Angiografi Jantung

Apa itu Angiografi Jantung

Angiografi jantung adalah tes untuk mendeteksi penyumbatan arteri jantung

Anda. Ini merupakan cara cepat dan efektif untuk memberikan bukti pasti
tentang adanya abnormalitas.

Bagaimana prosedur dilakukan

Tube kecil disebut kateter dimasukan kedalam pembuluh darah pada

selangkangkaki/pergelangan tangan/tangan dan diarahkan ke jantung Anda.
Kontras special kemudian disuntikkan dari keteter ke arteri jantung untuk
membuat pembuluh darah tampak pada x-ray. Gambar direkam dengan film x-
ray, menghasilkan gambar gerak dari jantung dan pembuluh darah.

Sebelum prosedur

Anda akan ditanya apakah Anda pernah alergi obat-obatan atau makanan,
khususnya kontras x-ray atau senyawa yodium. Anda disarankan untuk
memberitahu dokter tentang alergi Anda.

Sehari sebelum prosedur, Anda harus mencoba dan tidur malam cukup. Jika perlu,
minta obat tidur.

Anda diminta untuk puasa enam jam sebelum angiograf Umumnya Anda harus
terus minum semua obat-obatan Anda kecuali diberitahu sebaliknya oleh dokter.
Jika prosedur dilakukan sore hari, Anda bisa makan pagi seperti biasa.

Saat prosedur

Saat prosedur, Anda akan diminta untuk mencopot gigi palsu, lensa kontak dan
perhiasan apapun. Tolong jangan membawa uang atau benda berharga lainnya
pada saat prosedur.

Sesudah prosedur

Dokter akan mengevaluasi hasil Anda dan kemudian menyarankan pengobatan

yang paling sesuai. Anda mungkin diperbolehkan pulang pada hari yang sama
setelah prosedur. Jika ditemukan penyumbatan arteri yang parah, dokter jantung
mungkin melakukan Angioplasti Jantung untuk Anda segera setelah angiograf.
Sebaliknya, Anda akan diminta kembali di lain hari untuk prosedur atau
untuk operasi bypass arteri jantung.
Jakarta - Penyakit jantung saat ini masih menjadi penyebab utama kematian di seluruh dunia,
termasuk di Indonesia. Namun, meningkatnya jumlah penderita jantung ini tidak dibarengi
dengan peningkatan jumlah pusat pelayanan jantung yang komprehensif. Akibatnya tidak
sedikit pasien penyakit jantung yang memilih operasi ke luar negeri.

Menurut dokter spesialis bedah jantung dari Siloam Hospitals Kebon Jeruk, Maizul Anwar,
jumlah operasi jantung di Indonesia saat ini diperkirakan mencapai 4.000 kasus per tahun.
Padahal potensi kasus bedah jantung sekitar 20.000 kasus per tahun. Sementara jumlah pasien
yang memilih operasi ke luar negeri sekitar 2.000 kasus. Mereka paling banyak ke Penang,
Singapura dan Kualalumpur.

"Masih banyaknya pasien penyakit jantung yang memilih operasi ke luar negeri
memperlihatkan ketidakpercayaan masyarakat akan kualitas pelayanan jantung di Indonesia.
Contohnya ke Penang, operasi di sana itu image-nya murah dan dekat. Padahal di sini juga
punya fasilitas dan tenaga medis yang kompeten dengan biaya yang murah," kata Maizul di
Jakarta, Kamis (26/1).

Sejak 2013, Siloam Hospitals Group juga telah mendirikan Siloam Heart Institute (SHI) yang
berpusat di Siloam Hospitals Kebon Jeruk.

Menurut Anwar, SHI menjadi pusat layanan jantung terpadu yang terdiri dari tim
multidisiplin, mulai dari kardiologi anak, kardiologi dewasa, bedah jantung, dokter anestesi
dan tim rehabilitasi medik dengan jaringan rumah sakit di lebih dari 10 kota besar di
Indonesia.

"Visi dari SHI adalah menjadi pilihan utama untuk pelayanan bedah jatung di Indonesia
melalui pelayanan terpadu yang terjangkau dan berkualitas internasional," kata Anwar yang
merupakan kepala Siloam Heart Institute.

Hingga Februari 2015, SHI telah melayani pasien bedah coronary artery bypass graft
(CABG) sebanyak 159 kasus dengan mortality rate 1,8 persen. SHI juga sudah menangani
bedah toraks sebanyak 23 kasus dan bedah vaskuler 25 kasus. "Di tahun ke-3, SHI
menargetkan bisa menangani operasi jantung sebanyak 1.000 kasus per tahun
dengan mortality rate kurang dari 1 persen," ujar Anwar.

Kehadiran SHI, menurutnya, juga turut mendukung kondisi finansial pasien. Misalnya untuk
kelas 3, biaya yang perlu dikeluarkan hanya sekitar Rp 75 juta, kelas 2 Rp 85 juta, kelas 1 Rp
95 juta, dan VIP sekitar Rp 110 juta.

"SHI menawarkan paket, jadi biaya ini sudah termasuk biaya operasi, dua hari pemulihan di
ruang ICCU, dan lima hari di kamar perawatan. Sementara di Penang, biaya operasinya saja
sampai 30.000 ringgit atau sekitar 100 juta," kata Anwar.

Tahun ini, Siloam Hospitals Medan juga akan segera diresmikan.

Menurut Anwar di rumah sakit tersebut nantinya juga akan dikembangkan pusat layanan
jantung terpadu seperti yang ada di Jakarta, sehingga pasien jantung di sana tidak perlu lagi
melakukan operasi bedah jantung di Penang atau Kualalumpur.

DISAAT BEDAH JANTUNG MERUPAKAN SATU SATUNYA PILIHAN

Tengah malam, seorang laki-laki berusia 50 tahun mengeluh merasakan nyeri

dada, dan semakin lama semakin merasakan sesak napas. Keluarga segera
membawanya ke rumah sakit terdekat. Beruntung karena di sana ada dokter
spesialis jantung yang baru 1 minggu bekerja dan berkenan datang ke rumah
sakit tersebut untuk melihat keadaannya.

Kesimpulan dari hasil pemeriksaan dan rekaman jantung adalah suatu serangan
jantung akut. Dokter berpikir tindakan yang akan segera dilakukan adalah
menyuntikkan obat penghancur bekuan darah. Ternyata obat tersebut belum
tersedia di rumah sakit tersebut. Oleh sebab itu, sang dokter segera menelpon
spesialis jantung yang ada di provinsi untuk menanyakan apakah dokter tersebut
bisa menolong pasien tersebut dengan suatu tindakan yang disebut Primary
PTCA. Dengan menggunakan Ambulans yang dilengkapi tabung Oksigen dan
ditemani oleh seorang perawat, 3 jam kemudian pasien tiba di RS Provinsi.

Setibanya di RSU Provinsi, oleh Spesialis Kardiologi Intervensional pasien

langsung dibawa ke Ruang Kateterisasi. Dokter menjelaskan manfaat dan resiko/
komplikasi Kateterisasi yang bisa terjadi (Informed Consent). Keluarga Pasien
segera menyetujui sehingga persiapan dan prosedur bisa segera dikerjakan.

Prosedur dimulai dengan anestesi lokal daerah paha dilanjutkan dengan

memasukkan kateter sebesar 2,5mm sampai ke pangkal aorta dan disemprot
dengan kontras. Hasilnya terdapat sumbatan dari beberapa arteri koroner
dengan aliran darah yang lambat. Dari data tersebut, Spesialis jantung tersebut
memutuskan hanya mengatasi serangan jantung akut tersebut dengan
melebarkan atau dilatasi, serta memasang cincin (Bare Metal Stent) pada
pembuluh koroner kiri. Selanjutnya direncanakan untuk bypass koroner setelah
pasien stabil. Keluhan pasien langsung berkurang dan lama-lama hilang. Total
lamanya prosedur lebih kurang 1 jam. Dua hari setelah itu, penderita menjalani
bypass koroner (CABG) dengan hasil yang baik.

