FREMANTLE HOSPITAL & HEALTH SERVICE |
Department of Cardiology - Testing Unit |
Percutaneous Coronary Intervention - (PCI) |
Introduction: Percutaneous
Coronary Intervention (PCI) is one of the methods performed to treat coronary artery
disease. Coronary artery disease is caused by
the build up of plaque (fatty deposits) inside the blood vessels, thereby reducing or
blocking the flow of blood through them. PCI
is a procedure used to open these narrowed or blocked arteries by using a special balloon
or metal scaffolding (stent) which will improve blood flow to the heart muscle. Pre-angioplasty: Prior to
PCI, your Doctor will have performed cardiac catheterisation (coronary angiography) to
determine the presence of coronary artery disease. This
information will be used to decide if PCI is the most suitable treatment for you. Outpatient
preparation for PCI: A couple of
days before the procedure, you will have an appointment to have some preliminary tests,
these will include a chest x-ray, blood tests and an ECG (electrocardiogram). The Doctor will perform a brief physical examination
and may commence you on a new tablet which you will continue taking for a couple of weeks
after your angioplasty. The
procedure will be explained to you together with any possible risks or complications. You will be asked to sign a form consenting to the
procedure, and also giving permission to proceed to bypass surgery (CABG) if necessary.
This is an opportunity for you and your family to ask any questions. On the
morning of your procedure, you will need to arrive at the hospital by 10am, entering via
the main entrance on Once you
arrive at the Same Day Unit, the Nurses will complete some paperwork, check your blood
pressure and weight and shave both sides of your groin. You
will be changed into a hospital gown. The Doctor will insert an IV drip. Just prior to your procedure, which is usually in
the afternoon, you will be given a sedative tablet to help you relax and then escorted by
your Nurse to the Cardiac Catheter Theatre on a stretcher. The
procedure: The angioplasty procedure is
very similar to the cardiac catheter you will have already had. The catheter,
however, has a special balloon which when inflated pushes the plaque outward against the
artery wall (much like squashing a banana) and opens the blood vessel to improve blood
flow. You will be asked to move
onto the special x-ray table and the Nurses and Cardiac Scientists will prepare you for
the procedure by connecting you to the heart monitor, cleansing your groin areas and
covering you with a sterile drape. If the procedure needs to be performed via the wrist,
you will be prepared in the same manner, except your wrist will be cleansed with the
antiseptic solution. The Doctor
will then inject the area with a local anaesthetic and a sheath will be inserted into the
artery. A guide catheter will then be
manoeuvred to your heart artery. A guidewire
and balloon catheter will then be positioned at the area where your artery is narrowed. The balloon is then inflated and the fatty deposit
is compressed against the wall of the artery. In
this way the vessel is expanded and blood flow improves. The
Doctor will then most likely insert a stent into the narrowed area. A stent is a small metal tube (commonly made of
stainless steel) which acts like a scaffold and holds the artery open. You will
remain awake during the procedure although you may feel a little drowsy because of
sedatives that you will be given. X-ray
contrast will be injected to see the narrowing in the artery and X-ray pictures will be
taken throughout the procedure. You will
feel some pressure at the insertion site, but you shouldn’t feel any pain because of
the local anaesthetic. Some chest pain,
similar to the angina you’ve been experiencing may be felt when the balloon is
inflated because blood flow through the artery is temporarily blocked. Pain medication can be given to counteract this. Once the Doctor is satisfied with the result, the
catheters and balloon are removed. A small,
plastic sheath is left in your groin. The
procedure normally takes one to two hours. After
the procedure: You will
be escorted up to the Coronary Care Unit where you will be cared for until you are ready
to go home. There is a
waiting room next door to the Coronary Care Unit where your family or friends can wait
until the procedure is finished. Whilst the
sheath is in your groin, you will have to remain in bed with your leg straight, although
you may sit up a little. The Nurses will check
your ECG and you will be placed on the heart monitor for observation. Your pulse and blood pressure, as well as the
insertion site and limb, will be checked frequently. You will be able to resume eating and
drinking and IV fluids and medication will be given through the drip. During the procedure you will have been given some
medication to thin the blood, once this has worn off, the nurses will remove the tube in
your groin and apply pressure over the site for approximately 30 - 40 minutes. You will be
given some medication to relieve any pain you may experience. A small dressing will then
be applied over the incision. You will then
need to remain in bed for 8 - 10 hours with your leg straight so the puncture site can
heal. Discharge: The doctor
will see you the next morning to discuss your results and answer any questions you may
have. If you are feeling well and have no
angina you will be discharged later that day. The
nurse will give you an instruction pamphlet and some large bandaids for your wound,
together will follow-up appointments and medications. You
should remain in the metropolitan area for one week in case your angina or chest pain
returns. Remember, you won’t be able to
drive for two days and you should avoid straining or heavy lifting for several days. When you
remove your dressing, you may notice a small bruise and hard lump at the incision site. The bruise may become slightly larger over the next
few days. This is a normal part of the healing
process and should disappear within one to two weeks. |
|
Transoesephageal
Echocardiography. Electrocardiography.
Echocardiography. Holter
Monitoring. King of Hearts Monitoring.
Exercise ECGs. |