) spray or tablets.

If you already have coronary heart disease, you may get chest pain or discomfort now and then. Sometimes this will be angina, which you will be able to manage at home with your GTN. However, it could also be the symptoms of a heart attack. Here’s what to do if you get:

A crushing pain, or heaviness or tightness in your chest, or

A pain in your arm, throat, neck, jaw, back or stomach

You may also sweat, feel light-headed, sick or short of breath.

Step one: Stop what you are doing.
Step two: Sit down and rest.
Step three: Take your GTN spray or tablets. Take the GTN as your doctor or nurse has instructed you. The pain should ease within a few minutes. If it doesn't, take your GTN again.
Step four: If the pain does not ease within a few minutes of taking the GTN the second time, call 999 immediately.
Step five: If you're not allergic to aspirin, chew an adult aspirin tablet (300mg) if there is one easily available. If you don't have an aspirin next to you, or if you don't know if you are allergic to aspirin, just stay resting until the ambulance arrives.

If you have symptoms that do not match the ones we have described above but you think you are having a heart attack, call 999 immediately.

How successful is coronary angioplasty?

In the majority of cases, the blood flow through the artery is improved, and many people will find that their symptoms have improved.

Sometimes the stent which has been inserted into the artery can become narrowed later on (restenosis). The blood flow through the artery can become limited which can cause angina.

Are there any risks?

A small number of people have complications. Very occasionally, the treatment completely blocks the coronary artery and if the doctor thinks that this will do serious damage to the heart, a bypass operation might need to be done. Urgent surgery is needed in around one in every 1,000 cases.

There is a small risk of having a heart attack or stroke. If you are in a stable condition when you have the angioplasty, the risk of this happening is less than one in 100. The risk varies depending on your overall health and your individual heart condition.

Source - British Heart Foundation