Heart condition...angioplasty?

Question

I posted before about my friends dad having a heart attack, followed by heart failure. He was released from hospital 3 weeks ago, and 2 days ago had an angioplasty. From what I know he was told that all of his arteries are clogged, and that they won't be able to do an angiogram. He was released from the hospital and told to rest, but he got admitted again today and apparently isn't in a very good condition. What happens now? Does he have to do bypass surgery (from what I know that is the next step?)

He is currently on the following medications : plavix, trihemic, furohesimide, digoxin (forgive me if I have the spelling wrong)

What are his chances? And what do you think is the real story here? For some reason I believe that there is alot left unsaid, and that there is some need for other opinions on his health issue. They said he was to unstable to even do an angioplasty, and then they do one? I don't know, some clarity would be helpful.

Answer 1

It sounds like your best friend and his/her dad have gone through a lot lately. I'm sorry that added to this is the confusion of medical and surgical treatment, etc.

As you may know, angioplasty is usually for one clogged vessel, done through an arm or leg vessel, and can be done while the patient is awake. It is much safer than coronary artery bypass graft (CABG) surgery. CABG is usually for people with more than one clogs or clogged heart vessels, but needs to be done not only with the patient asleep (under general anesthesia) but also with him/her on a bypass machine that functions as the heart and lung while the heart is being operated on. In some cases, depending on his health condition and his expected overall outcome, the risks of the CABG procedure outweigh the benefits, even in his case with mulitple diseased or clogged vessels.

For heart attacks (or myocardial infarctions, or MIs), treatment depends on the type of MI and how long the person has had it. The goal of treatment is to restore blood flow if the tissue is still alive, and/or to prevent future changes that will lead to worsening heart condition.

Your best friend's father seems to have had a severe MI, with areas of dead heart tissue, that has led to inadequate pumping of blood by his heart to his body. In other words, heart failure. As he is 3 weeks out from his MI, the angioplasty done would not have been for the area affected by the MI, but may have been to help another area that has decreased blood flow. I'm not quite sure why CABG is now thought to be the next step---but here is where good communication plays an essential role. Be informed- read patient education handouts online from reputable sources (I have linked some below), and ask your doctor(s) questions. It is important to clear any or as much of the uncertainties now rather than later.

Your best friend and family should have a very lengthy discussion with the primary doctor or admiting team, if that hasn't occurred already, as well as to get updates from them everyday while he is in the hospital. Ask as many questions as needed and repeat as needed; doctors understand that during these times knowledge and reassurance go hand-in-hand.

Answer 2

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Answer 3

If your friend father had an angioplasty 2 days ago to widen his arteries, it shouldn't have been clogged again so soon (i.e. 2 days later). I think you mean he had an angiogram? And it shows that all of he arteries are clogged?
Plavix is an anti-platelets, if he need to do a bypass surgery, the surgeon would usually off this med.
To do a bypass surgery, there are few things that the surgeon needs to determine, e.g. whether his BP is stable, his blood clotting factors, age, any other pre-existing conditions, etc.. He has to be clinically stable before any surgery takes place.
It is best to discuss with his Dr.

Answer 4

Well yes the next step of what you described is bypass surgery, but there is the risk of the operation itself. So doctors balance the benefits of going through the operation VS the risks. The decision depends on which is more.

If he has sever heart failure an operation might be too risky for a surgery and anesthesia. Sometimes a transplant can be the option in severe cases.

Answer 5

Your friend's dad is seriously ill, based on your question nobody can give you a direct answer without making a diagnosis and only a doctor with all the information can do that.You are probably correct assuming there is much you don't know about his condition.
I would say the best thing you can do is provide support and comfort for your friend and you will be told his dad's condition and what treatment is appropriate as it unfolds.

Answer 6

his doctors are best judge at the moment..let them do there job....
its nice that you care about some one.lets us all pray for him to get wel soon.

Answer 7

Angioplasty is the mechanical widening of a narrowed or totally obstructed blood vessel. These obstructions are often caused by atherosclerosis. The term derives from the roots "angio" or vessel and "plasticos" fit for molding. The term has come to include all manner of vascular interventions typically performed in a minimally invasive or percutaneous method.

One way to unblock a coronary artery is percutaneous transluminal coronary angioplasty (PTCA), which was first performed in 1977 by Andreas Gruentzig. A wire is passed from the femoral artery in the leg (or, less commonly, from the radial artery or brachial artery in the arm) to beyond the area of the coronary artery that is being worked upon. Over this wire, a balloon catheter is passed into the segment that is to be opened up. The end of the catheter contains a small folded balloon. When the balloon is hydraulically inflated, it compresses the atheromatous plaque and stretches the artery wall to expand. At the same time, if an expandable wire mesh tube (stent) was on the balloon, then the stent will be implanted (left behind) to support the new stretched open position of the artery from the inside.