Apa itu Coronary Artery Bypass Graft (CABG)?

CABG atau Bypass koroner adalah membuat pembuluh darah baru dari aorta
(pembuluh nadi besar) melewati pembuluh darah koroner yang menyempit/
tersumbat, sehingga otot-otot jantung kembali mendapat pasokan darah yang
cukup untuk kebutuhan kerja jantung.

Mengapa pembuluh darah koroner dapat tersumbat atau menyempit?

Penyempitan atau penyumbatan ini terjadi karena adanya proses athecosclerosis
di dinding pembuluh darah yang dimulai sejak beberapa tahun sebelumnya.
Proses endapan atheroma tersebut semakin tebal dan menonjol ke dinding
bagian dalam. Ada kalanya lapisan endothel di atasnya pecah dan diendapi
thrombosit yang membentuk bekuan darah yang makin lama makin banyak
sehingga tertutup total dan terjadilah apa yang disebut serangan jantung akut
(MCI).

Apa tanda serangan jantung?

Tanda yang paling khas adalah nyeri dada atau angina pectoris, dirasakan di
daerah/di bawah tulang dada agak ke sebelah kiri dan rasanya seperti beban
berat, ditusuk-tusuk, rasa terbakar dan lain-lain, kadang menjalar ke rahang,
lengan kiri dan punggung serta keringat yang banyak. Kalau pada tahap awal,
keluhan tersebut akan berkurang dalam beberapa menit bila pasien istirahat dan
akan terjadi lagi bila aktivitas meningkat. Hal ini disebut angina pektoris stabil.

Penyakit jantung koroner yang manakah yang harus dilakukan CABG?

Operasi CABG dilakukan bila terdapat penyempitan pada pembuluh utama kiri
>50%, atau 3 cabang utama koroner menyempit dengan gangguan fungsi
pompa jantung <50% (EF), atau bila pangkal dari pembuluh darah utama kiri
tersumbat. Operasi juga dilakukan pada pasien jantung koroner yang akan
menjalani operasi katup sekaligus atau operasi besar lainnya.

Keuntungan CABG adalah dapat menghilangkan keluhan angina pektoris

sekaligus memperbaiki kualitas hidup penderita, sehingga dapat kembali normal
melakukan aktifitas sehari-hari.

Persiapan apa yang diperlukan sebelum CABG?

Karena ini adalah operasi besar, maka semua sumber infeksi harus dihilangkan
terlebih dahulu. Pasien akan di konsultasikan ke dokter gigi dan Spesialis THT.
Persediaan darah untuk menghadapi terjadinya situasi perdarahan, serta
pemeriksaan laboratorium untuk fungsi organ yang lain.

Bagaimana resiko operasi CABG?

Yang disebut dengan resiko adalah kematian akibat CABG secara umum kurang
dari 2% untuk fungsi jantung yang normal. Makin bertambah umur maka resiko
akan semakin bertambah karena organ-organ yang lain juga mengalami
penurunan fungsi.

Teknik Operasi.

Pemasangan pembuluh darah baru (graft) ini dapat dilakukan dengan memakai
mesin jantung paru (Cardio Pulmonary Bypass/ CPB) atau tanpa menggunakan
CPB (OFF PUMP)

Bila memakai CPB, maka kerja jantung dan paru sementara diambil alih oleh
mesin selama proses penyambungkan graft berlangsung. Pada operasi OFF
PUMP, operator memakai alat stabilizator sehingga graft dapat disambung ke
pembuluh darah koroner. Syarat untuk bypass tanpa CPB haruslah pembuluh
darah cukup besar dan jumlah graft tidak lebih dari 3.

Lama Operasi bypass rata-rata 3 -4 jam di luar proses anestesi.

Pasca operasi pasien akan dirawat di ICU/ICCU selama 1-2 hari. Kemudian pasien
dipindah ke ruangan selama 5-7 hari, dan menjalani fisioterapi. Setelah itu,
pasien siap untuk pulang ke rumah. Proses penyembuhan luka dan recovery
fungsi jantung dapat dinilai saat pasien kontrol ke Poliklinik.

Untuk menjaga agar jantung tetap sehat, sebaiknya pasien harus menghentikan
kebiasaan merokok, mengkonsumsi makanan yang rendah kolesterol,
memperbanyak makan sayur dan buah, Diet Diabetes pada penderita DM,
mengurangi konsumsi garam. Olahraga sebaiknya dilakukan minimal tiga kali
seminggu(jalan kaki minimal 30 menit). Obat-obatan seperti pengencer darah,
obat anti hipertensi dan obat anti Diabetes(pada penderita DM) sebaiknya rutin
untuk diminum. Pengecekan Laboratorium dilakukan sesuai anjuran dokter.

Dr. Heston Napitupulu, SpBTKV, Siloam Hospitals Kebon Jeruk

For Multiple Heart Blockages, Bypass Surgery or Stents?

Study Compares Pain, Quality of Life After Drug-Coated Stents or

Coronary Artery Bypass Surgery
By Brenda Goodman, MA
Listen

FROM THE WEBMD ARCHIVES

March 16, 2011 -- For patients who have several blocked arteries around
their heart, the gold standard treatment has long been coronary artery
bypass surgery.
Now a large clinical trial suggests that drug-coated stents, springy lattice
tubes used to prop open clogged arteries, may also work well in patients
with multiple blockages. And in some patients, the stents produce equally
good results with faster recovery times.
The caveats, experts say, are that people with daily or weekly chest
pain from advanced coronary artery disease will probably experience slightly
better relief from bypass surgery compared to stenting; but they can also
count on waiting to get the full benefit of that procedure weeks to months
longer than people who get stents.
Experts say the study, which is published in The New England Journal of
Medicine, brings to light important trade-offs that people with complex
coronary artery disease need to weigh before making a decision between
the two procedures.
I think the message here, therefore, is not a simple one -- that theres a
clear winner -- but that patients will need to choose based on their own
priorities and values, says study researcher David J. Cohen, MD, a
cardiologist at St. Lukes Mid America Heart Institute in Kansas City, Mo.
Independent experts agree.
If you take the 50,000-mile view, it looks like these procedures got about
the same results, says A. Marc Gillinov, MD, cardiac surgeon at the Sydell
and Arnold Miller Family Heart & Vascular Institute at Cleveland Clinic, in
Ohio. But if you really dig down and look at the clinical circumstances going
in, youll see there are important differences. So the real value in this study
is that it can help patients and doctors make informed decisions on an
individual basis.

Comparing the Effectiveness of Stents vs. Bypass

For the study, researchers at 85 medical centers around the world randomly
assigned 1,800 patients with at least three clogged arteries around their
hearts, or alternatively, a clogged left main coronary artery -- the vessel
that carries the lions share of blood to the hearts primary pumping
chamber -- to one of two treatments: coronary artery bypass graft (CABG)
surgery or percutaneous coronary intervention (PCI).
In CABG, surgeons typically saw through the breast bone and open the rib
cage, a procedure that, in and of itself, requires significant downtime for
recovery. Doctors usually also need to make incisions in other parts of the
body, often the legs, to harvest healthy vessels that can be used to bypass
blockages.
In PCI, a catheter is threaded through an artery in the groin up to the heart,
where a doctor uses a video monitor and radioactive dye to locate the
blockages within arteries. The doctor then inflates a balloon to compress the
buildup against the artery walls and places a stent to hold the spot open.
The stents in this trial were coated with the drug paclitaxel, which is thought
to help prevent the formation of scar tissue around the site of stent
implantation, a problem called restenosis.

