PATIENT INFORMATION AND PROCEDURES

Pre-Procedure Instructions / Post Procedure Instructions / The Basics After Angioplasty

PRE-PROCEDURE INSTRUCTIONS
(FOR ALL DIAGNOSTIC & INTERVENTIONAL PROCEDURES)

General Information: Your procedure will be scheduled at Washington Adventist Hospital, 7600 Caroll Avenue, Takoma Park, Maryland. The telephone number is (301) 891-7600

Arriving to the Hospital: You will need to arrive at the hospital at least 3-4 hours prior to your procedure and report to TRANSCARE, Lower Level 1 (enter through the Emergency Room door, next to the parking deck.) Please be advised that we will do everything to have your procedure at the scheduled time. However, emergencies may cause unavoidable delays and we appreciate your patience.

Lab Work: Your pre-admission testing will be done at the hospital upon your arrival. Patients with HMO insurance must go to their corresponding lab.

Procedure Instructions & Medications
(IMPORTANT - PLEASE REVIEW ALL INFORMATION)

1. Do not eat or drink anything after midnight the night before the procedure.
2. You can take all of your medications the morning of the procedures with a small sip of water.
3. If you are DIABETIC, withhold all of your diabetic medications in the morning of the procedure. If you take GLUCOPHAGE, discontinue TWO DAYS PRIOR to your procedure.
4. If you take COUMADIN, discontinue FOUR DAYS PRIOR to your procedure.
5. Please inform us of any allergies to drugs. If you have a dye allergy (or allergy to shellfish or iodine), you will need to be pre-medicated THREE DAYS PRIOR to your procedure.
6. Bring all of your nedications in their original containers with you to the hospital.

FOR CAROTID STENT PATIENTS: DO NOT TAKE ANY MEDICATIONS THE MORNING OF YOUR PROCEDURE

If you need further clarification, or if any of the pre procedural information above is unclear, contact us before the scheduled procedure is to take place.

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POST-ANGIOPLASTY PATIENT INSTRUCTION SHEET
(IMPORTANT - PLEASE REVIEW ALL INFORMATION)

Now that you have had a successful angioplasty, you and your physicians need to monitor your heart to make certain that the results continue. Listed below are some instructions and general information.

ACTIVITY:

1. Light activity for the first 3-5 days after the angioplasty. No heavy lifting. Do not push yourself to the point of fatigue, shortness of breath, or chest pain. Leisure walking is a good activity.
2. Moderate activity after 5 days up to 4 weeks after the angioplasty.
3. Full activity level after 4 weeks. You should not engage in strenuous activity or manual labor until a stress test has been performed and you have then been given clearance.
4. You may shower after an angioplasty when you go home. You can easily remove any bandage/Band-Aid at the groin puncture site in the shower. Do not soak in the bathtub until 5 days after the procedure.

TESTING:

1. A nuclear stress test may be performed 6 to 12 weeks after the angioplasty. The results of this test are generally favorable and help to guide your physician in prescribing an activity level for you.
2. Another follow-up stress test may be performed in 4 to 6 months to assess any restenosis (re-blockage) which can occur up to 2-50% of cases [even with drug eluting stents].

MEDICINES:

1. Aspirin. You should take one tablet (325 mg) daily. If you have problems with upset stomach or bleeding, a coated aspirin such as Ecotrin should be used. A children's/baby aspirin is sometimes recommended. Aspirin mildly anticoagulants ("thins") the blood and prevents clotting at the site of the angioplasty. Aspirin should be continued indefinitely. Stent patients should take adult strength (325 mg) aspirin unless advised by your doctor.
2. Plavix. This medication prevents blood clotting from the platelets. Plavix is similar to aspirin, but is also used with aspirin in patients with stents. It is very important to take this medication EVERY DAY for at least one year or longer if recommended by you doctor.
3. Cholesterol/Lipid-lowering medications. Zocor, Lipitor, Mevacor, Pravachol, Lescol; Niacin; Cholestyramine/Questran; Colestipol; Lopid. These medications help lower the blood cholesterol and triglyceride levels and can slow the progression of heart disease. They do not prevent recurrence of blockage after angioplasty or stenting.
4. Nitroglycerin tablets. Put 1 tablet under the tongue for chest pain if the discomfort persists for at least 5 minutes. Sit or lie down when you take this medication. You may take another nitroglycerin in 5-10 minutes up to a total of 3 tablets. If the discomfort is still present after 2-3 tablets, call your doctor or go immediately to the closest emergency room.
5. Beta-blocker. (Atenolol/Tenormin; Corgard/Nadolol; Toprol {Lopressor/Metorolol}; Inderal/Propranolol). These medications slow the pulse and control the blood pressure. They are used to prevent angina/chest pains and to treat high blood pressure.
6. Nitrates (Nitroglycerin patch; Ismo/Imdur/Monoket/Dilatrate/Isordil). Nitrates prevent spasm of the artery that was treated with angioplasty. Nitrates also prevent episodes of angina or chest pain. Nitrates can cause headache that usually can be relieved with Tylenol.
7. Calcium channel blocker. (Procardia/Adalat/Norvasc/Calan/Isoptin/Verapamil; Cardizem/Diltiazem; Cardene) may be prescribed for several months after the angioplasty. This medicine prevents spasm of the artery that was treated by angioplasty. It is frequently used for patients who have undergone the Rotoblator procedure.
8. Acid blocking medications. (ulcer-type medications - Prilosec, Axid, Zantac, Tagamet/ Cimetidine, Pepcid). These medications prevent stomach bleeding in patients on powerful anticoagulants like the combination of aspirin and Coumadin.
9. Coumadin. Some patients are placed on this medicine, which is a strong "blood thinner". Your blood will need to be tested every 1 to 2 weeks in the beginning to regulate the medicine. Call your physician immediately if you notice excess bruising or bleeding, black tarry stool, blood in the urine, or vomiting of bloody or coffee-ground appearing material.

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THE BASICS AFTER ANGIOPLASTY

WHAT IS NORMAL AFTER AN ANGIOPLASTY:

1. Bruising or discoloration in the groin area where the catheter was inserted. This may extend along the inner thigh and up towards the abdomen. It may take 3 to 4 weeks to disappear.
2. A small lump where the catheter was inserted. The lump should not increase in size.
3. Soreness over catheter insertion site when pressed upon.
4. Slight oozing of clear or pink-tinged liquid from the catheter hole for the first few days after the angioplasty.
5. Tiredness and fatigue in the first few days after the procedure.
6. Fleeting chest discomfort that lasts a few seconds is probably not important.

WHAT IS ABNORMAL AND SHOULD BE REPORTED TO YOUR DOCTOR:

1. Chest pain or discomfort similar to what you felt before the angioplasty or similar to the discomfort you may have felt when the balloon was inflated in your artery during the procedure.
2. A lump in the groin that increases in size and/or is painful without touching the area.

WHAT YOU CAN DO TO HELP:

1. If you smoke, stop immediately. Smoking causes cholesterol deposits to build in the blood vessels.
2. Eat a low-cholesterol, low-fat diet. A dietician or your physician can instruct you further on this.
3. If you are diabetic, stick to your diet and keep your blood sugar well controlled. If you have high blood pressure, keep your blood pressure controlled with prescribed medicines. Low salt diet is recommended for patients with high blood pressure or heart failure.
4. If you are overweight, lose weight.
5. Exercise ONLY as prescribed by your doctor. Aerobic exercises (walking, swimming, running, bicycling, etc) help condition the heart and blood vessels.
6. Alcohol may be consumed in moderation only.

If you need further clarification, or if any of the post procedural information above is unclear, contact us with any questions.

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