The heart muscle depends on a regular and optimum supply of oxygen to function properly. In turn, it pumps blood throughout the
body. The oxygen supply to the heart is completed with the help of a system of coronary arteries.The blood flowing through the
coronary arteries carries oxygen to the heart muscles. Sometimes deposits of substances like cholesterol,excess muscle cells, collagen
and sometimes the accumulation of proteins on the inner walls of the arteries cause narrowing and hardening of these blood
vessels.This process in medical term is known as "atherosclerosis".
Blockage of an artery in this way starves the heart of oxygen.
If the blockage is mild only pain results. If severe, the part of the heart that is starved of oxygen actually dies—this is what we call a
heart attack .An angioplasty is a medical procedure used to open a blocked coronary artery and improves blood flow to the heart.
Sometimes after a heart attack, surgeons attempt to open up a clogged artery through a technique called 'Balloon Angioplasty.'In
balloon angioplasty, a long tube (catheter) with a balloon at one end is inserted through the groin and is guided to the clogged artery in
the heart. At the site the balloon is inflated. The inflated balloon crushes the plaque (deposit) on the artery wall. The balloon is then
deflated and withdrawn.
Besides balloon angioplasty there is another technique called laser angioplasty in which a laser beam is used to cut through the plaque.
After the procedure, your doctor may insert a device called a stent to keep the artery open for a longer period of time. In most cases,
this procedure is safe and effective. If complications occur, they can include nausea, minor infections, and temporary pain.
What Is Angioplasty?
Balloon angioplasty (also known as just angioplasty) is a procedure that allows your doctor to open blocked coronary arteries, which
are the arteries that provide oxygen and nutrients to your heart muscle. In this procedure a balloon catheter (thin tube) is inserted into
a blocked artery to remove the blockage. The blockage may be present in an artery in the arm, leg, or in the heart.
The catheter is inserted into a blood vessel either at the elbow or groin. It is pushed through the inside of the blood vessel so that the tip of the catheter is at the point of the blockage in the artery. The narrowed artery is stretched by inflating a balloon at the tip of the catheter allowing blood to flow normally through the artery again. The doctor then removes the catheter and balloon.
Often, an expandable device, called a stent, is inserted into your blocked artery after the procedure. Stents can help the artery remain open for a longer period of time. Your doctor's choice to perform an angioplasty or insert a stent is based on the type and location of your blockage.In addition to being effective, this procedure is safe and well tolerated in most cases.
What are the causes of blocked coronary artery?
Research have revealed that blockage in the coronary artery starts when certain factors damage the inner layers of the coronary arteries. These factors are :-
- High percentage of certain fats and cholesterol in the blood
- High blood pressure
- High percentage of sugar in the blood due to insulin resistance or diabetes
When damage occurs, your body starts a healing process. Excess fatty tissues release compounds that enhence this process. This healing causes plaque on the inner walls of the arteries cause narrowing and hardening of these blood vessels.
The buildup of plaque in the coronary arteries may start from childhood. Over time with age, plaque can narrow or completely block some of your coronary arteries. This results in reduced flow of oxygen-rich blood to your heart muscle.
Plaque also can crack, which causes blood cells called platelets (PLATE-lets) to clump together and form blood clots at the site of the cracks. This narrows the arteries more and worsens angina or causes a heart attack.
What are the symptoms of blocked coronary artery?
The accumulation of fats and plaque within the arteries not only thickens, but also narrows the arterial walls. As a result there is an impeding flow of blood that is clinically referred to as ischemia. This condition led to symptoms like :-
- Angina pectoris or a severe pain in the chest.
- A cardiac or heart attack, caused by the sudden failure of part of the whole heart muscle. A heart attack occurs when blood flow through a coronary artery is completely blocked. Angioplasty is used during a heart attack to open the blockage and restore blood flow through the artery. Reduce the risk of death in some patients.
- Pain and/or discomfort in the center of the chest.
