Royal Brompton Hospital Your coronary angioplasty · (heart attack) and affects less than 1 in 200 people (

A lifetime of specialist care

Your coronaryangioplasty

Royal Brompton Hospital

Your coronary angioplasty-RBH_Patient Booklet 01/06/2017 16:36 Page 2

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What is a coronary angioplasty? 3Benefits of a coronary angioplasty 3Risks of a coronary angioplasty 3Alternative treatments 5Choosing no treatment 5Female patients 6Before your coronary angioplasty 6Preparing to come into hospital 7What to bring to hospital 8Appointment date 8Bed confirmation 8Arrangements for going home 9Arriving at hospital 9On the ward 9What happens during your angioplasty? 10After your angioplasty 11Visiting times 11Going home after your angioplasty 12Medication 12Getting back to normal 12Work 12Exercise 13Hygiene and wound care 13Driving 14Follow-up 14Useful contacts 14

Contents

This leaflet gives general information about your coronaryangioplasty. It does not replace personal advice from ahealthcare professional. If you have any questions, please askyour doctors and nurses.


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Your coronary angioplasty

A coronary angioplasty is atreatment to widen the mainblood vessels that supply theheart with blood and oxygen.These blood vessels are calledthe coronary arteries.Narrowing of the arteries iscaused by a build up of a fattysubstance, called atheroma.

A coronary angioplasty issimilar to a coronaryangiogram. A thin flexibletube, called a catheter, isinserted into an artery in your

wrist or groin. A special dye isinjected through the catheter,so the coronary arteries showclearly on X-ray.

Then a catheter with a balloonis directed through yourarteries to your heart. Theballoon is inflated anddeflated to widen thenarrowed artery and improvethe blood flow. Usually a smallmetal tube, called a stent, isleft in place to keep the arteryopen.

What is a coronary angioplasty?

A coronary angioplasty aims towiden narrowed coronaryarteries and increase the flowof blood to the heart.Widening the arteries

decreases the risk of heartattack, reduces the symptomsof angina, and slows theprogress of coronary arterydisease.

Benefits of a coronary angioplasty

All medical procedures carrysome risk. An angioplasty is arelatively safe treatment andserious complications are rare.

Less than 1 in 100 people(<1%) have a seriouscomplication as a result of

having a coronary angioplasty.

The risks depend on youroverall health and thecondition of your heart. Yourdoctor will discuss the risksspecific to your condition.

Risks of a coronary angioplasty


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Minor complications Inserting the catheter causesbruising in 1 in 10 people(10%). The bruising can bepainful for a few days, but itusually only covers a smallarea and will disappear withtime.

Removing the catheter causesbleeding in 1 in 100 people(1%). Bleeding is controlled byapplying firm pressure.

Blood may build up under theskin to form a lump(haematoma). The haematomawill gradually disappear anddoes not normally need anytreatment.

Vasovagal attack (fainting) iscaused by a drop in bloodpressure and heart rate, andaffects 1 in 100 people (1%).Feeling faint is treated bylowering the head of the bed,or raising your feet, and givingmedication (drugs).Intravenous fluids (fluids givenstraight into a vein) canincrease the heart rate andraise the blood pressure.

Development of an abnormalheart rhythm affects less than1 in 100 people (<1%). Iftreatment is needed, anelectrical shock to the heart

usually restores its normalrhythm.

Major complications Some people may experiencean allergic reaction to the dyeused to show the blockedarteries. Allergic reactions canbe treated with medication.

The coronary angioplasty maycause damage to a coronaryartery, causing it to suddenlynarrow or block. This is knownas a myocardial infarction(heart attack) and affects lessthan 1 in 200 people (<0.5%).Damage to the artery istreated by insertion ofadditional stents, or by usinganother vein or artery as abypass to redirect bloodaround the blocked arteries.This is called a coronary arterybypass operation.

