Read this guide to learn:• What angioplasty is• Thebenefitsandrisksofangioplasty• What will happen during the procedure• Whatyoucanexpectaftertheprocedure

C034-D

Angioplasty

Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.ca© 2016 University Health Network. All rights reserved. This information is to be used for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific medical condition. A single copy of these materials may be reprinted for non-commercial personal use only.

Author: CardiologyRevised: 07/2016Form: D-5152

A guide for people living with heart disease

What is angioplasty?

Angioplasty is a procedure that opens up a narrowed or blocked artery in your heart. Itisatreatmentthatcanworkwellforpeoplewhohavethisproblem.

Angioplasty is done in a hospital, but it is not surgery. You will not have any incisions (cuts) in your chest or heart.

Angioplastyisatreatment,butnotacureforcoronarydisease.Coronarydisease needslifelongmanagement.Otherwaystocontrolyourdiseaseisby:

• takingmedicinesprescribedbyyourdoctortohelpifyouhave:

◦ high blood pressure

◦ highcholesterol(afatinyourblood)

◦ high blood sugar

• leadingahealthylifestyle

Yourdoctorcanperformanangioplastyusingdifferentmethods.Yourdoctorwillfirstperformanangiogram, which is a heart x-ray. Then he or she will talk to you about whetherangioplastyisatreatmentforyou.

Technicalnamesforangioplastyare PTCA or PCI.Theselettersstandfor:

PTCA:• Percutaneous – through the skin• Transluminal – inside the blood vessel• Coronary – having to do with the heart• Angioplasty – opening the artery

PCI:• Percutaneous – through the skin• Coronary – having to do with the heart• Intervention–thetypeofprocedureusedtoopenanarrowedartery

1

What are the benefits of angioplasty?

Over 90% of angioplasties are successful.Thismeansthatoutof10peoplewhogetthisprocedure,9doverywell.Bloodflowthroughthearteryreturnstonormalornearnormal.Mostpeoplegetcompleterelieffromangina.

Peoplewithseverecoronaryarterydiseasemaystillhavesymptoms,buttheyfeelmuchbetter.Thisallowspeopletobemoreactiveandcomfortable.

People recover much quicker from angioplasty than from heart surgery. During angioplasty, there is no incision (cut) or general anesthesia (being put to sleep).

Most people go home the same day as their procedure while others may need to remain in hospital overnight and are discharged home the next day.

How will I know if angioplasty is a treatment for me?

Your angiogram will show the blockage in your coronary arteries. Your doctor will explainthedifferenttreatmentoptionsavailabletoyou.Thesetreatmentsinclude:

• managing your symptoms with medicines

• angioplasty

• bypass surgery

Thetreatmentthatisbestforyoudependson:

• how bad your coronary disease and symptoms are

• any other medical conditions that you may have

• yourlifestyle

• whattreatmentsyouwouldprefertohave

Youandyourdoctorwilltalkaboutwhetherangioplastyisatreatmentoptionforyou.

2

When is angioplasty not a good treatment option?

Angioplastymaynotbeagoodtreatmentoptionif:

• therearemanynarrowedareasinseveraldifferentcoronaryarteries• the balloon cannot get through a very tight blockage• thecathetercannotreachablockagebecauseofatightcorner

What happens during an angioplasty?

Angioplasty is done in a catheterization laboratory, also called a cath lab. A cath lab is a room in the hospital that has a heart x-ray and other equipment. Thisequipmenthelpsdoctorsperforman angioplasty.

Your doctor will insert a catheter (small tube) into your body. To do this, they use an introducer sheath (a slightly larger tube).

• The catheter is inserted in either your groin or your wrist. The catheter has a small balloon on the tip.

• The catheter is moved through one artery into the narrowed heart artery.

• The balloon on the catheter is theninflated.Thisopenstheartery so that more blood can flowtotheheart.

• Theballoonisthendeflatedandremovedfromtheartery.

3

Theplaque(fattylayersthatcausethenarrowing)isnotremovedfromtheartery. Itispushedagainstthewalloftheartery.Thisallowsmorebloodandoxygentoflowthrough the artery to the heart.

