Find out the most important advice given by our consultant and the most adequate medical responses for each particular case.
The angioplasty can be performed through surgical incision or the percutaneous method:
The procedure usually takes between 1 hour and a half and 2 hours and a half, but the preparation and recovery makes it longer. After undergoing an angioplasty, the patient can remain in the hospital overnight for observation.
Severe complications of percutaneous angioplasties (the obstruction of the artery through the wall cleavage or hematoma, hemorrhage) are very rare. Sometimes, after a while, a new narrowing might occur (restenosis); however it is usually treated successfully through another angioplasty.
In case of coronary restenosis, which is relatively frequent, the repairing techniques have diversified nowadays:
The majority of patients require:
These tests might require separate appointments and are usually performed one day prior to the intervention. The patient who requires an interventional procedure is not allowed to eat or drink after midnight, prior to the day of the intervention. If the patient has false teeth, a hearing aid or glasses, it is best to have them with him/her on the day of the intervention, in order to be able to communicate better with the medical personnel.
Moreover, the patient should notify the physician or the nurse if s/he is undergoing treatment with anticoagulants, insulin or diuretics, or if s/he is allergic to any substances, especially iodine, seafood, contrast substances used for X-rays, latex or rubber (such as rubber gloves or balloons) or medicines belonging to the class of penicillin.
The patient will have to take aspirin before the procedure; therefore s/he should tell the physician or the nurse if s/he did not take the aspirin. The patient will remain awake during the intervention, but s/he will be administered medicines in order to relax.
The patient must remain stretched out (e.g. without bending his/her knees) as long as the inguinal muff is still in place. A folded sheet can be placed alongside the leg in order to remind the patient not to bend the knee.
After the inguinal muff is removed, the patient must remain stretched out for another six hours in order to prevent bleeding; however, after two hours a nurse can place a pillow under his/her head. The nurse will also tell the patient when s/he can get out of bed accompanied by someone, six to eight hours after the inguinal muff has been removed (or even sooner if a collagen plug has been placed in the artery).
The patient should not eat or drink anything other than clear liquids until the inguinal muff is removed, because during this time, nausea can occur. Once the patient is allowed to eat, s/he is recommended to follow a diet that is low in cholesterol and salt.
The patient can be held under observation until the next day. The physician or the nurse must be immediately informed if the patient is feverish, feels chest pains, pain or tumefaction in the inguinal area or in the leg. If, after being discharged, the patient bleeds in the inguinal area, s/he should call an ambulance, lie down immediately, get undressed and keep pressure on the affected area, where s/he feels the pulse.
If during the angioplasty a stent was placed, then the patient should take anticoagulants in order to reduce the likelihood of blood clots occurring in the stent area. When the patient has recovered sufficiently and has spoken to his/her physician about the care s/he will require, the patient is ready to go home.
In the first few days after the intervention, the patient needs a lot of rest. The patient will be able to climb up the stairs, but at a slow pace and s/he should not force the time of bowel movements. The patient's level of activity will increase gradually, until it reaches the normal level of activity. This usually takes place at the end of the first week after the intervention.
Even though the procedure performed during the coronary angioplasty will open the obstructed artery, it will not heal the coronary disease. The lifestyle factors that can aggravate coronary disease, such as smoking or a diet rich in fat, must be changed. We also recommend a regular program of physical exercises in order to improve the heart's health.
Coronary catheterisation is an investigation that studies the coronary arteries of the heart with the view to:
This procedure is recommended when the physician suspects the presence of a myocardial infarction or of angina pectoris, more precisely in case of:
This investigation uses X-rays and a iodine-based contrast substance. Its aim is to offer the cardiologist the possibility of visualising the coronary arteries by making them opaque.
A catheter is introduced inside the blood veins (femoral artery) and manoeuvred inside the heart where it injects the contrast substance that mixes in with the blood. Thus the vascularisation system of the heart becomes visible (in X-ray images due to the radiopaque properties of iodine).
A cardiologist who is superspecialised in Interventional Cardiology will perform the procedure. During the exploration, the patient lies down on his back. The cardiac rhythm and the arterial pressure are constantly monitored.
The procedure is performed in sterile conditions and under local anaesthesia. The cardiologist starts by disinfecting the skin at the base of the thigh and administers the local anaesthesia. After the area is anaesthetised, the cardiologist introduces the catheter into the femoral artery. This catheter is then manoeuvred up to the origin of the coronary arteries. The entire procedure is monitored on a screen. Then, the cardiologist injects the contrast substance that makes the vascular network of the heart become visual on the screed.
If an obstruction is identified, the cardiologist will perform a coronary angioplasty that dilates the narrowed blood vein by using a balloon and possibly a stent as well (see coronary angioplasty). The procedure takes about 30 minutes - 1 hour.
