Coronary Interventions & Coronary Artery Bypass Surgery

Interventions in Cardiovascular Health

Percutaneous Coronary Interventions (PCIs)

  • Definition of Percutaneous:

    • Derived from Latin, meaning "through or by the skin." This refers to accessing the coronary arteries via a puncture site without the need for open surgery.

  • Overview of PCI:

    • A form of revascularization, which is often performed simultaneously with cardiac catheterization (heart cath) to treat blockages in coronary arteries.

    • Example Scenario: Jamie is a patient who had a successful heart cath and is undergoing PCI for a blockage in the right coronary artery.

Procedure of PCI

  • Methodology:

    • Catheterization: A catheter with a deflated balloon is inserted into the artery.

    • Inflation of Balloon: Once positioned, the balloon is inflated, pressing the plaque against the arterial wall in a process called balloon angioplasty.

    • Stent Placement:

    • A stent (a mesh tube) is positioned over the balloon; once the balloon is deflated and removed, the stent remains in place to keep the artery open.

    • The stent may be coated with medications to help prevent blockage recurrence.

Stenting and Complications

  • Multiple Stents:

    • Patients can have more than one stent placed if necessary.

  • Risk of Reblockage:

    • Stents can become thrombogenic, meaning they can induce clot formation, necessitating preventive medications.

    • Thrombogenicity:

    • Definition: The potential to cause clots easily.

Antiplatelet Therapy

  • Medication Usage:

    • Post-PCI patients are prescribed antiplatelet medications to prevent clot formation.

    • Common medications include:

    • Aspirin

    • Clopidogrel (Plavix)

    • Brilinta

    • Importance of adherence: Discontinuation of these medications can lead to stent occlusion and subsequent heart attack.

Monitoring Post-PCI

  • Assessment for Complications:

    • Complications include abrupt closure, vessel rupture, coronary artery spasm, dye allergies, renal issues, infection risks, and embolism leading to stroke.

  • Post-procedure Assessments:

    • Vital signs, bleeding checks, and renal function monitoring (BUN and creatinine levels).

    • Patient vigilance for angina (chest pain) is crucial, as it may indicate complications like stent re-occlusion.

    • Nurses should educate patients about medications and signs of complications, emphasizing the importance of following drug regimens.