Correcting blocked arteries in patients who may have a heart attack
The key to saving a heart attack victim’s life is to resume the flow of oxygen-rich blood through the patient’s heart by opening coronary arteries blocked by plaque. Coronary angioplasty offers a nonsurgical method of opening the arteries and restoring the blood flow. However, not all blockages can be treated with angioplasty. Some require coronary artery bypass surgery.
Angioplasty may also be used to treat angina (persistent heart pain) and to prevent heart attacks.
Before the procedure
• Tell your cardiologist if you are taking any medications, including nonprescription drugs and herbs; if you are allergic to seafood, anesthetic medications, contrast material or iodine; if you’re taking Viagra; or if you may be pregnant.
• Follow directions regarding not eating or drinking before the test.
• Swallow the pills your physician asks you to take (such as pain medication or blood thinners) with just a small sip of water. Ditto if you’re instructed to take your usual medications. (Your doctor may ask you to stop taking aspirin, nonsteroidal anti-inflammatory drugs or a blood thinner for a specified period of time before your procedure.)
• Inform your doctor about recent illnesses and other medical conditions.
During the procedure
Throughout the procedure, you lie down and remain awake. Your cardiologist makes a small incision, usually near the groin, and then inserts a balloon-tipped catheter (flexible tube) through the incision and into the artery. Sometimes the catheter goes into your arm or wrist.
Dye injected into your body highlights the blood flowing through your arteries and helps the doctor see any blockages that lead to your heart. Live X-ray pictures show where to guide the catheter into your heart and arteries.
The cardiologist moves a guide wire into and across the blockage, then pushes the balloon catheter over the guide wire and into the blockage and inflates the balloon. The balloon is then deflated and removed. To help keep the artery open, the doctor sometimes places a stent (a small metal wire mesh tube) in the blocked area, along with the balloon catheter.
The stent expands when the balloon is inflated and remains in the artery. Some stents are coated with slow-releasing medication (drug-eluting stents) to help keep the artery open.
As with all medical procedures, angioplasty poses some risks, such as:
• Allergic reactions to the X-ray dye, stent material or the drug in the drug-eluting stent
• Bleeding or clotting in the area where the catheter was inserted
• Damage to a heart valve or blood vessel
• Heart attack
• Kidney failure, especially in people who already have kidney problems
• Irregular heartbeats
• Stroke (rare)
• Blood clot
• Clogging of the inside of the stent
When the procedure is over, the catheter is removed and pressure is applied to stop any bleeding. The opening in the skin is covered with a dressing. No sutures are necessary.
You may have to lie in bed with your legs straight for several hours. If your physician uses a “closure device” that seals the small hole in the artery, you may be able to move around more quickly.
After the procedure:
• Keep the area where the catheter was inserted dry for 24 to 48 hours.
• Take pain medication if needed.
• Take a clopidogrel drug (e.g., Plavix) if prescribed by your doctor. These medications thin the blood and keep it from forming clots in your arteries and stent. Follow directions and don’t stop taking the medication without first speaking with your doctor.
Hospital stays are usually up to two days. Some people go home the same day. Patients can usually walk around within six hours after angioplasty. Complete recovery usually takes a week or less.
Angioplasty is not a cure for artery blockages. Your arteries can become clogged again. To help prevent blockages, eat a heart-healthy diet, exercise, don’t smoke, reduce stress and take medications as prescribed by your healthcare provider.
Open heart surgery
For more serious cases, open-heart surgery may be necessary. This refers to surgery done on the heart muscle, valves, arteries or other structures through an opening in the patient’s chest. A heart-lung machine takes over the heart’s pumping action to provide the patient with oxygen-rich blood while the surgeons operate on a still heart.
New minimally invasive surgeries, including robotic-assisted surgery, are performed through smaller incisions. During some of these surgeries the heart remains beating and no heart-lung machine is necessary.
These new methods may reduce risks and recovery time. According to the National Institutes of Health, studies that compare new types of heart surgery to traditional open-heart surgery will help doctors decide the best procedure for each patient.