Study Details
Before any procedure was performed, an interventional cardiologist and a
cardiac surgeon consulted together on each case. If there was mutual
agreement that the blocked vessels might be effectively opened using either
procedure, the patient was cleared to enter the study.
Before patients were assigned to one procedure or the other, doctors asked
patients questions about how often and how strongly theyd been
feeling angina, or chest pain, their physical limitations and general quality of
life. Based upon the answers, patients were scored on a scale of 1 to 100,
with higher scores indicating fewer symptoms and better health status.
Those questions were asked again one month, six months, and 12 months
after their procedures.
A disease severity score was also determined at study entry for each
patient. This score is dependent upon the degree and extent of blockages as
demonstrated on the initial angiogram, with higher scores indicating more
complex disease. For subsequent analysis purposes, the patients in the
study were divided into three subgroups depending upon their disease
severity scores (0 to 22, 23 to 32, and 33 to 83).
In all, 903 patients received stents, while 897 had bypass surgery. In both
cases, doctors tried to open all the arteries that were at least 50% blocked.
In the first phase of the study, which was published in 2009, researchers
looked primarily at the risk of having a major event, like a heart
attack, stroke, or having to reopen an artery that had clogged a second
time. After one year, there were about 5% fewer total events in the bypass
group compared to the stent group, 12.4% compared to 17.8% respectively.
More patients needed to have clogged arteries reopened in the PCI group
than in the CABG group, 13.9% vs. 5.9%, respectively.
After one year, the rate of heart attack or death was similar between the
two groups, while stroke was more likely to occur in the bypass group
(2.2%) compared to the stent group (0.6%).

Looking at Quality of Life

When researchers looked at angina and quality of life in study participants,
overall, both groups fared well. In fact, slightly more than half of people in
both groups reported substantial improvement in angina as early as one
month after their procedures.
But when investigators looked at those measures across various time points,
and in people with more and less severe disease, differences emerged.
As was expected, people who got stents generally felt better faster,
compared to the group that had bypass surgery, probably because there
was less healing time required after the less invasive procedure.
But by six and 12 months after their procedures, both groups reported
nearly equal improvements in physical functioning, pain, vitality, and social
and mental health.
And after six months, researchers say people that went into the study with
daily or weekly chest pain experienced greater relief after CABG than did
those who got PCI.
Angina relief at six months and a year was better with bypass surgery,
though the difference was small, says Cohen. But there were clear
differences in the early quality of life on a wide range of dimensions that
clearly favored PCI, but those benefits were transient, he says.
The study was sponsored by Boston Scientific, which produces paclitaxel-
coated stents.
WebMD Health News Reviewed by Elizabeth Klodas, MD, FACC on March 16, 2011

ByRichardN.Fogoros,MDReviewedbyaboardcertifiedphysician.

Updated January 25, 2017

The controversy over whether patients withcoronaryarterydisease(CAD) do better

withstentsor withbypasssurgery(also called coronary artery bypass grafting, or CABG),
has been going on ever since stents were invented. And today, despite the fact that clinical
studies now have been published comparing stents to CABG, the question remains unsettled.

Invasive Treatment of CAD

Before discussing stents vs. CABG, we need to keep in mind that neither of these approaches
is required in most patients with stable CAD.

In most patients,medicaltherapyis sufficient to relieve the symptom of angina, and yields

equivalent results compared with invasive treatment in terms of subsequent mortality or heart
attacks.

However, invasive therapy is clearly indicated in the following circumstances:

in patients withacutecoronarysyndromes(ACS, that is, eitherunstable

anginaormyocardialinfarction).

In patients with stable angina that continues despite optimal medical therapy.

In patients with complex CAD -- those who have either significant blockage in
their left main coronary artery, or significant blockages in the three other major
coronary arteries - the right, left anterior descending and left circumflex
arteries.Readmoreaboutcoronaryarteryanatomy.
When Are Stents Preferred?

Stents are generally preferred over CABG in patients with ACS, or who have failed with
medical therapy, and who have one- or two-vessel CAD.

For these patients, long-term outcomes with stents seem similar to outcomes with CABG.

However, the situation in patients with complex CAD is far less settled - and this is where the
controversy remains.

Stents vs. CABG In Complex CAD - The Controversy

Doctors have known for a number of years that in patients with left main or triple-vessel
CAD, survival is improved with CABG.

Indeed, these are the only patients with "stable" CAD (that is, CAD which is not currently
causing ACS) who generally do better with invasive treatment than with medical therapy
alone.

Accordingly, these cases of left main or triple-vessel CAD have remained something of a
"last stand" for cardiac surgeons -- these patients are nearly the only ones the cardiologists
still feel obligated to refer for CABG. And, as one might expect, the cardiologists have been
busy conducting clinical trials designed to show that stents are as good as bypass surgery
even in these patients.

The SYNTAX trial, published in 2009, was the major randomized clinical trial to compare
stents to CABG in patients with complex CAD. This study showed that patients treated with
CABG had significantly fewer endpoint events (a composite of death, stroke, myocardial
infarction, and the need for repeat revascularization) than patients receiving stents (12.4% vs
17.8% after 12 months). Similar results were reported in the BEST trial in 2015.

So the two randomized clinical trials comparing stents to CABG in patients with complex
CAD both came out in favor of CABG.

Cardiologists point out, however, that while the composite endpoint was worse with stents,
the short-term risk of stroke appears higher after CABG (0.6% for stents vs. 2.2% for CABG)
after 12 months.

This is a legitimate point, though the risk of stroke was statistically equivalent in both groups
after three years.

Investigators who ran the SYNTAX trial have since developed what they call a SYNTAX
score, which essentially grades the characteristics of a patients CAD in terms of its
complexity. Patients with lower SYNTAX scores appear to do relatively better with stents
than those with higher SYNTAX scores. However, the SYNTAX score has never been tested
in a clinical trial.

So the controversy continues.

The Bottom Line

The bottom line is that for most people who have severe triple-vessel CAD or significant
blockage in their left main coronary artery, CABG still ought to be considered the primary
mode of therapy.

Using stents instead of CABG for complex CAD ought to be reserved for patients who, after
understanding all the risks and benefits, still opt for the less invasive approach.

Source:

Serruys P, Morice MC, Kappetein P, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J
Med 2009; 360:961-972.

Farooq V, van Klaveren D, Steyerberg EW, et al. Anatomical and clinical characteristics to guide decision making between coronary artery bypass surgery and
percutaneous coronary intervention for individual patients: development and validation of SYNTAX score II. Lancet 2013; 381:639.

Park SJ, Ahn JM, Kim YH, et al. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med 2015; 372:1204.

Stents or Surgery? Which Is Right for You? Six Questions to Ask Your Doctor
11/14/2014

Why did my doctor recommend heart bypass surgery for me, but my
uncle, neighbor, or spouse underwent coronary stenting? The answer to
this question is unique for every patient, and your doctor considered many
factors before making the recommendation. It is impossible for a website
to answer which treatment is right for you. However, SecondsCount can
provide general, up-to-date information, and suggest questions to ask
your doctor to understand why a procedure is right for you.

