Understanding coronary angiography and coronary intervention

View or download this information as a PDF

Aches and pains

After coronary intervention (also known as angioplasty) people are often more aware than normal of any little aches or pains that they might get. It is important to remember that flickering pains in your chest lasting a few seconds are quite common after coronary angioplasty and nothing to worry about.

If you get pain that lasts longer than a few minutes you will need to follow the 10 minute rule.

‘The 10-minute rule’

Sit down, rest and try to relax
If pain is present and you have been prescribed GTN (Glyceryl trinitrate), use
one spray or tablet under the tongue and wait five minutes
If pain is still present use another spray (or tablet) under your tongue and wait five minutes

If pain is still present dial 999 to call for emergency services.

Introduction

This page is written for people are having or have had a coronary angiogram and/or coronary intervention for coronary heart disease. It aims to give you, and the people who care for you, information about your treatment, hospital stay and recovery.

At different stages of your recovery, you and your family will want to know about different things. Some people find it difficult to remember information given to them while in hospital. Often people do not know what to ask during their hospital stay and find that when they get home they have questions, but nobody to ask.

To help with this, we have provided a list of contacts, self-help groups, advice lines and other sources of information at the end of the page. You will also find an explanation of some medical words that you may have heard used during your stay.

Please feel free to ask questions during your hospital stay or visit. We understand that we cannot cover all of the information that you might want on this page.

If you speak a language other than English and you need an interpreter, please mention this to the ward staff where you are being cared for, or if you are having a planned procedure ring the ward to let them know. If you could do this 3-4 days before you are admitted this will give us an opportunity to arrange an interpreter for you.

If you are having a planned procedure and have any questions about your treatment please contact:

Cardiology admission office: 0113 392 3960 (9.30am-3.30pm)

Ward L14: 0113 392 7414

Explain my procedure

Please access the appropriate website below to watch a video that will explain your procedure:

www.explainmyprocedure.com/angiography-leeds

www.explainmyprocedure.com/angiographyangioplasty-leeds

Key take home messages

Angiography is a test which shows x-ray pictures of the heart arteries. This will show any narrowing’s in the coronary arteries that could be limiting blood flow to the heart muscle
Coronary intervention (also known as angioplasty) is a treatment performed under local anaesthetic to widen narrowed coronary arteries. This usually involves the use of ‘stents’ which act like scaffolding to strengthen the artery
Coronary intervention relieves angina symptoms for most people. It is also a very effective treatment for patients having a heart attack
If you are having a planned procedure you will need to prepare for your admission. The pre-assessment nurses along with this page will guide you in how to prepare for your angiography and/or coronary intervention
Most people having planned procedures are in hospital for six hours after angiography or coronary intervention
If you have been admitted to hospital unwell, you may be required to stay for longer than if it were a planned procedure
If you get pain or discomfort in your chest that lasts longer than a few minutes and does not go with rest, you will need to know how to manage it. Information on page three explains how
When you go home, you and your family can get advice about living a heart healthy lifestyle from this page and the specialist cardiac rehabilitation nurses
The British heart foundation has a help line that you can ring for advice about heart health – 0300 330 3311
Email: [email protected]
Website: www.Bhf.Org.Uk

You and your treatment

What are coronary arteries?

Your heart is a muscle that works as a pump to ‘push’ blood around your body. It can do this because its walls are made of powerful muscle. To stay healthy and work properly your heart muscle needs its own supply of food and oxygen.

The picture below shows the pipes or blood vessels that carry blood containing food and oxygen to your heart muscle. These pipes are called coronary arteries.

Model of the heart

Illustration of the heart with arrows pointing to 2 of the 3 coronary arteries

Why have my coronary arteries become narrowed?

Coronary arteries supplying the heart can become diseased. This process is part of a condition known as coronary heart disease.

The exact cause of coronary heart disease is unknown but there are factors that increase your risk of it developing such as high blood pressure, diabetes, raised cholesterol and cigarette smoking. Coronary heart disease builds up over many years. Fatty deposits can collect inside the coronary artery making it narrow.

The good news is that you can reduce the risk of the narrowing getting any worse by living a healthy lifestyle. This is something that is in your control. Further advice on healthy living and how this can help your heart is provided later on this page.

Remember that you are not alone. Coronary heart disease is a common condition affecting more than two million people in the UK. In time, you can get back to living your normal day-to-day life.

How do I know I have narrowed coronary arteries?

People often get symptoms when their coronary arteries narrow. This is usually what makes people visit their doctor or the hospital for help and advice. No two people have exactly the same type of symptoms. People may feel discomfort, pain, an ache or a feeling of heaviness in their chest when they exercise e.g. walking up a slope. They may also feel slightly out of breath.

Typically these symptoms may occur with exercise during which the heart rate is increased, for example walking up an incline or carrying a heavy load. This is because during exertion the heart muscle needs more blood and oxygen to function. The narrowed arteries cannot supply blood fast enough. This reduced blood supply at a time when the heart muscle is demanding more can result in the symptoms mentioned above.

Sometimes the symptoms caused by narrowing of the heart arteries can come on at rest. It may prompt admission to hospital for more urgent investigation and treatment. If you experience any of the symptoms mentioned and you have a GTN spray or tablet to use you should follow the advice at the top of this page (the 10 minute rule).

What is angina?

Angina is the term used for chest discomfort caused by reduced blood flow to the heart muscle. Angina is a sign of coronary heart disease, it is not a mini heart attack. In other words, the discomfort of angina does not cause damage to the heart muscle. When you rest or take a nitrate medication (such as GTN spray) the chest discomfort or breathless feeling will go away.

In the meantime it is important to let your nurse know if you get any feelings like these during your hospital stay. You can be given medicine to relieve these feelings, should they occur.

What is a heart attack?

A heart attack, also known by the medical term ‘myocardial infarction’ or ‘MI’ for short, occurs when the blood supply to the heart muscle is blocked for a longer period of time. A heart attack develops when there is a rupture or erosion of a fatty deposit, causing a blood clot to form within the artery.

This usually happens without any warning. This results in damage to the heart muscle beyond the area of blockage. Symptoms of a heart attack are usually the same as angina but more severe, commonly last longer than 30 minutes and are not relieved by rest or medication, such as GTN spray. A heart attack may be the first sign of coronary heart disease for some people.

What is a coronary angiogram?

This is a test done under local anaesthetic using X-ray contrast (a clear iodine containing solution) to show up the coronary arteries and highlighting any narrowing.

The test usually takes 20 – 30 minutes. It involves inserting a small flexible tube (catheter) into the artery in your wrist following an injection of local anaesthetic to numb the skin. Occasionally, a tube may be inserted into the artery in the groin instead. Through X-ray guidance, this is passed up to your heart. X-ray pictures are taken as the X-ray contrast goes through your coronary arteries. You should not feel any pain as there are no nerve endings in the coronary arteries, but you may feel a few palpitations (missed beats). The X-ray contrast can occasionally cause you to feel quite hot and flushed but this should pass in a few seconds. The X-ray contrast passes out through the kidneys and in the urine. Sometimes people can experience blurred vision after the procedure until the X-ray contrast clears.

After the test, a doctor or nurse will remove the tube and pressure is applied until the bleeding has stopped, usually with a wrist band device.

What is coronary intervention and how does it work?

Coronary intervention (also known as angioplasty) is a treatment that widens a narrowing or blockage in your coronary artery (for some people this can be performed at the same time that you have your angiography procedure). This means that blood flow to your heart muscle is improved. This treatment restores blood flow and limits damage to the heart in people with heart attacks and helps to relieve symptoms of chest discomfort in people with angina.

Coronary intervention is not a cure for coronary heart disease. The two most powerful things you can do to improve your heart health are to live a healthy lifestyle and take your medicines as recommended.

To widen your coronary artery your cardiologist passes a small balloon into the narrowed or blocked artery under X-ray monitoring.

Once the blockage has been found, the balloon is inflated and in doing so widens the narrowed coronary artery. The picture below shows the difference between a coronary artery before and after treatment.

Photograph of a scan showing before and after coronary intervention

In most coronary intervention procedures a coronary stent is used to scaffold open the narrowed part of the coronary artery. This helps to stop the coronary artery renarrowing in future.

A coronary stent acts like a scaffold to hold the coronary artery open after it has been widened. The picture below shows a stent which looks like a short, tiny wire-mesh tube.

A coronary stent

Once the stent has been put into your coronary artery it cannot move. In time a new lining grows over it and it becomes part of the wall of your coronary artery.

Complex coronary intervention

Sometimes the nature of the narrowing or blockage means the procedure will be more complex. This could be due to a long-standing complete blockage of the artery or the presence of calcium in the artery.

In cases of long-standing complete heart artery blockages special techniques are used to allow your doctor to open the artery, and often requires two tubes to the heart to deliver the equipment needed. There is a small chance in these cases that despite best efforts the artery cannot be opened. If successful then stents are used to scaffold open the artery.

In cases where there is a lot of calcium the artery is hardened and ‘rock-like’. So, it is safer and better for the calcium to be cracked before the stent is used. Your doctor can use specialist equipment for this, which will be chosen based on the type of narrowing. This can include special balloons, some with the ability to cut into the calcium and some that can deliver sound waves to cause shock cracks in the calcium. Alternatively, a drill or laser can be used that breaks down and cracks the calcium. The drill is noisy and sounds similar to a dentist’s drill. On occasions with these techniques, you can be aware of chest discomfort similar to your angina. Finally, a stent is used to scaffold open the treated artery.