Places where the catheter might enter your body:

4

The doctor usually puts a stent into the insideofthearteryduringanangioplasty.Astentisasmalltubemadeofstainlesssteelmesh.Itholdsthearteryopenafterangioplasty.

When a stent is used, your doctor will place it over a balloon. When the balloon isinflatedthestentexpands.Itispressedintothewalloftheartery.Theballoonisthendeflatedandremoved.

Afterthestentisputin,theinnerliningofthearterywillgrowoverit.Thisusually takes about 2 weeks. This keeps the stent securely in place. The stent is kept in permanently to keep the artery open.Stentslowertheriskofthisareanarrowing again.

Will my arteries get narrow again?

Anarterymaybecomenarrowagainafterangioplasty.Thisiscalledrestenosis.

Ifthearterynarrowsenough,youmayfeelanginaagain.

Restenosiscanhappenasaresultofscartissueforminginthestent.Mostcasesofrestenosishappeninthefirst3to6monthsafterangioplasty.

Restenosis is usually easily treated with a second angioplasty.

Angioplasty using a stent

5

What are the risks during an angioplasty?

Angioplasty is a common procedure. However, like any procedure done in the body, there are some risks. Risks include:

• bleeding• artery collapse• heart attack• stroke

Ask your doctor about the risks and benefits of angioplasty for you.

What will happen before the procedure?

When you arrive at the hospital, you will be admitted directly to the Cath Lab (Cardiovascular Investigation Unit/CVIU) or to a Cardiac inpatient unit.

Here, a nurse will:• put a hospital ID (identity) bracelet onto your wrist• help you change into a hospital gown• help you to shave your groin, wrist, or both• place an intravenous (IV) in a vein in your arm

TheIVhelpsthedoctorsandnursesgiveyoufluidsandmedicines,forexample,bloodthinnersandpainmedicine.TheIVhelpsthemgiveyoufluidsandmedicinebefore,duringandaftertheangioplasty.

When they are ready, you will be moved to the Cardiac Catheterization lab. The angioplasty will be done here. This is also called the “cath lab”. You will meet your doctorbeforeyourprocedure.

Thecathlabisusuallycool.Askforanextrablanketifyouarecold.Thelightsinthecath lab will be dim during the procedure. This is so the doctor can see the x-ray images more clearly.

6

What can I expect during the procedure?

Yourangioplastywilltakeabout1hourtocomplete.Ifyourconditionismorecomplex, your procedure will be longer. You will be awake but your nurse will give you medicine to help you relax.

For the procedure, you will lie on an x-ray table. You will be covered with a sterile sheet. You will be able to breathe and talk.

An x-ray camera will move across your chest. You will be on a heart monitor. During the procedure, your cardiologist and nurses will explain what is happening. They will alsoaskhowyouarefeeling.

1. Youwillgetcomfortableonthex-raytable.Yourteamofdoctor(s)andnurseswillperformasafetychecklistandgiveyousedationasneededthroughyourintravenous.

2. The area where the catheter will be inserted (your leg or wrist) will be washed. Thiswillhelppreventinfection.

3. Your doctor willfreezetheareawherethecatheterwillgoinusingasmallneedle. It may sting a little. Once the medicine starts to work, it is normal to stillfeelsomepressureinthatarea.Tellthedoctorifyoufeelpain.

4. When the areaisfrozen,yourdoctorwillmakeatinyincision(cut).Thisallowsa short tube (introducer sheath) to be inserted. This tube will protect your artery during your angioplasty.

5. Then,yourdoctorwillinsertalongflexibletube(guidingcatheter)intotheintroducer sheath. It will move through the main artery in your chest (aorta). Yourdoctorwillguideittowherethecoronaryarteriesbranchofftotheheart.

6. Then,yourdoctorwillinjectasmallamountofx-raydyethroughtheguidingcatheter.Thisdyewillgointothecoronaryarteries.Youmayfeelawarmflushingsensationwhenthedyeisinjected.Thisisnormalandpassesquickly.

7

7. Your doctorwillwatchthemovementofthex-raydyeonascreen.Thedyeletsyour doctor see the places where your arteries are narrowed. You may be able to see the screen as well.

8. Your doctorwilllookforthenarrowingonthex-rayscreen.Whenoneisfound, a balloon catheter is passed through the guiding catheter.

