Coronary Angioplasty(PCI)

NB: If you have an allergy to SEAFOOD or IODINE/DYE please inform your nurse or Doctor

What is a Coronary Angioplasty/PCI?

Coronary Angioplasty (Percutaneous coronary intervention)is a procedure used to treat coronary heart disease. A small balloon is inflated inside one or more of your coronary arteries to open up an area that has become narrowed from a build-up of fatty plaque. A metal coil(stent) is then deployed across the blockage to hold the artery open. This procedure aims to improve the flow of blood flow to your heart muscle. 

How is an Angioplasty done?

A PCI can either be performed urgently to help quickly restore blood flow to your heart muscle during a heart attack, or it can be done less urgently to treat chest pain and reduce your chances of having a heart attack.

Coronary angiography and coronary angioplasty may be performed at the same time (see angiogram info sheet if required). Angiogram is the investigation and PCI is a treatment option. Both procedures are accessed through an artery either in the groin, arm or wrist.  

Before the Angioplasty

You will be asked to either fast from MIDNIGHT or AFTER BREAKFAST, however, you can keep drinking water. Your nurse will let you know. You will have a ‘drip’ or IV line inserted into your arm which may be used to give you some fluids prior to the procedure. The nurse will shave your groin and wrist area to prepare you for the test. You may need to take some extra medication and some of your regular medicines may need to be with-held. This will be discussed with you.

During the PCI

You will be awake during the procedure and given a local anaesthetic to numb the area where the catheter tube will be inserted. You may feel some mild discomfort. The Doctor will insert a thin tube (sheath) into your artery through a small puncture site. Then they will insert a long catheter tube with a tiny balloon at its tip. The catheter is gently threaded through the main artery (aorta) and into the coronary artery that has the narrowing. (You are not likely to feel the catheter moving through your arteries as there are no nerves inside them) Once positioned the doctor will inflate and deflate the balloon several times to “squash” the fatty plaque and make your coronary artery wider.  A stent (expandable mesh tube) is inserted at the same time to make sure that it stays open. A final check will be done to assess the blood flow through your arteries.    

How long will it take?

A PCI generally takes about an hour depending on the complexity of the procedure. If you have had a heart attack prior to your procedure and they discover more than one narrowing, you may only have the ‘culprit’ artery fixed. Sometimes your heart needs time to recover before further stents can be inserted. If this is the case, your Cardiologist will explain the plan to you.

After the Angioplasty

You will move from the procedure room to a recovery area/ day unit where the nurse will keep a close eye on you. If the puncture was through your groin there will still be a sheath in your groin area, so you must keep your leg straight. You will be moved to the Coronary Care Unit for your recovery. The sheath may need to remain in your artery for a few hours as blood thinning medication, given to you during the procedure, will still be in your system. Small blood samples will be taken from the sheath. Once your clotting times are safe, the nurse will remove the sheath. As they remove the sheath the nurse will need to push down with firm pressure for about 20 mins. Once the sheath has been removed you will be able to eat and drink BUT you need to remain flat. You must keep your head down on the pillow and keep your leg straight for another 3-4 hours.

If the doctor has gone through the artery in your arm, a support band (TR Band) will have been applied. This is a manually air-filled compression device that provides pressure to a radial artery puncture site. It will have been applied immediately following your procedure. You will be able to mobilise as directed however, all forceful movement of the affected hand and arm is discouraged for 24 hours.     

The nurse will check your fingers/ feet, your blood pressure and the puncture site regularly. If you cough, sneeze or laugh you will need to apply pressure to the groin area for support. If you feel any warmth or wetness near the puncture site you must notify your nurse immediately by using the call buzzer.

Are there any risks?

As with any medical tests there are risks, but serious problems are rare.  For most people there are no problems and knowing the result of the test outweighs the risk involved. Your doctor will discuss any risks with you at the time of signing the consent form.

Going back to work:

Depending on the type of work that you do, you may need to have a week off work. If you have had a heart attack you may need 2-4 weeks off work. Please discuss this with your doctor prior to discharge and request a medical certificate,if required.

Angioplasty Discharge Information Sheet

• If you experience ANY CHEST PAIN within 72 hours of an angioplasty you MUST present immediately to your nearest Emergency Department. Call “000” for assistance.
• Rest quietly on the day of your discharge from hospital. For patients living more than 1 hour away from Townsville you are required to stay locally in Townsville for an extra 24 hours after being discharged from hospital.
• You can remove the waterproof dressing, the day after you have been discharged.
• Avoid hot water and rubbing of the puncture site when showering for 24hrs.Simply wash gently and pat dry, do not have a bath or soak in water until the puncture site is fully healed (approx 1 week)
• For groin puncture apply pressure to the site for 48 hours when coughing, sneezing, laughing or sitting on toilet.
• For radial puncture avoid any forceful movement of the hand and arm for 24 hours.
• Bleeding rarely occurs at the puncture site once you have been discharged. If it does occur, lie down, apply firm pressure for 10 mins and seek medical assistance. Remember, this is an artery, call ‘000’ if bleeding persists or if you have any concerns.
• If you have experienced a Heart Attack prior to your procedure you must still adhere to the post heart attack recovery guidelines. (2-4 weeks recovery)
• You are not to drive a vehicle for 48 hours after the procedure. If you are a Commercial driver you may be restricted for up to 4 weeks or as directed by your doctor.
• Look and feel around the puncture site each day for a week. You may experience some bruising. A small pea-sized lump may develop, this is normal and no action is required. Continue to observe the area. Seek medical advice if the lump increases in size, if you develop swelling, pain, redness, oozing or signs of infection.
• If you have any change in sensation, feeling or colour in the leg or arm of the puncture site, present to your local hospital.
• Do not participate in strenuous activity for the next 7 days. (ie: sports, lifting, gardening, bending, squatting etc)
• Even if you are well, you need to make an appointment to see your own doctor (GP) 5 – 7 days following discharge from hospital.

• If angina symptoms return, administer your Anginine. Follow your chest pain action plan. If pain is unrelieved despite using Anginine  call “000”. Keep your GP informed of your symptoms.
• Medication compliance and risk factor control is ESSENTIAL in preventing the return and progression of heart disease. We cannot cure you. Managing your heart health is your responsibility too.