ANGIOPLASTY/STENT. Information Leaflet. Your Health. Our Priority.

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1 ANGIOPLASTY/STENT Information Leaflet Your Health. Our Priority.

2 Page 2 of 10 What is Angina? Angina is a pain or tight discomfort across the chest. It occurs when the coronary arteries have narrowed and the blood and oxygen to the heart muscle is decreased. The pain of angina is usually brought on by exercise or emotional stress, but can come on at rest or even awake you from your sleep. The pain is usually less severe and is not associated with sweating or nausea, which are the typical symptoms off a heart attack. The use of a GTN (nitrate) spray/tablet is usually effective. Please note that severe indigestion symptoms, which are not relieved by medication, may be a heart attack. Learn to listen to and know your body, in order to be able to distinguish between different types of chest pain e.g. angina, indigestion or muscle pain. IF THE PAIN HAS LASTED LONGER THAN 15 MINUTES IN DURATION AND HAS NOT BEEN RELIEVED BY YOUR NORMAL MEDICATION OR YOU THINK YOU ARE HAVING A HEART ATTACK, DIAL 999 FOR AN AMBULANCE. Acute Coronary Syndrome This is a general term that describes a heart attack or unstable angina. Coronary angioplasty is used as an emergency treatment, to treat some people with acute coronary syndrome. What is an Angioplasty? This is a treatment to improve the blood supply through the narrowed artery. It is also known as a PTCA (Percutaneous Transluminal Coronary Angioplasty) or PCI (Percutaneous Coronary Intervention). It involves opening up the artery by stretching it from the inside using a balloon. How is this treatment performed? This procedure is undertaken in the cardiac catheterisation laboratory using X-ray screening. If you think you are pregnant will you please let us know before we begin. The procedure involves passing a fine plastic tube (referred to as a sheath) into an artery via a small puncture hole in the groin or wrist. The groin is the usual site. Through this sheath another tube called a guiding catheter is passed. This is threaded up to the heart and is positioned at the opening of the coronary artery. A guide wire is then passed down the artery through the site of narrowing. A balloon catheter is manoeuvred along the wire to the narrowing. Once the position of the balloon is correct the balloon is inflated, usually for a few seconds only. This will cause the narrowing to be compressed up against the wall of the coronary artery. At this stage it is likely that you feel some angina (chest pain), please inform the nurses if this happens.

3 Page 3 of 10 They may have to do several inflations of the balloon and also may need to use several catheters or balloons to widen the narrowed artery. More often than not during the angioplasty the doctor will use a stent to support the artery wall - this is described in the next section. Once the doctor is happy with the result, the catheter and balloons will be removed. The sheath in your groin/wrist will be left in until the doctor is satisfied it can be removed. What is a Coronary Stent? This is a small metal tubular mesh that is inserted into an artery at the site of the narrowing to act as a form of internal scaffolding to support that blood vessel. The stent is mounted on a balloon and is positioned by inflating the balloon. This expands the stent, which pushes it up against the artery wall. When the balloon is deflated the stent remains in place. In the weeks following insertion of the stent, a thin film of cells will start to grow over the framework and line the walls of the artery like a skin. There is a risk of the blood sticking on the stent. The chances of this are reduced by aspirin and clopidogrel (see further on). What is the preparation? You will be asked not to have anything to eat or drink for 4 hours prior to your procedure. Prior to your procedure, you will have a small needle inserted into the back of your arm or hand. This is in case the doctor needs to give you some fluids or medication during the procedure.

4 Page 4 of 10 What happens when you go down to the catheter lab? When you arrive in the laboratory you will be greeted by a nurse, who will take you into the X- ray room. Here you will find some of the doctors and nurses wearing gowns and gloves. The procedure is kept as clean and sterile as possible. You will be transferred on to an X-ray table. This is very narrow, and firm, and can move up and down. It is then necessary to attach you to an ECG monitor so we can monitor your heart rhythm. It is normal practice for patients to have a small amount of sedation while in the catheter laboratory. This will make you sleepy but it is not a general anaesthetic. Your groin or arm will be cleaned with an antiseptic solution and then covered with sterile towels. The doctor will numb your groin or arm area with an injection of local anaesthetic. This does not take the sensation of touch away, but does remove the feeling of pain. The catheter will be guided up to the heart under X-ray screening. The X- ray equipment will at times be brought very close to you and there will be times when it will be necessary for you to rest your arms above your head, and turn your head from left to right. The procedure takes from 30 minutes to 2 hours depending on the complexity and number of narrowings in your coronary arteries. At the end of the procedure, sometimes a closure device will be used to seal this hole in your groin. If it is used then the nursing staff on the ward will explain the after-care. Risks An angioplasty cannot be performed without some element of risk. Complications are less common during planned (elective) procedures than emergency ones, but potential problems will depend on your individual circumstances. The majority of patients (about 99%) have no major problems, but complications can occur. It is important to be aware of the following before you sign your consent form: Bleeding/bruising under the skin where the catheter has been inserted (usually the groin). This is known as a haematoma and is very common, (more than 1 patient in every 20). This can be uncomfortable and take several weeks to disappear. Damage to the artery in the groin causing a swelling, known as a false aneurysm. This occurs to less than 1 patient in every 100 and could increase your hospital stay. Blood loss needing a blood transfusion (1 patient in every 100). Having an allergic reaction to the dye (less than 1 patient in every 100). It is important that you tell your nurse if you have had any previous allergic reactions.

