Question

The patient was prepared and draped in a sterile fashion and 20 ml of 1% lidocaine was infiltratred in the right groin.  A catheter was inserted into the femoral artery and progressed into the left and right coronary arteries.  A 75% stenosis was noted in the right coronary artery.  Angioplasty was performed  which corrected the stenosis to a level of 20%.  The patient was placed on heparin over the next 12 hours to prevent thrombosis.

Question 1.       In your own words, what condition was detected in the right coronary artery?

Question 2

Where are these coronary arteries located?

Question 3

In your own words, what procedure was performed to correct this condition?

Question 4

In your own words, what was the reason for placing the patient on heparin?

Answer 1

Percutaneous coronary interventions are done to resolve the various abnormal condition of the heart, there are the various procedure that is performed to resolve the complications associated with the heart such as,

PTCA - PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

CORONARY ARTERY STENT

ATHERECTOMY

BRACHYTHERAPY

ETC......

ANSWER 1.

The condition that was detected in the right coronary artery is Atherosclerosis, It is the condition in which hardening or the narrowing of the vessels takes place due to deposition of the fat and the cholesterol called plaque.

these substances block and narrow the coronary vessels in a way that reduces blood flow to the myocardium. atherosclerosis is the repetitious inflammatory response to injury of the arterial wall and subsequent alteration in the structure and biochemical properties of the arterial walls.

Answer 2

LOCATION OF CORONARY ARTERIES

THE RIGHT AND THE LEFT CORONARY ARTERIES

THE branch of these two arteries of the heart supplies blood to the heart, it originates from the aorta just above the aortic valve leaflets,

THE LEFT CORONARY ARTERY HAS THREE MAIN BRANCHES

1. The artery from the main point of origin that is from the aorta to the first major branch called the LEFT MAIN CORONARY ARTERY.

2. TWO BRANCHES ARISES FROM THE LEFT MAIN CAROTID ARTERY

A)  THE LEFT ANTERIOR DESCENDING ARTERY WHICH COURSES DOWN THE ANTERIOR WALL OF THE HEART.

B)  CIRCUMFLEX ARTERY WHICH CIRCLES AROUND TO THE LATERAL LEFT WALL OF THE HEART.

The right side of the heart is supplied by the RIGHT CORONARY ARTERY which leads to the A) INFERIOR WALL OF THE HEART and the posterior wall receives blood from the by an additional branch of the right coronary artery called the ) B POSTERIOR DESCENDING ARTERY.

SUPERFICIAL TO THE CORONARY ARTERY ARE THE CORONARY VEINS, VENOUS BLOOD FROM THESE VEINS RETURNS TO THE HEART PRIMARILY THROUGH THE CORONARY SINUSES, WHICH IS LOCATED POSTERIORLY TO THE RIGHT ATRIUM.

ANSWER 3.

The procedure that was performed to correct the situation was PTCA ( PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY )

IT IS A DIAGNOSTIC PROCEDURE WHICH IS USED TO TREAT CORONARY ARTERY DISEASES,

In PTCA, a balloon-tipped catheter is used to open blocked coronary vessel and resolve ischemia. it is used in the patient with angina and as an intervention for acute coronary syndromes, it is also used in CABG to open the blockage due to ATHEROSCLEROSIS, The purpose of performing PTCA Is to improve blood flow within a coronary artery by compressing and cracking the ATHEROMA, it is performed when there are chances that blood flow can be improved with the heart.

PTCA is carried out in the cardiac catheterisation department, a hollow catheter called a sheath is inserted into the femoral vein, providing a conduit for other catheters, and the procedure is carried out such as atheroma and the CABG BY inserting radioopaque contrast agent commonly called dye.

a balloon-tipped sheath is passed from the femoral artery to the coronary artery where a plaque is accumulated and the cutting and grinding of the plaque is done, also by monitoring it on the computer screen, multiple inflation and the several sizes of balloons are used to break or compress the plaque. this continuous process helps in making space for the blood to flow.

Answer 4

some patients with an unstable lesion and at high risk for abrupt vessel closure are restarted on HEPARIN after sheath removal or this patient may receive IV infusion of a GP II B/ III INHIBITOR and are monitored closely and may have a delayed recovery period.

To reduce the risk of clogging of the artery and the occlusion can lead to thrombus inside the artery immediately after the procedure as the plaque remains in the circulation for a longer period of time,

To reduce the risk of occlusion inside the artery, there is a need to put the patient on the continuous low molecular weight heparin that reduces the risk of coagulation and also to reduce the abrupt closure of the vessels after PTCA can be avoided. In many cases, the initial dose of heparin is 10,000 to 15000 is given to achieve clotting time.