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Thursday, September 15, 2016

ALL ABOUT CORONARY ANGIOGRAPHY, ANGIOPLASTY AND STENT


Various Sources of the following compilation:
http://www.mayoclinic.org/tests-procedures/coronary-angiogram/basics/results/prc-20014391

http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Care_of_the_patient_post_cardiac_catheterisation/

http://nursingcrib.com/medical-laboratory-diagnostic-test/cardiac-catheterization/

http://journals.lww.com/nursing/Fulltext/2011/10001/Preparing_a_patient_for_cardiac_catheterization.4.aspx

https://www.cedars-sinai.edu/Patients/Programs-and-Services/Heart-Institute/Patient-Resources/Preparing-for-Cardiac-Procedures-and-Studies/Preparing-for-Cardiac-Catheterization.aspx

http://www.wales.nhs.uk/abmucardiac/angioplasty.html

https://www.kingstonhospital.nhs.uk/media/43040/patient-info-booklet-dec-2012.pdf

http://www.nhs.uk/Conditions/CoronaryAngiography/Pages/Afterwardspage.aspx


A chat with Dr. Devi Shetty, Narayana Hrudayalaya (Famous Heart Specialist) Bangalore was arranged by WIPRO for its employees. The transcript of the chat is given below. Useful for everyone.
Qn1. What are the thumb rules for a layman to take care of his heart?
Ans:
1. Diet - Less of carbohydrate, more of protein, less oil
2. Exercise - Half an hour's walk, at least five days a week;
3. Quit smoking
4. Control weight
5. Control BP - Blood pressure and Sugar
Qn2. Can we convert fat into muscles?
Ans: It is a dangerous myth. Fat and muscles are made of two different tissues, fat is fat ... Ugly and harmful... Muscle is muscle. Fat can never be converted into a muscle.
Qn3. It's still a grave shock to hear that some apparently healthy person
gets a cardiac arrest. How do we understand it in perspective?
Ans: This is called silent attack; that is why we recommend everyone past the age of 30 to undergo routine health checkups.
Qn4. Are heart diseases hereditary?
Ans: Yes
Qn5. What are the ways in which the heart is stressed? What practices do you suggest to de-stress?
Ans: Change your attitude towards life. Do not look for perfection in everything in life.
Qn6. Is walking better than jogging or is more intensive exercise required to keep a healthy heart?
Ans: Walking is better than jogging, since jogging leads to early fatigue and injury to joints.
Qn7. You have done so much for the poor and needy. What has inspired you to do so?
Ans: Mother Theresa, who was my patient.
Qn8. Can people with low blood pressure suffer heart diseases?
Ans: Extremely rare.
Qn9. Does cholesterol accumulate right from an early age (I'm currently only 22) or do you have to worry about it only after you are above 30 years of age?
Ans: Cholesterol accumulates from childhood.
Qn10. How do irregular eating habits affect the heart ?
Ans: You tend to eat junk food when the habits are irregular and your body's enzyme release for digestion gets confused.
Qn11. How can I control cholesterol content without using medicines?
Ans: Control diet, walk and eat walnut.
Qn12. Which is the best and worst food for the heart?
Ans: Fruits and vegetables are the best and oil is the worst.
Qn13. Which oil is better - groundnut, sunflower, olive?
Ans: All oils are bad.
Qn14. What is the routine checkup one should go through? Is there any specific test?
Ans: Routine blood test to ensure sugar, cholesterol is ok. Check BP, Treadmill test after an echo.
Qn15. What are the first aid steps to be taken on a heart attack?
Ans: Help the person into a sleeping position, place an aspirin tablet under the tongue with a sorbitrate tablet if available, and rush him to a coronary care unit, since the maximum casualty takes place within the first hour.
Qn16. How do you differentiate between pain caused by a heart attack and that caused due to gastric trouble?
Ans: Extremely difficult without ECG.
Qn17. What is the main cause of a steep increase in heart problems amongst youngsters? I see people of about 30-40 yrs of age having heart attacks and serious heart problems.
