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Common Drugs Used For Treatment of Heart Diseases

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Percutaneous Transluminal Coronary Angioplasty (PTCA)

Narrowed or blocked arteries may produce a heart attack , angina , or other problems. In some cases a special diet or medication or both may be the best treatment for such arterial problems; in other cases, bypass surgery or coronary angioplasty may be the best answer. The full name for coronary angioplasty is percutaneous transluminal coronary angioplasty (PTCA). This means that, through the skin (percutaneous), a procedure is performed inside an artery (transluminal) of the heart (coronary) that reshapes (angioplasty) that artery.

The procedure is simpler than its name. PTCA is performed with local anesthesia while you are awake. This procedure is quite like the diagnostic procedure called coronary angiography.

Before the procedure:

You need to have a shower or bath on the morning of your angioplasty. This will make sure your groin area is clean and help to reduce the risk of infection. You will also need to shave your right groin area.

You should have a light breakfast before 6am on the day of your angioplasty. You must not eat anything else until after the procedure. You should however drink fluids freely until you have your angioplasty and continue to drink plenty of fluids for 12 hours afterwards.

On the day of the procedure: When you arrive at the ward you will be seen by a doctor or nurse who will take your medical history, perform a medical examination and insert a small tube (cannula) into one of the veins in your hand or arm for any medicines you may need. You will also have some blood taken for routine blood tests and a routine ECG (electrocardiogram ).

Procedure:

After a local anesthetic is injected into your groin or shoulder area, the physician inserts a hollow, flexible tube, called a guide catheter, into a leg or arm artery. While watching on a TV monitor that displays an x-ray image of the blood vessel and catheter, the physician guides the catheter into the narrowed coronary artery.  Fluid called contrast dye will be injected through the catheter into your heart arteries. This fluid can be seen under x-ray, so your doctor will be able to view and take ‘pictures’ of your heart arteries before, during and after your angioplasty.

A smaller catheter is then inserted inside the guide catheter. This one has a balloon at its tip. When the catheter tip reaches the area of obstruction in the coronary artery, the balloon is inflated for about half a minute to widen the obstructed part of the artery. While it is inflated, you may feel chest pain; when it deflates the pain will fade. Several inflations and deflations usually are necessary.

Then the balloon catheter is removed, and more x-rays (angiograms) are taken to see how blood flow has improved. The entire process usually takes between 30 and 90 minutes. The procedure also may be used to treat blocked arteries elsewhere in the body, including the legs. An angioplasty is usually performed through the large artery in your groin. Some cardiologists prefer to do this procedure through a blood vessel in your arm. The procedure is very similar. Your cardiologist will explain this to you in more detail if this method is chosen.

In a small percentage of cases, the procedure is unsuccessful and bypass surgery  is necessary; usually, a surgical team is available to proceed immediately. When the angioplasty alone is successful, the need for major surgery and the use of a heart-lung machine are avoided.

Recovery and Rehabilitation:

For 24 hours after the procedure, your heart rate and rhythm and other vital signs will be closely monitored. Because the procedure involves insertion of a small catheter through the skin, the incision is small and many people go back to work a week after the procedure.

Your doctor will usually explain the results of your procedure to you immediately after it is finished, or he/she will come to see you once you are back on the ward. You will be taken to the recovery area for about 20 to 30 minutes and then back to your ward.

The sheath is commonly left in place as we need to wait for the heparin (a blood thinning medication used during the procedure) to wear off. It is very important to lie flat, keeping your leg straight whist the sheath is in your leg. After taking a blood test to check that the heparin has worn off (about 3-4 hours after you have returned to the ward) your nurse will remove the sheath. This will be done either by applying firm pressure to the area for about 15-20 minutes or by using a special device that puts firm pressure on your groin for about an hour. This may be uncomfortable, but is necessary to stop the bleeding.

Who Is a Candidate for PTCA?

People whose angina has not been relieved by medications are candidates for this procedure. The ideal candidate has only one narrowed artery, although many persons with several areas of narrowing can undergo PTCA. The decision to recommend PTCA rather than bypass surgery is based on the location, number, and severity of blockages as well as on the overall function of the heart.

However, the procedure does not cure the underlying disease. In fact, the procedure may have to be repeated to reopen the same or another coronary artery that becomes blocked. In future years, physicians may be able to remove plaque by using laser light or mechanical devices.

Wound care

It is normal for your groin to be tender for a few days after the angioplasty. It is also normal for a bruise to develop. However, if you notice any of the following please contact your doctor:

  • A hard tender lump under the skin around the area of incision.
  • Pain, swelling, redness and/or discharge at the site
  • A cold foot on the same side as the procedure.
  • A raised temperature/fever.

If your groin starts to bleed you should lie down and apply pressure to the area keeping your leg as straight as possible. If the bleeding does not stop after 10 minutes dial 911.

 

 

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