After finishing the investigation the catheters are removed, the vein located at the puncture place of the femoral artery (at the base of the thigh) is compressed and a compressive dressing is applied for 24 hours. The patient must remain immobile, on his back, in bed for 24 hours. This is necessary in order to avoid bleeding in the puncture place of the femoral artery. In the hours after the procedure you can eat and drink normally.
The local anaesthesia consists of a simple sting, followed by the puncture of the femoral artery. This part is slightly unpleasant, but not painful, since the entire procedure is performed under local anaesthesia.
The treatment of acute myocardial infarction is an emergency treatment that must be performed as soon as possible after the commencement of the infarction, in order to reduce the myocardial necrosis area and to prevent complications. The amount of muscle dying due to the lack of blood can be reduced by dissolving the clots in the coronary arteries and re-establishing blood flow.
When the pain begins, you can take a NITROGLYCERIN tablet under your tongue, if this medicine is already part of your treatment. If the pain does not go away, you can take 2 more tablets at an interval of 5 minutes.
If the symptoms do not disappear after 15 minutes, call an ambulance immediately! Attention! Do not take Nitroglycerin if it was not prescribed to you by your physician (because there are certain conditions that can be aggravated by taking this medicine!).
In the Emergency Room of the hospital the diagnosis is determined through clinical examination and electrocardiogram; then, the patient is transported to special units, called Infarction Centres, where the physicians perform a coronary monitoring and they start the treatment for acute myocardial infarction.
The treatment includes:
Another method of treatment for re-opening the coronary artery affected by AMI is coronary angioplasty of the artery (in the centres have a laboratory for catheterisation).
The physicians will continue to administer heparin, beta blockers (e.g. Metoprolol), Aspirin and possibly Clopidogrel, as well as other medicines that improve the heart function, depending on the patient's status. Anxiety treatment (frequent in patients with AMI in the first 24-48 hours) involves administering medication such as: Diazepam, Alprazolam and Hydroxyzine.
What you need to bear in mind is that treatment is not identical for all patients with AMI. It varies depending on the patient's clinical status, the location of the AMI and the occurrence or non-occurrence of complications.
Usually, the patient with AMI remains in the Infarction Centre for 24-48 hours (in cases that do not involve complications) and then s/he is transferred to the 2nd ward – the ward for post-infarction monitoring.
Nowadays, physicians know much more about the healing process of the heart and therefore patients receive a much better early care for myocardial infarction. Moreover, the recovery period has shortened.
In normal cases, when there is a blood flow in the coronary arteries, the healing process is faster. The area of the heart muscle that has suffered a permanent lesion is replaced by a scar.
The myocardial infarction can leave certain sequelae that are variable and depend on:
The sequelae can be minimal in the following cases: many patients agree to give up smoking, to do physical exercises, to lose weight and after a few months they recover well.
There is also the possibility of some sequelae:
Such problems need to be discovered as soon as possible – their occurrence after a myocardial infarction should lead you to a visit to your cardiologist! Depending on the results, the cardiologist will adapt your treatment.
Each person that is in convalescence after an acute myocardial infarction has two main purposes:
If there are no complications, patients do not have to remain in bed for more than 12 hours. Daily activities should be resumed progressively and in a personalised manner, depending on the patient's general state, age and physical capacity.
Stage 1 (days 1-2)
On the first day, the patient will remain in bed and will be able to feed himself/herself with the help of a support table. The patient will receive complete assistance for personal hygiene. With help, the patient will be able to make passive movements with his/her arms and legs.
On the second day, the patient can sit on the side of the bed or on an armchair for 1-2 hours/day. S/he will be able to actively move his/her arms/feet for 5-10 minutes/day.
Stage 2 (days 3-4)
The patient can do his/her personal hygiene and can dress himself/herself, but only in sitting position. The patient will be able to sit on a chair or in an armchair for as long as s/he wants and s/he can stroll across the ward.
On the fourth day, the patient can take a shower while standing or sitting (using a chair reduces the anxiety and fear of falling). The patient can stroll 50-100m under supervision, several times a day.
Stage 3 (days 5-7)
The patient can stroll for about 100 m, 3 times a day. S/he can shave or wash their hair (activities that consist of raising the arms above the head). S/he can climb up and down the stairs under supervision.
Usually, the best results are obtained when there are several people involved in the recovery program. The family should be understanding and should actively participate in the patient's program. However, an over-protective family or a family with high expectations can slow down the process. The physician is the person who recommends the progressive increase of activity, exercises and treatment.
Discharge
The discharge date depends on the patient's status and on the type of treatment. Before getting discharged, patients will receive clear recommendations regarding the treatment, nutrition and the physical activities allowed. Some of the activities that used to be possible might be limited after the infarction. Nevertheless, the majority of patients can adapt and thus they can resume their active life in a satisfactory manner, including going back to work, if the case.
Recommendations upon discharge
At first, we recommend you to avoid significant physical effort and lifting heavy objects. Resting several times a day is important at this stage. In time, you will be able to do more activities, depending on how your body sustains them.
