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Coronary Angioplasty ballooning your heart to heatlh
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Beginning as a medical curiosity in the year 1977, coronary angioplasty has blossomed into a widely accepted alternative treatment to open-heart coronary bypass surgery. A mere two hour procedure with a promise of a quick return to normal life after a shortest hospital stay, it is becoming increasingly popular the world over. About 500,000 patients benefit from it annually.
What is coronary angioplasty?
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Is coronary angioplasty useful in all kinds of CAD patients?
How is this selection of patients for angioplasty made?
What kind of preparation is required before the angioplasty is undertaken?
How long is the procedure? Is the patient put under sleep while it is performed?
Does it not cause any pain, not being anaesthetized?
What are the steps in the procedure?
By what time is the patient back on his toes, fully recuperated?
What are the risks of undergoing angioplasty?
In such cases, can a repeat angioplasty help?
Would a bypass surgery not have been more useful?
What is coronary angioplasty? Top
It is a technique aimed at restoring normal blood supply to the heart by opening narrowed, clogged coronary arteries. To achieve this, a special kind of balloon catheter is used. The catheter is pushed into the body by puncturing an artery in the leg, or, occasionally, the arm, and threaded all the way to the blocked coronary artery. On reaching the exact site of obstruction, the balloon-fixed catheter tip is inflated. This acts to compress the fatty plaque-laden area in the artery and restores its inner calibre back to normal. The procedure requires no opening up of the patient, other than the tiniest of incision given at the arterial site from where the catheter is pused in.
Is coronary angioplasty useful in all kinds of CAD patients? Top
Its usefulness is limited to only certain kind of patients. Patients with single, or in a few cases, two, blocked coronary arteries, with the block lying close to the beginning of the artery, and the narrowing not having gone hard with calcium, are suitable cases for angioplasty. Such patients constitute 10% of those who would, otherwise, require bypass surgery.
How is this selection of patients for angioplasty made? Top
All patients of CAD not responding to medical treatment
and being considered for surgery need to undergo a heart; catheterization to determine the exact nature of their heart problem. Special dyes are injected into the coronary bloodstream so that arteries feeding the heart get clearly defined in the motion pictures taken on a kind of X-ray machine.
These pictures of the heart arteries constitute an angiogram. They give the physician a detailed look at the condition of the coronary arteries-providing the exact site(s), number, and kind of blocks they harbour. Depending 0)1. information thus available, a decision is taken
whether an angioplasty or a bypass surgery is required.
What kind of preparation is required before the angioplasty is undertaken? Top
Some routine diagnostic tests-an ECG, blood tests, chest X-ray-may be performed. The cardiologist reviews the angiogram in great detail.
After these preliminaries are over and a formal date and time decided upon, the patient is admitted to hospital a day before the scheduled angioplasty. After partaking a light dinner, the patient is asked not to eat or drink anything until the time ngioplasty procedure is over the next day. He receives medication at bed time which helps him relax.
How long is the procedure? Is the patient put under sleep while it is performed? Top
The procedure usually takes two hours. It does not require putting the patient under sleep, or general anesthesia. He is awake and alert throughout the procedure.
Does it not cause any pain, not being anaesthetized? Top
The pain is limited to the prick of the needle of the hypodermic syringe, used for injecting local anaesthetic at the site where the catheter is pushed into the artery. After a momentary stinging sensation, this makes the area numb and one does not feel a thing throughout the procedure. However, there can be another kind of pain, of which we shall talk a little later.
What are the steps in the procedure? Top
Patients who have undergone an angiogram will find that an angioplasty procedure is a very similar experience, It is performed in a cardiac catheterization lab. The patient lies on an X-ray table with a camera moving over the chest area. The doctors wear a lead apron.
The procedure begins by making a tiny incision under local anaesthesia over an artery, most often in the upper leg or groin area, but sometimes in the arm. A sheath is inserted through this opening for a catheter to pass. The catheter is then pushed under X-ray guidance to the blocked coronary artery.
Then a smaller tube with a tiny, uninflated balloon at its tip
is threaded through the larger tube and taken to the plaquenarrowed area of the artery. The balloon is inflated for several seconds, flattening the fatty plaque against the artery walls and opening the passage.
Every situation is unique, but in most cases the inflation will last from 30 seconds to several minutes. The balloon is inflated at least twice; however, it may have to be inflated ten or more times.
When the balloon is inflated, some people feel chest pain that is similar to the angina they've experienced. This happens because the balloon is temporarily blocking the artery and thus, the flow of blood and oxygen it carries to the heart. The patient
should tell the doctor if he feels such pain.
The balloon catheter, having done its job, is withdrawn and the physician takes a set of pictures with the X-ray device to verify the success of the procedure.
How long must the patient stay in the hospital after angioplasty is over? What kind of care does he require during this period? Top
After angioplasty is over, most hospitals require the patient to be taken to the cardiac care unit, where blood pressure readings, pulse monitoring and ECGs are regularly performed. If a patient experiences any chest discomfort or pressure during the recovery period, the nurse or physician should be told right away.
Recovery in the hospital is usually just a matter of allowing the arterial puncture site to close up. Patients are, therefore, required to hold their leg or arm straight and still for six to eight hours.
After a day or two, most patients leave the-hospital for home.
By what time is the patient back on his toes, fully recuperated? Top
It is usually a matter of eight to ten days before he can resume full activity.
What are the risks of undergoing angioplasty? Top
In judiciously selected patients and trained medical hands, angioplasty, or PTCA-as it is technically called-is a safe and effective procedure. There is, however, a small risk of complications, requiring emergency bypass surgery in about' 3% of cases and a risk of death in lout of 200 cases. Therefore, a full operating surgical team and the operation theatre has to remain at a stand-by while angioplasty is under way.
How are the results? Top
Success rates- of angioplasty vary from 87 to 94% round the world. But, it has been found that in some cases-about one-third-the arteries get clogged again and become narrow, leading to reappearance of the disease.
In such cases, can a repeat angioplasty help? Top
Yes, possibly; although the severity of the disease needs to be reassessed.
Would a bypass surgery not have been more useful? Top
The answer is, probably no. Recurrence of the narrowing of an artery occurs largely because neither angioplasty nor bypass surgery claims to cure the disease. These procedures are merely attempts at reviving the fuel lines of the heart. To stem the disease, the best way is to make the required changes in lifestyle and minimize the risk factors.
Angioplasty has been called a revolution in the treatment of coronary artery disease. What precisely are its major benefits? Top
The benefits are not difficult to see. The relative ease of the procedure, its high success rate, and the short hospital stay with early resumption of full normal activity are its obvious. advantages. In comparison to bypass surgery, the costs to the hospital and the individual are much lower.
Are the facilities for angioplasty available in India? How are the standards when compared to the West? Top
Facilities for angioplasty exist in several cardiac care hospitals of the country today. The results are comparable with those of the most advanced centres of the world.
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