Tuesday, November 19, 2013

Angiogram and Angioplasy

Many of you reading this have been aware that I've been having some cardiac issues recently. After the California trip in July, I started having pressure and burning pain in my chest when faced with physical or psychological stress. It would go away if I took it easy for a bit and I would be good to go until the next time. I immediately suspected angina, not unsurprising in an overweight person with bad eating habits who had been smoking for 45 years and had a family history of coronary artery disease.

While on the Arkansas trip, I did have to share the situation with a few people who noticed I was off my game, but generally kept it under my hat. As soon as we got back from Arkansas, I hauled myself straight to our family doctor. He agreed that it probably wasn't heartburn, given all the risk factors, and arranged for an expedited stress test at the local cardiac clinic. I was already scheduled for an echocardiogram in a few weeks as part of regular monitoring of my aortic valve stenosis, but they got me in for the walk on the treadmill in a few days.

Two years ago, I had a stress test as part of  my regular monitoring and I did well. They had to take the treadmill beyond the regular levels to get my heart rate into the target zone of 138 beats per minute. This time, I made it to level three and my heart rate was stuck at 110 when another angina attack struck. I had to stop right there. My regularly scheduled visit with the cardiologist to follow up on the echo was at the end of the month, but the day after the stress test I got a call telling me that the appointment was moved up to the day after that test. The young lady told me that of they could have accelerated the echo, they would have.

The day after the echocardiogram, Sandy and I sat down with the cardiologist. He said there was almost certainly a blockage and he should conduct an angiogram to check it out. The first available date was in mid-November, so he gave me a prescription for nitroglycerin spray to use for angina and told me to take it easy. Soon after, I got a call from the hospital telling me that the angio would be done November 18th and that I should be there for a pre-admission check on the 15th.

Skip ahead through a month of waiting. On the 15th, I attended the pre-admission clinic at Health Sciences North and gave them my medical history. Because I had already had a recent chest X-ray, they just took some blood and gave me an ECG. I was told to report to admitting at 6:30 AM on Monday.

Heather and Kim drove up to Sudbury through nasty weather on Sunday so they could be there to support Sandy. I had pointed out that it was just an angiogram with minimal risk and maybe they should hold off in case I was going to need open heart surgery, but they wouldn't hear of it. They arrived after dark, having driven through some nasty patches of rain on the way up.

Monday morning, we had no trouble getting a parking space before 6:30 AM.. We all reported to the admitting department where I was given a bracelet and some forms to take to the 3rd floor. There was a special waiting room for the angio department. About a half dozen of us were taken into the suite where we were assigned beds. I was number two, since diabetics are treated first. We were told to change into hospital gowns and our medications and vital signs were noted. I laid back on the gurney and a nurse named Dwayne started an IV line into the back of my left hand. It burned more than I remember from any previous time. He didn't hook the line up yet and sent me back out to the waiting room to stand by until my name was called.

It wasn't long before Dwayne came back and got me. In the suite, I reclined on the gurney and they wheeled me into the OR where I was transferred to a narrow bed as gowned and masked staff bustled about. Someone connected the IV and shot some Lorazepam into my system, putting me in a much more relaxed mood. Then a nurse named Nathan tried to get a line into my femoral artery. He had some trouble, probably because I forgot to tell them about my 1996 right inguinal hernia repair. They had applied local freezing so it wasn't painful but someone probing your groin forcefully with a large bore needle does fit the definition of uncomfortable. They were just about to give up and go to my wrist (an optional site) when Nathan said he had it.

My cardiologist entered the scene. The angiogram procedure involves threading a catheter from the line in the groin up through the arteries to the heart and then injecting a dye that is opaque to X-rays. This way, they can see the blood flow through the vessels that feed the heart and detect any blockages. When they inject the dye, you can feel a warm flush go down your body from the top to the bottom. They did this twice in rapid succession. Other than the warm sensation, there was no sense of  the catheter being there.

When the angiogram was done, the moment of truth had arrived. My hope was that an angioplasty, where a balloon is introduced via the line to the site of a blockage and then inflated to open the vessel, followed by a mesh stent that is expanded at the site to keep it open, would do the trick. The less preferable alternative would be open heart surgery for an arterial by-pass (or several).

The cardiologist asked what he had told me about the calcified valve. I said he had told me that he believed the valve was still OK and, if the dye confirmed this and a stent was all that was required, he would leave it for now. That's it, he replied. One stent in the circumflex artery, which was about 90% blocked. Talk about a feeling of relief.

Now the neurologist doesn't do the angioplasty or stent. That is the province of an interventionist and the one who would do mine hadn't arrived yet. With the line still in my groin, they wheeled me back to the ward where I laid flat on my back for four hours. I hadn't had coffee and they were out of Styrofoam cups. Sandy and the girls fed me a muffin and I napped for a while. When the cups finally arrived, I got no coffee because it was time to take me back to the OR. Once again, I felt nothing as the catheter with the balloon was threaded through my system nor when the stent was inserted via the same route. In a few minutes, it was done and they wheeled me out, but not before giving me before and after photos of the arteries in my ticker.

Before and after photographed by Heather

They wheeled me to elevator and whisked me up to the Eighth Floor where they had a special recovery room for the angio patients. There were two nurses, Melinda and Erin, for six of us. People who only had angiograms were released the same day after four hours of lying still after the arterial line was removed, but those of us who had angioplasties were kept overnight due to a large dosage of anti-clotting drug Plavix.

I was in recovery for about an hour before Erin and Melinda removed the line in my groin. As soon as it was out, they clamped me to the bed with what was basically a large plastic C-Clamp. I laid there for 45 minutes  as Erin periodically reduced the pressure in increments. When the clamp came off, Erin put a pressure dressing on (after shaving some vital parts to prevent later pain when the dressing came off). I had to lie on my back with a ten pound sandbag on top of the dressing for two hours. Then I was permitted to lay on my side for another two hours but had to remain flat. After that, I could move from side to side on the bed and raise the head end, but wasn't allowed up until the next morning.

It was a long night lying there, with nothing but the beep and hum of monitors to keep us amused. Several times, one of the ECG leads pulled off my chest causing a warning and night nurse Mike had to come in and reattach it. At one point, my blood pressure reading was 85/49, causing a different alarm to sound. The cuff on my arm had slipped and the pressure readout returned to 110/75 after adjusting it.

As morning broke, we all heaved a sigh of relief. Melinda and Erin came back on duty and breakfast of oatmeal and toast arrived. A lab tech took some blood and we were encouraged to get up and wander the halls, towing the stand with our IV bags with us. They warned us that if we felt a popping sensation or felt wetness, we should hightail it back to the ward.

When nothing went wrong, we were allowed to get dressed and waited for the cardiologist. He arrived and gave us our instructions. He gave me a prescription for Plavix, which I'll be taking along with aspirin for at least a year, and orders to take it easy for a week. I was told no driving due to fear that the leg action of moving from the accelerator to the brake might open the artery up, and if bruising spread rapidly or it started bleeding, apply pressure above the wound and call 911. After the week, I could do whatever I wanted as long as I followed a low salt, low fat and low sugar diet. Wow, not much food to look forward to. I was to see my family doctor in a week and go for another stress test in early February.

Sandy and the girls came and picked me up and we went home. They left later in the day because Heather had to be back at work tomorrow and I settled in for a week of leisure.

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