Coronary Angioplasty

WHAT YOU SHOULD KNOW:

• Coronary Angioplasty (AN-g-o-plas-tee) is a procedure to open one or more small arteries in your heart. It is also called a "PTI" or "PCI". "PCI" or "PTI" means percutaneous (per-q-TANE-e-us) transluminal (trans-LEW-mih-null) intervention (n-ter-VEN-shun). The arteries that supply blood to your heart muscle are called coronary arteries. Plaque (plak) is a mixture of fat and cholesterol. When plaque builds up on the inside walls of the coronary arteries, they become clogged or blocked. Your heart muscle may not get enough blood when this happens. Blocked arteries can cause chest pain called angina, heart disease, or a heart attack.
  
  
• Caregivers put a catheter (long, thin, bendable tube) into an artery, usually in your groin. The groin is the area between your abdomen (belly) and the top of your leg. Caregivers gently thread (push) the catheter up to your heart. They use dye and x-rays to find the blocked arteries. Your caregivers may do one or more procedures to open up your blocked arteries. They may use a balloon-tipped catheter. During this procedure, caregivers inflate (blow up) a tiny balloon on the tip of the catheter. The inflated balloon flattens (pushes) plaque against the artery walls. This opens them up and causes more blood to go to the heart muscle again.
  
  
• Caregivers may put in a stent to keep the artery open and plaque from building up again. A stent is a tiny mesh tube or coil. Sometime caregivers do an atherectomy. They may use a catheter with a tiny drill tip to get rid of plaque. Caregivers may vaporize (melt away) plaque with a laser light. A PCI may cause chest pain to go away and decrease the need for bypass surgery. You may go home 1 or 2 days after your PCI.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• There are risks in having a PCI. An artery in your heart could become completely closed or have a spasm. If this happens, your heart would not get enough blood. This could cause chest pain or a heart attack. You might need heart surgery right away to bypass (go around) the bad artery.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• Fluid could build up in your lungs and cause trouble breathing. You could also have an allergic reaction or kidney problems caused by the dye. Your arteries could become blocked again after the PCI. If your arteries become blocked again, you may need another PCI or heart surgery to fix them. Caregivers will watch closely for these problems. If you do not have a PCI, your problem could get worse. You could have a heart attack and die. Call your caregiver if you have questions about your care.

WHILE YOU ARE HERE:

Before Your PCI:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Gown: A hospital gown is used so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. When you feel better you may be able to wear your own gown or pajamas.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• IV: An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Urine sample: For this test you need to urinate into a small container. You will be given instructions on how to clean your genital area before you urinate. Do not touch the inside of the cup. Follow instructions on where to place the cup of urine when you are done.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• Pulse Check: A caregiver may take a blood pressure reading in both arms and both legs. The pulses (heartbeat) in your feet and ankles will be measured. The pulse is the feeling under the skin when your heart pushes blood through a vein or an artery. A caregiver may put an "X" over the spots on your legs and feet where the pulse is the strongest.
  
  
• Bathroom: Go to the bathroom before your PCI procedure. Otherwise you may need to wait until after the procedure is over.
  
  
• Transport: You will be taken on a stretcher to the room where your PCI will be done. Your caregiver will help you get as comfortable as possible on a hard movable x-ray bed. A belt may be put over your legs for safety. Your arms may be tucked at your sides to give your caregivers more room to stand beside you. If you get cold, ask for more blankets.
  
  
• Medicines: You may be given a sedative right before the PCI. This medicine may make you feel sleepy and more relaxed. You may also receive the following types of medicine before or during the procedure:
  
  
  • Antibiotics: This medicine may be given to help you fight infection caused by a germ called bacteria.
    
    
  • Blood thinner medicine: This medicine may be given to prevent clots from forming during and after the PCI procedure.
    
    
  • Antihistamines: This medicine may be given to help decrease itching. This medicine may protect you from a reaction to the dye.
    
    
  • Steroids: If you had an allergic reaction to dyes or medicines in the past, you may get steroids. Steroids may help to protect you from a reaction to the dye.
    
    
  • Nitroglycerin: This medicine may be given if you have chest pain or discomfort during the PCI. Nitroglycerin opens the arteries to your heart so the heart gets more oxygen.

