Heart is made of a special muscle. This muscle pumps blood into arteries which supply blood to all parts of body. Coronary artery disease affects nearly about 61 million people across the world, making it a leading form of heart disease. Latest healthcare predictions estimate that by the year 2020, heart disease especially coronary atherosclerosis will be supreme global cause of total disease burden. When coronary artery of patients is blocked, heart muscle will starve from nutrients & oxygen & this condition often leads to angina, myocardial infarction or heart attack. Percutaneous coronary intervention, commonly called as coronary angioplasty is a restorative procedure to manage & treat narrowed coronary arteries of heart caused due to coronary heart disease.
What is Coronary Angioplasty?
Coronary arteries are the main vessels supplying blood to heart. The term angioplasty implies using a balloon to stretch open a blocked or narrowed artery. Coronary angioplasty is a procedure which is used to broaden narrowed or blocked coronary arteries. However, latest angioplasty procedures also involve inserting a wire-mesh tube, known as stent, into the artery. Stent is left in position permanently to permit flow of blood freely through the arterial passage. Coronary angioplasty is many times referred to as percutaneous transluminal coronary angioplasty while a combination of coronary angioplasty along with stenting is generally called as percutaneous coronary intervention. Coronary angioplasty is less invasive & requires shorter recovery time than conventional bypass surgery.
Heart needs constant blood supply for working like all other organs inside the human body. Blood is supplied to heart by coronary arteries. These arteries can sometimes become narrowed due to following reasons.
- Atherosclerosis – In older people, coronary arteries can become hardened & narrowed causing coronary heart disease. This condition is known as atherosclerosis.
- Angina – When flow of blood to heart is restricted, it leads to pain in chest & this condition is known as angina. Angina is generally triggered by stress or physical activity.
- Ischemia – Evidence of significantly reduced blood flow to a portion of heart muscle caused by a contracted coronary artery.
While conditions like angina can usually be treated with proper medications, coronary angioplasty however may be necessary to restore heart’s blood supply in extreme cases where primary medication has proven to be ineffective. Coronary angioplasty is also often performed as an emergency treatment after heart attack.
Main Function of coronary arteries is to supply oxygen & blood to heart muscles. Coronary artery disease may develop & cause trouble to any individual who is experiencing the following signs & symptoms.
- Coronary artery disease may develop when cholesterol plaque, which is a thick & hard substance consisting varying amounts of cholesterol, muscle cells, calcium & connective tissue, accumulates inside the walls of coronary arteries resulting in arteriosclerosis.
- Arteriosclerosis causes serious narrowing of one or more coronary arteries over time.
- When coronary arteries contract more than 45% to 75%, blood supply beyond plaque becomes insufficient to meet increased demand for oxygen during exercise.
- Shortfall of oxygen in heart muscle results in chest pain in most patients. However, some 20% of those with severe coronary artery narrowing experience no pain in chest at all or may only observe shortness of breath. These patients are said to have silent angina & have an equal risk of heart attack.
Coronary heart disease can be diagnosed with the help of several tests as elaborated below.
- EKG – Resting electrocardiogram records the electrical activity of heart & shows changes indicative of heart attack or ischemia. Often, EKG in patients with coronary artery disease is regular & normal at rest & it only becomes irregular when heart muscle ischemia is brought on by any exertion. Bicycle testing (stress tests) or exercise treadmill are convenient screening tests for patients suffering from coronary artery disease & a regular resting EKG. These tests give 50% to 60% accuracy in diagnosing coronary artery disease.
- Nuclear Agent – If the above stress tests are not diagnostic, a nuclear agent generally, cardiolite or thallium can be given to patients intravenously during stress tests. These agents help imaging of blood flow to various areas of heart, using an external camera. Reduced blood flow during exercise signifies substantial contracting of the artery.
- Stress Echocardiography – This test combines echocardiography that is ultrasound imaging of heart along with exercise stress testing. It is a precise method for detecting issues in normal functioning of coronary arteries. Echocardiography & thallium stress tests are 85% to 90% accurate in identifying serious coronary artery disease.
- Intravenous Medications – When patients cannot undergo an exercise stress test due to arthritic or neurological problems, helpful medications can be given intravenously to simulate stress on heart which is typically brought on by exercise. Heart imaging can be done with either echocardiography or with help of a nuclear camera.
- Coronary Arteriography – Cardiac arteriography is a process of cardiac catheterization with angiography. Basically, it is a method that allows X-ray images to be taken of coronary arteries. It is most authentic test to identify narrowing or hardening of coronary arteries. Catheters (small hollow plastic tubes) are progressed under X-ray to opening holes of arteries. Afterward, an iodine contrast dye is injected into coronary arteries while at same instant of time an X-ray video is recorded. This test gives a picture of severity of hardened artery segments. This helps the cardiac surgeon in selecting proper medications, percutaneous coronary intervention or any other treatment option which is most suitable alternative procedure.
- CT Coronary Angiography – High-speed CT coronary angiography is the latest, lesser invasive method. It involves dye & radiation exposure but catheters are not required in this test which decreases risk of this procedure.
Coronary angioplasty can be performed by several techniques depending upon the requirement of patient & the heart condition.
- Balloon Angioplasty – A specifically designed catheter with a tiny balloon is attentively directed through artery to the blockage site, then expanded to widen the opening & boost blood flow to heart. A stent is generally placed during this procedure so as to keep the artery open after balloon is exhausted & eliminated.
