Coronary Angioplasty

Overview

Coronary angioplasty is a procedure that opens up a narrowed or blocked artery in your heart. A doctor passes a very thin tube through a blood vessel — usually in your wrist or groin — and guides it up to your heart. At the narrow spot, a tiny balloon is inflated to stretch the artery open. In most cases a small mesh tube called a stent is left inside to keep the artery open. The full medical name is percutaneous coronary intervention, or PCI. It is not open-heart surgery: there is no big cut, you are usually awake, and many people go home the same day or the next day.

Yes. Angioplasty is one of the most common heart procedures in the world, with millions performed each year. It is a routine, well-studied treatment in hospitals that have a heart unit.

It mostly affects adults whose heart arteries have narrowed — a condition called coronary artery disease. It becomes more common with age: men are often affected from their 50s and 60s, and women more often after the menopause. It is also more common in people with diabetes, high blood pressure or high cholesterol, in people who smoke, and in people with a family history of early heart disease.

Symptoms

Common symptoms

• Chest tightness, pressure, heaviness or squeezing, often brought on by walking, stairs or cold weather and eased by rest — this is called angina.
• Pain or discomfort spreading to the arm, shoulder, neck, jaw or back.
• Shortness of breath when you are active.
• Feeling very tired, dizzy or light-headed with effort.
• Indigestion-like discomfort rather than classic chest pain — this is more common in women and in older adults.
• After the procedure: a bruised, tender spot at the wrist or groin where the tube went in. This is normal and fades over a week or two.

Causes

Main causes

• Coronary artery disease — fatty, cholesterol-rich patches called plaques build up inside the artery walls over many years.
• As the artery narrows, less blood reaches the heart muscle, especially when you are active, which causes angina.
• If a plaque cracks, a blood clot can form suddenly and block the artery, causing a heart attack.
• Less common causes include sudden artery spasm, or damage to the arteries after radiotherapy to the chest.

Risk factors

• Smoking or using other tobacco products.
• High blood pressure.
• High cholesterol, especially the 'bad' type.
• Diabetes, including type 2 diabetes.
• A family history of early heart disease.
• Getting older.
• Carrying extra weight, especially around the middle.
• Not being physically active.
• A diet high in salt, saturated fat and added sugar.
• Drinking more alcohol than is recommended.
• Long-term stress and poor sleep.
• Kidney disease.
• Some ethnic groups, including people of South Asian and African or African Caribbean heritage, have higher rates of heart disease.

When to see a doctor

See a doctor urgently if:

• Chest pain at rest, or angina that is suddenly worse or more frequent — get medical help the same day.
• Bleeding, spreading redness, fever or a growing lump at the wrist or groin after your procedure.
• Numbness, coldness or weakness in the hand or leg used for the procedure.
• New shortness of breath or new ankle swelling.

Book a routine appointment if:

• You get chest discomfort with effort that you have not had checked before.
• Your usual angina pattern changes, even if it settles with rest.
• You are having side effects from your heart medicines — ask before stopping anything.
• You are due any surgery or dental treatment and you have a stent.
• You feel low, anxious or frightened after your procedure.
• You want help with smoking, weight, diet or getting active.

Diagnosis

Doctors first ask about your symptoms and examine you, checking your pulse, blood pressure and heart. Tests then show whether an artery is narrowed and where. The clearest picture usually comes from a coronary angiogram, a test that uses dye and X-rays to film the heart arteries. Angioplasty is often carried out in the same session if the pictures show it is the right treatment for you.

Tests that may be done

• Electrocardiogram (ECG) — painless sticky pads record the heart's electrical signals.
• Blood tests, including a test for heart muscle damage when there is concern about a heart attack.
• Echocardiogram — an ultrasound scan that shows the heart's shape and how well it pumps.
• Exercise stress test — walking on a treadmill while your heart is monitored.
• CT coronary angiogram — a detailed scan that can show narrowed arteries without a tube being inserted.
• Coronary angiogram — dye and X-rays give moving pictures of the arteries; this is the key test before angioplasty.
• Stress imaging tests, such as a perfusion scan or stress MRI, which show areas of the heart not getting enough blood.

What to expect at your appointment

A coronary angiogram and angioplasty are usually done in a catheter laboratory. You stay awake, though you may be given medicine to help you relax. A small patch of skin — usually at the wrist, sometimes the groin — is numbed, and a thin tube is inserted. Dye is injected and X-ray pictures are taken; you may feel a warm flush. If a narrowing can be treated, the balloon is inflated and a stent placed. The whole session often takes about 30 to 60 minutes, longer if more than one artery is treated. Afterwards you rest with pressure on the entry point for a few hours, and most people go home the same or the next day. Arrange for someone to take you home.

Treatment

Angioplasty is one option for treating narrowed heart arteries, alongside medicines, lifestyle changes and cardiac rehabilitation. In a heart attack, angioplasty is often the quickest way to restore blood flow and limit damage. For stable angina, it can greatly reduce chest pain and breathlessness, but it treats the narrow spot rather than the whole underlying condition — which is why the other parts of treatment matter just as much.