Interventional cardiologists and cardiac surgeons are doctors who

have been trained to perform procedures to treat cardiovascular
disease. Interventional cardiologists specialize in angioplasty and
stenting to treat cardiovascular disease. By using catheters,
interventional cardiologists are able to treat many conditions without open
surgery. Cardiac surgeons specialize in performing bypass surgery and
other open-chest operations to treat disorders of the heart. Both catheter-
based procedures and bypass surgery are effective options for treating
heart disease. The question you may be facing is, which option is right for
you, a loved one, or a friend who has a cardiac condition.

As you and your care team consider your treatment options, you will
probably feel more comfortable evaluating your treatment options if you
are familiar with how interventional cardiologists and cardiac surgeons
decide to recommend angioplasty and stenting or bypass surgery.

Much of the information about cardiovascular treatments -- on the news

and even what you might hear from friends and family -- may be
outdated, incorrect, and even dangerous. Understanding your options and
understanding the alternatives for your specific case can happen only with
the physician who knows your situation.

If you have been diagnosed with heart disease, you will have many
questions.

Here are some questions to get you started and some background
information to help as you talk with your doctor.

Question 1: What are my options for treating my heart disease?

When you learn you have heart disease, this is a very important question.
To be an informed patient, youll want all of the information you can get
about your options going forward. Heart disease is a chronic, progressive
disease, which means you and your doctor wont be curing it so much as
managing it and working together to control the symptoms so you can live
the life you choose. When you and your doctor discuss this question,
consider all of the options for your specific situation.

Question 2: Why are you recommending angioplasty or surgery

for me?
In some cases, your heart disease will rule out angioplasty and stenting as
a treatment option for you. In some cases where bypass surgery is
recommended, angioplasty and stenting may be an option. Be sure to ask
your doctor to explain why he or she believes one treatment or the other
is best for YOU. It is likely your doctor will talk about the severity of your
disease, your overall health status, how any other conditions you may
have impact the recommendation, and the benefits and risks that apply to
you specifically.

Heart disease severity: This refers to how many of your heart arteries
have blockages and how blocked those arteries are. Your doctor may tell
you how blocked the artery is using a percentage, such as, "This artery is
80 percent blocked. Or your doctor may describe your condition in terms
of how much of your heart muscle is supplied by the blocked artery,
whether the branches of the artery are involved in the blockage, and
whether the blockages are long or short. All of this information is unique
to your situation, which is why your doctor is the best person to
recommend a treatment option for you. Together, you can decide which
treatment option to pursue.

Other medical conditions: Some studies have suggested that surgery may
be a better treatment for people with diabetes. If you have lung disease,
surgery may not be the right choice for you. Be sure your doctor is aware
of your full medical history. The information available to help doctors
evaluate how other medical conditions affect treatment of heart disease is
constantly evolving. And each new study is evaluated in the context of all
the research done before. It is rare for a single research study to
drastically alter the practice of medicine by itself.

Overall health: Your doctor will consider your overall health when
recommending a procedure to treat blockages of the heart. For some
patients, especially if they are older or weakened by another condition
(such as heart valve problems), the risks of open-heart surgery outweigh
the benefits of the procedure. Ask your doctor to explain the benefits and
risks - for you, specifically - with each of your options.

Doctors make recommendations about treatment based on scientific

evidence compiled over decades of research and medical judgment
acquired by treating many patients, each with a somewhat unique
situation. Talk with your doctor about whats right for you. If you dont feel
comfortable, seek a second opinion.

Question 3: How many angioplasties or surgeries have you

performed, and are you Board certifed?
Your doctors experience matters because greater experience tends to
result in better results. Dont hesitate to ask your interventional
cardiologist how many procedures he or she performs each year and how
many of them are on patients like you. Professional medical societies that
recommend standards for care have advised that most doctors performing
angioplasty and stenting procedures perform at least 75 procedures per
year although there are some exceptions for those practicing at busy
hospitals and for doctors who have been on leave for reasons such as
pregnancy. Likewise, if you are considering bypass surgery, ask your
cardiac surgeon how many surgeries he or she performs each year.

You may also want to ask if your interventional cardiologist or cardiac

surgeon has been certified in his or her specialty. Doctors are granted
certification by taking regular exams and completing other requirements
to demonstrate they have the knowledge, skills, and attitudes essential
for excellent patient care.
Question 4: What results has your hospital had with patients like
me?
No matter how skilled your doctor is, he or she does not work alone. In
other words, your results will be affected not just by your doctor, but by
the whole healthcare team. So ask about the hospitals outcomes with
patients like you who undergo the treatments you are considering.

Question 5: What is the recovery like for angioplasty and

stenting and for bypass surgery?
Recovery from bypass surgery is more difficult than for angioplasty
procedures. Your cardiologist and surgeon will consider your ability to
recover and complete cardiac rehab when making their
recommendation.

Question 6: What should I do if I have more questions?

Ask them. Any time you have a healthcare decision to make, the
conversations you have with your doctor are the key to successful results.
Be sure your doctor is aware of all of your symptoms as well as all of the
medications, vitamins, and supplements you may be taking. And ask
every question you have.

We hope you will also use this website to learn more about your
cardiovascular health and treatment options. SecondsCount.org was
developed by the Society for Cardiovascular Angiography and
Interventions (SCAI), the medical society for interventional
cardiologists. Learn more here about interventional cardiologists.

I'm getting a cardiac catheterization. If blockages are found, what's the best treatment,
angioplasty or bypass surgery?

Answers from Rekha Mankad, M.D.

During cardiac catheterization, your doctor will examine images of the inside of your
coronary arteries. If plaques in these arteries (coronary artery disease) have caused areas of
narrowing, you may need treatment. Treatment options depend on various factors, including:

Severity and extent of coronary artery disease

Symptoms, such as chest pain and shortness of breath

Overall heart function

Other medical conditions, such as diabetes, peripheral artery disease, or

prior stroke or heart attack

For some people, medications and lifestyle changes may be the treatment of choice.

In other cases, angioplasty also known as percutaneous coronary intervention may be

recommended to open the clogged arteries. Angioplasty may especially be recommended if
you are having chest discomfort (angina) due to reduced blood flow that has not responded to
medication and lifestyle changes.

During angioplasty, your doctor inserts a tiny balloon at the site of the blockage and expands
it to widen the narrowed artery. Your doctor then may implant a small metal coil (stent) in the
clogged artery to keep the artery open and reduce the risk of it narrowing again. It's possible
you may even have angioplasty during your cardiac catheterization, if your doctor thinks it's
the most appropriate treatment option for you.

If your arteries are narrowed or blocked in multiple areas, or your left main coronary artery is
narrowed, your doctor may recommend coronary bypass surgery. Some studies show
coronary bypass surgery may also be an appropriate treatment if you have multiple blocked
or narrowed arteries and diabetes.

During bypass surgery, surgeons take a section of healthy blood vessel often from inside
the chest wall or the lower leg and attach it above and below the blocked artery. This
allows blood to bypass the blocked area and flow to the heart muscle.

Operasi Pasang Ring Jantung

 Operasi Pasang Ring Jantung Penyakit jantung kini telah
menempati level teratas dari penyebab kematian diseluruh dunia. Hal ini
dibuktikan dengan tingkatan presentasi yang tinggi dari nominal pasien yang
meninggal karena penyakit jantung ini. Serangan penyakit ini membutuhkan
penanganan yang cukup serius agar pasiennya mendapatkan solusi
pengobatan dari penyakit mematikan ini. Salah satu solusi yang umum
dilakukan oleh dokter adalah dengan melakukan operasi pasang ring pada
organ jantung didalam tubuh pasien walaupu ada beberapa alternatif yang
salah satunya saya informasikan di bagian paling bawah halaman ini.
Pasang ring jantung umumnya lebih dikenal dengan nama pasang stentatau
cincin pada organ jantung. Perlu diketahui bahwa pasang ring jantung
merupakan sebuah prosedur untuk memperlebar pembuluh darah koroner
pada bagian jantung yang tersumbat dan menyempit bukan untuk
menghilangkan plak penyumbatan atau thrombus pada dinding pembuluh
darah kita.
Hal ini dimaksudkan untuk membuka atau memperlebar pembuluh darah
yang mengalami koroner / sumbatan menuju jantung jantung supaya jantung
dapat kembali menerima asupan darah dan oksigen yang cukup.

