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An angioplasty is a procedure that opens the narrowing in the arteries of your heart muscle to improve blood flow. It's not surgery, and you won't have any cuts in your chest or heart.
Instead, your doctor uses a tube (catheter) and inserts it into one of your arteries through your wrist or your groin. The catheter threads its way toward the heart and to the heart artery. Then a wire is passed along it, into your heart artery where the narrowing needs to be opened. A smaller catheter – with an inflatable balloon on the tip – is then passed along the wire to the blockage. The balloon is then inflated to open the artery and increase blood flow to the heart.
It's common for the doctor to also use what's called a coronary stent inside the artery. It's a device made of stainless steel or a metal alloy mesh that holds the artery open like a scaffold. When the balloon catheter is deflated and taken out, the stent stays in place permanently to keep the artery open. Over the next few months, the inner lining of the artery grows over the stent and helps it repair and heal.
If an additional type of procedure is required in your case, your physician will describe it to you in detail.
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You will need to have a blood test before the procedure. If this has not been arranged before your test, then call the Triage office. If you have any questions, you can call your doctor's office or the Triage Office at 416 340 5184.
If there are any changes in the booking of your test, you will be called by the Triage office. If you cannot go to your test, call the Triage Office as soon as you know. If you are unable to reach the triage office, then leave a message at 416 340 5184.
Take a shower the night before or the morning of your test.
Please bring with you a list of your current medications. This includes prescription medications, over-the-counter medications, vitamin or mineral supplements and herbal remedies.
If your procedure is in the morning you can have NOTHING to eat or drink from midnight the night before your procedure. Medications can be taken with a sip of water unless you are instructed otherwise by your doctor. Your doctor will give you instructions about your blood thinner or diabetes pills.
If your procedure is in the afternoon you can have a small breakfast (such as toast and juice) before 6:00 am. Do not have anything else to eat until after your test. Medications can be taken with a sip of water unless you are instructed otherwise by your doctor. Your doctor will give you instructions about your blood thinner or diabetes pills.
If you take a "blood thinner" (i.e. Coumadin® or Warfarin) or you are not sure, call the Triage Office or family doctor. Ask what you need to do about your "blood thinner".
If you take pills (i.e. Metformin®) or insulin for your diabetes, then call the Triage Office or your family doctor. Ask what you will need to do about your medication and breakfast on the day of the test.
If you need an interpreter, bring a friend or family member who has to be present in the lab for the test. You'll be sedated during this procedure. The friend or family member will be instructed on how to care for you after the exam and be required to drive and/or accompany you home. They can also help you gather information, take notes and ask questions.
Your procedure will be done in the
Cardiovascular Investigations Unit.
At the Toronto General Hospital, you will initially check in at the Cardiac Short Stay Unit on the 5th Floor Munk Building. Please check in at the nurses' station.
At the Toronto Western Hospital, you will check in directly at the reception desk at the
Cardiovascular Investigations Unit.
Please have the following ready:
When you check-in, the receptionist will give you a name band to wear. You will be assigned a room to wait until it's time for your procedure. You will be asked to change into a hospital gown. Your family should keep your valuables with them.
When you have finished changing, an RN will prepare you for the test and the physician will explain the procedure and ask for your consent.
A coronary angioplasty can be done in two ways: using the femoral artery or the radial artery. Both ways are safe. A catheter is inserted through the femoral artery, which is a large artery near your groin, or the radial artery in your arm. For either method, hair is first removed from the area.
We give you medication to help you relax before you enter the lab, but you'll remain awake during the procedure.
The coronary angioplasty is done in a lab. The lab is kept cool to keep the machines working properly, so you may feel cool as well. During the procedure, the nurses will monitor your heart rhythm and blood pressure. Sterile sheets will be put on you to keep the insertion site clean.
The doctor will give you an injection to numb the area where the catheter will be inserted. Then a hollow plastic guide (sheath) will be inserted into the artery – you may feel some pressure and tingling, which is normal. Then your doctor will insert a longer tube, which goes to the top of your heart. If you feel any pain or discomfort during the procedure, tell the doctor right away.
