Coronary Angioplasty and Cardiac Rehabiltation.pptx

Coronary angioplasty (AN-jee-o-plas-tee) is a procedure to open clogged blood vessels of the heart. Coronary angioplasty treats vessels, called coronary arteries, which deliver blood to heart muscles. A tiny balloon on a narrow tube, called a catheter, is used to widen a clogged artery and improve blood flow.

Angioplasty is often followed by the placement of a small wire mesh tube called a stent. The stent helps prop the artery open and decreases the chance of the artery narrowing again. Most stents are coated with medicine that helps keep the artery open.

Angioplasty and stent placement may be a planned procedure to improve blood flow to the heart muscles. The procedure also may be used as emergency treatment for a heart attack.

Coronary angioplasty and stent placement also are called percutaneous coronary intervention. Angioplasty with stent placement is used to treat the buildup of fats, cholesterol, and other substances in and on the artery walls, a condition called atherosclerosis. Atherosclerosis is a common cause of blockages in the heart arteries. Blockage or narrowing of these blood vessels is called coronary artery disease.

Angioplasty improves blood flow to the heart. Your healthcare team may recommend this treatment if:

Medicines or lifestyle changes have not improved heart health.
Chest pain, called angina, caused by blocked arteries is worsening.
Blood flow needs to be fixed quickly to treat a heart attack.

1. CORONARY ANGIOPLASTY N. LEMUEL MATHEW MSc . Cardiac Catheterization & Interventional Technology

2. Definition: - Angioplasty is a minimally invasive procedure that opens arteries (large blood vessels) to let blood flow more easily. - It most commonly treats atherosclerosis (a collection of plaque made of fat and cholesterol) in your arteries. - Angioplasty involves a tiny medical balloon that pushes plaque through in spots that are too narrow or blocked. - Angioplasties are generally safe procedures. - They’re less invasive than other heart and vascular procedures, like bypass surgery.

3. Types of angioplasty: Coronary artery angioplasty: Blood vessels in the Heart. Peripheral artery angioplasty: Blood vessels carries blood away from the heart ( legs and arms) Different angioplasty techniques include: Balloon angioplasty:  Involve a tiny medical balloon to move the plaque Angioplasty with or without stenting : Excimer laser coronary angioplasty (ELCA): The laser destroys the plaque.

4. Indications: Heart attack: Angioplasty may limit damage to your heart Carotid artery disease: Blocked carotid arteries can lead to a stroke Chronic kidney disease: When plaque collects in the arteries in your kidneys Coronary artery disease (CAD): A blocked coronary artery can cause chest pain and/or a heart attack Peripheral artery disease (PAD): Angioplasty can clear plaque in the major arteries in your arms, legs and pelvis

5. CONTRA- Indications : - Critical left main coronary stenosis without a collateral flow from a native vessel - Coagulopathy - Hypercoagulable states - Diffusely diseased vessels without focal stenosis - Total occlusion of coronary arteries - stenosis <50%

6. Angioplasty Equipments: - Sheath - Guidewire - Catheter - Inflation Device - Stent - Balloon Other Equipments: - Contrast Medium - Puncture Needle - Manifold - Pressure line - Control syringe - PTCA kit

7. Types of Catheters; Catheters are used depending about the anatomy of patient and doctor’s choice. Some of the commonly used catheters are: - Tiger Catheter - EBU catheter - Judkins Right - Judkins Left - Amplatz Left - Amplatz Right - MPA catheter - Pigtail Catheter Other Catheters: - Picard catheter - Sim catheter - Sones catheter - Cournald Catheter - Vert catheter - Swan – Ganz catheter

8. Types of Stents: - Bare Metal Stent (BMS) - Drug Eluting Stent (DES) Sirolimus , Everolimus , Zotarolimus - Bio absorbable Stent (BAS) TYPES OF BALLOONS: - Conventional Balloons - Drug Eluting Balloons - Cuttings Balloons - Special – Purpose Balloons

9. Types Of Guide wires: Commonly used guidewires are: - Confianza Pro 9-12 - Hornet 10, 14 - Fielder XT-A - Miracle Bros 3 – 12 - Fielder XT-R - RG3 - Fielder FC - R350 - GAIA First - SION Blue - GAIA Next - SION Black - Gladius Mongo - Hi Torque Cross – IT 100 XT - Hi Torque Pilot 150, 200 - Hi Torque Progress 40, 200

10. Patient Preparation: - Medical history of patient including allergies and medications - Nil per oral 6-8 hours before the test - Check vital signs and send blood investigations and report should be collected - Patient and guardian should be explained about the procedure and with the risks and outcomes - The procedure cost and stent cost should be explained - Proper consent form should be signed before the procedure - Patient should be asked to empty bladder and change to hospital gown - Armpit or groin area shaving is required -IV line is inserted before the procedure - The patient is instructed to lie on the c-arm table

11. Procedure: - Surgeon will make a small incision in groin to main artery after numbing area and relaxing patient with medication. - A flexible wire is inserted in artery along with the catheter and fed up to blockage in heart - After reaching the block, Guide Wire will be pushed through blockage and a small balloon will be inflated to open the blockage. - A stent will placed in the artery to keep it open and preventing restenosis - Wire is removed and blood flow will be increased after the artery is opened - Incision will be closed and the patient is kept in ICU for a day in observation and shifted to ward.

12. Stent: - A stent is a small mesh tube typically used to hold open passages in the body, such as weak or narrowed blood vessels. - Stents are often used to treat narrowing in the coronary arteries, which provide the heart with oxygen-rich blood. - Stents can also help to treat an aneurysm, which is a bulge in the wall of an artery, as well as narrowed airways in the lungs . Classification: - Metal Stents - Fabric Stents - Silicone Stents

13. Risks: Bleeding or bruising Blood Clots Infection Allergic reaction Kidney damage Less common but more serious, Heart Attack Stroke Damage to blood vessels Stent restenosis Abnormal heart rhythms Rupture of coronary artery Factors Increasing risk, Age Pre- existing conditions (diabetes, heart failure)

14. Cardiac Rehabilitation: Cardiac rehabilitation is a medically supervised program designed to help heart disease patients improve their cardio vascular health and quality of life after a heart event or diagnosis. Benefits: Cardiac rehab is recommended for individuals who have experienced heart attacks, heart failure, angioplasty or heart surgery, as well as those with stable angina or other heart conditions.

15. Components: Exercise Training: A personalized exercise program designed to improve cardiovascular function and endurance. This may include, - Walking - Cycling - Swimming Education and counseling: Patients receive infromation about heart disease, medications and healthy lifestyle choices, including nutrition, smoking cessation and stress management

16. Pyschological Support: Addressing the emotional and psychological impact of heart disease, which can include, - Anxiety - Depression - Difficulty adjusting to lifestyle changes Phases of cardiac rehab: Phase 1 (inpatient): Begins in the hospital, focusing on early mobilization and education Phase 2 (outpatient): Occurs after discharge, involving supervised exercise

17. And continued education Phase 3 (maintenance): Long term program to maintain healthy habits and prevent recurrence of heart problems. Benefits of cardiac rehab: - Improved cardiovascular function and exercise capacity - Reduced risk of future heart problems and mortality - Improved quality of life and well- being - Encourages healthy lifestyle changes

18. Importance of cardiac rehab: - Cardiac rehab is a vital part of the recovery process after a heart event or diagnosis - It helps patients regain their physical and emotional well-being.

19. THANK YOU