When a patient experiences chest pain accompanied by other symptoms like shortness of breath and heart rhythm abnormalities, there are 3 possible scenario: unstable angina, NSTEMI and STEMI.
Unstable Angina and NSTEMI usually have temporary ECG changes because arterial supply in the heart is partially blocked off. STEMI, on the other hand, indicates the whole thickness of heart muscle is completely blocked off. Enzyme changes will show heart muscle damage.
Initial management includes continuous ECG monitoring, oxygen, anti-platelets, opiates and anti-emetics. The doctors will examine for heart murmurs, evaluate a 12-lead ECG, conduct blood tests for biochemical makers like troponin and do a Chest X-ray.
Once diagnosed of having STEMI, there are 2 ways to open up blocked coronary arteries – through the use of Thrombolytics and PCI (Percutaneous Coronary Intervention) or Primary Angioplasty.
Coronary angioplasty also called percutaneous coronary intervention, is a procedure used to open clogged heart arteries from build up fatty plaques. Angioplasty uses a tiny balloon catheter that is inserted in a blocked blood vessel to help widen it and improve blood flow to the heart. This is a preferred method of treatment and can be performed within 90minutes of the the time the patient received thrombolysis. It can be carried out up to four (4) hours after a myocardial infarction.
With Angina, it can be a planned procedure. With STEMI, it can be carried out as an Emergency treatment.
Angioplasty is often combined with the placement of a small wire mesh tube called a stent. The stent helps prop the artery open, decreasing its chance of narrowing again. Most stents are coated with medication to help keep the artery open (drug-eluting stents). It is done by a coronary angiogram initially. A coronary angioplasty balloon is advanced thru a guide catheter and deployed to compress the atheroma surrounding the artery.
The stent is deployed with the balloon and will remain in place once the balloon is deflated and withdrawn. It stays in position and keeps the blood vessel open.
Angioplasty can improve symptoms of blocked arteries, such as chest pain and shortness of breath. Angioplasty is also often used during a heart attack to quickly open a blocked artery and reduce the amount of damage to the heart.
Angioplasty may be a treatment if:
- Patient tried medications or lifestyle changes but these have not improved your heart health.
- The chest pain (angina) that is worsening.
- It is a real heart attack.
Angioplasty isn’t for everyone. Depending on the extent of your heart disease and your overall health, your doctor may determine that coronary artery bypass surgery is a better option than angioplasty for you.
You may need coronary artery bypass surgery if:
- The main artery that brings blood to the left side of your heart is narrow
- Your heart muscle is weak
- You have diabetes and multiple severe blockages in your arteries
After a coronary angioplasty, a TR band (Transradial band) is placed in the wrist or an Angioseal to the groin as special plugs to prevent further bleeding and bruising. Then, recover the patient afterwards in a monitored bed or CCU.
Drugs upon discharge in the hospital may include anti-platelet, beta blockers, ACE inhibitors or ARBs, diuretics as well as statins.
References:
Understanding and dealing with Heart Diseases by Dr. Keith Souther (2014)
Handover Sheets by Nikko 