5 Page 5 of 10 Occasionally the heart artery can be damaged during the procedure (1 patient in every 500). If this happens, you will need to have emergency surgery, such as a bypass to repair the artery (1 patient in every 500). As with any procedures involving the heart arteries, it is possible you may have a heart attack (1 patient in every 100) or stroke (less than 1 patient in every 100). Your coronary angioplasty procedure involves a period of x-ray scanning. In some cases, when we have to perform more extensive investigation and treatment, there is a chance that you will experience a skin reddening reaction like sunburn which will fade after a few days. Please ask the radiographer if you would like further information on this. Although a rare complication, it is important for you and your relatives to know an angioplasty carries a risk of death. The incidence is very low when the procedure is performed in a non-emergency situation, (less than 1 patient in every 100). Benefits of the procedure The aim of angioplasty/stent procedure is to relieve angina. It has been shown to be very effective even in the long term. This procedure allows the narrowed or blocked coronary artery to be treated without you undergoing cardiac surgery, which involves opening the chest wall. The angioplasty/stent procedure is simpler and the recovery shorter than for a standard coronary bypass surgery. Angioplasty can be used in people who have just sustained a heart attack (myocardial infarction) and where thrombolytic therapy (clot busting treatment) has failed as well as in unstable/worsening angina. On return to the ward When you return to the ward you will be placed on an ECG monitor. This usually remains on until the next day. You will also have an ECG taken and a nurse will check your blood pressure, pulse, foot pulses and the puncture site in your groin for any complications. Normally you will be asked to lay flat for 4 hours after the tube is removed from your leg. It is very important that while the tube is in place that you lay with your legs straight but if you speak to the nurses they will help you to roll on to your side. If you see this as a MAJOR problem please bring it to the nurse s attention on admission!! Backache is a big problem! So please do not suffer in silence. Ask the nurses for some pain killers. When the tube is removed the nurse or doctor will push on the puncture site for about 15 to 20 minutes or until the bleeding has stopped. You will then be instructed how long the doctors will require you to lay flat. When appropriate (usually 4 hours) the nurses will slowly sit you up and later that evening or the following day they will allow you out of bed.

6 Page 6 of 10 Wound Some bruising or discoloration might occur at the site, this is not serious and might get worse before it gets better. Paracetamol can be taken for any minor discomfort. However if the site becomes swollen or painful then please contact your GP for advice or ring the Catheter Lab on (Tuesday-Friday) and, at all other times, Coronary Care Unit on What medication will I need for my Stent? All patients with a stent must be on Aspirin. In addition, you will have been prescribed a drug called Clopidogrel. This stops blood cells (platelets) sticking together on the stent which you have had implanted in your coronary artery. You will normally be asked to take this for at least a year. This is the time it takes the cells to grow over the stent. Prior to your discharge you will be given a supply and specific instructions. You must also continue taking your Aspirin, cholesterol-lowering tablets and any other tablets for your heart as instructed by the doctor. Chest pain after discharge Most people never get chest pain again. However, some people may get further angina which may be coming from other diseased arteries. You may be sent home with a GTN spray or tablets that go under the tongue. Ask the doctor if you are likely to get angina from arteries other than the stented artery. If you experience severe chest pain, or pain similar to your angina pain, use your GTN spray as prescribed. If your pain lasts longer than 15 minutes after using your GTN spray, dial 999 or go to the nearest Emergency Department. DO NOT DRIVE. Tell the ambulance people that you have had a coronary stent inserted and that they need to get you to hospital as soon as possible. If you are unsure what to do you can always ring the Cardiac Rehabilitation Nurses on (during working hours) or Coronary Care Unit on (24 hours). When can I go Home? It is normal for you to be discharged the same day as the procedure or the next day after your procedure. This will often mean a stay of two days (one night). Sometimes due to changes in medication and bruising to the groin area this might be slightly extended.