Ans: Increased awareness has increased incidents. Also, sedentary lifestyles, smoking, junk food, lack of exercise in a country where people are genetically three times more vulnerable for heart attacks than Europeans and Americans.
Qn18. Is it possible for a person to have BP outside the normal range of 120/80 and yet be perfectly healthy?
Ans: Yes.
Qn19. Marriages within close relatives can lead to heart problems for the child. Is it true?
Ans : Yes, co-sanguinity leads to congenital abnormalities and you may NOT have a software engineer as a child.
Qn20. Many of us have an irregular daily routine and many a times we have to stay late nights in office. Does this affect our heart? What precautions would you recommend?
Ans : When you are young, nature protects you against all these irregularities. However, as yougrow older, respect the biological clock.
Qn21. Will taking anti-hypertensive drugs cause some other complications (short/long term)?
Ans : Yes, most drugs have some side effects. However, modern anti-hypertensive drugs are extremely safe.
Qn22. Will consuming more coffee/tea lead to heart attacks?
Ans : No.
Qn23. Are asthma patients more prone to heart disease?
Ans : No.
Qn24. How would you define junk food?
Ans : Fried food like Kentucky , McDonalds , Samosas, and even Masala Dosas.
Qn25. You mentioned that Indians are three times more vulnerable. What is the reason for this, as Europeans and Americans also eat a lot of junk food?
Ans: Every race is vulnerable to some disease and unfortunately, Indians are vulnerable for the most expensive disease.
Qn26. Does consuming bananas help reduce hypertension?
Ans: No.
Qn27. Can a person help himself during a heart attack (Because we see a lot of forwarded e-mails on this)?
Ans: Yes. Lie down comfortably and put an aspirin tablet of any description under the tongue and ask someone to take you to the nearest coronary care unit without any delay and do not wait for the ambulance since most of the time, the ambulance does not turn up.
Qn28. Do, in any way, low white blood cells and low hemoglobin count lead to heart problems?
Ans: No. But it is ideal to have normal hemoglobin level to increase your exercise capacity.
Qn29. Sometimes, due to the hectic schedule we are not able to exercise. So, does walking while doing daily chores at home or climbing the stairs in the house, work as a substitute for exercise?
Ans : Certainly. Avoid sitting continuously for more than half an hour and even the act of getting out of the chair and going to another chair and sitting helps a lot.
Qn30. Is there a relation between heart problems and blood sugar?
Ans: Yes. A strong relationship since diabetics are more vulnerable to heart attacks than non-diabetics.
Qn31. What are the things one needs to take care of after a heart operation?
Ans : Diet, exercise, drugs on time , Control cholesterol, BP, weight.
Qn32. Are people working on night shifts more vulnerable to heart disease when compared to day shift workers?
Ans : No.
Qn33. What are the modern anti-hypertensive drugs?
Ans: There are hundreds of drugs and your doctor will chose the right combination for your problem, but my suggestion is to avoid the drugs and go for natural ways of controlling blood pressure by walk, diet to reduce weight and changing attitudes towards lifestyles.
Qn34. Does dispirin or similar headache pills increase the risk of heart attacks?
Ans : No.
Qn35. Why is the rate of heart attacks more in men than in women?
Ans: Nature protects women till the age of 45. (Present Global census show that the Percentage of heart disease in women has increased than in men).
Qn36. How can one keep the heart in a good condition?
Ans: Eat a healthy diet, avoid junk food, exercise everyday, do not smoke and, go for health checkups if you are past the age of 30 ( once in six months recommended) ....
Please, don't hoard knowledge.
It takes sharing of knowledge to discover and understand the world in which we live. Do send it to all your friends and relatives....... They might benefit.


What causes angina?