Self-care at home

• Take all your medicines exactly as prescribed, including any that prevent blood clots. Never stop one without asking your heart team — stopping some suddenly can be dangerous.
• Keep the wrist or groin entry point clean and dry. Avoid heavy lifting, straining or strenuous exercise for the few days your team advises.
• Go to cardiac rehabilitation — a supervised programme of exercise, education and support. People who complete it usually recover better.
• Stop smoking, and get help to do it if you can.
• Keep a note of your stent type if your hospital gives you a stent card, and show it to any doctor or dentist you see.
• Attend your follow-up appointments and have your blood pressure and cholesterol checked regularly.
• Know the warning signs and act quickly if chest pain becomes severe or does not settle with rest.

Medical treatments

Treatment continues long after you leave hospital. Doctors usually combine several kinds of medicine to protect the heart and arteries: medicines that make the blood less likely to clot, medicines that lower cholesterol, medicines that control blood pressure and heart rate, and medicines that ease chest pain when it comes. The exact choices depend on your own health and other conditions. Cardiac rehabilitation and support to change habits such as smoking, diet and activity are counted as treatments too, not extras — they are among the most effective things you can do.

When is surgery considered?

Angioplasty is not right for everyone. If several arteries are narrowed, or a narrowing sits somewhere a stent cannot safely reach, a heart surgeon may advise a coronary artery bypass — open-heart surgery that uses a healthy blood vessel from elsewhere in the body to route blood around the blocked part. Which option is best depends on your arteries, your other health conditions and your own preferences, and it is a decision to talk through carefully with your heart team.

Living with this condition

Most people notice less chest pain and more energy within days to a few weeks. Tiredness and a tender bruise at the entry point are normal at first. Ask your team when you can drive, lift things, go back to work and have sex — the answers vary from person to person, and car insurers may have their own rules. Build activity back up gradually rather than all at once.

Lifestyle tips

• Stay smoke-free — this is the single biggest change you can make for your heart.
• Be active most days, building up slowly, ideally with a mix of walking or cycling and some strength work.
• Eat more vegetables, fruit, beans, wholegrains, nuts and oily fish, and less salt, processed meat and sugary food.
• Keep alcohol within recommended limits and avoid binge drinking.
• Aim for a healthy weight and waist size, with support rather than strict diets.
• Get enough sleep and find ways to manage stress, such as breathing exercises or time outdoors.
• Keep up with your medicines even when you feel well.

Diet and exercise

A heart-friendly way of eating — often called a Mediterranean-style diet — is rich in vegetables, fruit, beans, wholegrains, nuts and oily fish, and low in salt, processed meat and sugary drinks. You do not need to be perfect; small, steady swaps work best. For activity, aim for something that makes you breathe a little harder but still lets you talk, building up to about 30 minutes on most days. Cardiac rehabilitation gives you a safe, guided start, and your team can tell you what is right for you.

Mental health and emotional wellbeing

It is very common to feel anxious, low, angry or frightened after a heart procedure. Some people feel vulnerable for a while or worry about every twinge in the chest. These feelings usually ease with time, support and getting back to normal activity — but they deserve attention, not silence. If you feel low for more than a couple of weeks, or if you ever feel you cannot cope or have thoughts of harming yourself, contact your doctor or your local crisis line straight away, or call your local emergency number.

Prevention

You cannot change your age, your genes or your family history. But most heart artery disease is closely linked to things you can change, and prevention often works well. Importantly, angioplasty fixes one narrow spot — it does not stop new plaques forming elsewhere, so the steps below matter just as much after the procedure as before.

Screening programmes

There is no single screening test for heart artery disease offered to everyone. Some countries offer general heart health checks for adults in midlife — for example, the NHS Health Check in England for people aged 40 to 74. If you have risk factors such as high blood pressure, diabetes or a strong family history, ask your doctor whether your heart risk should be assessed.

Complications

If left untreated

• Angina that limits walking, work, sleep and everyday enjoyment.
• A heart attack if a plaque cracks and a clot suddenly blocks an artery.
• A weakened heart muscle (heart failure), causing breathlessness and ankle swelling.
• Dangerous irregular heart rhythms.
• In the most serious cases, sudden cardiac arrest.

Long-term outlook

The outlook is generally good. Angioplasty relieves symptoms for most people and, in a heart attack, it saves heart muscle and lives. Many people are back to normal activities within a week or two and feel considerably better. As with any procedure there are risks — bleeding or bruising at the entry point, a reaction to the dye, an irregular heartbeat, and rarely a heart attack or stroke during the procedure — and your team will explain your own risks. A stent can also slowly narrow again over months or years, which is why medicines and follow-up matter. With treatment and heart-healthy habits, most people live full, active lives afterwards.

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