Nah, untuk mengetahui tentang operasi ring yang dilakukan pada jantung
dengan lengkap maka simak pembahasan selengkapnya berikut ini :
KO N D I S I R I N G JA N T U N G P E R L U DI PA S A N G
Bagi yang belum mengetahui hal ini, tentunya anda ingin tahu bukan dalam
kondisi apa dan bagaimana ring jantung ini perlu dipasang. Nah, menurut
pada dokter spesialis jantung, ring jantung dibutuhkan saat seseorang mulai
terdeteksi mengidap penyakit jantung koroner.

Penyakit jantung koroner ini umumnya terjadi karena pembuluh darah

koroner pada bagian jantung ini menyempit sehingga seluruh kerja organ-
organ tubuh yang lainnya pun ikut terhambat karena aliran darah sebagai
bahan vital yang dialirkan keseluruh tubuh yang membutuhkan asupannya
tersebut melewati pembuluh darah koroner.

Oleh karena itu, apabila seseorang mengalami penyempitan dan

penyumbatan sebagai akibat dari lemak yang menumpuk serta kalsium yang
mengendap pada jantung akan sulit untuk mendapatkan pasokan darah dan
oksigen untuk dialirkan. Dan yang lebih fatal lagi, hal ini dapat menyebabkan
otot-otot jantung mengalami kematian sehingga berjung dengan kematian
seseorang.
 P R O S ED U R DA L A M M E M A SA N G R I N G J A N T U N G

Pasang ring
jantung diperlukan saat pembuluh darah koroner menyempit, dalam keadaan
demikian maka dibutuhkan sebuah penyanggah supaya pembuluh darah
terbuka dan aliran darah serta oksigen dapat lancar mengalir ke otot jantung.
Oleh karenanya ring jantung diperlukan untuk membuka pembuluh darah
supaya lebih lebar lagi.

Prosedur pertama operasi pasang ring jantung adalah memperlebar

pembuluh darah koroner yang mengalami penyempitan yang dilakukan
dengan cara melakukan suntikan anestesi pada pangkal paha.
Berikutnya kemudian, dokter spesialis bedah jantung melakukan
langkah selanjutnya dengan memasukkan selang kecil atau dalam bahasa
medisnya disebut kateter ke dalam lengan atau tungkai.
Didukung dengan bantuan gambar pada layar monitor, dokter
mengarahkan selang kecil tersebut pada arah arteri yang sedang menyempit
atau mengalami penyumbatan didalam jantung.
Setelah itu menginjak pada langkah selanjutnya dengan disediakannya
kateter kedua yang memiliki ukuran lebih besar serta dilengkapi balon dan
ring jantung atau stent. Lalu kateter yang kedua tersebut disambungkan
pada kateter pertama yang sudah dimasukkan ke dalam pembuluh darah itu.
Ujung pada kateter kedua ini haruslah sampai kedalam sumbatan arteri
koroner hingga balon pada kateter kedua tersebut bisa ditiupkan dan
melakukan perlebaran pada bagian yang tersumbat atau menyempit didalam
arteri koroner.
Cincin atau ring jantung yang dipasang didalam arteri koroner ini
dibuat dari paduan dan jalinan logam yang kecil dengan bentuk tabung dan
berguna sebagai penyanggah supaya pembuluh darah tetap terbuka
sehingga tidak mengalami penyumbatan dalam memasok darah serta
oksigen kedalam otot jantung.
Perawatan Pasca Operasi Ring Jantung
Perawatan setelah operasi pasang ring jantung ini sangat perlu dilakukan
untuk mendukung proses pemulihannya. Sebagai contoh seperti terapi,
kontrol serta mengkonsumsi jenis-jenis makanan pendukung yang dianjurkan
dalam perawatan pasca operasi.
Para pasien dianjurkan agar memiliki pola makan yang seimbang juga
menghindari asupan makanan yang memiliki kadar kolesterol tinggi.
Makanan yang berkolesterol tersebut seperti jeroan atau organ dalam hewan,
kambing, sapi, kuning telur, susu dan masih banyak lagi.

Selain itu wajib pula dihindari makanan-makanan yang mengandung natrium

dan trigleserida seperti margarin, garam, gula, santan dan minyak goreng.
Sedangkan makanan yang menjadi anjuran adalah buah-buahan, minyak
zaitun, minyak salmon, sayuran dan gandum.

Hal lain yang diperlukan adalah mengikuti arahan dari dokter tentang terapi
dan kontrol yang diperlukan. Hal ini penting dilakukan untuk memastikan
kondisi jantung yang berkesinambungan dan untuk dapat mengetahuinya
dengan pasti, sebaiknya pasien tersebut melakukan USG secara rutin pada
jantung. Dengan demikian pasien akan mengetahui dan mengikuti anjuran
yang aman dengan tujuan segera memiliki keadaan yang membaik.

K I S A R A N B I A YA PA S A N G R I N G JA N T U N G
Hal pertama yang sering terfikir dalam benak pasien maupun keluarga pasien
yang akan melakukan operasi pasang ring jantung ini biasanya adalah
berapa biaya operasi pasangnya.

Nah, hal ini tentu saja penting untuk dipertimbangkan sebagai persiapan
utama terlaksanya sebuah operasi. Biaya pasang operasi ring jantung ini
tergantung dari kualitas ring jantung yang dimiliki. Ring jantung yang
memiliki kualitas tinggi bisa bertahan sampai 7 tahun dan bebas dari
serangan jantung. Kisaran harga ringnya adalah antara 50-75 juta rupiah.

Namun kisaran tersebut belum termasuk biaya kateter, perawatan dan

penginapan serta dokter spesialisnya. Dengan seluruh rincian yang ada maka
kisaran biayanya sekitar 150-250 juta rupiah. Perlu diketahui jika didalam
jantung terdapat lebih dari satu penyumbatan pembuluh darah, maka ring
jantung yang dibutuhkan sebanyak pembuluh darah yang mengalami
penyumbatan.

Bagi sebagian kalangan, kisaran harga tersebut sangatlah mahal bahkan

kebanyakan penderita tidak mampu melakukan operasi ini karena tidak
memiliki biaya yang cukup, cobalah menggunakan BPJS asuransi kesehatan
dari pemerintah untuk mendapatkan perawatan bebas biaya.

Efek Samping / Resiko Pemasangan Ring Jantung

Selain biaya yang sangat mahal, operasi pasang ring jantung juga memiliki
resiko atau efek samping seperti beberapa contoh yaitu tekanan darah yang
menurun, terjadinya pembekuan darah serta reaksi tertentu pada bahan
yang dipakai ketika memasang ring.
Resiko yang paling besar kedua adalah apabila stent atau ring tersebut pecah
disebabkan oleh terjadinya penyumbatan keras sehingga harus melakukan
operasi bypass agar dapat menyelamatkan nyawa pasien dan yang paling
buruk adalah kegagalan operasi yang dapat berujung pada kematian.

