With our state-of-the-art facility and highly trained personnel, Southern California Heart Centers commits to provide excellence in cardiac catheterization and an enhanced overall patient experience.


PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY (PTCA)

AND STENT PLACEMENT

PTCA:

Angioplasty is a procedure that is performed during heart catheterization to open blockages of the coronary vessels (the blood vessels that supply the heart). In general, it is performed when the blockage is so great that it produces symptoms such as chest pain or shortness of breath, or significantly increases the risk of suffering a heart attack. Angioplasty is not necessary for all blockages. On some occasions, all you have to do is adopt a healthier lifestyle and often take some medication to lower the risk factors that cause the progression of heart disease.

These may include:

  • Following a healthy diet
  • Staying physically active
  • Losing weight
  • Lowering blood pressure
  • Quitting smoking
  • Lowering cholesterol, especial LDL (bad) cholesterol
  • Controlling diabetes.

It is possible that other patients may not need to undergo an angioplasty, but may need to take medications to control the symptoms caused by blockages, such as chest pain and shortness of breath. In the case of patients who need to undergo an angioplasty, the doctor will analyze the risks and benefits of the procedure beforehand.

The procedure consists of inserting a catheter (a long and thin tube) with a small and narrow balloon at the tip in the coronary artery where the blockage is. Once the catheter is in the place of the blockage, the balloon is inflated, opening up the obstructed area.

STENT PLACEMENT:

In some patients, a stent is placed simultaneously to keep the artery open. A stent is a tube-shaped metallic mesh that is placed during angioplasty in the coronary artery to keep it open. The stent is at the tip of a thin catheter that has a tube-shaped balloon at the end. The stent collapses around the outside area of the balloon that is at the tip of the catheter. The catheter is then threaded through the arteries up to the heart and, finally, it is introduced into the coronary artery where the blockage is. When the balloon is blown up, the stent expands and is locked in place. The stent stays in the artery and keeps it open permanently. This way the blood flow to the heart muscle is improved and symptoms such as chest pain are relieved.

The size of the coronary artery and the location of the blockage determine whether stents must be used in the angioplasty to keep the coronary arteries open. Stents are used to try to decrease the risk of restenosis (repeat narrowing or reocclusion) appearing after the balloon angioplasty or other procedure in which catheters are used. Stents also help restore normal blood flow and keep the artery open if it has been opened or injured with the balloon catheter.


PREPARING FOR A CARDIAC CATH AND PTCA

Heart catheterization is generally performed on an outpatient basis. It is carried out at the hospital in a specialized procedures room known as catheterization laboratory. Before the angioplasty, a catheterization is performed to identify the area of blockage that needs treatment.

Medications:

Your doctor will tell you which medications you should take on the day of your examination. Don't stop any of your medications without first talking to your doctor. He will tell you which medications you should stop taking and when to stop taking them. Usually you will be instructed to stop taking aspirin or Coumadin (warfarin) a few days before the procedure. If you have diabetes, ask the nurse how to adjust your diabetes medications or insulin.

Food and drink

Eat a normal meal the evening before your procedure. However, DO NOT eat, drink or chew anything after midnight before your procedure. This includes gum, mints, and water. Try to take all your medications before midnight. If you must take medications after midnight, only take them with small sips of water. When brushing your teeth, do not swallow any water.


BEFORE A CARDIAC CATH AND PTCA

The patient should wear comfortable clothing and leave all jewelry and valuables at home. You will change into a hospital gown for the procedure. Remove all makeup and nail polish. If you use false teeth, eyeglasses or hearing aids, you must use them during the procedure to be able to communicate.

Please bring the followings items with you:

  • Prescription or referral from your physician
  • Insurance cards and identity cards issued by government
  • A one-day supply of medications. Do not take the medications without first talking with the doctor or nurse.

When you arrive, you may have to complete additional medical information. You must know the name of all the medications you take and whether you are allergic to anything. Do not forget to remind the doctor or male nurse if you suffer from any allergy. This is especially important if you are allergic to iodine, shellfish or radiographic dye. It is also important to report an allergy to latex. Some medications could increase the risk of suffering complications due to the catheterization. These include aspirin and related medications, Coumadin (warfarin), Plavix (clopidogrel), diuretics and insulin. Take a list of your medications (including over-the-counter ones) and the doses.


DURING A CARDIAC CATH AND PTCA

WHERE IS THE PROCEDURE PERFORMED?

Cardiac catheterizations are performed on an outpatient basis at the local hospital affiliated with our clinic doctors.