Glyceryl trinitrate (GTN)

GTN comes as tablets or sprays. You take a dose under your tongue as required when your angina pain develops. GTN is absorbed quickly into the bloodstream, from under the tongue. A dose works to ease the pain within a minute or so.You should always carry your GTN spray or tablets with you.
How long people with chest pain should wait before calling an ambulance is a question familiar to general practitioners and emergency doctors.
The British Heart Foundation advises patients with known ischaemic heart disease that chest pain that lasts more than 15 minutes is probably a heart attack.2 Within this time patients are advised to use their glyceryl trinitrate (GTN) spray three times at five minute intervals before calling an ambulance.
https://myheartsisters.org/2013/08/19/nitroglycerin/

http://www.netdoctor.co.uk/medicines/heart-and-blood/a6820/gtn-sublingual-tablets-glyceryl-trinitrate/


ALL ABOUT CORONARY ANGIOGRAPHY, ANGIOPLASTY AND STENT THAT YOU WANT TO KNOW

 Each person’s individual condition is unique and this leaflet contains general information and is not a substitute for discussion with the doctor or nurse.
Coronary angiography is recognized as the gold test for diagnosis of coronary artery diseases. 

An angiogram can show doctors what's wrong with your blood vessels. It can:
·         Show how many of your coronary arteries are blocked or narrowed by fatty plaques (atherosclerosis)
·         Pinpoint where blockages are located in your blood vessels
·         Show how much blood flow is blocked through your blood vessels
·         Check the results of previous coronary bypass surgery
·         Check the blood flow through your heart and blood vessels

Preparing to come to hospital
Please do not yourself shave or remove hair from your chest, arms, legs or groin before coming into hospital. If needed, this will be done in hospital by experienced nurse just before your coronary angiogram.

It is very important that you have a thorough shower or bath the night before you come into hospital.

NURSE DUTY:  Assess the client’s and family’s knowledge and understanding of the procedure. Provide additional information as needed. Explain that the client will be awake during the procedure, which takes 1 to 2 hours to complete. A sensation of warmth (a “hot flash”) and a metallic taste may occur as the dye is injected. A rapid pulse or a few “skipped beats,” also are common and expected during the procedure. A good understanding of the procedure and expected sensations reduces anxiety and improves cooperation during the procedure. • Provide routine preoperative care as ordered.The nurse will shave around your groin and upper thigh area. Shave and prepare both groins with antiseptic solution, if the site for insertion will be the femoral vein.

Although the client remains awake, sedation may be given. Signed consent is required, and pre procedure fasting may be ordered. • Administer ordered cardiac medications with a small sip of water unless contraindicated. Regularly ordered medications are continued to prevent cardiac compromise or dysrhythmias during the procedure. • Assess for hypersensitivity to iodine, radiologic contrast media, or seafood. An iodine-based radiologic contrast dye is typically used for an angiogram. Iodine or seafood allergy increases the risk for anaphylaxis and requires an alternative dye or special precautions. • Record baseline assessment data, including vital signs, height, and weight. Mark the locations of peripheral pulses; document their equality and amplitude. The data provide a baseline for evaluating changes after the procedure. • Instruct to void prior to going to the cardiac catheterization laboratory,to promote comfort.
OPERATING ROOM 
The room is kept at a cool temperature because of the hi-tech equipment, television screens and monitoring equipment. You may shiver there as you will be without warm clothes. You will be asked to move over on to the x-ray table, which is quite narrow . 

You will be lying face up with a green towel over the private parts on the x-ray table and awake throughout this procedure and asked to lie flat and keep still as possible. They may strap you to the bed.
The shaved groin area is washed and disinfected and then numbed with an injection of local anesthetic. A small incision is made at the entry site, and a short plastic tube (sheath) is inserted into your artery. The catheter is inserted through the sheath into your blood vessel and carefully threaded to your heart or coronary arteries.
Threading the catheter shouldn't cause pain, and you shouldn't feel it moving through your body.