The catheter may cause a smalltear in one of the chambers ofthe heart, in 1 in 1,000 people(0.1%). This can lead to bloodcollecting around the heart.The blood may need draining,using a small tube insertedbelow the breastbone, or withan operation.

Damage to the radial orfemoral artery, leading tobleeding or blockage of the


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artery, affects 1 in 1,000people (0.1%). An operation isusually needed to correct thedamage. Very rarely, the lackof blood supply may lead tothe loss of a limb.

Less than 1 in 100 people(<1%) have a stroke as a resultof having an angioplasty.

The dye could affect yourkidney function (how yourkidneys work), but the risk isvery low if your kidneyfunction is normal before yourcoronary angioplasty. If yourkidney function is abnormalbefore your angioplasty, wewill give you fluids to protectyour kidneys.

In less than 1 in 100 people(<1%) the artery where the

catheter was inserted doesnot heal completely. This canbe at the radial artery (wrist)or the femoral artery (groin),depending on where thecatheter was inserted. Thiscan lead to a bulging(swelling) in the wall of theartery, called a femoral orradial aneurysm. If you havean aneurysm, you may needan operation to repair it,which means staying inhospital a few more days.

Fewer than 1 in 1,000 people(<0.1%) die during a coronaryangioplasty, as a result of theirheart condition or othercomplications.

If you have any questionsabout these risks, please askyour doctor.

Alternative treatments include medication or coronary arterybypass grafting (heart bypass surgery), which involves a generalanaesthetic (being put to sleep).

Alternative treatments

If you do not have an angioplasty, your coronary artery diseasemay get worse and your risk of heart attack may increase. If youhave any questions about your treatment options, please talk to your doctor.

Choosing no treatment


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You may have a pre-assessment appointmentbefore your angioplasty. Anurse specialist will check yourhealth, and do blood tests andMRSA swabs. MRSA is acommon infection. If you haveMRSA we need to treat itbefore your angioplasty.

If you do not have a pre-assessment appointment, youwill have the health checkswhen you come into hospital.

If you have any questions,please ask your nurse or callthe pre-assessment nursespecialists on 020 7349 7753.

Before your coronary angioplasty

A coronary angioplasty uses X-rays that may be harmful toan unborn baby.

If you think you may bepregnant, please contact thepre-assessment nurse specialistson 020 7349 7753.

If you have not had a period inthe 10 days before yourcoronary angioplasty, we willcarry out a pregnancy testwhen you come into hospital.

Female patients


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MedicationThe nurse at your pre-assessment clinic will give youadvice on your medication.

Please bring all yourmedication (including warfarinand metformin) with you tohospital. On the day of yourangioplasty, you should takeall your usual morningmedication (except warfarinand metformin, see below).

If you have any questionsabout your medication, pleaseask your doctor or nurse.

WarfarinYou may need to stop takingwarfarin before your coronaryangioplasty. Please talk to thepre-assessment nurse specialistsfor advice, on 020 7349 7753.

MetforminPlease stop taking metformin48 hours before your coronaryangioplasty. You should starttaking it again 48 hours afteryour angioplasty.

Medication to reduceblood clots Taking medication before your

angioplasty can reduce the riskof blood clots. You will needto take aspirin. You will alsoneed to take clopidogrel,unless you are already takingclopidogrel, ticagrelor orprasugrel.

You should start taking aspirinand clopidogrel one weekbefore you come into hospital,and continue taking it for onemonth to one year after yourangioplasty.

Your doctor or nurse willdiscuss your medication withyou before you go home.

Eating and drinkingYour confirmation letter hasinstructions about eating anddrinking before yourangioplasty. Please follow theinstructions. At your pre-assessment appointment, yournurse will remind you whenyou can eat and drink.

If you do not have a pre-assessment appointment andhave questions about eatingand drinking, please call thepre-assessment nursespecialists on 020 7349 7753.