You should avoid any activity that causes you anginous chest pain!
It is very important to have Nitroglycerin with you at all times to use in case of need.
A long-term plan will include methods of reducing the risk factors that might cause recidivism of the AMI.
It is essential that you give up smoking permanently! In patients who have given up smoking, the risk of heart disease has diminished significantly in the following years.
Correct nutrition is also of major importance. It involves reducing the level of fat and cholesterol. In the first place, you have to reduce the ingestion of fat from meat and dairy products. It is beneficial to introduce fresh fruit and vegetables in your diet. In some cases, in order to reduce the cholesterol level in the blood you might need to take certain medication. Hypertensive patients also have to reduce the quantity of ingested salt.
Physical exercise and physical activity in general represent a major factor in the process of recovery after an AMI. It is very important to ask you physician about the amount of physical exercise that you are allowed to make. You will be put in contact with a consultant in cardiology recovery who will offer guidance. Under the supervision of said consultant, your physical activity will be monitored and guided for a good physical recovery. You should discuss all of this with your physician, without any inhibitions.
Sexual activity can only be resumed after undergoing an effort test at the hospital. The patient can usually resume sexual activity after s/he is able to climb two flights of stairs without any problems.
Other measures that need to be taken to reduce the cardiovascular risk in the future: control of the arterial hypertension, of diabetes mellitus and of dyslipidaemia (if present), weight control and avoiding stress. After an AMI or angina pectoris, medication is not enough. Medication can be insufficient if you are not fighting the risk factors as well: obesity, smoking, diabetes mellitus, arterial hypertension, dyslipidaemia, sedentary lifestyle.
The medication treatment prescribed upon discharge should be continued on the long term. It will include several categories of essential medicines that should not be interrupted without the consultant's approval.
Any adjustment of dosage or of the therapeutic scheme must be made with the physician's approval.
After suffering an acute myocardial infarction or even after the onset of angina pectoris, patients should undergo periodical cardiological exams.
These exams are essential for:
It is very important to discuss with your cardiologist about the scheduling of medical exams that you will undergo in the hospital or at the polyclinic that you belong to.
Overweight or obese people have a higher risk of developing cardiovascular diseases, even when there are no other risk factors involved. The excess weight caused by fat forces the heart to work more and unbalances the cholesterol and glucose levels in the blood.
In order to answer this question, specialists use two indicators: BMI (body mass index) and AC (abdominal circumference).
BMI (body mass index) is an official index used to measure the ideal body mass for a certain height. BMI helps determine a person's weight category, the degree of obesity and it also helps measure the number of kilograms that a person should lose or gain in order to reach the ideal weight. This method can be used for both men and women aged between 18 and 65 years. In order to find out your BMI, use the following tool: the body mass index calculator created by the BMI-Club.
Interpreting the body mass index:
The formula used to determine the body mass index is: weight (kg) / [height (m)]2
AC (abdominal circumference) – excess fat can deposit in various parts of the body. The most harmful type of fat is the one deposited in the abdominal area. This type of fat is quantified with the help of this parameter. It is very easy to measure your abdominal circumference by using a tailor meter that you put around your abdomen.
Depending on the value, you can find out whether you are at risk or not. The people at risk have the following values:
Arterial hypertension usually progresses in a silent manner, without any signs or symptoms that would alert the patients about the presence of the disease. This is why it is important to measure the arterial blood pressure at regular intervals. Arterial blood pressure is characterised by 2 values: the first is higher and it is called systolic pressure, the second is lower and it is called diastolic pressure. The difference between these two values should be of approximately 40 – 50 mmHg.
The hospitalisation period depends on the patient's condition:
| VALUE CATEGORIES OF ARTERIAL BLOOD PRESSURE | SYSTOLIC VALUE | DIASTOLIC VALUE |
|---|---|---|
| Normal | under 120 mmHg or | under 80 mmHg |
| Prehypertension | 120-139 mmHg or | 80 -89 mmHg |
| Stage 1 hypertension | 140-159 mmHg or | 90 - 99 mmHg |
| Stage 2 hypertension | over 160 mmHg or | over 100 mmHg |
| Hypertensive crisis. Measure again in 5 minutes or call an ambulance | over 180 mmHg or | over 110 mmHg |
Your future depends on the risk of new coronary and myocardial lesions and on the sequelae of the previous ones.
In the people's view, the heart conditions is often considered to be characteristic of active people with a stressful life, full of responsibilities or of people who have had a life full of excesses.
No, this is not true. The heart condition is not specific of stressed people with many responsibilities and it is not necessarily a dramatic and crippling disease.
It is rather a disease that you can act on, but only if you adopt a healthy lifestyle and if you comply with your physician's recommendations. Your main aim could be having a more harmonious and healthier life than before the acute myocardial infarction and this aim is certainly achievable.
