Answers for Laymen About Angioplasty, Heart Catheterization, Stents

There is no particular order to what I will present, but I will try to present groups of related terms for a clearer picture. I will offer no opinions about the pros or cons of procedures or medications because that is between you and your doctor. As well, it would be illegal for me to do that because I am not a doctor.

It has been my observation that people tend to feel worse when they are afraid and do not really understand what has been said to them or what is being done to them. The doctors are so busy they cannot afford to spend very much time, and frequently that is what the patient needs the most.

HEART CATHETERIZATION, CORONARY ANGIOPLASTY, AND STENTS

The first grouping is in regard to the heart. If your doctor says you need to have a cardiac catheterization with possible angioplasty and/or stent placement, do you know what is coming? If you do understand his/her explanation, good for you! If you did not, then I will describe it for you so it makes sense.

When you have been prepared for your procedure with some sedation, intravenous fluids, and possibly some anticoagulation to make sure your blood does not clot in the wrong place, the cardiologist will sterilize the area of your right groin area (sometimes left). The groin area is just where the thigh of your leg meets your body. He will isolate your femoral artery and insert a hollow needle into this artery. Through the needle he will insert a tiny wire. With this wire and possibly using the fluoroscopy, he will gently go up your aorta which is the big main artery going up through the center of your body. The femoral artery where he entered is attached to the aorta like a branch to a tree. When the wire gets up to your heart which is where the aorta is connected to your heart, then he will place the catheter over the wire. The catheter is a small plastic hollow tube that is designed to travel on the small wire up to your heart. That way it should not get jammed up or go in the wrong direction because it is riding the wire. When the catheter is at the top of your heart, the doctor will pull out the small wire so that he can place an injection into the tube. The injection is a dye that shows up on fluoroscopy and can be seen wherever it goes in your heart. After this dye is injected and is photographed by the doctor, it pretty much washes away to be excreted along with other waste. You may feel a little warm all over, but this feeling is usually over quickly and in general is not too bad for most folks. The doctor will aim that little catheter into the mouths of your coronary arteries (the vessels that feed your heart). He may change catheters a time or two so he can get a better shot. It pretty much depends on your anatomy as to what is necessary. He will then aim the catheter down through your aortic valve (the gateway between your heart and that big aorta vessel). He will get some pressure readings and inject some more dye to see how your left ventricle (the big pumping chamber of your heart) is working. The doctor’s trained eye can see a lot from these pictures. He can see if you have blocks in your arteries, and he can see if parts of your heart muscle have been damaged or weakened.

If it looks like the arteries of your heart are blocked off, instead of having to have surgery where they actually open your chest and run bypass vessels around the diseased parts, the doctor frequently can put another kind of catheter with a tiny balloon on it down through the blockage in the coronary artery. He then blows up the balloon which forces the blockage open. This is called angioplasty. If he is worried the blockage may close up again, he may place a tiny tube called a stent into the blockage where the balloon just opened it. This is like running a pipe into another pipe that has been cracked or damaged. It will keep the blood flowing through the coronary artery into the muscle of the heart. If the heart can’t eat, it will starve to death and die. This would be bad.

Well, for those of you who are contemplating this procedure, I hope this description helps with your understanding of it. Good luck to you!