Preparing to come into hospital


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Appointment date

If you have any questionsabout your appointment date,or you need to change the

date, please contact thecardiac bookings team on 020 7352 8121, bleep 1195.

What to bring to hospital

Remember to bring:

• your completed hospitalforms

• all your medication

• a dressing gown

• slippers that fit well andhave a good grip

• something to read.

Bed confirmation

Most angioplasty patients areadmitted to either York Wardor Paul Wood Ward.

The day before you come intohospital, please call the

cardiology bed manager toconfirm your bed. If you arecoming into hospital on aMonday, or over the weekend,please call on Fridayafternoon.

ShavingPlease do not shave or removehair from your chest, arms,legs or groin before cominginto hospital. If needed,shaving will be done inhospital just before yourcoronary angioplasty.

HygieneIt is extremely important thatyou have a thorough shower

or bath the night before youcome into hospital. Please payspecial attention to washingunder skin folds such as underthe breasts, the groin andgenital area. At the pre-admission clinic we will giveyou an antiseptic body wash touse the night before and themorning of your admission.


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Arrangements for going home

You will need to arrange for someone to take you home afteryour angioplasty, as you will not be able to drive for the first 48 hours.

When you get to hospital, please go to the 5th floor, SydneyStreet and report to the nurses’ station on your allocated ward.

Arriving at hospital

When you get to the ward, anurse will show you your bed,where you will wait for yourangioplasty.

Male and female patients mayshare the same ward, but willhave separate bays andbathrooms. There areexceptions; for example, inintensive care and highdependency areas male and

female patients may be caredfor in the same bay.

We try to keep waiting timesto a minimum, but sometimesthere are delays when otherpatients need to be seen in anemergency. We will keep youinformed of any changes.

If you have any questions,please ask the ward manageror matron.

On the ward


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You will have your angioplastyin a cardiac catheterisationlaboratory (cath lab). Theangioplasty takes about one totwo hours.

A local anaesthetic is injectedin your wrist or groin, to numbthe skin. Then a small cut ismade, to insert a catheter. Ifyou feel anxious you can havea sedative. A sedative is a drugthat calms you down.

Then the doctor inserts thecatheter into the artery andpushes it gently towards theheart. The doctor watches thecatheter on a TV monitor,using a low dose X-ray. This iscalled fluoroscopy.

When the catheter reachesyour heart, the doctor injects aspecial dye into the arteries.The dye shows the narrowedareas or blockages in yourarteries on the X-ray. Whenthe dye is injected, you mayhave a hot flushing sensationfor a few seconds. You mayalso feel an occasional missedor extra heartbeat, but youshould not have any pain.

The doctor then inserts adifferent catheter, with a small

inflatable balloon at the tip.

When the catheter reachesthe narrowed area of theartery, the balloon is inflatedand deflated. The balloonsquashes the atheromaagainst the walls of the arteryto widen the artery andimprove the blood flow. Theballoon is inflated anddeflated several times.

Usually, the doctor puts a smallexpandable metal tube, calleda stent, in the artery, to keepthe artery open. The stent ismounted on a balloon, and asthe balloon is inflated thestent is pushed into the wall ofyour artery. The balloon is thendeflated and removed, leavingthe stent in place.

If you sometimes get angina(pain in the heart), you mayhave chest pain during yourangioplasty, but it should beno worse than usual. If youhave new pain or othersymptoms, such as shortness ofbreath, please tell the doctoror nurse.

When your angioplasty isfinished, the doctor willremove the catheter.

What happens during your angioplasty?


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Visiting times are 10am–1pm, and 2pm–8pm, on York Ward andPaul Wood Ward. We ask that you only have two visitors at atime.

Visiting times

After your angioplasty

After your angioplasty, we willtake you back to the ward.You will need to lie in bed forup to four hours. You can havefood and drink when you feelready.