These procedures are technically more challenging and likely to take longer, however the risks are only a little higher than that of a conventional procedure. Your doctor will explain the specific risks of your procedure at the time of your consent. As with other coronary angioplasty/intervention you will be awake and the procedure is still done under local anaesthetic.

Coronary intervention benefits and risks

It is important that you understand the benefits of coronary intervention and the possible risks. Your doctor and nurse will discuss these with you as part of a process called ‘informed consent’. Before going ahead with the procedure, you will be asked to sign a consent form. The following section provides information on the expected benefits of coronary intervention and the possible risks. The information provided is based on average results from the United Kingdom database of coronary intervention procedures. The risks may be lower or higher in individual cases. You will be able to ask any questions to the doctors and nurses before going ahead.

Coronary intervention involves widening a narrowing in one or more coronary arteries to improve blood supply to the heart. In most patients, the procedure includes the implantation of a stent. A successful result is achieved in over 92 out of 100 cases.

In stable coronary artery disease (angina) the main benefit is to improve symptoms. It is expected that coronary intervention will reduce the number of times you experience angina and allow you to carry out activities more easily. Lifestyle changes and medication are the most effective ways to reduce the risk of a heart attack in future.

In acute coronary syndromes (myocardial infarction or ‘heart attacks’), coronary intervention, in addition to lifestyle changes and medication, reduces the risk of having another heart attack in future and may improve long-term survival.

If your coronary angiogram shows multiple narrowings of the coronary arteries, or a narrowing affecting the left main coronary artery, your doctor may recommend coronary artery bypass graft surgery rather than coronary intervention. If your coronary angiogram reveals less severe narrowings, intensive medical management with tablets may be recommended.

If you decide not to have coronary intervention, in most cases continued treatment with medication will be recommended to improve symptoms and reduce the risk of heart attacks. Coronary artery bypass graft surgery may be appropriate in some patients. The option of coronary intervention can be considered again in future if your symptoms become worse.

What are the risks of coronary intervention?

Coronary intervention is an effective and well established treatment for coronary heart disease. Most people undergoing coronary intervention have a successful procedure without any problems. However, as with any medical treatment, it is important to recognise that problems can occasionally occur.

The following section explains the possible risks of coronary intervention. You need to be aware of these as part of the process of informed consent. If you have any questions, please discuss these with your doctor or nurse.

Serious problems

The most serious complications are: major heart attack, need for emergency heart surgery, need for further urgent coronary intervention, stroke or death.

The risk of serious problems depends on whether you are having coronary intervention for stable coronary disease (angina) or for an acute coronary syndrome (myocardial infarction or ‘heart attack’).

Risks

Major heart attack – four in every 1000 patients treated
Need for emergency heart surgery – three in every 1000 patients treated
Need for further urgent coronary intervention – 10 in every 1000 patients treated
Stroke – two in every 1000 patients treated
Death – 16 in every 1000 patients treated.

Major heart attack – six in every 1000 patients treated

Need for emergency heart surgery – two in every 1000 patients treated

Need for further urgent coronary intervention – 20 in every 1000 patients treated

Stroke – eight in every 1000 patients treated

Death – 74 in every 1000 patients treated

[Numbers from National Institute for Cardiovascular Outcomes Research (NICOR) audit 2017-18]

It is important to recognise that some of these problems may occur due to the acute coronary syndrome itself and not necessarily the coronary intervention procedure.

The following section provides more detailed information on the risks of coronary intervention, divided into problems that can occur at the time of the procedure and those that can occur later.

Complications which can occur at the time of the procedure or shortly afterwards

Bruising is common (more than one patient in 20) and usually fades within a few weeks.
Bleeding can occur and is usually controlled by the nurse or doctor applying pressure over the skin puncture site. A collection of blood (haematoma) may develop under the skin which will disappear over time. More serious bleeding can sometimes occur and may require a blood transfusion (less than 1 patient in 100. Rarely, problems with the access site in the groin can cause internal bleeding which may require another procedure or an operation. Very rarely such bleeding can be life-threatening.
Damage to the entry blood vessel occurs in fewer that one patient in every 100. Sometimes a swelling (false aneurysm) can develop in the wall of the blood vessel. This may disappear by applying pressure, but rarely an injection under ultrasound or an operation may be required. Sometimes flow in the radial artery can be reduced in the long term if this is used as the access site. This does not usually cause any symptoms as the hand is also supplied by blood by another artery (the ulnar artery).
Occasionally, pressure on the nerve close to the puncture site in the wrist can cause numbness or weakness in the hand.
Spasm (squeezing) of the blood vessel around the catheter (tube) may occur as it is passed through the artery in the arm. This can be uncomfortable but can be treated during the procedure by medication to help to widen the artery. Sedation can be given if necessary to help the artery to relax.

Blockage of the coronary artery or a side branch rarely occurs when inflating the balloon or implanting a stent. This can usually be dealt with by the cardiologist at the time. Rarely such a blockage results in a heart attack and can be life-threatening. Very rarely, an emergency coronary artery bypass graft operation may be needed to deal with a blocked artery (see ‘serious problems’ above).
Perforation of the artery can occasionally occur. This usually heals quickly but rarely can cause bleeding around the heart. This may require an extra stent to be implanted. Blood around the heart may need to be drained through a tube placed through the skin. Very rarely bleeding from a perforation can be life-threatening and may require an emergency operation.

Palpitations, flutters or skipped beats occur commonly but are usually short-lived. Occasionally, a more serious heart rhythm problem can occur and may require an electrical shock (defibrillation) to restore the heart rhythm to normal.

Kidney function may be affected by X-ray contrast. This is most commonly seen in people who already have kidney problems before the procedure. If this is the case, we will monitor your kidney function and use the least amount of contrast possible. Keeping well hydrated before and after the procedure also helps. Very rarely, dialysis may be needed if kidney function does not improve.

Stroke may occur due to clot or interruption in blood supply to the brain but is rare (see ‘serious problems’ above).
Bleeding in the brain may be caused by the medications used to prevent blood clots during the procedure but is extremely rare.

Allergic reactions can be caused by X-ray contrast, materials, medications or equipment used in the procedure. Allergic reactions usually cause a skin rash which settles after treatment with an antihistamine. The risk of serious allergic reactions is very low (one patient in every 2500). You should tell the doctors and nurses looking after you before the procedure if you have ever experienced any allergic reaction before, particularly reactions to X-ray contrast or latex.

X-ray dose is kept to the lowest possible to carry out the procedure. In very long procedures, X-rays can rarely cause redness or irritation to the skin. Exposure to any X-rays can increase the chance of developing cancer later in life but the risk is very small (one patient in every 1000).

Complications which may occur later after the procedure

Narrowing of the stent (restenosis) can sometimes occur, but the risk is low with modern stents (around 5 patients per hundred). If your stent narrows, you may experience symptoms of angina and another coronary intervention or coronary bypass graft surgery may be required.
Blockage of the stent due to clot (stent thrombosis) is rare – affecting fewer than one patient per hundred in the first year. After one year, stent thrombosis affects between 2-4 patients per thousand per year. Stent thrombosis is serious and can cause a heart attack. To help prevent this risk, it is very important that you take your medication as advised – in particular aspirin and other anti-platelet medications. Stopping anti-platelet medications too early is one of the major causes of stent thrombosis. If you think you will find it difficult to remember to take your medication, please speak to your doctor, nurse or pharmacist before you go home.

Sometimes reading lists of possible problems that could occur after medical procedures can seem frightening. It is important to remember that the majority of patients do not experience any complications. Your doctor has recommended coronary intervention taking into account the risks and benefits to you. If you have any concerns or require further information please do not hesitate to ask any of the doctors or nurses before going ahead with the procedure.

Notes

Information on the risks of coronary intervention in the UK was accessed from the British Cardiovascular Intervention Society
(https://www.bcis.org.uk/resources/audit-results/)

Angina is not a mini heart attack but is part of a condition called coronary heart disease
Angina is a common condition and many people manage their condition alongside living a full and active life
A heart attack is different to angina, but may require the same investigations and treatment
Coronary angiography is an X-ray test to looking for narrowing in the heart arteries
Coronary intervention is an effective treatment used to relieve the symptoms of angina and to treat a heart attack. Coronary angiography and angioplasty can be performed at the same time but sometimes may be performed on separate occasions
In some patients, the narrowing of the coronary artery cannot be easily widened with a balloon alone. In these cases, special techniques including a tiny drill, sound-waves or laser treatment may be used to prepare the artery for stent insertion.
Coronary intervention is an effective treatment used to relieve the symptoms of angina and to treat a heart attack. It usually involves widening the narrowed coronary artery with a balloon and inserting a stent
Coronary angiography and intervention can be performed at the same time but sometimes may be performed on separate occasions
Living a healthy lifestyle and taking your medicines are the most powerful ways of keeping your arteries healthy

Acute admission to hospital

You experience chest pain or other symptoms that prompt you to go to seek medical attention.

Your symptoms, ECG and blood tests suggest the problem is related to the heart.

You are admitted to a cardiology ward for further investigations, monitoring and treatment. Occasionally where there are no beds available on a cardiology ward, you may be admitted to a more general ward and our cardiology doctors will visit you there.

If the doctors feel that your symptoms are related to a narrowed heart artery or heart attack (myocardial infarction), you remain in hospital for further investigation and treatment.

