cholesterol plaque | Dr Raghu

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Coronary arteries are the blood vessels that delivers oxygenated blood to the heart muscle. But, sometimes these blood vessels may get narrowed or blocked due to accumulation of cholesterol plaque. To open the blockage and restore the function of arteries, coronary angioplasty is performed.

A coronary angioplasty involves the temporary insertion of a tiny balloon inside the artery to open the blockage. It is usually combined with the placement of a stent (a metal mesh tube) to widen the artery and prevent the further chance of narrowing.

coronary angioplasty

Why is coronary angioplasty done ?

Coronary angioplasty is done to treat narrowing or blockage of the heart’s blood vessels:

  • during or after a heart attack.
  • Blood vessel narrowing leading to poor heart function.
  • For relief of chest pain (angina) due to reduced blood supply to heart.

Risks of coronary angioplasty

Usually, it is a safe procedure, but like all other procedures, it also carries certain risks like:

Common Issues/Risks after angiography
Bruising Common to have bruise at groin or arm Lasts for few weeks Not to be worried about
Allergic reactions Usually related to contrast medicine used History of previous allergy – higher risk Present as rash and headache
Bleeding at the site of entry (Hematoma) Usually subsides in a few days But in case swelling is increasing and painful contact your physician immediately

Serious complications after coronary angiography Less than 1 in 1000 chance People with severe heart disease are at high risk Discuss with Cardiologist before procedure
Heart attack A serious medical emergency where the heart’s blood supply is suddenly blocked
Stroke A serious medical condition that occurs when the blood supply to the brain is interrupted
Loss of blood supply to limb Damage to the artery in the arm or groin in which the catheter was inserted, with the blood supply to the limb possibly being affected
Kidney injury Damage to the kidneys caused by the contrast dye
Radiation injury Tissue damage caused by X-ray radiation if the procedure is prolonged

What happens before the procedure?

A physical examination and blood test are done to evaluate the overall health condition. The person needs to follow instructions provided before undergoing the procedure:

1. Inform the doctor about:

  • Any allergies
  • The use of current medicines, including vitamin and mineral supplements
  • Any blood disorder
  • Any surgery you may had
  • The past and present medical condition

2. Medicines:

Tell the doctor if you are using blood thinners or any anti-diabetic medicines. The doctor will either advise you to stop or change the dose of the medication.

3. Food and fluid restrictions:

  • Avoid heavy meals, such as meat, fried or fatty foods eight hours before the procedure. Take light foods such as toast and cereal.
  • Fast for six hours before the procedure.
  • Stay hydrated, drink plenty of fluid up to two hours before the procedure.

In most of the cases, you will be discharged on the same day of the hospital, so ask someone to accompany you to the hospital.

What happens during the procedure?

Local anaesthesia would be administered to numb the area where the catheter would be inserted. Mostly, a catheter is inserted through the wrist, and sometimes through the groin. Under fluoroscopy (a type of X-ray), the catheter will be guided to the diseased artery. Then a special medicine (called contrast or dye) will be injected into the blood vessels supplying the heart. This will delineate the presence of obstruction to blood flow. 
Then a wire is passed across the obstruction and a balloon is inflated at the site of obstruction to compress the obstructing plaque in the artery. The balloon expansion will compress the plaques into the wall of the blood vessel and improve the blood flow. Once the blood flow is improved, the catheter will be removed, and a stent would be placed to prevent the risk of further blockage. Finally, the catheter will be removed and the puncture site is sealed.

What to expect after the procedure?

The nurse will check the vitals of the patient. Depending on the condition, the doctor would advise you the hospital stay. You will be advised not to bend or cross the leg for a few days if the procedure is performed through the groin region. Additionally, some other tests like X-rays and an electrocardiogram (ECG) would be done to check the condition. Before discharge, the doctor will give you certain instructions regarding wound care, medications and lifestyle.

Recovery after coronary angioplasty

Recover quickly and keep your heart healthy by following these tips:

  • Quit smoking.
  • Limit the intake of alcohol.
  • Take the prescribed medicines.
  • Check the cholesterol levels regularly.
  • Maintain a healthy body weight.
  • Have a healthy and well-balanced diet.
  • Exercise regularly.

Know your numbers

It’s important to periodically monitor and maintain the following numbers to prevent future cardiac events

  • LDL cholesterol – less than 55 mg/dL
  • Blood pressure – less than 120/80 mm Hg
  • Blood sugar – HbA1C less than 7.0%

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