9. A guide wire inside the balloon catheter is then moved through the artery. The guide wire will stop when the tip is past the narrowing.

10. The balloon catheter is then moved over the guide wire. It will stop in the narrowedpartoftheartery.

11. Whentheballoonisinplace,yourdoctorwillslowlyinflateit.Itmaybeinflatedseveraltimestopushtheplaqueagainstthearterywallsandopentheartery enough.

The balloonisinflatedupto30secondseachtime.Whentheballoonisinflated,thebloodstopsflowingthroughyourarteryforashorttime.Thistimeisnotlong enough to damage your heart. However, you may have some chest pain. Tellyourdoctorandnursesifyouhavechestpainoranydiscomfort.Painusuallygoesawayquicklywhentheballoonisdeflated.

12. Theballooncatheterisdeflatedandremovedonceyourdoctorissatisfiedwith the result.

8

9

What should I expect after the procedure?

Afteryourprocedure,youwillgothrough3stepsbeforeyouarereadytogohome.

The steps are:

1. Finishing up in the procedure room

2. Resting in the recovery room or hospital room

3. Preparing to go home

1. Finishing up in the procedure room

Whentheangioplastyisfinished,yourdoctorwilltalktoyouabouttheprocedure. Your doctor will tell you the results. They may even show you your artery on the x-ray screen.

Ifyourprocedurewasdonethroughyourwrist,theintroducersheathwillberemovedinthecathlabattheendoftheprocedure.Yourdoctorwillputaclamponyourwrist.Youwillbeallowedtowalktoyourstretcherfromthex-raytable.

Ifyourprocedurewasdonethroughyourgroin,theintroducersheathisnormallyleftinplacefor2to4hours.Thiswillallowtimeforthebloodthinners(medicinesthatthinyourblood,suchasheparin)towearoff.Youwillbehelpedtomovebacktoyourstretcherfromthex-raytableasyouarelyingon your back with your leg straight.

10

2. Resting in the recovery area or hospital room

Aftertheangioplasty,youwillbetakentotherecoveryarea.Youwillstayhereforabout30minutesandthenbetransferredbacktotheCardiacfloor.Ifyouwereasked to come in directly to the Cath lab, you will stay in the recovery area up to thetimeyougohome.Ifyourdoctordecidesyoushouldstayovernight,youwillbe admitted to a hospital bed.

Sometimespeopleexperiencechestpainordiscomfortrightafterangioplasty.Thisis usually because you are having spasms in your artery.

You may have some pain because your artery wall was stretched during the procedure. This usually goes away quickly. You may be given medicine to make youmorecomfortableuntilthepaingoesaway.

Yourdoctorandnursewillwatchyouclosely.Tellthemifyouhaveanydiscomfort.

In the recovery area you may have 1-2 visitors at a time once you are settled.

The nurses will check your:

• heart rate and rhythm using a small heart monitor

• blood pressure

• groin or wrist depending on which area the doctor used to do the procedure

• bloodcirculationinyourfootorhand

If the procedure was done through your groin:

Yourdoctorwillusuallyleavetheintroducersheathinyourlegfor2-4hoursafteryourprocedure.Ifthishappens:

• You will be able to eat and drink a small amount once the procedure is done

• Wewillaskyoutolieflatwithonepillowandtokeepyourlegstraight.Youmustnotmovethisleg.Tellthenursesifyouareuncomfortable.Theywillhelpyoutogetmorecomfortable.

• Your nurse will then remove this sheath. Using a clamp, your nurse will applypressuretoyourgroinforabout30minutes.Thiswillhelptopreventbleeding.

• Whentheclampistakenoff,yournursewillputapressuredressing,transparent dressing or a band aid on your puncture site.

• Youwillstayinbedwithyourlegstraightforanother3hours.

• Whenyouareready,yournursewillhelpyougetoutofbedandwalk.

If the procedure was done through your wrist:

• Thewristclampwillstayinplacefor1½hourstopreventbleeding.

• Afterthat,thenursewillslowlyreleasetheclampuntilitiscompletelyremoved.

• You will be able to walk once the procedure is done.

• Youcaneatanddrinkshortlyaftertheprocedureisdone.