Your doctor will then inject contrast through the catheter that goes into your heart. You may feel a hot flash lasting about 30 seconds. This is normal. Again, if you feel any pain or discomfort, tell the doctor immediately.
While the contrast is moving through your heart, the doctor will ask you to take a deep breath and hold it – this helps us get better pictures of your heart. The doctor will let you know when you can breathe normally again.
Once the blockage is seen on the x-ray screen, the balloon catheter is passed through to the area near the narrowing. A guide wire inside the catheter is then moved through the artery until the tip is past the narrowing, and then the balloon catheter is moved into place. It may take several tries for the doctor to inflate the balloon and open the artery.
The balloon is inflated for about 30 seconds each time. When the balloon is inflated, blood flow through the artery stops for a brief time. This isn't long enough to damage the heart muscle, but you may have some chest pain. Tell the doctor and nurses if you feel any discomfort. This usually goes away quickly when the balloon is deflated. The catheter is deflated and removed once the doctor is satisfied with the result.
The doctor usually puts a stent into the inside of the artery during the procedure. It's a device made of stainless steel mesh that keeps the artery open. The stent is first placed over a balloon, which is then inflated. The stent expands and is pressed into the wall of the artery. After the balloon is deflated and taken out, the stent stays in place permanently to keep the artery open.
After the procedure is completed, the catheter will be removed. The sheath may be removed in the lab, in the recovery room or in the Short Stay Unit.
If your doctor has used the femoral artery near your groin, a clamp will be applied to the area where the catheter was put in. If your doctor has used your arm artery, another type of pressure will be used. This is to stop any bleeding and to help the area heal.
When you return from the lab, you'll be lying flat on your back with your leg straight.
You need to stay in this position for 3 to 6 hours before you're allowed to sit up. This allows more time for the area to heal. One hour after the procedure, you'll be allowed to have something to eat and drink. A nurse will check the blood pressure and the pulses in your wrists and feet and will also check the area where the catheter was inserted.
The physician will speak to you following the angioplasty.
A coronary angioplasty usually takes 90 minutes to 2 hours, however, you will be here all day.
We do everything that we can to stay on time. Unfortunately, your appointment may be delayed by unforeseen circumstances. We recommend that you come prepared for delays.
You will be contacted with information about your first appointment.
Please bring the following to your appointment. Not all of these items may be needed for your appointment. Our clinic or your referring doctor will let you know what you must bring.
Please arrive 15 minutes before your appointment.
When you arrive, you will sign in with the receptionist. You will need your health card (OHIP card) to sign-in. If you do not have an OHIP card, please bring another form of government-issued photo ID, such as a driver’s license or passport.
You may be given a Measuring Health Equity Questionnaire to fill out. This form contains questions about your background. We collect this information to find out who we serve and what unique needs you may have. The form is voluntary and you can choose ‘prefer not to answer’ to any or all questions. However, the information you choose to give us will help us improve the quality of care for you and others.
First appointments take longer than follow-up appointments. Your first appointment can take 2 hours or more. Follow-up appointments usually take 15 to 30 minutes. We do everything we can to stay on time but sometimes unforeseen circumstances may delay your appointment.
At the end of your first appointment, the nurse or doctor will give you a contact list for your health care team. If you don’t get a contact list, feel free to ask for it.
After every appointment, a member of your health care team will tell you about your next visit. Be sure you understand what is going to happen next. For example, know the time and place of your next visit or if someone will call you with this information.
If you are unsure about what your next steps are, don’t be afraid to ask a member of your team. We are here to help you.
We understand that reaching us by phone can sometimes be difficult. Often our phone lines are busy or are turned over to the message centre so our staff can prepare for clinic visits or help other patients. We make every effort to return your call within 24 hours. Our staff will try to reach you 2 times. If we are not able to reach you directly you may need to call us again.