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Angioplasty

Why Is Angioplasty Done?

Last updated on:
16/03/2012

Contributing Author: Guy Slowik FRCS

The two main reasons angioplasty is performed are for:

  • Angina (chest pain) - A person may experience chest pain, or angina, during exercise or stress because the heart's arteries are too narrow to carry enough blood and oxygen to meet the increased demand. Different types of angina are discussed below. In those suffering angina, who have not responded to standard medical treatments, and continue to have symptoms, angioplasty will be recommended.
  • Heart attack - During a heart attack, an artery becomes completely blocked, cutting off blood and oxygen to part of the heart and causing that tissue to die. This is why heart attacks cause such severe pain. Reopening the artery right away can minimize the amount of heart tissue that is damaged during a heart attack. But this is not applicable for everyone after a heart attack.

Angioplasty will generally not be offered to people without symptoms (but who may have some blockage in a coronary artery), and angioplasty to a number of coronary arteries ('multilevel angioplasty') is usually not performed in diabetics.

Angina

Angina, or angina pectoris, is a medical term for chest pain that results from problems with the blood supply to the heart.

  • The job of the heart is to pump oxygen-rich blood to the body and then return it to the lungs, where it picks up more oxygen.
  • The heart itself receives blood and oxygen through two major coronary arteries and the blood vessels that branch off of them. The most important of arteries supplying blood to the heart are the left main, left circumflex, left anterior descending, and right coronary arteries.
  • Angina occurs when the coronary arteries are narrowed or blocked, and the heart muscle doesn't receive enough blood and oxygen. This shortage of blood and oxygen causes pain in the chest.

The two main types of angina are:

  • Stable angina - In stable angina, chest pain occurs during exercise or stress. How severe the pain is, and the kinds of situations that bring it on, are fairly predictable for each patient.
  • Unstable angina - In unstable angina, chest pain is unpredictable and may come on suddenly, even during rest.

Stable Angina

Stable angina is caused by narrowing of the arteries of the heart. This results from coronary artery disease (sometimes called coronary heart disease), which is a build-up of fat- and cholesterol-rich plaque in the wall of the artery.

  • People with stable angina may feel fine most of the time but experience chest pain when they climb a flight of stairs, do other types of exercise, or experience a stressful emotion, such as fear.
  • Chest pain comes on during activity or stress because narrowed arteries may be able to supply only enough blood to the heart to keep up with less intense, everyday activities. Anything that causes the heart to beat faster and need more blood and oxygen can bring on chest pain.
  • Stable angina may be treated with medications that reduce the stress on the heart or help the coronary arteries to open wider.
  • If the medication doesn't work well enough, or a person wants to lead a more active life, the doctor may recommend coronary angioplasty or coronary artery bypass surgery. In bypass surgery, blood vessels are taken from another part of the body and sewn into place above and below the narrowing, creating a new route for blood to travel that bypasses the trouble spot.

Unstable Angina

This type of angina, which causes a temporary, often-severe feeling of chest pain or pressure, is a more serious condition and requires immediate treatment. Unstable angina can indicate the artery is becoming increasingly narrowed and is in danger of becoming blocked completely, or that a blood clot may be forming, causing off-and-on blockage of the artery. These conditions can cause a heart attack.

  • Unstable angina usually is treated with medications that reduce the blood's ability to clot. During treatment, patients are observed closely in the hospital to make sure they don't develop a heart attack.
  • If medication isn't effective and the heart continues to receive too little blood and oxygen, angioplasty or coronary artery bypass surgery may be required.

Nice To Know:

What is variant angina?

A third type of angina, known as 'variant angina', is caused by a spasm of the coronary artery, and usually doesn't damage the heart or require angioplasty or surgery.

For further information about angina and its treatment, go to Angina.

Heart Attack

Angioplasty is also performed as an emergency procedure to widen the coronary arteries of a patient who is suffering, or who has just suffered, a heart attack.

  • A heart attack is caused by a completely blocked coronary artery. Usually an artery becomes blocked when a section of soft, inflamed plaque breaks open at one end, causing a blood clot to grow and fill the inside of the artery. When this happens, no blood can get to the part of the heart that had been supplied by the blocked artery.
  • In the past, heart attack treatment with angioplasty or clot-dissolving medication were viewed as equally good choices.
  • Now angioplasty is seen as the preferred treatment, because it can open the blocked coronary artery faster than clot-dissolving drugs can.
  • The disadvantage of angioplasty for the treatment of heart attack is that it is not available in many U.S. hospitals. To do angioplasty safely and well during a heart attack, hospitals must have the necessary equipment and a team of experienced cardiologists, nurses, and technicians ready at a moment's notice, 24 hours a day. Generally, only very large medical centers have this type of program in place.

For further information about heart attack and its treatment, go to Heart Attack.

Nice To Know:

My doctor says I have coronary artery disease that requires surgical treatment. I would like to have an angioplasty, but my doctor says it won't work for me. Why not?

Not all plaques respond to the angioplasty technique; some are too long or too hardened, or out of reach of the catheter. Or the artery may have so many blockages that coronary bypass surgery would be better. Also, the condition of the heart may play a role. In some cases, if the heart is weak, angioplasty is not the right choice.

Nice To Know:

Finding hidden coronary artery disease

Some people may also have angioplasty without ever having experienced chest pain. Usually these are people who:

  • Have a strong family history of atherosclerosis (the build-up of plaque in the artery walls)
  • Are at high risk for heart disease for other reasons, such as high blood levels of cholesterol, smoking, or diabetes.

As a precaution, they may have an exercise stress test or some other type of screening exam. If the results lead the doctor to suspect heart disease, the person may have a diagnostic test called an angiogram, or cardiac catheterization. This is an x-ray of the arteries that involves injection of a special x-ray dye that helps to show whether there are severe narrowings in the coronary arteries. If there are, the doctor may recommend angioplasty or bypass surgery.

 

 
 

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.