Operasi bypass jantung berbeda dengan operasi pasang ring jantung, cara ini
dilakukan dengan membuat saluran baru melewati arteri koroner yang
mengalami penyumbatan atau penyempitan untuk mendapatkan aliran darah
baru sehingga dapat membawa oksigen serta nutrisi lain menuju otot jantung
dan organ secara keseluruhan.
Saluran yang baru dibuat ini berasal dari arteri atau vena yang sehat (tidak
ada plak penyumbatan/penyempitan) dari bagian lain pada tubuh yang
biasanya diambil dari bagian belakang paha kemudian dihubungkan dengan
melakukan pencangkokan pada arteri koroner yang tersumbat dan
menyempit pada jantung.

B A G A I MA N A C A RA A LT E R N AT I F U N T U K M E N Y E M B U HK A N PE N YA K I T
J A N T U N G KO R O N E R TA N PA D IO PE R A S I ?
Pertama tama kita harus menyadari bahwa Kunci kesembuhan penyakit
jantung koroner terletak pada Bagaimana kita menghilangkan plak
penyumbatan pada pembuluh darah kita bukan pada Bagaimana
mengencerkan darah kita.
Walaupun tergolong baru namun sejalan dengan perkembangan teknologi
nano yang terjadi sejak tahun 2000-an telah mencapai terobosan terobosan
modern yang memberikan harapan baru bagi penderita penyakit jantung
koroner maupun kardiovaskular lainnya seperti stroke iskemik
(penyumbatan).

Apakah Thrombus / Plak Penyumbatan itu sebenarnya ?

Plak penyumbatan / Thrombus yang terdapat pada

dinding pembuluh darah kita terbentuk dari proses pengikatan antara fibrin
dengan kolesterol yang juga disertai pengerasan oleh kalsium maupun
radikal bebas yang mendorong percepatan terjadinya pembentukan plak,
sehingga lambat laun menjadi penyumbatan yang menghalangi darah kita
mengalir secara normal ke jantung kita.

Lumbrokinase adalah salah satu dari hasil terobosan teknologi nano yang
berasal dari enzim yang terdapat pada cacing yang dibudidaya secara khusus
di dataran tinggi yang mampu mengurai thrombus / plak penyumbatan yang
ada pada dinding pembuluh darah kita.
Menurut Profesor Mahendra Kumar Verma, Head Department of
Biotechnology RVR & J C College of Engineering dari India pada jurnal
ilmiah nya telah membuktikan bahwa 95% tingkat keberhasilan telah dicapai
melalui penggunaan Lumbrokinase sebagai pelarut thrombus atau
plak penyumbatan. Cara kerja Lumbrokinase sendiri sangat sederhana
namun memberikan dampak yang luar biasa, yaitu dengan mengurai kembali
struktur dari pembentukan plak yang terdiri dari fibrin dan kolesterol tadi
sehingga plak penyumbatan mengalami pelarutan secara perlahan dan
berkurang.
Selain itu di Indonesia juga dibahas mengenai Lumbrokinase sebagai Anti
Trombotik yang dikonsumsi secara oral :

Di Indonesia sendiri pada tahun 2015 telah memiliki produk yang

menggunakan bahan alami tersebut dengan merk dagang Gravistro yang
mampu memberikan hasil yang diharapkan oleh penderita penyakit
jantung koroner, stroke iskemik yakni membantu melarutkan plak
penyumbatan / thrombus. Tidak seperti produk lain yang mengklaim sebagai
obat jantung atau stroke namun ternyata hanyalah pengencer darah (salah
satu cirinya adalah diletakan dibawah lidah) yang memberikan efek kesan
telah sembuh, maka produk Gravistro bukanlah produk pengencer
darah melainkan melancarkan kembali pembuluh darah dengan
membersihkan dan mengurai sumbatan sumbatan thrombus/plak pada
pembuluh darah kita.
Salah satu pasien penderita penyakit jantung koroner & neuropathy
diabetic yang divonis dokter harus di Bypass dan memasang 2 buah
ring namun setelah menkonsumsi produk Gravistro selama 9 Bulan
memberikan hasil Angiogram Kateterisasi SEBELUM & SESUDAH
mengkonsumsi :
 Ibu Liana
Kumalawaty, Usia 56thn.
Mengalami Penyumbatan Pada Ketiga Bagian Jantung, setelah mengkonsumsi 9 bulan Gravistro, terjadi Diffuse
(pengurangan) pada plak penyumbatannya Di Rumah Sakit Harapan Kita, Hasil Angiogram Bulan Maret 2015
(Sebelum) dan Bulan Januari 2016 (Sesudah).
Penjelasan : No.1 Penyumbatan 2 Titik hilang. No.2 Dinyatakan Diffuse (berkurang), No.3 Dari 6 titik menjadi 4 titik.
Demikianlah seputar bahasan mengenai kesehatan tentang operasi ring
jantung yang dapat anda simak. Semua informasi tersebut akan memberikan
anda gambaran terkait dengan operasi stent atau ring pada jantung yang
dilakukan oleh para penderita jantung koroner.

Sayangilah jantung anda dengan menjaga pola makan dan pola hidup
sebagai langkah awal dalam pencegahan penyakit jantung. Hal ini
dimaksudkan agar kemungkinan seseorang terserang penyakit jantung dapat
berkurang serta kegiatan operasi pasang ring untuk penyakit jantung pun
tidak harus dilakukan. Semoga bermanfaat.

What is angioplasty?
Angioplasty, also called percutaneous coronary intervention (PCI), is a
procedure used to open blocked coronary arteries (caused by coronary
artery disease). It restores blood flow to the heart muscle without open-
heart surgery. Angioplasty can be done in an emergency setting such as
an acute heart attack or in an elective setting when heart disease is
strongly suspected from non-invasive testing.
For angioplasty, a special catheter (a long, thin, hollow tube) is inserted
into a blood vessel and guided to the blocked coronary artery. The
catheter has a tiny balloon at its tip. Once the catheter is in place, the
balloon is inflated at the narrowed area of the coronary artery. This
presses the plaque or blood clot blocking the artery against the sides of
the artery making more room for blood flow.

The use of fluoroscopy (a special type of X-ray thats like an X-ray

"movie") helps the doctor find the blockages in the coronary arteries as a
contrast dye moves through the arteries. This is called coronary
angiography.

The doctor may determine that another type of procedure is necessary.

This may include the use of atherectomy (removal of plaque) at the site
of the narrowing of the artery. In atherectomy, there may be tiny blades
on a balloon or a rotating tip at the end of the catheter. When the catheter
reaches the narrowed spot in the artery, the plaque is broken up or cut
away to open the artery.

Stents
Coronary stents are now used in nearly all angioplasty procedures. A stent
is a tiny, expandable, metal mesh coil that is put into the newly-opened
area of the artery to help keep the artery from narrowing or closing again.

Once the stent has been placed, tissue will start to form over it within a
few days after the procedure. The stent will be completely covered by scar
tissue within a month or so. Medicines called antiplatelets must be taken
to decrease the "stickiness" of platelets (special blood cells that clump
together to stop bleeding), and to prevent blood clots from forming inside
the stent. Your doctor will give specific instructions on which medicines
need to be taken and for how long.

Most stents are coated with medicine to prevent the formation of too
much scar tissue inside the stent. These stents, called drug-eluting stents,
or DES, release medicine within the blood vessel that inhibits the
overgrowth of tissue within the stent. This helps deter re- narrowing of the
blood vessel.

Some stents do not have this medicine coating and are called bare metal
stents or BMS. They may have higher rates of stenosis but do not require
long-term use of antiplatelet medicines. This may be the preferred stent in
people who are at high risk of bleeding.

