Cardiac catheterisation and coronary angioplasty
Vejthani Cardiac Center
Why should we have our coronary arteries checked?
The heart is an important organ, circulating blood into every part of our bodies. Coronary artery disease, or CAD, is a commonly found disease among Thais and lately it has become the number one killer in the country.
Coronary artery disease (CAD) is a condition in which plaque mostly made up of fat builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood.
Plaque narrows the arteries and reduces blood flow to your heart muscle. No symptom is shown at first, but when the arteries are 50% narrower from their actual diameters, some illness signs become more obvious. It also makes it more likely that blood clots will form in your arteries. Blood clots can
partially or completely block blood flow.
When your coronary arteries are acutely blocked, your heart muscle experiences an immediate lack of blood. A heart attack occurs when the blood flow to an area of your heart muscle is completely blocked, causing it to die. Without quick treatment, a heart attack can lead to serious problems or even death.
In the long run, CAD can weaken the heart muscle and lead to heart failure. Your heart cant pump enough blood throughout your body, leading to problems in the speed or rhythm of your heartbeat.
Warming signs
Some of the warning signs of CAD may be pain in the chest, a colicky pain right at the centre of the chest and difficulty in breathing as if something heavy was put on your chest. You might experience some pain in your neck, let arm or jaws. This can be associated with sweat and/or nausea. These symptoms often occur when you are exercising, but your condition can quickly be back to normal when you stop to rest or take heart medication. The smaller diameter in your arteries, the more severe your symptoms will be, which could even result in cardiac arrest.
How is coronary artery disease diagnosed?
If your doctor thinks you have CAD, he or she will probably do one or more of the following tests.
through body check
chest x-ray
blood tests
electrocardiogram (EKG)
Echocardiography
Stress testing or exercising to make your heart work and fast while heart tests are performed.
Your doctor will make a decision as to what kinds of tests and how many types of tests you should undergo.
What is cardiac catheterization?
Your doctor may ask you to have a coronary angiography if other tests or factors show that youre likely to have CAD. This test uses dye and special x-rays to show the inside of your coronary arteries.
The get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization. A long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is then threaded into your coronary arteries, and the dye, a radiopaque substance, is released into your bloodstream. Special
x-rays are taken while the dye is flowing through your coronary arteries.
(The radiopaque substance is iodine, which is found abundantly in seafood. The amount used is not harmful to the human body, except in patients with a seafood allergy background or patients with kidney problems. Then its up to your doctor to consider whether to lower the amount of iodine or charge to other methods.)
Cardiac catheterization is the most accurate testing method. Doctors can directly see how serious a blood clot is in the arteries or how many problematic spots occur. Moreover, they can determine what the best treatment is. Cardiac catheterization procedures can be finished within -1 hour.
Due to the fact that the method has 99.99% accuracy, it is widely believed to be the Gold Standard Test or the summary of all artery check-ups.
The preparation before cardiac catheterization
Usually, the catheter is put into your blood vessel at the right of your groin. Patients should clean themselves thoroughly, especially around the groin and thighs before the procedure. Refrain from eating and drinking 4-6 hours before catherisation. Your may drink a small amount of water when you ar taking your medicine. If you experience severe thirst, you can take a sip, leave the water into your throat for a while and then spit it out. Patients who take anti-coagulant such as Warfarin should stop taking the pill at least three days before catheterization.
Hair around the groin will be shaved off and cleaned with an antiseptic. Nurses also open blood vessels at the back of a hand or a wrist. On the operation day, patients should have a family member present at the hospital because after the test, patients are usually referred to receive treatments, depending on the doctors choices.
After having catheterization, patients should drink a high amount of water as to drain the radiopague substance out. They should lie down on the bed for 4-6 hours. Lying on one side is allowed, but bending at the groin is prohibited. While lying on the bed, you should not bend the body more than 30 degrees. Standing up, sitting and walking without help is not allowed. The next day, if there are no problematic symptoms, you are dismissed. You might continue your daily activities after taking a days rest. However, in the first day or two. You should not walk often and should keep the plaster over your wounded groin intact for 3-5 days to prevent water from getting into the open wound. You should see your doctor on every appointment. If you are having chest pains or other symptoms, you should immediately consult your doctor.
Coronary angioplasty
Cardiac catheterization is merely a diagnostic method. The treatment of the problems your doctor just found is called Coronary Angioplasty.
Coronary angioplasty is a procedure where a narrowed section of a coronary artery is widened by using a balloon and a stent attached to a catheter. Before the operation, a patient is given an anti-coagulant and then a special catheter with a balloon on its tip is inserted into the coronary artery. The balloon is blown up at the narrowed section of the artery to force it wider so that more blood can go through to the heart. In some cases, extending blood vessels with a balloon is insufficient. Doctors might consider putting in a special kind of tube or stent to extend gap in the blood vessel.
This method has an 85-99% rate of curability. However, it has its own limitations and we cannot use the method to replace a full surgery in some cases. It depends on your doctors choice as to what is best for your. In severe cases of this disease, and if the patient is fit for treatment, coronary angioplasty can be done after the cardiac catheterization is performed.
The procedure only takes 1-1 hours, depending on the location of the problem and the number of problematic spots. After the operation, the catheter might not immediately be taken out. A patient is placed in an observatory room for a while to make sure that he or she is in a stable condition. If so, they are moved to a heart disease patient ward. There, they are closely monitored over night. His or her heart waves will be checked all the time. The wards nurses will thoroughly check to make sure there are no other problems occurring, such as chest pain, bleeding etc. If the patients condition is stable within 5-8 hours, the catheter is taken out.
The can move to a normal room where their family members are waiting for them. Then, the doctor will make a decision regarding dismissal.
The advantages of coronary angioplasty are the immediate curing of the chest pain and a short rehabilitating period. Most patients can leave the hospital within one to two days. Then he or she can go back to normal daily activities within one week, compared to the 1-2 weeks or rehabilitation and the 3-4 weeks spent returning back to regular daily life that heart surgery requires.
After the treatment, your doctor explains how to take care of yourself. Some activities or food will be prohibited to control the risk factors that caused the heart problem in the first control the risk factors that caused the heart problem in the first place. Medication and a proper diet are suggested.
Seeing your doctor at the time of the scheduled appointment is crucial. There you will have everything properly checked such as the hearts capacity of blood circulation and any signs of CAD.
You can be happy, healthy and have a high quality life if you take good care of your heart.
Source: Vejthani Cardiac Center