You are prescribed medications to help protect your heart and reduce the risk of further problems. Blood tests are performed to check your cholesterol levels and determine whether or not you have diabetes. Often a cardiac ultrasound (echo) is carried out to assess the pumping action of the heart.

Among other tests and treatments that are recommended, you are likely to undergo coronary angiography and potentially coronary intervention. Depending on your condition coronary angiography and coronary intervention may all be carried out at the same time. This will be decided by the doctor whose care you are under on the ward.

If you are diagnosed with a heart attack or you undergo coronary intervention you may see a cardiac rehabilitation nurse in hospital. During this visit you will be offered further information about your condition, medication management and advice on recovery and lifestyle risk factor management. Referral to a specialist community based service will also be discussed. If you are diagnosed with unstable angina which is treated with medications, you can still see a cardiac rehabilitation nurse for support, you will need to ask the nurse caring for you on the ward to request this.

After you go home, it is important that you take your medications as recommended. The dose of some of the medications usually needs to be increased (or titrated) over the next 4-6 weeks to achieve maximum benefit. You will need to contact your GP practice to make sure this takes place.

What to expect when you have an unplanned admission to hospital

If you attended the hospital with pains in the chest or other symptoms that suggest a problem with the heart you are likely to have had a number of routine tests to help the doctors diagnose the problem.

This is a test in which electrodes are placed across the chest and on your arms and legs. It records the heart rate and rhythm and is likely to have been one of the first tests you had carried out. An ECG can sometimes demonstrate if there is a problem with the supply of blood to the muscle which could result from a narrow or blocked heart artery. These ECG changes can be subtle and are not present in everyone who has coronary heart disease. Other tests are required to inform the doctors alongside the ECG.

As well as routine blood tests you are likely to have had blood tests to measure the level of cardiac troponin. Troponin I and T are proteins which are normally only present inside the cells of the heart. They are released from the heart into the blood stream when any damage has occurred. Usually the level of troponin will be measured shortly after you arrive in hospital. A second sample will be taken later to see if there has been any change. Looking for changing levels of troponin in the blood is a very accurate way to assess for heart muscle damage. The most important cause for raised troponin levels is a heart attack, but there are many other reasons why troponin levels could be elevated.

In order to plan further tests and investigations the doctor in the Emergency Department or cardiac ward will have made an initial diagnosis pending further test results and treatment. This is likely to have been based on your past medical history, presenting symptoms, ECG and initial blood test results. At this stage the doctors should have been able to tell you if they felt the problem may be a blocked or narrowed heart artery or something different. From here the second Troponin test may help rule out or confirm a Heart Attack (myocardial infarction). If the troponin test is negative further investigations will help indicate whether a condition called unstable angina or another unrelated condition has caused your symptoms.

Acute coronary syndrome

Acute coronary syndrome is the name given to a group of conditions linked to coronary heart disease, where fatty deposits or plaques develop inside the heart arteries. In most cases, the fatty deposit becomes disrupted by a small ‘rupture’ or ‘erosion’ developing on its surface. This causes a blood clot to form within the artery, which can reduce or stop the blood flow to an area of the heart muscle. Because this can happen without an obvious trigger, patients with acute coronary syndrome often experience symptoms without any warning. The symptoms are similar to those in angina, but usually occur without provocation and are often more intense and longer lasting. These symptoms can vary between individuals, but most commonly include heaviness in the chest which may spread to the shoulders, arms, or throat; breathlessness; sweating; nausea and vomiting.

Types of acute coronary syndrome

There are three main types of acute coronary syndrome which are diagnosed depending on your symptoms, your ecg and the results of troponin levels on your blood tests:

STEMI is a heart attack in which one of your coronary arteries becomes blocked, leading to damage to the heart muscle. STEMI is diagnosed on your ECG and usually requires an emergency coronary angiogram and immediate coronary intervention to restore blood flow as soon as possible.

NSTEMI is a heart attack in which one of your coronary arteries is narrowed but not necessarily blocked.

The presence of clot in the artery reduces the blood flow and causes some degree of heart muscle damage, which is detected as elevated levels of troponin on your blood tests. NSTEMI is treated in the first instance by intensive medication to reduce clotting in the coronary arteries and improve blood flow. A coronary angiogram is usually carried out over the next few days.

Unstable angina is a type of acute coronary syndrome in which one of your arteries is sufficiently narrowed to cause symptoms on minimal exertion or at rest. There may or may not be clot within the artery. There is no heart muscle damage, such that troponin levels on your blood test are not elevated. Unstable angina is not technically a heart attack, but because the underlying cause is the same it is often dealt with in the same way as the other acute coronary syndromes.

All patients with suspected acute coronary syndrome are admitted to hospital for investigation and treatment.

While you are in hospital it is very important that you tell the nursing staff if you develop further discomfort in the chest or symptoms similar to that which brought you in to hospital. You may have a GTN spray already but it is best to tell someone before you use it, this way the nurses can ensure your safety and carry out tests such as an ECG to get more information at the time of your symptoms.

If you are suspected to have had an acute coronary syndrome (ACS) you are likely to be offered an angiogram with the option of coronary intervention if needed as part of your investigations. You need to stay in hospital whilst this is arranged. We hope to carry out procedures such as this within 2-3 days however occasionally that wait can be slightly longer. This is because our cardiac catheter labs care for urgent patients from across the region and also have to accommodate emergency admissions. This can sometimes delay the procedures for more stable patients. We try to inform you of the timing of your angiogram as soon as possible. However, please bear in mind that plans can sometimes change at the last minute if emergency procedures need to be carried out. We know that this can be very frustrating when you are waiting on the ward, but if this happens your understanding is much appreciated.

While you are waiting for your procedure in hospital, treatment for the heart has already started in the form of cardiac medications. These medications help stabilise the heart and heart arteries based on your initial diagnosis and form the mainstay of treatment for acute coronary syndromes. These medications will continue if you are found to have a narrowed or blocked heart artery.

Other tests which we may carry out while you are waiting for your procedure include:

Diabetes is one of the risk factors for developing coronary artery disease and can cause a number of problems if left untreated.

High cholesterol is also a risk factor for coronary artery disease. Most people who have angina or have had a heart attack will be started on a medication to help reduce cholesterol and help stabilise any fatty deposits already present in the heart arteries.

This will look at the structure and pumping action of the heart to look for any heart muscle damage or impairment.

The first part of this page gives information on Coronary Heart Disease and tells you what to expect from angiogram procedures and coronary intervention. Recovery in hospital after these procedures depends on the findings of your angiogram. Often following straightforward Coronary

Intervention patients are discharged home the same day. Sometimes further tests or treatments are required. Your doctor and the nursing staff on the ward will discuss this with you.

While you are in hospital it is a good time to consider any lifestyle risk factors that may have contributed to the development of narrowing in the coronary arteries and how these can be managed. While you are in hospital you can also talk to a cardiac rehabilitation nurse for further advice and support. Ask the ward nurse caring for you if you would like to see a member of the cardiac rehabilitation team. If you are diagnosed with a Heart Attack you will automatically receive a visit from a cardiac rehabilitation nurse.

Planned procedures

Information for day case patients undergoing planned procedures

Clinic visit before your planned procedure

The pre-assessment clinic is run by nurses with the aim of preparing you for your planned coronary angiography and/or coronary intervention. Not all patients coming in for a planned angiogram will be preassessed. If you need a preassessment appointment you will be informed of that in your admission letter.

During your visit a blood sample will be taken for routine tests, as well as a tracing of your heart and measurement of height and weight. Please bring a copy of an up to date repeat prescription slip with you. That way we can see which medications you take.

At the clinic you may be started on an anti-platelet medication such as Clopidogrel if this is not already in place. This reduces the risk of blood clots forming in the heart arteries during and after your procedure. The preassessment nurse will guide you in terms of which medications to stop and which to continue. Please inform the pre-assessment nurse if you take an anti-coagulant (blood thinning medication) or metformin for diabetes.

It is important that you tell the pre-assessment nurse if you have ever experienced an allergy or adverse reaction to the x-ray contrast or to latex.

A pre-assessment nurse will also ask you some questions about your health and talk to you about your procedure. You may like to bring a family member or friend with you. You will be given the opportunity to ask questions. So it may also be useful to jot down any questions that you have before you come to clinic. There are notes pages at the back of this book which can be used.

We would appreciate it if you could telephone us if you cannot attend your appointment.

The telephone number is: 0113 392 5639 or 0113 392 8110

This may help us to allocate the clinic place to another person.

Use the checklist below to prepare for your planned admission

You should avoid caffeinated drinks (tea, coffee, fizzy soft drinks and chocolate) for 24 hours before your procedure. Caffeine can interfere with some of the tests we may need to carry out during the procedure.
You can have a light breakfast on the day of your procedure
Take your usual medications on the morning of the procedure unless advised otherwise at your pre-assessment appointment. Please bring your regular medications in to hospital with you.
For most day case procedures you will be able to wear your own clothes during the procedure. Please wear something old and comfortable in case of marking (see the notes below for further information). A T-shirt and loose fitting trousers are ideal.
Bring a dressing gown and slippers with you in case you are required to wear a hospital gown or stay longer for monitoring after the procedure. You may wish to bring an overnight bag with some toiletries just in case a longer stay is advised.
Please remember to take any tablets the evening before the procedure if you have been advised to take a loading dose.

Notes: If you have been advised that your procedure will be performed via the groin, we ask you to shave a small area in your groin the night before you come into hospital, using an electric or disposable razor.

