Coronary Angioplasty and Stenting
What is Coronary Angioplasty?
It is a procedure that widens narrowed part(s) of your coronary artery (usually caused by athersclerosis.) Using x-ray pictures for guidance, a special tube (called a catheter,) with a deflated balloon attached to its tip, is passed via your groin into the coronary artery and positioned within the narrowed part. The balloon is then inflated to widen the artery to help blood flow better. Once the artery is opened the balloon is deflated and removed.
What is Stenting?
During the angioplasty procedure a stent (a metal mesh or coil tube) can be inserted into the newly opened artery. It presses against the artery wall keeping it open. Some stents are coated with medication to help stop the artery narrowing again. These are called ‘drug eluting stents’. If you have a stent you will be given some medication which thins your blood and prevents blood clotting on the stent.
When is angioplasty done?
Angioplasty is usually arranged in advance but occasionally is done in an emergency after a heart attack to try to improve blood flow throught the coronary artery.
How will angioplasty help me?
It may help more blood flow through your coronary arteries. You may be able to live a more active life with less medication.
How can I help angioplasty work well?
Make changes to your lifestyle to reduce the chance of more heart problems developing. Discuss these with your doctor or nurse.
Coronary Artery Bypass Graft Surgery (CABG referred to as ‘cabbage’)
What is CABG?
CABG is an operation to bypass any narrowed or blocked segments of your coronary arteries. A piece of a vein is usually taken from your leg (occasionally your chest wall or arm may be used instead.) This is used to redirect the blood flow so that the area of the coronary artery which is narrowed or blocked is bypassed and there is a new channel for blood to flow to the heart muscle. This is called a graft.
Why do I need a CABG?
CABG surgery will help your angina symptoms and enable you to have a more active and better quality of life, with less or no angina and less medication. Lifestyle changes will also help prevent your angina returning.
Will the operation cure me?
CABG treats symptoms of heart disease, but does not cure it. For 8 out of 10 patients, it is successful in giving immediate and lasting relief from their angina but there is still a chance that the artery may become narrow again. By making improvements to your lifestyle you can give the operation the best chance of being successful.
What should I do to prepare myself and my family for this surgery?
- Things to do: If you smoke, STOP. Smoking will slow your recovery and may block the new graft. It will take you up to 3 months to recover so sort out any legal or business issues which would need to be attended to within this time. If you work, tell your employer you will return to work within 6-12 weeks, and arrange to take this time off sick.
- Where will I go? Should you need to go to another hospital for your operation, your local hospital normally pays for your traveling costs. Your doctor will tell you who to contact to make this arrangement. If you have your operation away from your home town, there may be hospital accommodation which your relatives could use. Contact the hospital social work department to discuss any social or practical issues.
- What should I take? When you go to hospital take loose fitting sleepwear and clothes. Women should take a supportive, cotton bra, one size bigger than their usual size. Do not stop taking any of your usual medication unless your doctor tells you to. Bring all your medication to hospital with you. Don’t take valuables unless you really need them. You will have to remove all jewellery when you go for the surgery anyway it’s best to leave them at home.
When will I have the CABG?
Your doctor will advise you when your CABG surgery will take place and what it will involve. The waiting time you are given may not be exact and even when you are given a date, you may find the appointment is cancelled. This can even happen once you have been admitted. Appointments are not cancelled unless absolutely necessary and it is usually because an emergency case has had to take priority.
What is Cardioversion?
Cardioversion is used to correct abnormal heart rhythms (arrhythmias) such as atrial fibrillation (AF) while you are under general anesthetic. An electric shock is sent through your heart. You will not feel it. It temporarily stops all electrical activity in your heart so your heart rhythm can return to normal. Cardioversion restores a normal heart rhythm in nearly all (up to 95%) of patients and is performed in hospital.
What to expect…
- On the day of Cardioversion : do not eat for 4-6 hours beforehand. You will be given medication to help thin your blood and a general anesthetic so you are asleep throughout the procedure.
- Afterwards: you may have sore chest muscles for a few days and may need to take regular painkillers to help this. You may have slight burn marks which should heal normally.
- When you go home : even if Cardioversion works for you, the arrhythmia may happen again. You will probably be prescribed drugs to help prevent this.
What is pacemaker?
A pacemaker helps your heart beat regularly. It is a small electrical device, sealed in a metal case and placed under your skin. It senses whether your heart is beating normally and if not it produces an electrical impulse, which is sent directly to the heart via lead/s making it beat. The pacemaker can:
- Control your heart’s pumping action at a set rate.
- Help co-ordinate your heart’s pumping action.
- Increase your heart rate in response to physical activity demands.
It activates when your heart is beating too slowly, i.e. slower than the rate that your pacemaker is set at. This rate can be changed to meet your needs. The pacemaker can also be programmed to not activate at times when your natural heart rate would normally slow down, e.g. when sleeping.
Catheter Ablation Therapy
What is catheter ablation therapy?
This can be used to correct fast arrhythmias. Under x-ray guidance one or more fine tubes (electrode catheters) are fed into a vein and/or artery usually from the groin area. When the area of the heart which is causing the problem is found, the ablation catheter is placed near it. The catheter tip emits radio frequency energy which destroys the affected areas which causes scarring, which prevents any further electric signals being emitted. It takes up to 3 hours and is normally not painful although you will need to stay in hospital for a short time afterwards. Depending on how many electrical pathways needed to be destroyed, you may also need to have a pacemaker fitted.
Implantable Cardiovertor Defibrillator (ICD)
This electrical device is used to correct fast, life threatening arrhythmias to normal when other treatments have not worked. It is implanted into the chest below the left collarbone. It can monitor record and correct arrhythmias by giving your heart a shock when and if they happen. If the ICD does shock your heart you are likely to feel this and it may be painful.
Certain patients with atrial fibrillation and/or enlarged atria, may be recommended to have the Maze procedure which can treat the atrial fibrillation and restore the atria to a more normal size. During the Maze procedure, a series of precise incisions are made in the right and left atria to interrupt the conduction of abnormal impulses. This allows sinus impulses to travel to the atrio-ventricular node (AV node) as they normally should following Maze procedure. If successful, the Maze procedure can provide:
- Long-term freedom from atrial fibrillation
- Decreased symptoms
- Greatly reduced risk of embolic events (such as blood clots or stroke)
- Decreased atrial (top chamber of the heart) size in those with enlarged atria prior to surgery.
For more information about this procedure click this link: http://www.clevelandclinic.org/heartcenter/pub/atrial_fibrillation/maze.htm or http://www.sts.org/doc/4511 Click here to read the Society of Thoracic Surgeons Information about Maze Procedure.