Coronary Angioplasty

Welcome to Mercy Health Partners. We thank you for choosing us for your healthcare. This information will guide you step by step through the coronary angioplasty procedure, answering your questions and telling you what to expect before, during and after your visit. We hope this will ease any uncertainties or fears that you might have and make your experience at MHP as comfortable as possible.

What is a Coronary Angioplasty?

Coronary angioplasty is a non-surgical procedure designed to open a restricted or closed artery that feeds the heart muscle. Its purpose is to improve heart muscle function, relieve heart pain, or both. The procedure is typically performed by inserting a long, flexible tube called a guiding catheter into the femoral artery through a small incision in your leg. Your doctor guides the tube to your heart, locates the blocked artery and clears the blockage by inflating a balloon at the site. Often a latticed metal sleeve called a "stent" is inserted to help hold the artery open.

Your Care Team

You will be taken care of by a number of people before, during and after your procedure. They include:

• Your primary care physician
• Your cardiologist
• Nurses and technicians specializing in cardiac catheterization and coronary angioplasty
• Cardiac rehab specialists at MHP's Cardiac Rehab Center (The Mercy H.E.A.R.T. Center)

Before the Procedure

Preparation:

Prior to admission your cardiologist will meet with you to discuss the procedure and answer any questions you or your family may have. Typically this discussion takes place in your doctor's office. If you are already an in-patient, this discussion will take place in your room. Plan on a one-night stay at the hospital. Prior to, or upon admission you will be given an electrocardiogram, a chest x-ray and routine blood tests. Be sure to tell the doctor what medications you are taking and about any allergies you may have, especially to X-ray dye or iodine. It's likely you will be placed on blood thinners such as aspirin and Plavix several days prior to your procedure. It's important that you take these and any other medications recommended by your doctor. You will also be asked not to eat or drink anything after midnight on the night before your procedure. Sometimes clear liquids are allowed in the morning if your test is going to be in the afternoon.

Medications:

Although most medications can be continued as usual, some medications can interfere with preparation, the procedure, or with your recovery.

If you take insulin or oral diabetic medications, request special instructions from your physician.

Notify your physician's office immediately if you:

• Are currently taking the blood-thinner Coumadin
• Develop a fever, rash, cough or other signs of a new medical problem

What to bring:

Bring any personal items you need for an overnight stay, including any doctor-approved medications you are currently taking. Please leave your jewelry and other valuables at home.

During the Procedure

The procedure should take between one to two hours. In the preparation area your nurse will check your blood pressure and review your medications with you. A small painless oximeter will be placed on your fingertip to monitor your pulse rate and breathing functions. The area where the catheter will be inserted will be shaved to help prevent infection. An intravenous (IV) needle and tube may be placed in the vein in your hand or arm so that fluids or medications can be given quickly and easily if they are needed. You may also be asked to remove dentures or glasses.

A form of anesthesia called "conscious sedation" will be administered. This means you will be awake but calm, comfortable and relaxed during the procedure. Your doctor will inject a local anesthetic at the site of the catheterization. You may feel a slight sting when this is done. Once this medication takes effect you will feel only a dull pressure as the physician is working with the catheters. When the catheter reaches the blockage a small amount of dye will be injected and X-ray pictures taken. You may even be able to see these pictures on a monitor. These pictures help pinpoint the blockage.

Clearing the Blockage

A soft-tipped wire is passed through the blockage. Over this wire a balloon is passed to the site of the blockage and then inflated, compressing the blockage against the walls of the artery. The balloon is then deflated and removed and normal blood flow can resume. In cases where a stent is used, the stent is mounted over the balloon and inserted into the blockage. When the balloon inflates, it expands the stent, pressing it snugly against the inner wall of the artery. When the balloon is deflated and removed, the stent remains in place acting as a permanent scaffold to help keep the artery open.

After the Procedure

After additional X-rays have been taken to insure the procedure was successful, you will be transferred to the recovery area. You will spend approximately one hour in the recovery area before being moved to your room. The small tube or sheath that guided the catheter may be left in your leg for three to four hours after the procedure. Once the sheath is removed you will be asked to stay in bed for another four to six hours before you can get up and walk. Typically, you will spend the night at the hospital and be discharged the next morning.

Discharge Instructions

• Do not drive or operate any motorized equipment for 48 hours after leaving the hospital.
• Avoid making critical decisions or signing legal documents for 24 hours.
• After discharge you may resume normal dietary habits and medications unless otherwise instructed by your doctor.
• You may resume normal "in home" activities within 24 to 48 hours and you should be able to return to work within five to seven days without limitation.

What to Watch For

Problems infrequently occur after a coronary angioplasty. However it is important to be aware of the early signs of possible complications.

Go to the Emergency Department at Mercy Health Partners immediately if you notice any of the following:

• Temperature above 100.6 degrees F
• More than a few drops of blood on the bandage at the site of your catheterization
• Prolonged chest pain that does not respond to nitroglycerin
• Development of a new, large swelling at the catheterization site

The site will appear somewhat black-and-blue. This discoloration may move down your leg as you walk and is rarely a sign of new bleeding. A small lump at the site is common and goes away in four to six weeks. Call your doctor if you have any concerns about the catheterization site.

Special Instructions

Monitor the site of the catheterization. Some bruising or a tender lump is to be expected.

For More Information

Your health is very important to us. We hope the information you have just read will be helpful to you. If you have any unanswered questions, the Catheterization Lab staff will be glad to assist you at 231-672-3955.