The groin area

The picture shows you two blue square areas which indicate where you need to shave in your groin area. Shave here! Each square about 7cms by 7cms

Patients should avoid wearing:

Tight fitting pants/jeans
Remove bra prior to procedure, Bras with no metal including clasps can be kept on
No buttons on shirts/blouses.
Sleeves below the elbow
More than two layers of clothing if possible
Jewellery (especially necklaces)
Clothing with zippers or any other metal above the waist
Any clothing which you would not want to get damaged

On the day of your procedure

If you are having a planned procedure which will be performed via the artery in the wrist, you will be admitted to the Take Heart Cardiac Suite on E Floor of the Jubilee Wing at Leeds General Infirmary. This is a lounge area where patients are nursed in comfortable chairs before and after the procedure. A nurse will be present to care for patients in this area and refreshments will be available. Patients who are planned to have their procedure via the artery in the groin will be admitted to ward L14, this is next to the Take Heart Cardiac Suite and has beds available to enable patients to lay flat.

The visiting time on L14 is 14.00 – 20.00 – with a maximum of two visitors per bed. Relatives are asked to drop off the patient to the ward area and leave. You will be able to use your mobile phone if you wish to talk to your relative or friend. The visiting time for the Take Heart Suite is 14.00 – 20.00 – with a maximum of 1 visitor per patient.

Car parking is available in the hospital multi-storey car park but is expensive. It may be easier to arrange for a friend or relative to drop you off. It is advisable for you to be collected by car after the procedure and accompanied home.

Unfortunately we are unable to give you a specific time for your procedure as we have to provide a 24/7 service to emergency cases from across West Yorkshire.

People having their procedure done in the morning session (8.30am to 12.30pm) will be given a time to come to the ward between 7.30am & 10.00am.

People having their procedure done in the afternoon session (1.00pm to 4.30pm) will be given a time to come to the ward between 11.00am & 1.30pm.

Before your procedure you will be seen by a doctor who will revisit information about the procedure and discuss consent.

If for any reason you are unable to attend please let the ward know immediately. Also if you are pregnant, or think that you could be please contact the Cardiology Admissions Office for further advice.

On the day you may either walk from the ward with a nurse to the Catheter Lab or a porter will take you there on a trolley. You will lie on an X-ray table during your treatment.

Whether you are having coronary angiography, coronary intervention or both you will be awake during the procedure. You will need to lie as still as you can. You may also be asked to take deep breaths and hold these for a few seconds while X-rays are being taken. The doctors watch what they are doing on a screen.

During the procedure, X-ray contrast will be passed into your coronary arteries so that the doctors are able to see where the narrowing is. Occasionally, the X-ray contrast can make you feel hot and flushed. This is normal and will pass very quickly.

Let the staff know if you have any chest discomfort during the treatment so that they can give you pain relief. These procedures usually take between twenty minutes to an hour but can be longer.

After your procedure

After your coronary angiography/coronary intervention you will be taken back to your chair within the Take Heart Suite or bed on ward L14. The duration of bedrest and monitoring depends on whether you had coronary intervention or if you had angiography only. It also depends if the procedure was performed by the wrist or groin. Generally the recovery period is between two and four hours.

Your nurse will look at your wrist or groin for any signs of bleeding or swelling. Your blood pressure and pulse will also be monitored. This is routine for anybody treated with coronary intervention.

If you experience any pain, aches or discomfort in your chest, leg or arm it is important to let your doctor or nurse know immediately. Pain relief can then be given. It is common for people to be aware of a bruised feeling in the chest for a few hours or days after coronary intervention.

When the coronary intervention is done via a blood vessel in your wrist a pressure device will be applied and removed once any bleeding has stopped usually you are able to recover in a comfortable chair. No stitches are used.

Some bruising and a pea sized lump can be normal at the wrist. You will be advised what activities to avoid to prevent the risk of bleeding from the site before your discharge home.

When the procedure is done through a blood vessel in your groin you will be asked to lie still in bed for several hours.

A guide tube will be left in your groin for about two hours and then it will be removed. It is important that you stay in bed at this time to reduce the chance of bleeding or bruising occurring around the wound in your groin. You can normally lie slightly, but not completely, upright. You can eat and drink as normal.

When the nurse removes the guide tube he/she will either press on the site or place a pressure device on it to stop any bleeding. This can be slightly uncomfortable.

Once the nurse is confident that the bleeding has stopped you will be sat up in bed for another hour or so. After this time you will be able to get up and out of bed. The nurse will let you know when this is.

In some cases your doctor may remove the guide tube and close your artery with a plug called a closure device. This plug is made from collagen which is like glue. If this happens you are able to get out of bed earlier. The plug in your groin will dissolve within ninety days. You will be given an information card about the plug which will answer any questions you may have.

If you are having a planned procedure, you will be sent a letter giving you the date of your coronary angiography/coronary intervention treatment
You may be invited to a pre-assessment clinic two weeks before your planned procedure
If you are having a planned procedure your hospital stay is likely to be a day case (approximately 6 hours)
Please bring your medications with you
You can eat normally but avoid caffeinated drinks for 24 hours before the procedure
You may have your treatment done through a blood vessel in your wrist or groin. You are likely to need 2-4 hours bedrest if your procedure was performed through the groin
Patients undergoing day case procedures performed by the wrist are likely to recover in a comfortable chair within the Take Heart Cardiac Suite
You will need to arrange for somebody to escort you home after your treatment. Hospital transport can be arranged in some cases, discuss with the admissions team or ward staff

Going home and your recovery

Your hospital stay is short and before you know it you will be back at home.

Many people want to know about what they can or cannot do during early recovery. During the first week:

Avoid strenuous activities such as heavy housework, food shopping and cardiovascular exercise for three days
Have approximately three days off work
Do not drive for three days
Do not fly for three days

Note: If your doctor has advised you that you may need further investigation or treatment, you should seek advice from the ward staff prior to discharge, in regard to a return to usual activity.

(NB these guidelines will be different if you have had a heart attack prior to your angioplasty)

Avoid strenuous activities such as heavy housework, food shopping and cardiovascular exercise for one week – it is fine to go for a walk on the flat and important to keep gently active
Have approximately one week off work
Do not drive for one week – you can return to driving after one week provided you are not experiencing any pain or other problems. For a car driving license you do not need to inform the DVLA although it is advisable to notify your car insurer
PSV (public service vehicle) or HGV (heavy goods vehicle) license holders cannot drive for six weeks. You may be able to drive after six weeks. You will need to contact the DVLA and will need to surrender your license.
Do not fly for one week
This advice is given because your skin puncture site needs time to heal not because your heart is weak
You should take your medications as prescribed after the procedure. You will be able to get a repeat prescription from your GP so that you don’t run out.

You should contact the ward if you have concerns about how the cut in your wrist or groin is healing e.g if it is weeping, very painful or swollen.

If the cut in your wrist or groin starts to bleed press on it firmly with a clean tea towel. Call 999 for an ambulance.

If comfortable you may start having sex again 2-3 days after you arrive home.

Feeling emotional

Being told that you have coronary heart disease can come as a shock to people and their families.
The important thing to remember is that this condition is very common and you can go on to live a full and active life. By making healthy lifestyle changes and taking your medicines you can take control of things and reduce your risk of heart problems in the future.
In the first few days you may feel quite different from day to day. Up one day and down the next. There is no right or wrong way to feel. It is totally
individual. It may take time for you and your family to come to terms with what has happened.

It is quite common for people to feel worried and nervous about having problems with their heart. You may notice that you have a short fuse or feel down and cry at the slightest thing. This is a perfectly normal response and will usually lessen as time goes on. If the feelings don’t reduce it may help to talk to your GP and see if they can recommend some help for you. We have put details of some useful contacts at the end of this page.

Family members and friends are usually concerned about their loved one and this can lead to them being over protective. Sometimes this can be difficult as you want to get back to normal and they may try to wrap you in cotton wool. It will take time to get your confidence back.

Sometimes people have problems sleeping. This means that you may feel tired in the day time which means you have a nap. This will make it more difficult to sleep that night and can build into a pattern. Avoiding day time naps may help you sleep better at night Physical exercise such as walking can help you relax. Relaxation exercises may also be useful.

Aches and pains

If you get pain that lasts longer than a few minutes you will need to follow the 10
minute rule.

‘The 10-minute rule’

Sit down, rest and try to relax
If pain is present and you have been prescribed GTN (Glyceryl trinitrate), use
one spray or tablet under the tongue and wait five minutes
If pain is still present use another spray (or tablet) under your tongue and wait five minutes

If pain is still present dial 999 to call for emergency services.

We have included this information because many people worry about what to do if they get chest discomfort or chest pains. This information provides you with a plan of action. We have not included this because we think you will have a heart attack.

It is important to remember that if your pain is caused by angina it will go away with rest and/or your nitrate spray or tablets. It is not a mini heart attack.

People who have a heart attack have pain that stays whatever is done. There are treatments that can be given to people who have a heart attack. These are more effective if people who have chest pain or discomfort for longer than 10 minutes call an ambulance immediately.

Don’t delay! If you have pain that lasts more than 10 minutes it is important that you do not drive yourself to hospital or get a family member to drive you. The earlier you get treatment the better. Ambulance staff will be able to start your treatment there and then if needed.

Making lifestyle changes

Risk factors for heart disease

There are a number of factors that can contribute to the development of Coronary Heart Disease (CHD) and therefore increase your risk of having a heart attack or developing angina. These factors are known as risk factors for CHD. They can be divided into being ‘modifiable’ or ‘non-modifiable’.