During Your PCI:

• There will be large x-ray machines and other equipment in the room. Your caregiver will clean the skin in your groin area with soap and water. This soap may make your skin yellow, but it will be cleaned off later. The skin may be shaved to see the area better. Sheets will be put over you to keep the area clean. A shot of medicine called local anesthesia will be put into the skin of your groin. It may stop you from feeling pain when the catheter is put in. You will be awake during the PCI so that your caregivers can give you instructions. Caregivers may ask you to cough, hold your breath, or to tell them how you feel during the procedure.
  
  
• X-rays will be used with a TV screen to do the PCI. A catheter (long, thin, bendable tube) is put into the artery in your groin area. The catheter is gently threaded (pushed) into the heart to the place where the artery is blocked. Caregivers will use x-rays and dye to find the place where the artery is blocked. You may feel warm as the dye is put into the catheter. Caregivers will use x-rays and dye to look at your artery after the plaque has been removed. Caregivers may do one or more of the following to open up your arteries:
  
  
  • Inflate a balloon-tipped catheter. Caregivers inflate (blow up) a tiny balloon on the tip of the catheter. The inflated balloon flattens (pushes) plaque against the artery walls. This opens them up and causes more blood to go to the heart muscle again.
    
    
  • Vaporize plaque with a laser light. Caregivers may vaporize (melt away) the plaque with a tiny laser light.
    
    
  • Put in a stent. A stent is a tiny mesh tube or coil. Caregivers may put a stent in your artery to keep plaque from building up again.
    
    
  • Shave away plaque. Caregivers may use a catheter with a shaver or tiny drill tip to remove plaque from the arteries. Plaque may be suctioned away after it is shaved or drilled off the sides of the artery.
  
  
• When the PCI is finished, caregivers may take the catheter out or leave an opening for a few hours. The opening is called a "sheath" or "introducer". Once the sheath has been taken out, caregivers will press on your artery to stop the bleeding. A pressure bandage will be put over the artery. Caregivers may use one or more of the following to stop the bleeding:
  
  
  • A sandbag may be placed over the bandage for pressure. The sandbag will stay in place for 2 or more hours. You will need to lie flat in bed with your leg or arm straight for this time.
    
    
  • A collagen plug may be used to seal the place where the catheter went in.
    
    
  • One or more stitches may be put into your artery.

After the PCI:

• Aftercare: You will be taken back to your room or to a recovery area. Do not get out of bed until your caregiver says it is OK. Caregivers will take your vital signs every 15 to 30 minutes for 1 to 2 hours. The pulses in your feet will also be checked often. Your toes will be checked to see if they are warm. Caregivers will watch you closely for problems that can happen after a PCI. Tell your caregiver if you have any of the following:
  
  
  • Chest pain or discomfort.
    
    
  • Change in color or temperature of your arm or leg.
    
    
  • Pain, numbness (loss of feeling), or tingling in your arm or leg.
    
    
  • Swelling or bleeding from the area where the catheter was.
    
    
  • Pain in your back, thigh, or groin.
    
    
  • Nausea (sick to your stomach).
    
    
  • Sweating a lot.
  
  
• Activity:
  
  
  • You will need to lie flat and still in bed for at least 4 to 6 hours or longer. Lying flat and still is very important. This helps to prevent bleeding and other serious problems after a PCI. Your caregiver will tell you when it is OK to get out of bed.
    
    
  • Do not raise the head or foot of your bed without asking a caregiver first. Do not remove your pressure bag or bandage.
    
    
  • Tell your caregiver if you get tired of lying on your back. Caregivers may have ways to make you more comfortable.
    
    
  • Call your caregiver before getting up for the first time. If you ever feel weak or dizzy, sit or lie down right away. Then call your caregiver.
  
  
• Bathroom: You will use a bedpan or urinal while you must lie flat. After your caregiver says it is OK to get out of bed, you may walk to the bathroom.
  
  
• Eating and drinking: You may be on a liquid diet after the PCI. Drink as much water as you can after the PCI. This will help to flush out the dye from your body. It will help keep you hydrated (keep good body fluid levels).
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.