- Shortness of breath and a choking sensation.
- Nausea and vomiting.
- Excessive sweating.
- Cold and pale skin texture.
Angioplasty may be used to treat:
a) Persistent chest pain (angina) that medicines do not control.
b) Blockage of one or more coronary arteries that puts you at risk for a heart attack.
c) Blockage in a coronary artery during or after a heart attack Risks.
What happens during the procedure of Angioplasty?
Preparation for Angioplasty
Angioplasty is often performed when you go to the hospital or emergency room for chest pain, or after a heart attack. If you are
admitted to the hospital for angioplasty when it is not an emergency.
- Your doctor will record all your medical history like what drugs you are taking, even drugs or herbs you bought without a prescription, if you have had a bad reaction to contrast material or iodine in the past, if you are taking Viagra, if you are allergic to seafood, or if you might be pregnant.
- Before surgery, a consent form needs to be signed by the patient for angioplasty, bypass surgery and angiography (X-ray study of the blood vessels using dye). This consent form is needed in case complications arise during the angioplasty and emergency surgery is needed.
- Blood tests, electrocardiogram (ECG) and an X-ray of the chest will be done. You will usually be asked not to drink or eat anything for 6 to 8 hours before the test.
- The area where the catheter will be inserted (arm or groin) will be shaved and washed with antibacterial soap to prevent infection. Before the procedure is performed, an intravenous line (tube into a vein) will be set up. Medicines to relax the patient will be given.
During the procedure
Step 1 : Primarily your doctor will choose an artery for the catheter entry site. In most cases, an artery in the groin area of the leg is used in this case.
Step 2 : Before the process of angioplasty, that area is numb with some numbing medication or with some local anaesthetic.
Step 3 : After the area is numb, the doctor will insert an introducer--which is a small, hollow, plastic tube - into your artery.
Step 4 : A guide wire is then lowered into your artery, and a catheter, another small, flexible, hollow tube, is then inserted over the wire.
The catheter is carefully advanced to your heart, through the aorta, and to the coronary arteries.
an x-ray screen helps to monitor the catheter's movement . You will not feel the catheter as it moves through your blood vessels.
Step 5 : dye is injected into catheter, once the catheter reaches the coronary arteries. This special dye shows up on the x-ray screen and
helps your doctor to see the blockages that if present. The doctor will repeat the injection of dye several times, looking at the arteries
from many different angles.
Step 6 : After your arteries have been examined, the catheter will be redirected to your left ventricle.when a large amount of dye is
injected into the ventricle, you will have a feeling of heat flash for 20- to 30-second. This is to test how your ventricle is contracting and
to see whether your valves are functioning properly.
(It is important to let your doctor know if you are suffering from Chest or back pain, Tight squeezing feeling in your chest or between your shoulder blades , Shortness of breath, A severe headache, Dizziness, or Changes in your vision during the angioplasty procedure. These sensations indicates that something is wrong.)
Step 7 : Now when the doctor injects the dye and locates a blockage, he or she will prepare for the balloon angioplasty.During this
process, a special balloon-tipped catheter is inserted into your artery and guided to the blockage. If a clot that is blocking the artery, is
encountered , a medication will be given to dissolve the clot before continuing.
Step 8 : Once the balloon catheter is correctly placed, it is inflated and deflated several times. When the balloon inflates, it briefly
blocks the flow of blood. This may cause you to feel chest discomfort. If this happens, inform your doctor, as pain medicine can be
given. With a successful procedure, the blockage is squeezed outward against the wall of the artery and blood flow is restored.
Step 9 : Depending on the kind of the blockage, the doctor may place a stent in your artery. The stent is an expandable device that is
mounted on a balloon catheter.The stent and balloon are advanced to the blockage area, and the stent is expanded into place. A stent
supports the artery and helps it remain open for a longer time.