Modifiable risk factors: factors that may increase your risk of CHD which can be changed to reduce the risk of future problems. These will be discussed in detail over the following pages.
Non-Modifiable risk factors: factors that may increase your risk of developing CHD which cannot be changed.

Smoking
High Blood Pressure
Raised Cholesterol
Diet and lack of physical activity
Diabetes
Being overweight
Alcohol intake

Family History: CHD can run in families
Age: The risk of developing CHD increases with age
Gender: Men over the age of 45 are more at risk of developing CHD. Women are protected by the hormone oestrogen, but after the menopause women become as vulnerable as men.
Ethnic Origin: People from the South Asian population are more at risk of developing CHD.

Fortunately, you can control many of the modifiable risk factors that contribute to the narrowing of the coronary arteries. Your cardiac rehabilitation nurse can help you set realistic, achievable goals to reduce the risk factors that apply to you.

Smoking

Stopping smoking is the single most important thing you can do to improve your health.

When you smoke, the chemicals released into your body make your blood more sticky
Smoking encourages fatty deposits to collect in the lining of the arteries of the heart. This narrows the arteries which can reduce blood flow to the heart. These fatty deposits can also rupture causing a tear in the lining of the artery causing the fatty deposits to leak out and block the artery, which may cause a heart attack
Smoking tends to increase your blood cholesterol levels. It reduces the HDL (the good cholesterol), thereby increasing the LDL (bad cholesterol). See page 48.
When you smoke a cigarette, the burning process produces a gas called carbon monoxide. This gas is poisonous. In the body it sticks to the red protein of blood cells, making the blood less able to carry oxygen. This will starve the heart and other organs of vital oxygen and nutrients
Nicotine in cigarettes stimulates the body to produce adrenaline. This makes the heart work harder and can raise blood pressure. The high nicotine levels in cigarettes are the addictive part of the cigarette.

From the minute you stop smoking there are health benefits.

20 Minutes – Blood pressure and pulse return to normal

1 Hour – Your circulation improves, your hands and feet feel warmer

8 Hours – Nicotine and carbon monoxide levels fall and the oxygen in your blood begins to return to normal

1 Day – Carbon monoxide is now completely removed from the body, the lungs work more efficiently

2 Days – Nicotine is now removed from the body, your taste and smell improves

3 Days – The lungs begin to clear mucus and smoking debris, you may develop a cough but your breathing will soon become easier

2 Weeks – Withdrawal symptoms begin to ease, walking and daily tasks should become easier

1 Month – Withdrawal symptoms have now stopped, your breathing and energy levels continue to improve

6 Months – Risk of heart attack, cancer and other smoking related diseases begins to fall and you feel better about yourself!

Whilst in hospital, you can ask any of the ward staff for advice or help. Your Inpatient stop smoking team will discuss stopping smoking with you and explain approaches to stopping as well as the support available to you.
Support from healthcare professionals will start in hospital and can continue at home. When you make the decision to stop smoking, you will be given advice on preparing to stop and how to cope once you have stopped. You will also be advised on medication which may be appropriate to help you stop.
The inpatient stop smoking team can help you put a plan together for how you will stop smoking before you go home. Once home, Leeds Stop Smoking Service can offer continued support. The inpatient stop smoking service can arrange a referral for you once you have been discharged from hospital. If you decide to stop smoking at any time after leaving hospital you can contact Leeds Stop Smoking Service to discuss support on 0800 169 4219. The service provides support sessions throughout Leeds, including 1:1 or group sessions.
Your community pharmacy might also offer a smoking cessation support advice and medicines. Please ask your pharmacist for advice.

Nicotine replacement therapy (NRT)

Nicotine Replacement Therapy (NRT) replaces a small amount of the nicotine that you used to get from cigarettes. It is the addictive nature of nicotine that makes it hard for many people to quit. NRT provides you with some help with the addiction and allows you to deal with the habit side of smoking first. Remember you are four times more likely to quit for good using a combination of medication and specialist support.

Your cardiac rehab nurse or Stop Smoking advisor can advise you on which types of NRT would be most suitable for you and which products can be combined to achieve the best outcomes.

The use of medications to stop smoking

There are two medications that can also be considered to help you stop smoking; these should only be considered under advice from a specialist who can prescribe, such as the Stop Smoking advisor or your GP. Using medications such as those listed below can double your chances of stopping smoking. However, they can have side effects and may not be recommended in certain health conditions.

The use of e-cigarettes to stop smoking

Electronic Cigarettes or Vaporisers do not contain tobacco; they create vapour from liquid nicotine. E-cigarettes are not licenced for use as Nicotine Replacement Therapy (NRT) at present.
Public Health England state that e-cigarettes are at least 95% less harmful than smoking.
E-cigarettes are the most popular quit smoking aid and when combined with specialist stop smoking support can be the most effective way to quit smoking for good.

High blood pressure

Blood pressure is the force that circulating blood puts on the artery walls. When blood pressure is high, there is more pressure on the artery wall than usual. Some people have high blood pressure and do not know they have it. This extra pressure damages the smooth lining of the arteries and makes it easier for cholesterol and fat to build up along the artery walls. As the arteries become clogged with these fatty layers (atherosclerosis), less blood gets through. This causes the heart to beat harder as it tries to pump blood through narrowed arteries. If untreated, high blood pressure may in time damage the heart, brain and kidneys. It is a leading cause of heart attacks and strokes, heart or kidney failure.

The exact cause of high blood pressure is not fully known for many people. High blood pressure can be lowered with medication.

Get your blood pressure checked regularly or as often as your doctor suggests
Stop smoking
Take your medications regularly as prescribed
Reduce your salt intake and try to avoid processed, convenience and fast foods
Fruit and vegetables provide us with a good source of potassium which can help control your blood pressure. Aim for five portions of fruit and vegetables a day
Reduce stress by learning new ways to relax and by exercising
Lose weight if needed. The heart has to pump harder to supply an overweight body with blood and oxygen.

Cholesterol

Cholesterol and triglycerides are fatty chemicals in the blood. There are two main types of cholesterol; LDL ‘bad cholesterol’ which carries cholesterol from the liver to the rest of the body, and HDL ‘good cholesterol’ which returns excess cholesterol to the liver.

While foods with plant stanols and sterols are thought to reduce the absorption of cholesterol from the gut (British nutritional foundation), they do not provide sufficient reduction in cholesterol and should not replace the medicines prescribed to lower cholesterol. They can be taken alongside the cholesterol-lowering medicines that you were prescribed. Plant stanols and sterols are usually added to particular spreads and yoghurts and they are also found naturally in nuts and seeds and some fruits and veg.

If you have high levels of cholesterol and triglycerides, your risk of CHD is greater.

High levels of LDL cholesterol stick to the walls of your arteries and make plaque. This plaque blocks the arteries, interfering with the blood flow which can make a heart attack more likely.

The treatment for high cholesterol is now as routine as that of other common conditions. Treating raised blood cholesterol is a positive way you can do something to avoid future heart problems. The next section provides information about diet which can help you to control your blood cholesterol levels.

The aim of your cholesterol lowering medications is to reduce the bad cholesterol (LDL) to less than 1.8 mmol/L. If LDL is not measured then we aim for more than 40% reduction in non-HDL cholesterol (which is your total cholesterol excluding good cholesterol).

It is recommended that once starting cholesterol-lowering medications, you have your cholesterol checked after three months and then at least yearly, unless advised otherwise. This can be carried out by your local GP practice.

Cholesterol

Diet: getting the balance right

Overall dietary balance is important. No single food contains all the essential nutrients the body needs to be healthy and function efficiently. A balanced diet should include a variety of foods.

The following illustration represents each of the five food groups and gives a guide to the proportions of food we need to achieve a balanced diet.

Adapted from The Eatwell Guide as per crown copyright protection.

Ideally these foods should make up just over a third of the food we eat. Starchy foods are bulky, low in fat and the wholegrain versions are higher in fibre, so it can be a good idea to choose brown rice, wholewheat pasta, wholemeal bread for example. Choosing wholegrain or wholemeal varieties is beneficial as they contain more fibre, vitamins and minerals. This group also includes rice, pasta and noodles.

Aim to eat five portions of fruit and vegetables each day. Choose a variety, fish, frozen, tinned, dried and juiced all count. These foods provide us with important antioxidant vitamins and minerals such as potassium and folic acid. They are also an excellent source of soluble fibre. Fruit and vegetables are low in fat and calories, so they make the ideal snack.

Where possible try to choose low fat varieties. These foods provide us with a good source of protein, calcium and some fat soluble vitamins. This group includes milk, cheese, fromage frais, yoghurt, cream, butter and calcium fortified dairy alternatives.

This group provides us with a good source of protein, iron, B vitamins, zinc and magnesium. Try and choose lean cuts and low fat alternatives where possible. You can include your oily fish in this group, which is an excellent source of omega 3 fatty acids. This group includes eggs, nuts, textured vegetable protein, beans, lentils and tofu.

A healthy, balanced diet should include at least two portions of fish a week, including one of oily fish.

Oily fish are rich in omega 3 oils. These can help to make your blood less sticky, reduce the risk of blood clots and help the blood to flow around the body more easily.

If you don’t eat fish, you may need to take in omega oils in other ways, which may be nuts and seeds, but could be other ways (see cardioprotective diets).