The angiogram catheter will be put into an artery in your leg near your groin, or in your arm. The catheter travels through the artery to the area in the body that is being studied. Contrast liquid is put through the catheter to help your blood vessels and organs show up better. You may feel warm as the liquid is put into the catheter. You may get a headache or feel nauseated. These are normal feelings that will go away quickly.

A series of X-rays will be taken once the dye is injected. The X-ray machine will be moved around you and the bed will be moved to obtain the correct position. You will notice that the x-ray machine will move close toyour chest and will also move towards your head and from side to side. This enables a complete picture of the heart, arteries and valves to be taken
.Some people may experience a metallic taste in the mouth or a feeling of wanting to go to the toilet. These sensations are not unusual. If you feel sick, itchy or have any chest pain or discomfort you must tell the doctor. The procedure takes approximately 15 – 30 minutes.

ANGIOPLASTY:
During angioplasty, the balloon is blown up inside the coronary artery, squashing fatty deposits and widening the narrowed artery. Usually the catheter also carries a short hollow tube made of stainless steel (called a stent) which opens out as the balloon is blown up and is left inside your artery. It is like a tiny piece of scaffolding that holds the artery open.

AFTER THE PROCEDURE
• Assess vital signs, catheterization site for bleeding or hematoma, peripheral pulses, and neurovascular status every 15 minutes for first hour, every 30 minutes for the next hour, then hourly for 4 hours or until discharge. The data provide vital information about the client’s status and potential complications such as bleeding, hematoma, or thrombus formation. • Maintain bed rest as ordered, usually for 6 hours if the femoral artery is used, or 2 to 3 hours if the brachial site is used. The head of the bed may be raised to 30 degrees. Bed rest reduces movement of and pressure in the affected artery, reducing the risk of bleeding or hematoma. • Keep a pressure dressing, sandbag, or ice pack in place over the arterial access site. The nurse will check your groin area and feet pulses frequently. Check frequently for bleeding (if the access site is in the groin, check for bleeding under the buttocks). Arteries are high-pressure systems. The risk for significant bleeding after an invasive procedure is high. • Instruct to avoid flexing or hyperextending the affected extremity for 12 to 24 hours. Minimizing movement of the affected joint allows the artery to effectively seal and promotes blood flow, reducing the risk of bleeding, hematoma, or thrombus formation. • Unless contraindicated, encourage liberal fluid intake. An increased fluid intake promotes excretion of the contrast medium, reducing the risk of toxicity (particularly to the kidneys). • Promptly report diminished peripheral pulses, formation of a new hematoma or enlargement of an existing one, severe pain at the insertion site or in the affected extremity, chest pain, or dyspnea. While the risk of complications is low, myocardial infarction or insertion site complications may occur. These necessitate prompt intervention. • Provide instructions about dressing changes, follow-up appointments, and potential complications prior to discharge

1.You may need to lie flat and keep your arm or leg straight for several hours after your angiogram with a weight put over the punctured groin area. 
2.You must use a bedpan or a urinal until you are able to get out of bed and go to the bathroom.
3.No movement even to eat. The nurse will feed you till they see you improve.
4.No lifting heavier than 5 kilograms or 11 lbs. for 7 days
5.IT IS ESSENTIAL THAT YOU DO NOT STOP TAKINGYOUR CLOPIDOGREL FOR 12 MONTHS FOLLOWINGYOUR PROCEDURE, PARTICULARLY IF YOU HAVE ADRUG-ELUTING STENT.If any doctor asks you to stop taking Clopidogrel before 12 months, please ask them to contact your cardiologist to discuss their reasons.


Patient Reactions:
I losed my privacy fully at the hospital. The female nurses comes frequently after the procedure to check the groin area for any bleeding. She lifts the scrotum by her hand to wipe out any blood.They make you urinate too much by giving medicine after the proceedure so that the dye dont effect your kidneys. She picks up your penis and place it inside urinal and waits near you till you finish urination. Than she takes away the urinal from between your legs. All your privacy is always exposed to her. And the first thing every morning is a sponge bath given by three nurses, one attending top portion of my body ,one middle and one bottom. And lastly she spoon fed me. You feel like you are back to your childhood days with your mother. 