Step 10 : Once the angioplasty is over, the doctor will take out the catheter, but the introducer may remain in the artery. introducer in
place for a time to be prepared in case the artery recloses.
How long is the Recovery poriod for Angioplasty?
Monitoring in a cardiac care unit or a hospital room is done from several hours to a couple of days, depending on the location of the
blockage and the medical condition. In most cases, patients stay in the hospital for one to two days after an angioplasty. In general,
people who have angioplasty are able to walk around within 6 hours after the procedure. Complete recovery takes a week or less. You
should keep the area where the catheter was inserted dry for 24 to 48 hours.If the catheter was inserted into the groin, the patient will
have to lie flat on their back and not move the leg or groin for about 6 hours. A sandbag may be placed on the groin to apply pressure
and prevent excess bleeding. The patient will be up and walking in 12 to 24 hours after the procedure. When the condition is stable, the
patient will be released to rest at home.
When you leave the hospital to continue your angioplasty recovery, you should be given
specific wound care instructions and discharge instructions for driving, activity level, medication, and any other restrictions. You will
need to avoid physical exertion or strenuous activity for one to two weeks after balloon angioplasty.
How much expectation should you have from Angioplasty?
- Benefits of angioplasty often include a significant relief from chest pain and a decrease in the need for heart medication.
- It can restore the function of the artery without major surgery.It may remove the need for coronary artery bypass surgery.
- It does not require removing blood vessels from another part of the body (as is often necessary in bypass surgery).
- It can be performed without using general anaesthesia.
Before your procedure, it's important for your expectations to match your doctor's expectations. More than 90 out of 100 angioplasty
procedures are considered successful. But, it's important to understand that Angioplasty does not cure the cause of the blockage in
your arteries. That is the arteries may become reblocked after an angioplasty, even if a stent is used.
What are the complication Of Angioplasty?
This is true that there is no guarantee how long any artery will stay open, despite the use of angioplasty or a stent. In fact, the rate of
artery reclosure with angioplasty alone is approximately 10-30 out of 100 procedures within six months. Reclosure usually happens
slowly, after some weeks or even months after angioplasty. This is because new plaque deposits may form or your artery may narrow
during the healing process. After your procedure if the artery remains opened for six months, it usually stays open. Depending on your
condition and symptoms, reclosure can be solved with drugs or with a second angioplasty. About 25 out of 100 patients undergo a
repeat angioplasty because of reclosure. Coronary artery bypass surgery is also recommended to patients who cannot be treated with a
repeat angioplasty or by drugs alone.
Minor complications of balloon angioplasty are Temporary pain, Minor infections, Nausea and vomiting, Bleeding, Reaction to
medication or dye, Allergic skin reaction to tape or dressings or latex, Abnormal heartbeat, Bruising or scarring at the catheter entry
site. In most cases, these are temporary and are often treated by your healthcare providers.
Major Complications of Balloon Angioplasty are Serious bleeding, Heart or lung problems like Irregular heart rhythms or Lung or heart failure, Stroke, Heart attack ( The average risk of having a heart attack during angioplasty is 5 out of 10,000 patients), Artery reclosure, Blood vessel or nerve or organ damage, Blood clots, Failure of medical equipment, Serious allergic reactions to medication or dye, Kidney failure (possibly requiring dialysis). A major complication may lead to a longer hospital stay, coronary artery bypass surgery, intra-aortic balloon pump surgery, or insertion of a temporary pacemaker. Major complications may cause permanent disability or even loss of life. Loss of life related to this procedure is very rear,that is about 1 in 1,000 .
What is the Alternatives to Angioplasty?
Alternatives to angioplasty include heart medications and coronary artery bypass surgery which is also known as open heart surgery.
Medication can dilate the blood vessels in the heart, but it cannot remove the blockages. Bypass surgery requires general anesthesia,
and it involves replacing a damaged artery in your heart with a healthy blood vessel or a man-made graft. The main objective of these
alternatives is to increase the blood flow to the heart.