The most common oily fish are mackerel, pilchards, sardines, kippers and salmon. These can be fresh, frozen or tinned. A portion is approximately 4oz (100g). A portion is around 140g (4.9oz). Fresh and canned tuna do not count as oily fish.

Ideas to get you started:

Sardines/pilchards on toast
Tinned salmon sandwiches
Salmon steak with potatoes and vegetables

The healthiest choices of tinned oily fish are those in tomato sauce or spring water rather than those in brine. You should aim for one portion of oily fish a week and one or more portions of another type of fish.

Flaxseed and walnuts are another source of omega 3 oils.

Try to include 4-5 servings of unsalted nuts, seeds, beans or lentils per week particularly if you do not eat fish.

These are an important part of keeping healthy. Aim for at least five portions a day. This should be a variety of fruits and vegetables. Fruit and vegetables contain antioxidant vitamins, minerals and fibre that can keep your heart healthy.
A portion is:

A small bowl of salad
One third of an aubergine
or half a pepper
Two broccoli spears
Three tablespoons of vegetables (these can be either fresh, frozen or tinned) like carrots, peas, sweetcorn, cabbage, beans.

One apple, banana or nectarine
One handful of grapes, strawberries or cherries
One slice of pineapple, pawpaw, mango or melon
Two plums, satsumas or kiwis
Three dried apricots, prunes or figs
5-6 passion fruits or lychees
One small glass of fruit juice (150mls) – this only counts once a day
Fresh, frozen, tinned and dried fruit all count towards your five a day. (Potatoes are starchy and therefore do not count towards five a day).

Five easy ways to five a day

One glass of fresh fruit juice/vegetable juice
One bowl of cereal with dried fruit

Salad in sandwich
Add salad or vegetables to a hot meal
Piece of fruit as a dessert

Serve two types of vegetables with your main meal
Tinned fruit in fruit juice and low fat yoghurt
Stewed fruit

Try raw vegetable sticks like celery, carrots and cherry tomatoes, fresh fruit or dried fruit

Check this website for further examples (https://www.bhf.org.uk/informationsupport/support/healthy-living/healthy-eating/recipe-finder)

Cardioprotective diets

Cardioprotective diets generally follow the Eatwell Guide principles and are linked with a healthier heart. One example would be a Mediterranean style of eating. This is one well known whole dietary approach that may suit you.

Be mindful that other dietary approaches may work better for you, but the most important thing is to think of your diet as a whole. Continue with any cardiac beneficial, whole dietary approaches that suit you.

Have you tried using olive oil or rapeseed oil? These oils are higher in monounsaturated fat. Using unsaturated fats instead of saturated fats in cooking and preparing food is advisable.
Aim for at least five portions of fruit and vegetables a day. Eating a wide variety of fruit and vegetables every day helps ensure adequate intake of many vitamins, minerals, phytochemicals and fibre. Studies have shown that eating plenty of these foods is protective for cardiovascular disease (CVD) and cancer.
Where to start with plant based eating… Eat at least three servings (of 150g) of legumes (beans and pulses) each week. These foods are high in soluble fibre and other useful nutrients. Regular consumption is advisable for those with raised cholesterol.
Try to minimise red meat and other meat products – Choose lean or white meats instead. When cooking grill or roast without fat, casserole or stir fry. Choose to eat chicken or turkey routinely instead of pork, beef or lamb. ‘White meat’ choices are lower in saturated fat. Remove the skin and consider your cooking method.
Eat at least three servings of fish (100-150g) or seafood (200g) each week. Eat more oily and white fish. Oily fish is an excellent source of essential omega-3 fats. White fish is very low in saturated fat.
Aim to eat less butter, margarine or cream – avoid having this every day. These foods are high in saturated fat which can increase your blood cholesterol level. Try plant-based or reduced-fat alternatives.
Avoid sugar sweetened fizzy beverages. Excessive consumption of sugar-sweetened beverages can worsen many risk factors for CVD so keep consumption to less than once a day.
Eat less than three servings of commercial sweets/pastries each week and eat less processed food. These foods are usually high in saturated fat, salt or sugar and often contain trans fats. Replacing these with healthy snacks such as fruit or unsalted nuts is beneficial.
Add nuts and seeds to stir fries and salads. Nuts are recommended as part of the cardioprotective diet. Almonds, cashews, chestnuts and walnuts are all good sources of protein and vitamins, as are seeds (e.g. pumpkin, sunflower, sesame). Try to avoid salted nuts, as salt can raise blood pressure. As with all high-fat foods, consuming too much can contribute to obesity.
Get cooking! Flavour pasta, vegetable or rice dishes with garlic, tomato, leek or onion and try to introduce to meals at least twice a week. Using a tomato and garlic or onion or leek-based sauce regularly is a key feature of the Mediterranean diet.

Fat

A cardio protective style of eating is not necessarily low in fat, but the type of fat is important. There are two groups of fats: saturated and unsaturated. Healthy fats are better than very low fat. The cardio protective diet is more beneficial than a very low fat diet in prevention of CVD. If you need to reduce your weight, then you need to eat less fat of any kind and this should be a small proportion of your overall diet. Replacing saturated with unsaturated fat is better than replacing it with carbohydrates or protein.

Unsaturated Fat Unsaturated fats in small amounts are thought to be better for us as they help to lower your LDL (bad chol; total cholesterol and helps to lower your LDL (‘bad’ cholesterol). There are two types: Monounsaturated and Polyunsaturated.	Examples of foods *Monounsaturated Fat:* Avocados, olives, olive oil, rapeseed oil. Almonds, cashews, hazelnuts, peanuts, pistachios, spreads made from these nuts. *Polyunsaturated Fat:* Oily fish, corn oil, sesame oil, soya oil, and spreads made from those oils. Flaxseed, pine nuts, sesame seeds, sunflower seeds, and walnuts.
Saturated Fat Saturated fats usually come from animal products These fats tend to be solid at room temperature. Although we need a small amount of these fats in our diet, larger amounts can be harmful because they can raise your LDL or ‘bad’ cholesterol, so try to reduce the amount you eat. They need to be a very small percentages (less than 10%) of your diet. Try to reduce the amount you eat or substitute with polyunsaturated fats.	Examples of foods Processed meats like sausages, ham, burgers. Fatty meat. Hard cheeses including cheddar. Whole milk and cream, butter, lard, dripping, ghee, suet, palm oil and coconut oil, pies, cakes, biscuits, pastries, fried foods.
Trans Fat Trans fats are thought to behave in a similar way to saturated fats and are therefore harmful when taken in excess quantities. Try to avoid these when possible.	Examples of foods May be in some fried foods, takeaways, processed snacks like biscuits, cakes or pastries. Hard margarines

Information taken from British Heart Foundation website: www.bhf.org.uk

Use a monounsaturated spread instead of butter e.g try olive oil based spreads
Oven bake or grill instead of frying
If frying try to use olive, rapeseed or linseed oil instead
Buy leaner cuts of meats and remove the visible fat from meat before cooking
Skim excess fat off stews and casseroles
Remove skin from chicken and turkey
Choose low fat dairy products such as low fat cheese and low fat milk.

Salt

Most of us consume more salt than we need. High salt intakes can contribute to high blood pressure and fluid retention. Gradually reduce the amount of salt you add to foods – in cooking and at the table to allow you to adapt to the change in taste. Use other means of seasoning such as pepper, herbs, spices and lemon juice to flavour foods. Pre-prepared foods, sauces and soups can contain lots of salt – check the labels and try lower salt varieties, or prepare foods yourself without adding salt if possible.

Foods high in sugars

These foods should be eaten in small quantities. They provide excess calories and can contribute to weight gain. It is important to limit the amount of ‘free sugars’ in the diet. Too much free sugar can raise your triglycerides (fatty chemicals in the blood). Free sugar includes sugar added to food and drinks (either at home or during manufacturing) and sugar naturally found in foods like honey, agave syrup or fruit juice. Adults can have up to 30g of ‘free sugars’ a day. The sugar found naturally in whole fruits and vegetable is not free sugar and does not need to be included in this amount. There is advice on how to cut down on sugar on the NHS live well website. This group includes biscuits, cakes, ice cream, sweets, chocolate and fizzy or sweetened drinks.

How do I understand food labels?

Nutrition labels can help you choose between products and keep a check on the amount of foods you are eating that are high in fat, saturated fat, sugar and salt.

Packaging often shows foods in ‘traffic light’ colours, so that you can see at a glance if they are high (red), medium (amber) or low (green) in fats, sugar or salt. For a healthier choice, try to choose products that have more greens and ambers than reds.

If you have a smart phone you can download the food4life food scanner App. You can scan product bar codes to check levels of sugar, saturated fat, salt and calorie content of the item. This will allow you to make an informed choice about your purchase (or product at home).

Being overweight

If you are overweight, then aiming to reduce your weight by 10% is beneficial. For example, if you are 18 stone, aim for 16 stone or if you are 14 stone aim for 13 stone. This will reduce the strain on your heart and will help lower your blood pressure. If you follow the dietary advice to reduce fat intake, your weight should come down. Waist size is an indicator for heart disease risk. 37 inches for a man and 31.5 inches for a woman is the top end of waist measurement that is considered healthy (BNF).

You can reduce your energy intake by changing the snacks you eat, (e.g crisps, cakes, biscuits) to the fruits and vegetables suggested. Do not forget that all alcoholic drinks contain calories.

Be careful when choosing low fat foods as some can still be high in calories due to the amount of sugar in the foods e.g fruit juices, reduced calorie biscuits and low fat yoghurts.