The cardiac catheterization room will be cool and not very well lit. The air must be kept cool not to damage the equipment that is used in the procedure.

WHAT WILL HAPPEN DURING THE PROCEDURE?

  • A nurse will place an intravenous path in your arm so that liquids and medications can be administered to you during the procedure.
  • You will have to lie down on a special table that is hard. You will see a large camera and several television monitors. You will be able to see the cardiac catheterization on the monitors.
  • The nurse will clean your skin on the site (arm or groin) where the catheter (a thin plastic tube) is inserted. The site where the catheter is inserted may be shaved.
  • Sterile cloths will be used to cover the insertion site and prevent it from becoming infected. It is important for you to keep your arms and hands on the sides, under the sterile cloths.
  • Electrodes (small flat adhesive patches) will be placed on your chest. The electrodes are connected to an electrocardiography (electrocardiogram) monitor, which will monitor the heart rate and rhythm during the procedure.
  • A mild sedative will be applied intravenously for you to relax, but you will be awake throughout the procedure.
  • The doctor will use a local anesthetic to numb the site where the catheter will be inserted. A plastic introducer (a short and hollow tube that is used to guide the catheter up to the blood vessel) will be inserted in a blood vessel in the arm or groin. It may be necessary to make a small incision to insert the introducer through the skin. A catheter will be introduced through the introducer and will be threaded up to the heart. Y ou may feel pressure when the introducer or catheter is inserted, but you should not feel pain. Tell the nurse or the doctor if it hurts.
  • Once the catheter is in place, the lights will be dimmed and a small amount of contrast material (an intravenous dye that allows the heart and the blood vessels to be seen on the X-rays) will be injected into the arteries and the chambers of the heart through the catheters. The contrast material delineates the vessels, valves and chambers.
  • When the contrast material is injected into the heart, you may feel heat for several seconds. This is normal and will disappear in a few seconds. The symptoms of an allergic reaction may include itching or a feeling of tightness in the throat. You must inform the doctor immediately if this happens. Symptoms of nausea and chest discomfort may also appear. Inform the doctor or the male nurses if you perceive these symptoms or any other.
  • The X.ray camera will be used to take photographs of the arteries and the chambers of the heart. You may be asked to hold your breath while the X.rays are taken. Once the areas of blockage have been identified, the balloon catheter will be introduced in the area of blockage in the coronary artery and the procedure will be carried out. If a stent is required, it will also be inserted at this time. If there are multiple areas of blockage, the process will be repeated. When the procedure has finished, the catheter will be removed and the lights will be turned on.
  • Although you'll be sedated, you'll be awake during the procedure so that you can follow instructions. Throughout the procedure you may be asked to take deep breaths, hold your breath, cough or place your arms in various positions. Your table may be tilted at times.

AFTER A CARDIAC CATH AND PTCA

Following the procedure, the catheters and the introducer will be removed.

If the catheter was inserted into the arm:

  • The incision will be bandaged. You will have to keep your arm straight for at least an hour. You will be able to walk. You will remain under observation for a few hours to check whether any symptom or side effect from the procedure appears. You will be given instructions about how to care for your arm when you return home. Tell the male nurse if you think you are bleeding (if the site feels warm and moist) or if you feel tingling or numbness in the fingers.

If the catheter was inserted in the groin:

  • The incision will be closed applying pressure directly to the site where the catheter was inserted, or with a plug. The plug is out of a material that helps the body's natural scarring process to form a clot in the site punctured the artery. A suture may also be used to close the small incision on the skin in the catheter insertion site. You must lie flat and keep your leg straight for two to six hours to keep the catheter insertion site from bleeding (you will stay less time if a plug is used). You will not be able to raise your head more than 30 degrees (2 pillows). Do not try to sit up or stand up.
  • A sterile bandage will be placed on your groin to protect it against infections. The nurse will examine the bandage periodically, but contact him if you think that you are bleeding (you feel the site warm and moist) or if you feel tingling, numbness or coldness in the fingers.

You will need to drink lots of liquids to eliminate the contrast material from the body. You may feel the need to urinate more frequently. While you are in bed, you will have to use a commode or urinal.

The doctor will tell you if you can return home or have to spend the night admitted. You will be monitored for several hours after the procedure.

The treatment, including medications, diet and future procedures, will be explained to you before you return home. How to care for the wound, what activities you can do and what the subsequent treatment will be will also be explained to you.

The cardiac catheterization procedure with PTCA and stenting can take between 30 minutes and three hours, depending on the technical difficulty of the case and the number of balloon catheters that have to be employed. You could be hospitalized one day while your heart is monitored.