Angioplasty and stenting is performed through a thin flexible catheter during Cardiac Catheterization with just a local anaesthetic to the groin (or wrist) where the catheter was inserted, often making heart surgery unnecessary. While coronary angioplasty has consistently been shown to reduce symptoms due to coronary artery disease and to reduce cardiac ischemia, it has not been shown in large trials to reduce mortality due to coronary artery disease, except in patients being treated for a heart attack acutely (also called primary angioplasty). There is a small but definite mortality benefit (ie., reduction) with this form of treatment compared with medical therapy, usually consisting of thrombolytic ("clot busting") medication.

Traditional ("bare metal") coronary stents provide a mechanical framework that holds the artery wall open, preventing stenosis, or narrowing, of arteries feeding critical structures like the myocardium. Traditional stenting is superior to angioplasty alone in keeping arteries open.

Newer drug-eluting stents (DES) are coated with drugs that prevent re-stenosis of the artery. Three drugs, sirolimus, everolimus and paclitaxel, have been demonstrated effective and safe in this application by stent device manufacturers and are being used.

Risks of angioplasty are uncommon, and the procedure is widely practiced. Coronary angioplasty is usually performed by an interventional cardiologist, a medical doctor with special training in the treatment of the heart using invasive catheter-based procedures.

Angioplasty is sometimes referred to as Dottering, after Dr C.T. Dotter, who, together with Dr M.P. Judkins, first described angioplasty (without the balloon) in 1964 (Circulation 1964;30:654-70). As the range of procedures performed upon lumens of coronary arteries has widened, the name of the procedure has changed to percutaneous coronary intervention (PCI).

Angioplasty has become considerably safer over the years and is now commonly performed. Although it is associated with some risks[1] these are considerably less than for open-heart bypass surgery with its resulting post-operative pain. However the likelihood of recurrence of angina, and requirement for repeated procedures has been higher with angioplasty. The latest trial (ARTS II) has suggested that PCI with DES may be superior, at least in the short term.

Some chest discomfort occasionally may be experienced and it is for this reason that the patient is awake during minimally invasive angioplasty; the reporting of any symptom allows the cardiologist to take necessary immediate action. Bleeding from the insertion point in the groin is common, in part due to the use of anti-platelet clotting drugs. Some bruising is therefore to be expected, but occasionally a hematoma may form. This may delay hospital discharge as flow from the artery into the hematoma may continue (pseudoaneurysm) which requires repair. Infection at the skin puncture site is rare and dissection (tearing) of the access blood vessel is uncommon. Allergic reaction to the contrast dye used is possible, but has been reduced with the newer agents. Deterioration of kidney function can occur in patients with pre-existing kidney disease, but kidney failure requiring dialysis is rare. Vascular access complications are less common and less serious when the procedure is performed via the radial artery.

In the long term, the most common risk is of the stent restenosis, as discussed above. This has been reduced considerably with the use of newer stents coated with certain medicines (drug-eluting stents). The most serious risk is the rare provocation (3%) of a heart attack during or shortly after the procedure; this may require emergency open cardiac surgery. Angioplasty carried out shortly after a myocardial infarction has a risk of causing a stroke of 1 in 1000, which is less than the 1 in 100 risk encountered by those receiving thrombolytic drug therapy.

The overall risks of death with angioplasty is approximately 1%, but the underlying severity of the heart disease, fitness of the patient and presence of other illness affect each individual’s risk. Hence for those with relatively minor heart disease, preserved good cardiac function, reasonable level of fitness and absence of other illnesses, the risk will be considerably less than this.

When failures of PTCA occur, they are often treated using coronary artery bypass grafting (CABG).

Peripheral angioplasty refers to the use of similar techniques in opening blood vessels other than the coronary arteries. It is often called percutaneous transluminal angioplasty or PTA for short. PTA is most commonly done to treat narrowings in the leg arteries, especially the common iliac, external iliac, superficial femoral and popliteal arteries. PTA can also be done to treat narrowings in veins.

Atherosclerotic obstruction of the renal artery can be treated with angioplasty of the renal artery (percutaneous transluminal renal angioplasty, PTRA). Renal artery stenosis can lead to hypertension and loss of renal function.

Generally, carotid artery stenosis is treated with angioplasty and stenting for high risk patients in many hospitals. It has changed since the FDA has approved the first carotid stent system (Cordis) in July 2004 and the second (Guidant) in August 2004. The system comprises a stent along with an embolic capture device designed to reduce or trap emboli and clot debris. Angioplasty and stenting is increasingly being used to also treat carotid stenosis, with success rates similar to carotid endarterectomy surgery. Simple angioplasty without stenting is falling out of favor in this vascular bed. SAPPHIRE, a large trial comparing carotid endarterectomy and carotid stenting with the Cordis stent found stenting non-inferior to carotid endarterectomy.