- Carotid Artery Angioplasty with Stent Placement – This is a minimally invasive process in which a little hollow tube or catheter is positioned ahead from a blood vessel in groin region to carotid arteries. Once catheter is in position, the balloon may be bloated to open the artery & a stent is placed inside.
- Laser Angioplasty – This technique is performed for vaporizing blockage in affected coronary artery.
- Percutaneous Transluminal Angioplasty – This technique is a newer, minimally invasive procedure used to open narrowed femoral artery & to regulate arterial blood flow.
Patients will receive instructions from cardiac surgeons about what they need to do. Some of these important instructions may include the following.
- If patients are consuming any blood-thinning medications such as warfarin or any anticoagulant, they will need to refrain from taking this for 3 – 4 days before tests in order to prevent severe bleeding from the site of catheter insertion.
- If patients are taking diabetic medicines or insulin, they may need to change timing of when they consume these. Several medications may require to be stopped for 48 hours. Cardiac surgeons will clarify this with patients prior to performing coronary angioplasty.
- Patients may be asked to stop drinking or eating for a few hours prior to the procedure.
- Patients may also be told to shave both groins before undergoing coronary angioplasty.
- Patients will have to sign a consent form before surgery to confirm that they understand the entire procedure & possible complications & agree to undergo coronary angioplasty surgery.
Few important questions can serve as a great beginning point for conversation of patients with their cardiologists during initial consultation for coronary angioplasty. Patients can use the following list of queries as a tool to help them talk to surgeons about angioplasty & stent placement procedure.
- What will be the benefits of coronary angioplasty for me?
- What are the risks involved with coronary angioplasty?
- Are there any alternatives for me apart from undergoing coronary angioplasty?
- Could I be treated with only medicines instead of undergoing coronary angioplasty?
- Do I require a stent, or would coronary angioplasty alone be just as efficient?
- Will coronary angioplasty save my life?
- How long do I need to stay in hospital after my coronary angioplasty procedure?
- How much time will it take for me to get back to my regular routine?
- What restrictions & limitations will I have to follow after coronary angioplasty in long term?
Coronary angioplasty procedure takes place in the following steps.
- Anesthesia – Coronary angioplasty is performed by cardiac surgeons using local anesthetic, which means patients will be awake while the procedure is being carried out.
- Catheter Insertion – A narrow flexible tube known as a catheter will be inserted into one of the arteries of patients through an incision in the groin, arm or wrist. This is progressed to affected coronary artery with the help of an X-ray video. When catheter is properly placed, a thin wire is inserted down the length of artery, dropping a balloon to affected portion of artery. Balloon is then expanded to widen the coronary artery, compressing fatty deposits against artery walls so that blood can flow through it more easily when the shrunken balloon is evacuated.
- Stent – When surgeons use stent placement, this will be wrapped around thin balloon before it is inserted. Stent will extend when balloon is enlarged & it remains in position after deflation & removal of the balloon.
- Completion – Entire procedure normally takes between 45 minutes & three hours of time. If patients are being treated for angina disease, they may be able to go home later the same day. Patients however need to refrain from lifting heavy weights & excessive strenuous activities for at least a week after surgery. If patients have been admitted to hospital after a heart attack, they will however need to stay in hospital under the observation of cardiac surgeon for a few days more after coronary angioplasty.
In case patients had a non-emergency procedure, they will probably need to stay hospitalized only for one day while cardiac surgeons monitor the heart & important medications are adjusted. Patients will be able to return to their daily work & routine after a week following coronary angioplasty. If patients needed coronary angioplasty during a heart attack, their stay at hospital & recovery phase will be longer. Patients should ask their cardiac surgeons or nurses about restrictions & limitations in performing strenuous activity. Patients should drink plenty of water & fluids in order to stay hydrated & boost healing. Healthy diet & routine will also help the patient recover faster.
Chances of risks & complications from a coronary angioplasty mainly depend upon the factors mentioned below.
- Age of the patient
- General health of patients
- Whether patients have had a heart attack
Patients should immediately contact the doctor or hospital staff under the following conditions.
- When the site where catheter was positioned begins to swell or bleed
- Extreme pain at the site of catheter
- Signs of moderate to severe infection, such as swelling, redness, fever or drainage
- Noticeable change in temperature or color of arm that was used for coronary angioplasty
- When patients feel weak or faint
- Shortness of breath or chest pain
- Kidney failure
- Stroke is a rare complication
Rarely, some patients die during coronary angioplasty as a consequence of one of these severe complications.
Coronary angioplasty significantly increases blood flow through blocked or hardened coronary arteries. Patient’s chest pain generally diminishes & they may be fit enough to exercise. Undergoing coronary angioplasty doesn’t necessarily mean patient’s heart disease goes away. Patients will still need to maintain healthy lifestyle habits & take prescribed medications on time. If symptoms like shortness of breath or chest pain recur, then patients should immediately contact the cardiac surgeon. In order to keep their heart healthy after coronary angioplasty, patients must follow mentioned points.
- Stop smoking
- Maintain low cholesterol levels
- Maintain a stable & healthy weight
- Control diseases like diabetes & high blood pressure
- Exercise regularly
Following these guidelines, patients will reap the best benefits of a successful coronary angioplasty.
Merits of Medical Tourism in India for Coronary Angioplasty
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Affordable Coronary Angioplasty with Travcure Medical Tourism
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