Have you ever noticed that whenever there is a traffic jam due to an accident or a vehicle breakdown, some intervention is required to clear the roads as soon as possible? There could be a crane deployed to remove the blocking vehicles. This brings the traffic flow back to normalcy sooner.

In the event of a heart attack or critical chronic angina, when the coronary arteries supplying your heart are blocked, your cardiologist may need to perform a similar intervention.  Through this intervention he tries to reach the artery which is affected and helps clearing the block faster. This intervention is called as an ‘Angioplasty’.

The decision of whether to perform an Angioplasty is made after seeing the findings of a coronary angiography.  Critical blockage areas are selected which need to be handled. The approach to this intervention is similar to an angiography i.e. through the radial artery at your wrist or through the femoral artery through your groin.

After reaching the coronary artery, a very advanced apparatus is introduced through the sheath. This apparatus has a balloon which can be inflated under controlled conditions. It requires a high degree of expertise to inflate the balloon to the exact extent  so that the block is cleared without damaging the coronary arteries. After this your cardiologist may insert a very specialized structure called as a ‘Stent’ at the blocked site, so that the road block at the same site is prevented. We shall discuss more on the stents in another section.

As the Angioplasty involves some delicate handling of your heart, you need to follow certain precautions after you are discharged.

About resuming your routine activities:

When you return home after your angioplasty, do not do any strenuous activities for 1 week to allow the groin puncture site to heal.

• Pain: Use Paracetamol for pain.
• Lifting: Do not lift heavy items such as groceries, children, full laundry baskets, small pets.
• Climbing stairs: Climb stairs slowly for the first few days.
• Walking: Slow walking is good for you, unless your doctor has told you not to walk.
• Exercise: Do not do strenuous exercise such as aerobics, weight lifting until you see your cardiologist.
• Driving: You may drive a car 2 days after your procedure. However, if you had a heart attack before your angioplasty, wait until your doctor tells you when you can drive again (usually 4 weeks after the heart attack).
• Returning to work: Ask your doctor when you may return to work. This will depend on whether you have had a heart attack recently, and whether your work is physically demanding.
• Sexual activity may be resumed after you return home.

How should you care for your puncture site ?

Take the dressing off your groin the morning after you return home. Put a bandage on at the puncture site on your groin or wrist. Keep the bandage on for 1 day, then take the bandage off and leave it open to the air. • Take showers not baths for 1 week to help the puncture site heal. Do not sit in a hot bath for the first 7 days after your procedure because this can cause the puncture site at your groin to bleed.

• You may have a small lump (the size of a large marble at your groin or a pimple at your wrist) or you may just have bruising at the puncture site. This is normal. The lump will disappear in 4 to 8 weeks.
• As you become more active, you may see bruising on the inside of your leg. This is normal. It is just old blood under the skin moving down your leg. The bruising will be gone in about 2 weeks. Problems with the catheter insertion site are rare but can happen.
• In case of the wrist additionally:Rest with your forearm and hand supported on a pillow.
• Do not bend your wrist for 8 hours after your procedure.
• Do not work on a computer, knit or wring clothes for 1 day.
• You may drive an automatic car 1 day after you return home
• You may drive a standard shift car after 2 days.

When to call for help ?

If you have any of the following symptoms, call your family doctor immediately, or go to the nearest hospital emergency department:

• If you see the lump pulsate (move) under your skin, loosely cover it with a band-aid and go to the nearest hospital emergency department. Do not apply pressure. If the lump is pulsating (moving), it might be because something has gone wrong in the wall of the artery.
• If you do not have someone to drive you to the hospital, call Emergency Medical Services (108) for an ambulance. If the puncture site in your groin starts to bleed, lie down and have a family member apply firm pressure with 3 fingers for 15 minutes. If bleeding does not stop go to the nearest hospital emergency department.
• After a groin approach, if you have pain in the lower abdomen (stomach area) above the puncture site, go to the nearest hospital emergency department.
• If you have a fever, or the puncture site becomes red, swells up, or has pus draining from it, contact your doctor.
• If you get a bad pain in the leg where the puncture site is, or in your foot, or the leg or foot gets cold and turns blue, go to the nearest hospital emergency department.
• If the puncture site becomes painful, or the affected leg becomes weak or numb, contact your doctor.

What to do in case you have chest pain after your angioplasty?

It is not unusual to have some angina in the first days or weeks after angioplasty. This is usually due to spasm of the artery. You can relieve the angina with rest and your nitroglycerine prescribed by your doctor. If you have chest pain (angina), take your nitro and wait 5 minutes. If you still have chest pain, take a second nitro and wait 5 minutes. If you still have chest pain, take a third nitro and wait 5 minutes. If your angina does not go away in 15 minutes after 3 sprays of nitro, go to the nearest hospital emergency department or call Emergency Medical Services at 108. Do not drive yourself to the hospital. Contact your cardiologist if angina happens more often.

When do you see your Doctor again?

Your cardiologist would like to see you 1 month after your angioplasty.

He may ask you to have an exercise stress test* within 6 to 8 weeks or a nuclear perfusion scan* (to show the pattern of blood flow to the heart) about 6 months after your angioplasty.

Most of the people who receive timely intervention for their coronary artery disease are able to lead a normal life without any significant limitations.