If you have a TR band, thenurses will gradually remove

the air, and then remove theband, and apply a dressing.Nurses will also monitor yourpulse, blood pressure and yourheart rate and rhythm.

You will probably stay inhospital overnight and gohome the next day.

You will have a small woundin your wrist or groin, wherethe catheter was removed.

The doctor will apply firmpressure to stop bleeding from the wound.

If your angioplasty is carriedout through your wrist, thedoctor may put a band, calleda TR band, on your wound.

The TR band is inflated withair, to stop bleeding.

If your angioplasty is carriedout through your groin, thedoctor may use a small plug,called an angioseal, to stopbleeding. The angioseal ismade of collagen and isabsorbed by the body over 90 days.


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Getting back to normal

We will give you a leaflet called ‘After your angiogram orangioplasty’ that gives more information about your recovery.

Work

It is normal to have one week off work after your angioplasty.Please discuss this with your doctor or nurse.

You will probably stay inhospital overnight and gohome the next day. Before yougo home, we will ask you towalk up and down the wardseveral times to make sure thatthe wound in your wrist or

groin has healed well enough.

If you go home on the sameday as your angioplasty, youwill need to have someone tostay with you for the firstnight.

Going home after your angioplasty

Medication

Before you go home, the wardnurse will give you a supply ofclopidogrel (if you do not taketicagrelor or prasugrel). Youwill need to take clopidogrelfor either a month or a yearafter your coronary angioplasty,depending on the type of stent

inserted. Your doctor or nursewill tell you how long to takethe tablets. You will need toget more tablets from your GP.

We will also give youinformation on how to care foryourself after your angioplasty.


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You will have a dressing onyour wound when you gohome. You can take thedressing off the next day.

You may have some bruisingand a little tenderness aroundthe wound. Remember tokeep the area clean and dry. Itis OK to have a shower, but donot have a bath for 24 hoursafter your angioplasty.

If you have any questionswhen you are at home, pleasecontact the pre-assessmentnurse specialists. The contactdetails are at the end of thisleaflet.

If you feel you need treatmenturgently, please contact yourGP, or go to the nearestaccident and emergency (A&E)department.

Hygiene and wound care

Exercise

For a week after yourangioplasty, walking is theonly exercise you should do.

Start by walking shortdistances and gradually buildup. Rest after walking andavoid heavy lifting. This allows

the wound in your wrist orgroin to heal.

You should be back to normalby the end of the week. If youhave any questions aboutexercise, please ask yourdoctor or nurse.

Please remember that Royal Brompton Hospital does not have an A&E department.


York Ward 020 7351 8592 (24 hours)

Paul Wood Ward 020 7351 8598 (24 hours)

Pre-assessment nurse specialists 020 7349 7753 (Monday–Friday, 10am–4pm)

Useful contacts

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You must not drive for oneweek after your angioplasty.This is a DVLA regulation.

If you hold a bus, coach orlorry licence you must tell theDVLA about your angioplasty.This is a DVLA regulation.

You can find more informationon the DVLA website:www.gov.uk/angioplasty-and-driving/.

Driving

You will have a follow-up appointment about six weeks afteryour angioplasty. This will either be at Royal Brompton Hospitalor at your local hospital.

Follow-up

If you have concerns about any aspect of the service you havereceived in hospital and feel unable to talk to those peopleresponsible for your care, call the Patient Advice and LiaisonService (PALS) on 020 7349 7715 or email [email protected]. Thisis a confidential service.


http://www.gov.uk/angioplasty-and-driving/.Driving



mailto:[email protected]

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Royal Brompton HospitalSydney StreetLondonSW3 6NPtel: 020 7352 8121textphone: (18001) 020 7352 8121

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Website: www.rbht.nhs.uk

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© Royal Brompton & Harefield NHS Foundation Trust June 2017


http://www.rbht.nhs.uk

Documents

Royal Brompton Hospital Your coronary angioplasty · (heart attack) and affects less than 1 in 200 people (