Preparing For An Angioplasty

After scheduling angioplasty, the cardiologist or another member of the medical team will review all the details about the angioplasty procedure, including:

• The diagnostic cardiac catheterization that will be performed beforehand

• What to do the night and morning before the procedure

• What happens during the procedure

• What happens during recovery

• What to do after arriving home

Cardiac Catheterization

Before angioplasty, patients usually have a diagnostic test called coronary angiography, which is also known as cardiac catheterization.

In this procedure:

• A catheter is threaded through the blood vessels leading to the heart

• A special contrast dye that shows up on x-rays is injected into the coronary arteries

• X-ray images are taken to look for narrowed areas in the arteries and determine how severe the narrowings are.

In addition to being used to definitively diagnose coronary artery disease, angiography provides the physician with an image of exactly where the arteries are narrowed. This "road map" can be used to plan the best treatment strategy.

Usually, the catheterization is done first, with the patient returning at a later time for the angioplasty. If the test results show that an artery is dangerously narrowed, angioplasty may be performed immediately.

Getting Ready For Angioplasty

It is important to follow a few simple precautions before angioplasty. Talk to the doctor about how to prepare for the procedure.

• Do not eat or drink anything after midnight the night before.

• Ask the doctor about taking regular medications the morning of the angioplasty.

The Procedure

Coronary angioplasty is performed in a cardiac catheterization laboratory, generally by an interventional cardiologist, who has received special training and certification in the procedure.

• Before the procedure, patients are given a sedative to help them relax.

• An intravenous line is started in a vein in the arm, so that fluids and medications can be easily given during the procedure.

• A local anesthetic is injected in the skin near the femoral artery, the artery that leads from the groin to the coronary arteries. (Sometimes, the artery in an arm, the brachial artery, is used instead).

• To start the angioplasty procedure, the interventional cardiologist makes an incision and inserts a thin, hollow catheter through the artery, threading it up toward the heart and into the coronary artery that contains the blockage. X-ray photography enables the cardiologist to view the movement of the catheter on a TV monitor.

• After the catheter arrives at the site of the blockage, a second, thinner catheter is inserted into the first one. There is a small, deflated balloon at the tip of the second catheter.

• Once the balloon is in position at the site of the narrowing, it is inflated. The temporary widening of the artery either crushes or breaks the plaque, and the balloon is then removed. The artery is widened by the balloon inflation, and blood flow improves.

• The balloon may be reinflated one or two times to keep the artery open. If a coronary stent is used, a new catheter is inserted to guide the stent into place. Once in place, the stent pushes against the wall of the artery to keep it open.

• The procedure usually takes about two hours, depending on the number and severity of the blockages.

What Happens Afterward?

Sedatives take a while to wear off, so many patients sleep after the procedure. After the catheter is removed, the cardiologist or another hospital worker will apply heavy pressure to the incision in the groin or arm for about 20 minutes to stop any bleeding, while the patient lies in bed, remaining still.

• In some hospitals, a special device is used to apply pressure, rather than a person.

• It is important to stay in bed for about six hours after angioplasty. Later, a nurse or medical technician will assist the patient in getting out of bed and walking around.

• The patient usually stays in the hospital overnight. If no problems such as bleeding or chest pain occur, the patient usually goes home the following day.

• A family member or friend should drive the patient home.

After Arriving Home

After angioplasty, it's a good idea to relax and take it easy for a few days.

• Avoid driving a car with a standard transmission for a few days to rest the leg where the catheter was inserted.

• It is safe to return to a desk job almost immediately. However, your doctor may advise waiting for several days before returning to a job that involves using the legs a lot or bending or lifting.

• Many patients take some type of blood-thinning drug to prevent blood clots angioplasty. Talk to the doctor about exactly how to take the drug.

• The cardiologist will probably schedule a return visit at six weeks for an exercise stress test or other form of stress test. This is done to make sure that the arteries have remained open, and also to furnish results that can be used for comparative purposes if chest pain or other symptoms develop later on.

• If chest pain or other cardiac symptoms return, contact the doctor immediately.