Coronary Heart Disease and Cardiac Catheterisation
Coronary Heart Disease
Coronary heart disease results in an under-perfusion of the heart muscle due to changes in the arteries which surround the heart. These arteries (coronary arteries) become clogged so that the supply of oxygen and nutrients to the heart muscle is inadequate. These narrowed sections are mostly due to fat-like deposits and hardening of the blood vessel wall, similar to calcifications in water pipes. This hardening of the arteries is commonly known as arteriosclerosis.
One of the major symptoms of coronary heart disease is a tight feeling in the chest, also called angina pectoris. The aim of treatment in coronary heart disease is, first of all to alleviate the symptoms of angina pectoris and to avoid more serious problems, such as a heart attack. Heart rhythm disorders can also be due to coronary heart disease.
How is a heart catheter examination carried out?
Your specialist has performed various tests, such as a stress electrocardiogram (ECG), in order to make an exact diagnosis. This also includes performing coronary angiography, which is carried out during a heart catheter examination. A special contrast agent is injected into the coronary arteries under local anaesthetic, so that x-ray images of the coronary arteries can be obtained. In this way,narrowing of the arteries can be seen and a correspondingtreatment can be undertaken. Your specialist will explain the treatment options if the diagnosis coronary heart disease is confirmed.
The objective of angioplasty, also referred as PTCA (percutaneous transluminal coronary angioplasty), is to free blocked coronary arteries so that the blood can flow normally again. A small balloon is first positioned within the blocked section (stenosis) of the artery and inflated. The deposits causing the blockage are pressed against the vessel wall so that the blood supply is improved again.
PTCA is carried out under a local anaesthetic in a heart catheter laboratory. An introducer is first put into place in an artery in the groin or arm, so that a guiding catheter can be introduced. The contrast agent needed is injected through this in order to be produce images of the coronary arteries on a screen with the help of an x-ray machine.
In the coronary angiogram, which is an x-ray contrast image of the coronary blood vessels, it is possible to clearly recognize a narrowing of the blood vessel on the left of the picture (the narrow section in the artery has been marked an is shaped like an egg-timer).
After the narrow section has been localized in the artery, a guide wire and a second catheter which has an inflatable balloon on the end are introduced and positioned by the cardiologist in the stenosis. The balloon is then inflated at the narrowed point, in order to restore blood flow. Sometimes the patient may feel a slight pain in the chest during the inflation, similar to angina pectoris. This is normal and you should tell the doctor, if you feel any pain. As soon as the artery has been sufficiently freed, the balloon pressure is released (deflation) and then removed with the catheter from the artery.Only a small wound remains at the point where the artery was punctured, and pressure then has to be applied using a compression bandage or sandbag in order to help stop the bleeding.
Following angioplasty, the specialist may decide to implant a stent straight away. A stent is a small stainless steel scaffold used to help keep the artery open. The stent is introduced into the artery with a catheter and, similar to angioplasty, inflated at the right position where blood flow is severely reduced. The stent remains permanently in position and helps to keep the artery open.
After the intervention
You will stay lying flat in bed after the operation and should keep the leg with the catheter introducer straight and still. The introducer will be removed from the groin after a while and a compression dressing or a closure system will be applied, in order to avoid bleeding. Bed rest is recommended for 12 hours with a compression dressing, or, if a closure system is used, according to the recommendations of the manufacturer. You will also receive anti-coagulant drugs or blood-platelet aggregation inhibitors in addition to your normal medication for at least 4 ? 6 weeks after the intervention. These are absolutely essential and help ensure that the unblocked vessel does not close up again.
Stent implantation in case of nickel allergy
Approx. 10% of the population are distinctly allergic to nickel, which arises as a ?natural? component in stainless steel. It is therefore important for patients with nickel allergy who are to receive a stent for the treatment of a coronary heart disease condition that their specialist knows this. Therefore, let your specialist know, if you react in an allergic way to nickel, so that a more suitable stent can be used.