Primary Angioplasty (CathLab) 

 

Your patient is having acute myocardial infarction or commonly called heart attack. This diagnosis is based on patient symptoms and an abnormal electrocardiogram (ECG).

 

Most of the patients with this diagnosis have one of the three main arteries (coronaries)that supply blood to the heart muscle completely blocked due to blood clot. Abrupt and complete stoppage of blood supply to a part of the heart is a very serious condition. If it is not treated promptly, it leads to permanent damage to the heart muscle. 

 

Restoring blood supply to the heart is therefore of utmost importance this can be done by two ways

1 Thrombolysis: administering an intravenous injection that can dissolve blood clot and start blood flow the success rate of this treatment is 60 to 70%

2 Primary angioplasty: This is an emergency procedure. Coronary angiography is done to identify the artery that is blocked completely. This particular artery is then opened by a procedure called primary angioplasty. To open the occluded artery one or more metallic springs (stents) are generally implanted inside the artery. This procedure has success rate of more than 99% in restoring blood flow to the heart.

 

What happens after primary angioplasty?

1 Course in the hospital

2 Complications during the procedure and afterwards

3 Importance of medicines

4 Long term course and care

 

Course in the hospital. 

Usual uncomplicated course in the hospital is seen  in about 80% of patients. Your patient will stay in the ICU for 1-2 days and then will be shifted to the room. Total hospital stay can be 4-6 days.

 

High risk cases

Not all patients of heart attack are the same. Some patients will be at greater risk than others. The high-risk patients are as follows.

1 Late presentation after symptom onset

2 Large part of the heart affected

3 Poor pumping of the heart (EF< 35)

4 Presence of clot in the heart

5 Low blood pressure at onset or during the course of hospitalization needing medicines

6 Need for intra aortic balloon pump.

7 Fast heart rate

8 Rhythm abnormality like atrial fibrillation, ventricular arrhythmias or slow heart rate

9 Mechanical complications 

            free wall rupture 

            papillary muscle rupture

            ventricular septal rupture

10 Critical block of the left main artery or critical blocks in more than one arteries.

 

How is the course of these patients?

These patients are the ones who have 

1 Longer ICU and Hospital stay.

2 Recurrent admissions for heart failure

3 Death during procedure or during Hospital stay 

4 Sudden death during Hospital stay or up to 1 to 2 months after discharge.

 

Is there anything that can go wrong with the procedure

Angioplasty procedure is a very refined procedure with very low risk of complications related to the procedure itself. Most of the complications that happen during the procedure or later on are because of patient related factors which have been already mentioned.

The procedure related complications may happen in a small proportion of patients

1 Vascular or site related complications

  Femoral or radial hematoma

  Femoral pseudoaneurysm

  Retroperitoneal hematoma

2 Coronary dissection or perforation

These complications may lead to prolonged Hospital stay or rarely emergency surgery or death.

 

What happens if there are blocks in other arteries?

During primary angioplasty only the culprit artery is opened. If that is the only artery that has blocked, then the procedure is generally complete. 

However some patients have critical blocks in other arteries as well. These blocks are treated after a few days or a few weeks, when it is safer to do a staged angioplasty. Patients who have critical blocks of all three arteries or have critical stenosis of the left main coronary artery may need bypass surgery either as an emergency procedure or after stabilization.