Because stents can become blocked, it is important for you to talk with
your doctor about what you need to do if you have chest pain after a stent
placement.
If scar tissue does form inside the stent, a repeat procedure may be
needed. This may be using either balloon angioplasty or with a second
stent. In some cases, radiation therapy may be given through a catheter
placed near the scar tissue to stop the growth of scar tissue and open up
the vessel. This is called brachytherapy.

Why might I need angioplasty?

Angioplasty is done to restore coronary artery blood flow when the
narrowed artery is in a location that can be reached in this manner. Not all
coronary artery disease (CAD) can be treated with angioplasty. Your doctor
will decide the best way to treat your CAD based on your circumstances.

What are the risks of angioplasty?

Possible risks associated with angioplasty, stenting, atherectomy, and
related procedures include, but are not limited to:

Bleeding at the site where the catheter is put into the body (usually
the groin, wrist, or arm)
Blood clot or damage to the blood vessel from the catheter
Blood clot within the treated blood vessel
Infection at the catheter insertion site
Abnormal heart rhythms
Heart attack
Stroke
Chest pain or discomfort
Rupture of the coronary artery or complete closing of the coronary
artery, requiring open-heart surgery
Allergic reaction to the contrast dye used
Kidney damage from the contrast dye
You may want to ask your doctor about the amount of radiation used
during the procedure and the risks related to your particular situation. It is
a good idea to keep a record of your radiation exposure, such as previous
scans and other types of X-rays, so that you can inform your doctor. Risks
associated with radiation exposure may be related to the cumulative
number of X-rays or treatments over a long period.

For some people, having to lie still on the procedure table for the length of
the procedure may cause some discomfort or pain.

There may be other risks depending on your specific medical condition. Be

sure to discuss any concerns with your doctor before the procedure.

How do I get ready for angioplasty?

Your doctor will explain the procedure to you and you can ask
questions.
 You will be asked to sign a consent form that gives your permission
to do the procedure. Read the form carefully and ask questions if
anything is unclear.
Tell your doctor if you have ever had a reaction to any contrast dye,
or if you are allergic to iodine.
Tell your doctor if you are sensitive to or are allergic to any
medicines, latex, tape, and anesthetic agents (local and general).
You will need to fast (not eat or drink) for a certain period before the
procedure. Your doctor will tell you how long to fast, whether for a few
hours or overnight.
Tell your doctor if you are pregnant or think you could be. Radiation
exposure during pregnancy may lead to birth defects.
Tell your doctor if you have any body piercings on your chest or
abdomen (belly).
Tell your doctor of all medicines (prescription and over-the-counter),
vitamins, herbs, and supplements that you are taking.
Tell your doctor if you have a history of bleeding disorders or if you
are taking any anticoagulant or antiplatelet (blood-thinning) medicines,
aspirin, or other medicines that affect blood clotting. You may need to
stop some of these medicines before the procedure. However, for
planned angioplasty procedures, your doctor may want you to continue
taking aspirin and antiplatelet medicines, so be sure to ask.
Your doctor may request a blood test before the procedure to
determine how long it takes your blood to clot. Other blood tests may
be done as well.
Tell your doctor if you have a pacemaker or other implanted device.
You may get a sedative before the procedure to help you relax.
Based on your medical condition, your doctor may request other
specific preparation.
What happens during angioplasty?
Angioplasty may be done as part of your stay in a hospital. Procedures
may vary depending on your condition and your doctor's practices. Most
people who undergo angioplasty and stent placement are monitored
overnight in the hospital.

Generally, angioplasty follows this process:

You will be asked to remove any jewelry or other objects that may
interfere with the procedure. You may wear your dentures or hearing
aid if you use either of these.
You will be asked to remove your clothing and will be given a gown
to wear.
You will be asked to empty your bladder before the procedure.
If there is a lot of hair at the area of the catheter insertion (often the
groin area), the hair may be shaved off.
An intravenous (IV) line will be started in your hand or arm before
the procedure. It will be used for injection of medicine and to give IV
fluids, if needed.
 You will be placed on your back on the procedure table.
You will be connected to an electrocardiogram (ECG) monitor that
records the electrical activity of your heart and monitors your heart rate
using electrodes that stick to your skin. Your vital signs (heart rate,
blood pressure, breathing rate, and oxygen level) will be monitored
during the procedure.
There will be several monitor screens in the room, showing your
vital signs, the images of the catheter being moved through your body
into your heart, and the structures of your heart as the dye is injected.
You will get a sedative in your IV to help you relax. However, you will
likely stay awake during the procedure.
Your pulses below the catheter insertion site will be checked and
marked so that the circulation to the limb below the site can easily be
checked during and after the procedure.
A local anesthetic will be injected into the skin at the insertion site.
You may feel some stinging at the site for a few seconds after the local
anesthetic is injected.
Once the local anesthetic has taken effect, a sheath, or introducer,
will be put into the blood vessel (often at the groin). This is a plastic
tube through which the catheter will be threaded into the blood vessel
and advanced into the heart.
The catheter will be threaded through the sheath into the blood
vessel. The doctor will advance the catheter through the aorta into the
heart. Fluoroscopy (an X-ray movie) will be used to help see the
catheter advance into the heart.
The catheter will be threaded into the coronary arteries. Once the
catheter is in place, contrast dye will be injected through the catheter
into your coronary arteries in order to see the narrowed area(s). You
may feel some effects when the contrast dye is injected into the IV line.
These effects include a flushing sensation, a salty or metallic taste in
the mouth, or a brief headache. These effects usually last only a few
moments.
Tell your doctor if you feel any breathing trouble, sweating,
numbness, itching, nausea or vomiting, chills, or heart palpitations.
After the contrast dye is injected, a series of rapid X-ray images of
the heart and coronary arteries will be taken. You may be asked to take
in a deep breath and hold it for a few seconds during this time.
When the doctor locates the narrowed artery, the catheter will be
advanced to that location and the balloon will be inflated to open the
artery. You may have some chest pain or discomfort at this point
because the blood flow is temporarily blocked by the inflated balloon.
Any chest discomfort or pain should go away when the balloon is
deflated. However, if you notice any continued discomfort or pain, such
as chest pain, neck or jaw pain, back pain, arm pain, shortness of
breath, or breathing trouble, tell your doctor right away.
The doctor may inflate and deflate the balloon several times. The
decision may be made at this point to put in a stent to keep the artery
open. In some cases, the stent may be put into the artery before the
 balloon is inflated. Then the inflation of the balloon will open the artery
and fully expand the stent.
The doctor will take measurements, pictures, or angiograms after
the artery has been opened. Once it has been determined that the
artery is opened sufficiently, the catheter will be removed.
The sheath or introducer is taken out and the insertion site may be
closed with a closure device that uses collagen to seal the opening in
the artery, by the use of sutures, or by applying manual pressure over
the area to keep the blood vessel from bleeding. Your doctor will decide
which method is best for you.
If a closure device is used, a sterile dressing will be applied to the
site. If manual pressure is used, the doctor (or an assistant) will hold
pressure on the insertion site so that a clot will form on the outside of
the blood vessel to prevent bleeding. Once the bleeding has stopped, a
very tight bandage will be placed on the site.
Staff will help you slide from the table onto a stretcher so that you
can be taken to the recovery area. NOTE: If the insertion was in the
groin, you will not be allowed to bend your leg for several hours.
If the insertion site was in the arm, your arm will be kept elevated on
pillows and kept straight by placing your arm in an arm guard (a plastic
arm board designed to immobilize the elbow joint). In addition, a plastic
band (that works like a belt around the waist) may be secured around
your arm near the insertion site. The band will be loosened at given
intervals and then removed when your doctor decides the pressure is
no longer needed.
What happens after angioplasty?
In the hospital
After the procedure, you may be taken to the recovery room for
observation or returned to your hospital room. You will stay flat in bed for
several hours after the procedure. A nurse will monitor your vital signs,
the insertion site, and circulation and sensation in the affected leg or arm.