You may notice that you tend to eat more when you are feeling worried, low in mood or bored. If this happens to you, try and find an activity or hobby that will take your mind off food or have a glass of water or no added sugar squash instead.

Keeping a diary of what you eat and drink can also help you to find ways in which you can reduce the amount of energy you eat. The support of your friends and family is also important to help you to keep motivated.

See the following website for further details: https://www.nhs.uk/livewell/healthy-weight/start-the-nhs-weight-loss-plan/

There are also tools and information on the British Heart Foundation website that can help you to build healthier eating habits into everyday life (for example Heart Matter Healthy Recipe Finder).

BMI Chart

Diabetes

What is diabetes?

Diabetes is a condition which occurs when either the body does not produce enough insulin or the insulin that is produced by the pancreas does not work properly. This means that the glucose (sugar) cannot enter the cells in the body where it would normally be converted into energy. It therefore stays in the blood stream, causing the level of glucose to be too high.

Diabetes can occur at any age. The most common is called Type 2 which mainly affects those people over 40 years of age. Type 2 diabetes is strongly linked with being inactive, over-weight and often has a link with family history. It can also happen more commonly in certain populations, for example those with South Asian and African-Caribbean origins.

The risk of developing Type 2 diabetes can be reduced by taking regular exercise and maintaining a healthy weight.

Type 1 diabetes occurs when the pancreas is unable to produce any insulin and is usually diagnosed in young people or children. We do not know at present what causes this.

What effect does diabetes have on the heart?

High glucose levels in the blood affect the walls of the arteries, making them more likely to develop atheroma (a narrowing of the blood vessels)
The heart muscle itself can become affected, therefore making it a less efficient pump
Diabetes can increase the damage done by smoking, high blood pressure and high cholesterol.

People with Type 2 diabetes often have high triglyceride levels and low levels of HDL cholesterol (the protective type of cholesterol).

High glucose levels can affect the nerves to the heart, so dangerous symptoms are not felt in the usual way (for example, people with diabetes may not feel any pain with a heart attack which can lead to difficulty and delay in the diagnosis of heart problems).

What can I do about diabetes?

Diabetes cannot be cured, but it can be managed and controlled. The two main aims of diabetes management are to resolve the symptoms of diabetes and prevent the health problems associated with this condition. Glucose levels can be improved by following a healthy diet, being physically active and taking the medications prescribed. Keeping to a recommended weight is also beneficial.

What are the health risks associated with having diabetes and what can be done to keep healthy?

People with diabetes have a higher chance of developing high blood pressure, circulation problems, nerve damage, damage to the kidneys and the eyes. The risks are particularly high in someone who is also overweight, who smokes and is not physically active.

by controlling blood glucose levels
by controlling blood pressure
by eating a healthy diet and taking regular exercise.

It is important to attend regular check-ups, where blood glucose, blood pressure, kidney function, eyes and feet are monitored and overall diabetes control can be assessed. Further information about diabetes is available on request.

Alcohol

Drinking more than the recommended amount of alcohol can have a harmful effect on your heart and general health. It can cause abnormal heart rhythms, high blood pressure, damage to your heart muscle and other diseases such as stroke, liver problems and some cancers.

Alcohol is also high in calories so it can lead to weight gain. (See drinkaware.co.uk to check calorific value of alcoholic drinks.) It also lowers your inhibitions which might mean you find it harder to stick to your healthy eating plans when you have been drinking. If you are trying to lose weight, cut down on alcohol.

Men and women should not regularly drink more than 14 units a week.
Spread your drinking over three days or more if you drink as much as 14 units a week.

These guidelines apply whether you drink every day, once a week or occasionally.

Most people don’t drink alcohol every day – but if you do, try having some days off – aim for at least two alcohol free days a week. Just make sure you don’t increase the amount you drink on the other days.

Drinking large amounts of alcohol in one go can cause damage to your heart muscle so avoid drinking 6 or more units in a day on a regular basis.

Your GP can help to support you in reducing your alcohol consumption if you decide you would like to do this. If you are a dependent drinker, please seek medical advice before you stop drinking suddenly.

You can find more information at www.drinkaware.co.uk

Alcohol units

1 single measure of spirits, 1 single measure of apertifs, 1 small glass of sherry, 1 small glass of wine, 1/2 pint of ordinary strength beer, lager or cider

Ensure you check the strength of what you are drinking, as this will affect the units, particularly if you are drinking stronger ales or lagers.

Consider the measures you pour when you are drinking at home, as these tend to be more generous than standard pub measures.

If you require further information or support with reducing your alcohol intake, please seek advice from your cardiac nurse or GP.

Exercise and physical activity

Regular exercise helps to strengthen your heart. A strengthened heart has more stamina and does not have to work so hard to get oxygen to your body when you exercise.
Reduces your cholesterol levels
Helps to prevent narrowing of coronary arteries in the future
Improves the blood flow through your body
Keeps your blood pressure within normal limits
Helps with weight control

You need to aim for 30 minutes every day. This may take a little time to build up to, depending on your previous level of fitness. Aim for exercise of a moderate intensity which makes you breathe more deeply and possibly sweat slightly. You should still be able to talk in full sentences and not be gasping for breath.

Aim to gradually increase the amount of physical activity you do week by week. Although 30 minutes a day may seem like a lot, you can break this down into 10 or 15 minute sessions at first. Almost any increase in physical activity will benefit your health. Exercising with your family or a friend will help you keep motivated. Remember to always warm up and cool down.

It may help to keep a diary so that you can keep a note of the distance you walk each day. You can gradually increase the distance you cover week by week.

You should be doing aerobic activity. Aerobic activity is exercise or activity that uses more oxygen than when you are resting, for example brisk or fast walking, swimming, jogging, dancing or cycling.

Most people can continue with their work even after being diagnosed with angina. If you have a job that involves heavy physical activity (e.g. lifting heavy objects) it may be advisable to discuss this with your Doctor or Cardiac Rehabilitation nurse. It is important to focus upon living a normal life and being active.

Cardiac rehabilitation

We mentioned earlier that there is professional help available to help you take control of your life again. The name given to the structured program of education and support is Cardiac Rehabilitation. If you have had coronary intervention you may be contacted by the community cardiac rehabilitation team in your area.

There may be a local cardiac exercise group near to you that you can join. Doing this may help you to continue to take regular exercise.

You can get details if you contact the British Heart Foundation Helpline on 0300 330 3311 or via their website at www.bhf.org.uk or see the list near the back of the book for the contact in your area.

Medication after your procedure

After planned angioplasty you will need to take several medicines. Some of these will be taken for a period of months, others will be for life.

Antiplatelets

Examples: Aspirin, Clopidogrel, Prasugrel, Ticagrelor.

After your stent is in place you will need to take medicines to reduce the risk of a blood clot forming in the heart arteries. These drugs are called antiplatelet drugs.

After a few weeks the lining of your artery will grow over the stent and it will become part of your artery. Until then anti-platelet drugs help to reduce the risk of clots forming on the stent. (If you normally take Warfarin or a DOAC (Rivaroxaban, Apixaban , Edoxiban or Dabigatran) this will be discussed with you on discharge.)

If you already take Clopidogrel and Aspirin continue with your normal dose before and after the procedure.
If you do not take Clopidogrel you may be asked to start this before the procedure (unless you are already on a similar medication such as ticagrelor or prasugrel).
If you do not take Aspirin you may be asked to start taking it before the procedure and continue taking it afterwards. However if there is a reason you cannot take Aspirin please inform the doctor or nurse.

Are there any side-effects?

Medicines that thin the blood can mean that you bruise more easily. Aspirin and Clopidogrel should be taken with food as they can cause indigestion. Tell your doctor if you get indigestion.

Proton Pump Inhibitors

Lansoprazole, Omeprazole, Esomeprazole, Rabeprazole, Pantoprazole

How Do Proton Pump Inhibitors Work?

Your body produces a natural mucous barrier to protect the lining of your stomach from ‘stomach acid’. Antiplatelet medications can alter this natural barrier and make the lining of your stomach and gut more susceptible to damage. Proton pump inhibitors reduce the amount of acid produced in the stomach, which protects the lining of your stomach and gut from irritation and ulceration.

If you are taking ‘dual antiplatelets’ (aspirin plus a second antiplatelet) or a single antiplatelet with an anticoagulant, you may be prescribed a proton pump inhibitor. It is important to keep taking a proton pump inhibitor to protect your stomach for the duration of your dual antiplatelet treatment.

You may be able to stop taking your proton pump inhibitor after 12 months and this should be discussed with your GP.

Proton pump inhibitors should be taken at least 30 minutes before food and other medicines.

Unwanted effects

The most common side effects are on the gastro-intestinal system and include constipation, diarrhoea, bloating, flatulence, feeling sick and tummy pain.

For full information about the side effects of proton pump inhibitors read the information leaflet you get with your tablets. If you have any questions ask your doctor, nurse or pharmacist.

Beta-blockers

Beta-blockers slow your heart rate which reduces the work load of the heart and improves cardiac function. They are particularly important if your heart has been damaged by a heart attack or if you have heart failure. Some people experience side effects with these medications such as cold hands and feet, nausea, diarrhoea, skin rashes, erectile dysfunction and nightmares.

If you are affected in this way, please talk to your doctor but do not stop taking the beta blocker unless you are advised to do so.

Statins

Statins reduce the production of cholesterol. They reduce levels of bad cholesterol and increase levels of good cholesterol. Statins also make any fatty deposits in your coronary arteries more stable. This means that they are less likely to cause a blockage in your coronary artery.

