Ans- CHD is caused by a thickening of the
inside walls of the coronary arteries. This thickening, called atherosclerosis
(at a row skle row sis), narrows the space through which blood can flow,
decreasing and sometimes completely cutting off the supply of oxygen and
nutrients to the heart.
Atherosclerosis usually occurs when a
person has high levels of cholesterol, a fat-like substance, in the blood.
Cholesterol and fat, circulating in the blood, build up on the walls of the
arteries. The build up narrows the arteries and can slow or block the flow of
blood. When the level of cholesterol in the blood is high, there is a greater
chance that it will be deposited onto the artery walls. This process begins in
most people during childhood and the teenage years, and worsens as they get
older.
Right now your symptoms suggest that
you have coronary heart disease. If that is the case, your doctor will
recommend changes in your lifestyle, possibly medications, and possibly
procedures to re-establish blood flow to the heart muscle that needs it. But
first it's important to confirm that your symptoms are caused by blockages in
your coronary arteries. If there are blockages, it's important to see just how
serious the blockages are. All this can be done with an angiography.
Before Your Angiography:
Although an angiography is not surgery, there are a few
guidelines that need to be followed.
Please do not eat or drink anything after midnight the night
before your procedure.
·
If you need to take medications in the
morning, just have them with a sip or two of water
·
If you smoke, be sure not to smoke the
morning of your procedure, since nicotine will distort the results of some
tests.
·
Since you will not be allowed to drive
yourself home after the procedure, arrange for transportation to and from our
facility.
·
Please be on time for your appointment,
since there’s a lot to do.
·
After completing a few last-minute
forms, it will be time to change into a hospital gown.
·
We will draw a small sample of your
blood, for lab work, and we will place an IV in your arm.
·
As we're about to go to the lab, we'll
add a medication to your IV that will help you to relax.
During the Procedure:
Although you'll feel groggy, you will be awake, and able to
speak with him.
The large machine hanging from the
ceiling is the X-ray camera. What makes this machine unique is that, instead of
a single snapshot, like a traditional X-ray, this machine takes pictures
continuously. These pictures are displayed on the monitors next to you, and
they are also filmed, for later review.
The procedure begins with a very small
incision, where your leg joins your torso. Through this small cut a hollow
tube, called a catheter, is threaded into your artery system. Soon the catheter
is at the heart. Although blood is constantly circulating through the heart;
the heart itself is nourished just by the blood that makes it through the three
coronary arteries. The doctor shall carefully guide the catheter until it is
exactly at the entrance to the first of the coronary arteries. At the right
moment the radio-opaque dye is released through the tube. Through this careful
timing, and by placing the catheter in exactly the right place, the dye will be
pulled into the coronary artery, and not simply flushed through the heart. On
the monitor, the delicate vessels that feed the heart wall will stand out, much
like a river with many small streams leading from it. Partial blockages will
show as unusually narrow sections of the river; complete blockages will look like
dams, with X-ray dye unable to pass.
Since there are three different
coronary arteries the doctor will repeat the procedure as necessary. He might
ask for your help, for example by asking you to cough, to help flush the heart.
While the catheter is in place, other tests may be run as well. Common tests
include measuring how much blood your heart pumps in a beat, and how well your
heart valves work.
Correcting Blockages:
Your angiography is a procedure to help identify the problem
- it is not a treatment. Sometimes your treatment will be as simple as feeding
special medications through the tube, while it's in place. Other times the
treatment is what's called an angioplasty. During an angioplasty a very small
uninflated balloon is fed through the tube. The balloon is positioned where the
blockage is, then inflated. When the balloon is inflated, it pushes the
build-up in your vessel back against the walls, widening the vessel once again.
Sometimes the balloon is used to push miniature wire scaffolds, called stents,
into place against the walls of the vessel, to help keep it open.
After Your Procedure:
When your angiography is done, a piece of tape will be
placed over the cut. Although the incision is very small, the area needs to
begin healing before you go home. Consequently, you'll need to be in the
hospital for the rest of the day, lying flat. Although you'll need to lie
still, you'll be able to eat and drink, and visitors are allowed. Expect that
you'll be released in the late afternoon. You will not be allowed to drive home
yourself, and you shouldn't drive for the rest of the day.
Your Recovery:
Take it easy at first. Although you should be fine to return
to desk-work the day after your angiography, avoid lifting or straining for at
least a week. If you're uncomfortable, take Tylenol (Acetaminophen).
For the first few days, if you feel
that you're about to cough or sneeze, put gentle pressure where the incision
was, to keep the wound from reopening.
During the healing process, if
something happens, and you do begin bleeding from your wound, put pressure on
it, and call us. If we're not available, be safe, and get to an emergency room.
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