Tell your nurse right away if you feel any chest pain or tightness, or any
other pain, as well as any feelings of warmth, bleeding, or pain at the
insertion site.

Bed rest may vary from 2 to 6 hours depending on your specific condition.
If your doctor placed a closure device, your bed rest may be shorter.

In some cases, the sheath or introducer may be left in the insertion site. If
so, the bedrest will be last until the sheath is removed. After the sheath is
removed, you may be given a light meal.

You may feel the urge to urinate often because of the effects of the
contrast dye and increased fluids. You will need to use a bedpan or urinal
while on bed rest so that your affected leg or arm will not be bent.
After the specified period of bed rest has been completed, you may get
out of bed. The nurse will help you the first time you get up, and will check
your blood pressure while you are lying in bed, sitting, and standing. You
should move slowly when getting up to avoid any dizziness from the long
period of bed rest.

You may be given pain medicine for pain or discomfort at the insertion site
or from having to lie flat and still for a long time.

You will be encouraged to drink water and other fluids to help flush the
contrast dye from your body.

You may go back your usual diet after the procedure, unless your doctor
decides otherwise.

You will most likely spend the night in the hospital after your procedure.
Depending on your condition and the results of your procedure, your stay
may be longer. You will get detailed instructions for your discharge and
recovery period.

At home
Once at home, monitor the insertion site for bleeding, unusual pain,
swelling, abnormal discoloration, or temperature change. A small bruise is
normal. If you notice a constant or large amount of blood at the site that
cannot be contained with a small dressing, tell your doctor.

If your doctor used a closure device at your insertion site, you will be
given specific information regarding the type of closure device that was
used and how to take care of the site. There will be a small knot, or lump,
under the skin at the site. This is normal. The knot should slowly disappear
over a few weeks.

It will be important to keep the insertion site clean and dry. Your doctor will
give you specific bathing instructions.

You may be advised not to participate in any strenuous activities. Your

doctor will instruct you about when you can return to work and resume
normal activities.

Tell your doctor if you have any of the following:

Fever or chills
Increased pain, redness, swelling, bleeding, or other drainage from
the insertion site
Coolness, numbness or tingling, or other changes in the affected
arm or leg
 Chest pain or pressure, nausea or vomiting, profuse sweating,
dizziness, or fainting
Your doctor may give you other instructions after the procedure,
depending on your particular situation.

Next steps
Before you agree to the test or the procedure make sure you know:

The name of the test or procedure

The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that persons
qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how will you get the results
Who to call after the test or procedure if you have questions or
problems
How much will you have to pay for the test or procedure

What Is Heart Angioplasty and Stent Placement?

Angioplasty and stent placement are common procedures to open arteries
in the heart that are clogged. These procedures are formally known as
coronary angioplasty or percutaneous coronary intervention.

Angioplasty involves the use of a tiny balloon to widen the artery.

A stent is a tiny mesh tube that your doctor inserts into the artery. The
stent stays there to prevent the artery from closing. A surgeon typically
performs both procedures at the same time.
PURPOSE
Why Do I Need Heart Angioplasty and Stent Placement?

The procedure is commonly done when a fatty substance known as plaque

attaches to the walls of an artery. This is a condition known
as atherosclerosis. The buildup of plaque causes the inside of the artery to
narrow, restricting blood flow.

When plaque affects the coronary arteries, its known as coronary heart
disease, a serious health condition. The buildup of plaque in the arteries is
particularly threatening to your health because the coronary arteries
supply the heart with fresh, oxygenated blood. Without it, the heart cant
function.

Angioplasty and stent placement can alleviate the blockage of an artery

and angina, or persistent chest pain, that medications cant control.
Theyre also emergency procedures used if the person is having a heart
attack.

Angioplasty and stents cant help some conditions. For example, coronary
artery bypass surgery could be a better option when the main artery on
the left side of the heart experiences a blockage. A doctor might also
consider coronary bypass surgery if the patient suffered multiple
blockages or has diabetes.

RISKS
What Are the Risks Associated with Heart Angioplasty and Stent
Placement?

Any surgical procedure carries risks. Theres an increased risk of adverse

effects in angioplasty with stent placement because the procedure deals
with arteries of the heart.

The risks associated with the procedure include:

an allergic reaction to medication or dye

breathing problems

bleeding

a blockage of the stented artery

a blood clot

a heart attack

an infection
 re-narrowing of the artery

Rare side effects include stroke and seizure.

More often than not, the risks of not going through the procedure
outweigh the risks associated with angioplasty with stent placement.

PREPARATION
How Do I Prepare for Heart Angioplasty and Stent Placement?

If you need to undergo angioplasty with stent placement in your coronary

arteries because of an emergency event, such as a heart attack due to
coronary artery disease, youll have little time to prepare.

If youre undergoing the procedure with plenty of time to plan, there are
several things youll need to do to prepare.

Tell your doctor what drugs, herbs, or supplements youre taking.

Stop taking any drugs that make it harder for your blood to clot,
such as aspirin, clopidogrel (Plavix), ibuprofen (Advil), naproxen
(Aleve, Naprosyn), and other drugs your doctor tells you to stop
taking.

If you smoke, quit smoking.

Tell your doctor about any illnesses you have, even a common cold
or flu.

Take any medications your doctor prescribes for you.

Arrive at the hospital with plenty of time to prepare for surgery.

Follow whatever instructions your doctor or surgeon gives you.

Youll receive numbing medicine at the site of the incision. Youll also get
medicine through your veins using an IV. The medicine will help you relax
during the procedure.

PROCEDURE
How Is Angioplasty and Stent Placement Performed?

Angioplasty with stent placement is a minimally invasive procedure. The

following steps occur during this procedure:

1. Your surgeon will make a small incision in your groin to access an

artery.
2. Your surgeon will insert a thin, flexible tube known as a catheter
through that incision.
 3. Theyll then guide the catheter up through your body to your
coronary arteries. This will allow them to view your arteries using a
special X-ray called fluoroscopy. A special dye can also guide them.

4. Your surgeon will pass a small wire through the catheter. A second
catheter will then follow the guide wire. This catheter has a small
balloon attached to it.

5. Once the balloon reaches the blocked artery, your surgeon will
inflate it.

6. Your surgeon will insert the stent at the same time as the balloon,
allowing the artery to remain open and blood flow to return. Once
the stent is secure, your surgeon will remove the catheter and leave
the stent in place so blood can continue to flow.

Some stents are coated in medicine that slowly releases into the artery.
This prevents the affected artery from closing. Other stents are made of
fabric and are designed for larger arteries.

FOLLOW-UP
What Happens After Heart Angioplasty and Stent Placement?

You may feel soreness at the site of the incision. You can treat this with
over-the-counter painkillers. Youll also likely have prescribed medication
to prevent your blood from coagulating. This helps your body adjust to the
new stent.

Your surgeon will probably want you to stay in the hospital overnight to
ensure there are no complications, such as bleeding, blood clots, or
problems with blood flow to the heart. Your stay might be even longer if
you had a coronary event, such as a heart attack.

When you return home, drink plenty of fluids and restrict physical activity
for some time. Its important to follow your doctors instructions.

Angioplasty with stent placement may be a life-saving procedure, but

youll still need to make lifestyle choices to improve your heart health.
Healthy lifestyle habits include having a balanced diet, exercising, and
quitting smoking if you smoke.