11

3. Preparing to go home Youwillhavetodothesethingsbeforeyoucangohome:

• You will have blood tests and an electrocardiogram (ECG). These tests will make sure that your heart muscle was not damaged during the procedure.

• Your nurse will talk to you about doing your activities again. Your nurse will also talk to you about your medicines.

• Wewillexplainhowtoarrangeanyfollow-upappointmentswithyourdoctors.

• YouwillbeabletogohomewhentheresultsofyourbloodtestsareOKorwithin the normal range.

What do I need to do after the procedure?

Ifyourcardiologistputastentinyourarteryyouwillusuallyneedtotake2typesofantiplateletmedicine(AspirinandPlavixarethemostcommonmedicinesweprescribeforpatients).

Youwilltakethemedicinefortheprescribedtime.Youmayhavetotakeitforupto 1 year. Take your medicine exactly as your doctor teaches you to.

What can I expect after I return home from angioplasty?

ActivitiesDo not do physically challenging activities during your first week at home. One exampleisheavylifting.Don’tliftanythingthatisheavierthan10lbs.Avoidingheavyliftingwillhelpyourpuncturesitehealcompletely.

Mostpeoplehavenoproblemsafterasuccessfulangioplasty.Theycandotheirusualactivitieswithinafewweeks.

Howquicklyyoureturntoyourusualactivitiesmaydependonafewthings.Itmaydepend on whether you have had a recent heart attack. It may also depend on what typeofactivitiesyoudo.Yourdoctorwilltalktoyouaboutthis.

12

Feelings and coping

Itisnormaltofeelanxious(worried)aboutyourhealthafterhavingproblemswithyour heart. At home you may start to think more about why you have coronary arterydisease.Youmightstarttothinkabouthowyoucanchangeyourlifestyletopreventmoreproblems.Thismayfeeloverwhelmingordepressing.

Youmayfeeldepressedafterbeingdiagnosedortreatedforheartdisease.As you become more active, these feelings usually go away. Tellyourfamilydoctorifyoufeeldepressedforlongerthan2weeks.Heorshecanhelpyoufeelbetter.

Lifestyle changes

Youcanbeanimportantpartofyourowntreatment.Youcanmakechangestopreventyourheartdiseasefromgettingworse.

Theriskfactorsthatyoucanchangeare:

• High cholesterol• Diabetes• High blood pressure• Smoking• Obesity• Sedentarylifestyle(notgettingenoughexercise)• Stress

Tomaketheseimportantchanges,youneedthehelpandsupportofyourfriends,familyanddoctor.Yourheartdiseasecanaffectthepeopleclosesttoyou.

Talktoyourfamilyandfriendsandgetsupport.Thiswillhelpyouandyourfamilycope with any changes in your lives.

Support groups and programs such as Cardiac Rehabilitation are available to help youandyourfamily.Theycanhelpyoualladjusttolivingwithheartdisease.Yourhealthcareteamcanhelpyoufindtheresourcesthatfityourneeds.

13

Remember:Lifecanbefulfillingagain.Moderntreatmentsforheartdiseaseworkwell.Patientsliveformanyyearsafterbeingdiagnosedwithheart disease.

Formanypeople,findingouttheyhaveheartdiseaseisachancetomakechanges.Thesechangescanleadtoahealthierandhappierlife.Youmayfeelbetterthanyouhaveinyears!

14

This resource was written by:

Jeannine Costigan, RN, MScN, ACNPRuth Elias, MSc, RDJanice Jickling, RN, MScN, ACNPMin Hong, BSC. PharmJane MacIver, RN, MScNHeather Moon, BHSc OTNicki Morris, BHSc PTDiane Neil-Pollinger, MSW, RSWPeter Nielsen, RN, BSCN, MNGraham Reid, PhDJohn Ross, MD, FRCP©

Reviewed and revised by CICU Patient Education Committee, 2004Reviewed and revised by Zelia Souter (PCC), Pauline Glaves (PCC) and Rob Fuerte (APNE), 2012

Revised by Amanda Matthews, Zelia Souter, Danielle Small, Pauline Glaves, and Dr. C. Overgaard, 2016

Reviewed by the Patient and Family Education Program