From a medical point of view I think you should NOT shave anything before you go in;; If you cut or nick yourself it is a source of infection ; Let the professionals do their job;; why risk it? 

I didn't have a problem with them shaving there..good luck with your tests...take care 

I've shaved and then went in and they just redid it. I think that they do it no matter what just to make sure it's done right. I even had male nurses twice and they make you feel comfortable while they shave you. Good luck on your angio. 

I have had several angiograms, and have been given a dry run in my pubic area each time. They shave both sides of the groin area in case the first side doesn't work. Each time, I've been awake and had female nurses. 

I was in bed with only a gown on when a female nurse in her mid 20s came in with a cart, pulled the curtain closed, and pulled down the bed covers. She announced that she would shave my  pubic area. After donning a pair of rubber gloves, she started dry shaving from my navel down to my penis and down around my balls. As she was starting to shave me with the single edged razor, a fellow female nurse showed up to my embarrassment. 

The hospitals around here do it after you are asleep. They do NOT want you to shave at home. 

I had a heart attack at work and was brought to Yale. The residents were very courteous and relatively concerned about my dignity. Not so the female surgeon who pulled up my gown and left me exposed, fortunately flacid, before several women and med students, all female. One of the residents who came in periodically (male), apparently embarrassed for me, eventually covered my penis with the sterilizing cloth. It was cold and wet and shocked me, but restored some dignity. It disappeared later after the local anesthetic set in and I was again left exposed. The tech (also a female MD) inserting the femoral artery cath for the stent never looked at my face or my genitals, that I noticed, but she had a silly, perhaps embarrassed grin on her face throughout the procedure.  

Upon entering the cold operating room (with doctor, 4-5 female nurses and other technicians present). Once on the operating table, one nurse lifted my gown and began shaving my groin area with my genitals completely exposed. She had to move my penis and scrotum with her gloved hand to complete her site prep. When finished, she pulled up my gown and left my genitals completely exposed to all nursing/tech staff in the room. It was humiliating. After about 5 minutes, of my lying there completely exposed, one male tech placed a cloth over my genitals. This was completely uncalled for and an unforgiveable violation of my privacy.- 

The nurses would only have been 20 or 21. They undressed me when I was admitted and I remember both stared quite hard at my penis when they took my gown off. I was in pain and didn't find that at all stimulating. When I got my first sponge bath ,I was very embarrassed. The nurse was obviously amused and actually scrubbed my penis, scrotum and anus with a warm towel. I eventually got used to these early morning baths and things were more or less under control. 

Second day after the procedure a young nurse came in my area in ward and said she was going to give me a sponge bath. After she had washed everything except my genitals and bottom she asked if I wanted to wash those areas myself or have her do it. I had IVs in one arm and attempted with my other, but I was still in quite a bit of pain and she she offered to help. She had me roll over onto my side and she gently washed my butt. Then I turned back over and she washed my entire groin area. She was very gentle and kind.God Bless her. .

In 1980, I had gone to the hospital for the angio and the day after the operation, I was given a bed bath by the nurse which was very embarrassing. At the start, she had me sit up, then took off the gown, the only thing I had on (although the sheet and blanket still covered my legs and genitals). She washed my back, then had me lie down to wash my chest and abdomen. Next, she uncovered my left leg and hip to wash that, At the time, I was thinking she probably wouldn't wash my genitals, but then she uncovered my right leg and hip--the bed coverings only partially covering my genitals .She washed my right leg and hip while I was thinking surely she won't be washing my penis. WRONG! A few minutes later, the bed coverings were gone completely and there I was naked while she washed my manhood! Very embarrassing to say the least!

Read More About Patient experiences http://patientmodesty.org/modesty.aspx

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