7 Page 7 of 10 Going home When going home you may feel worried leaving the hospital environment. You may notice changes in mood and experience good and bad days. This is quite normal do not worry too much about this. You will soon make progress and be able to do more. For the first few days check your puncture site. Some bruising may be present which can last several weeks. Avoid heavy lifting and demanding activities for at least a week. Gradually increase the amount of activity you do as the weeks go by. Do not be afraid of going upstairs or outside for fresh air. An ideal form of exercise is the graduated walking programme that can be found in your patient information pack. Avoid going out in very cold or windy weather. Avoid hill climbing. Some patients may live on an incline and therefore it is unavoidable. You must learn to pace yourself and ensure you walk uphill when beginning your walk, so if any problems do occur, it is easier to walk downhill. It is important to stop and rest if you are tired, breathless or experience any chest discomfort. Housework Avoid any strenuous activity including: heavy lifting, shopping, laundry or carrying suitcases. Please refer to your patient information booklet for guidance with commencing housework. Dental treatment Avoid dental treatment, unless an emergency, for a month after the stent insertion. This is due to the risk of bleeding due to your medication. Sex You may be anxious about how sex may affect your heart. It does raise the blood pressure and heart rate. However, it is usually safe to have sex if you can walk 300 yards on the level comfortably without experiencing pain, shortness of breath or light headedness. Driving DVLA regulations at the time of writing, indicate that patients should not drive for one week following angioplasty. Patients who have a vocational (e.g. HGV) licence will need further assessment before resuming driving. Current regulations can be found on the internet at: Return to work You can return to work as you feel physically and psychologically able to do so. This can be within four to eight weeks if you have had a heart attack. You might want to talk to your employer, GP or cardiac rehabilitation nurse to plan your return to work with them.

8 Page 8 of 10 Holidays and Flying It is normally safe to fly 2-3 weeks after an angioplasty. If you have any plans to fly, please discuss this with your doctors. You should also check with your airline and insurance company. The British Heart Foundation can send you a list of insurance companies when seeking insurance cover for your holiday. What is Cardiac Rehabilitation? The Cardiac Rehabilitation Programme is for patients who are recovering from either heart problems or heart surgery. The programme takes place in the hospital or at home, four to six weeks after an event. It can be beneficial in several ways, whether you are mildly or severely affected by your heart disease. If you have severe disease that may affect your activities the programme can help to restore your confidence, maximise your recovery and improve the quality of your life. The programme also helps you to understand and gives you an opportunity to discuss prevention of heart disease; this includes lifestyle issues, medication and stress. Therefore one of the best things you can do to help your recovery and stay healthy is to join the cardiac rehabilitation programme run by an enthusiastic team of healthcare professionals. What happens in a Cardiac Rehabilitation Programme? Initially, you will be contacted at home post discharge to discuss your recovery and any concerns you may have at the present time. At this point you will be invited to attend for an induction/assessment, or offered a home based programme. At induction/home visit we will discuss your progress and concerns about returning to your normal routine (resuming household chores, hobbies, DIY projects, physical activity and if appropriate return to work). If you have an induction you will meet our Physiotherapist or exercise specialist who will then perform a treadmill walk test to assess your overall physical fitness. They will then work out a programme of exercises for you, tailored to your individual needs, aimed at helping you return to your normal routine. Your heart rate, blood pressure and any changes in symptoms will be monitored. You will be taught how to self monitor your progress and fitness levels. This will be useful, even after the programme has been completed, when trying new physical activities. You will gradually move on to different levels of exercise that will build up your overall fitness level. You can learn skills to help manage and reduce stress. You will have the opportunity to speak to our department based psychologist for an informal session should your recovery not be progressing as well as you anticipated.

9 Page 9 of 10 We offer sessions on lifestyle changes and current therapy, giving you the opportunity to ask questions and talk about any worries you may still have, and help you to understand how these can reduce the risks of further problems. We offer advice and help on smoking cessation. NHS Quit Smoking Line. Tel: Stockport Smoking Cessation. Tel: You will have a dietary assessment. Support will be offered to help you create a healthy eating plan to reduce the intake of foods which are high in saturated fat and cholesterol and also guidelines on weight control. If required you may want to be referred to a dietician. You will meet our community based exercise facilitator who will help and encourage you to continue exercising when discharged, by ensuring the appropriate exercise to meet your needs. You will meet people who have had similar concerns with their health. By the end of the programme patients tell us they feel better and fitter than they have done in a long time. Finally on discharge we refer you back to your Practice Nurse who will continue to monitor you at least yearly. Follow up You will be followed up by either the Consultant who performed the angioplasty, or the referring Consultant. Contact us Cardiac Catheterisation Suite recovery: /4650, Tuesday-Friday (8.00 am-7.00 pm) Cardiac rehabilitation team: , during working hours (8.30 am-5.00 pm) Coronary Care Unit: (24 hours) NHS direct:

10 Page 10 of 10 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Information Leaflet. PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MED16 Publication date November 2014 Review date November 2015 Department Medicine Location Stepping Hill Hospital