Statins can sometimes affect your digestive system. Inform your doctor if this does not get better after a few weeks. A rare side effect of statins is pain or weakness of your muscles. If you experience this please visit your GP. Some statins react with food containing grapefruit.

ACE inhibitors

ACE stands for angiotensin converting enzyme. Angiotensin is a chemical in the body that makes blood vessels narrower and can damage the heart. ACE inhibitors act by lowering blood pressure and protecting the heart.

People usually start on a small dose of this medicine to see how it affects them. The dose will need to be increased by your GP. If you have had a heart attack, it is important that the dose is increased to the target dose over 4-6 weeks. Your GP will monitor this. Sometimes people get a dry irritating cough with this medicine.

Take it as soon as you remember. If it is nearly time for your next dose, miss out the one you forgot. Do not double up.

The length of time you are on Clopidogrel or other antiplatelet varies from person to person. It is usually between 1 and 12 months depending on the type of stent used. Your GP will be informed of this by letter.

It is very important not to stop taking Aspirin or Clopidogrel before the recommended period as there is a risk of a clot forming within the stent which could result in a heart attack.

You will probably be taking Aspirin, a statin, a beta blocker, and an ACE inhibitor for the rest of your life. It is very important not to stop taking any medicine without discussing it with your doctor first. You should always read the information sheet that comes with your medicine. If you have any questions you can talk to your doctor, nurse or pharmacist.

Patients having a planned procedure will meet a cardiac rehabilitation nurse at the pre-assessment appointment
To improve the health of your heart live a healthy lifestyle and take your prescribed medications
Health professionals can advise you but you and your family/friends are the ones who will manage these changes from day-to-day!
Do not stop any medications without discussing with your doctor first
Once you leave hospital your care is shared by your cardiologist and your GP

Common medical terms explained

The name given to a group of conditions linked to Coronary Heart Disease, where fatty deposits or plaques develop inside the heart arteries.

Chest discomfort, ie chest heaviness or tightness which may radiate to either or both arms, neck, jaw, or back. This is caused when coronary arteries are narrowed.

X ray of the arteries indicating any narrowing.

A procedure to widen narrowed arteries, improving the blood flow to the heart.

A device to close the puncture site in the groin. This will dissolve over a period of time.

This is a large artery from the left side of the heart which supplies the body with blood.

This is the place where your angiogram/coronary intervention takes place.

The blood vessel that supplies blood to the heart muscle from the beginning of the aorta.

This is when you receive a letter inviting you to come in for your angioplasty from home.

When blood supply to the heart is blocked by a blood clot. The symptoms usually last for more than 30 minutes and may last for many hours.

This is when there is a blockage in your artery preventing a good supply of blood to the rest of your heart.

When the artery becomes blocked again after having had a coronary intervention/angioplasty.

A wire mesh tube inserted into the coronary artery to widen the artery during the coronary intervention/ angioplasty.

Further contacts

Health advice

Allows registered mobile phones to text an emergency to 999. A text relay assistant will speak your emergency to the 999 operator. You must register your mobile phone with the service before an emergency happens.

Text register to 999.

Website: www.emergencysms.org.uk

NHS Choices is an online health information service. It has a self-help guide, a list of common health questions and a health A-Z. It contains over 700 topics covering illnesses and conditions, tests and dentist or support groups online.

Website: www.nhs.uk

111 is the NHS non-emergency number. It’s fast, easy and free.

Call 111 and speak to a highly trained adviser, supported by healthcare professionals. Available 24 hours a day, 365 day a year, free from landlines and mobile phones.

Tel: 111

Advice

City Centre CAB, 31 New York St, Leeds, LS2 7DT

Tel: 08082 787 878

Text relay: 0344 411 1445

Website: www.citizensadvice.org.uk/local/leeds

Directgov is the official online government information service. The Money, Tax and Benefits section includes information on tax and any benefits you may be entitled to (including details of how to make a claim). Other topics covered include pensions, mortgages, managing your finances and managing debt.

Website: www.directgov.uk

Alcohol/drug misuse

National 24hr helpline & local meetings in Leeds for friends/families of problem drinkers.

Tel: 0800 008 6811

Email: [email protected]

Website: www.al-anon.org.uk/groups/leeds

Daily meetings in the Leeds area for people who have experienced problems with alcohol and want to stop drinking.

Helpline: 0113 245 4567

Website: www.alcoholicsanonymous.org.uk/

Email: [email protected]

Alcohol and drug service in Leeds for adults, young people and families

Tel: 0113 887 2477

Email: [email protected]

Website: www.forwardleeds.co.uk

Anxiety & Depression

This is a service aimed at supporting people suffering from depression and anxiety disorders.

Tel: 0113 843 4388

SAM is an application to help you understand and manage anxiety

Website: www.sam-app.org.uk

Confidential 24-hour listening service.

Tel: 0113 245 6789

Free phone: 116 123

Email: [email protected]

Website: www.samaritans.org

Bereavement

Bereavement support, information and advice for any bereaved person, regardless of age, nationality or belief.

Tel: 0113 234 4150

Website: www.cruse.org.uk

Email: [email protected]

Carers

6-8 The Headrow, Leeds, LS1 6PT

Advice, information, financial help, social events, courses & support from other carers.

Tel: 0113 380 4300

Email: [email protected]

Disability

The Mary Thornton Suite, Armley, Grange Drive, Leeds LS12 3QH

Information & advice line covering most aspects of disability including: benefits, access, education and employment, holidays and leisure. Enquiries by phone or letter.

Tel: 0113 467 6981

Text relay: 18001 + 0113 + 378 2990

Website: www.dial-leeds.org.uk

Driving

Drivers Medical Enquiries, DVLA, Swansea, SA99 1TU

Drivers medical information can now be found under the Motoring section in Directgov. Directgov was created to provide all UK citizens easy access to public services in one place.

Website: http://www.dvla.gov.uk

Exercise

A website full of ideas from the walking the way to health initiative.

Website: www.walkingforhealth.org.uk

Information

A website for further useful information
Website: www.patient.info

Website: www.nhs.uk

Offers factsheets on a variety of food and nutrient aspects on medical conditions.
Website: www.bda.uk.com/food-health/food-facts/all-food-fact-sheets.html

Offers information and advice covering specific conditions, treatments and information about looking after your heart.

Tel: 020 7935 0185

Helpline: 0300 330 3311

Email: [email protected]

Website: www.bhf.org.uk

Advice on stopping smoking.

Helpline: 0300 123 1044

Website: http://www.nhs.uk/smokefree

Tel: 0800 169 4219

Information on healthy diets, understanding food labels and on health issues like obesity. It can help you find a registered dietician or nutritionist.

Website: www.nhs.uk/Livewell/healthy-eating

Cholesterol Charity which provides information on the risks of high cholesterol and cardiovascular disease.

Tel: 01628 777 046

Helpline: 0345 450 5988

Email: [email protected]

Website: www.heartuk.org.uk

Healthtalk lets you share in other people’s experiences of health and illness

Website: www.healthtalk.org

Patient medicines helpline

Tel: 0113 206 4376

Email: [email protected]

Tel: 0113 206 4376
Email: [email protected]

Medication

Website: www.leedsth.nhs.uk/a-z-of-services/leeds-pharmacyservices/contact-us/

Older people

Provides range of services for older people from Leeds including meals on wheels, hospital aftercare, educational and social courses, insurance & advocacy.

Tel: 0113 389 3000

Website: www.ageuk.org.uk

Age UK also provides information regarding Neighbourhood network schemes. Neighbourhood Network Schemes are community based, locally led organisations that enable older people to live independently and pro-actively participate within their own communities.

Tel: 0113 389 3000

Website: www.ageuk.org.uk/leeds/about-age-uk-leeds/neighbourhood-network-schemes/

PALS

Great George Street, Leeds, LS1 3EX

A PALS officer can give you advice about what services might be available in your area. Advice can also be given about how to lodge a complaint.

Tel: 0113 206 7168 or 6261

Email: [email protected]

Website: www.leedsth.nhs.uk/patients-visitors/patients-and-visitor

Voluntary services/networks in Leeds

If you’re looking for support/assistance on discharge there is a vast amount available. You can get assistance with practical tasks such as shopping and gardening, assistance with checking benefits and completing the forms, social groups and drop-in centres to name a few.

These services are available through three main networks that can be accessed by telephone or on-line. They are:-

Whose aim to support you to live well

Tel: 0113 378 4610

Website: http://leedsdirectory.org

Tel: 0113 244 1697

Website: www.opforum.org.uk

Aim to find the voluntary service that’s right for you

Tel: 0330 555 0310

Website: www.royalvoluntaryservice.org.uk

Community Cardiac Rehabilitation Teams Contact Numbers

Airedale Cardiac Rehabilitation Team

Tel: 01535 294 557

Bradford Cardiac Rehabilitation Team

Bradford Hospital Trust:

Tel: 01274 364 565

Bradford Community Based Cardiac Rehabilitation Nurse:

Bradford City – Tel: 01274 383 718
Bradford South & West – Tel: 01274 322 131

Calderdale Cardiac Rehabilitation Team

Tel: 07909 290265

Huddersfield Cardiac Rehabilitation (Local)

Areas included: Cleckheaton, Batley, Liversidge, Mirfield, Heckmondwike, Huddersfield
Tel: 0300 304 5555

Harrogate Cardiac Rehabilitation Team

Tel: 01423 553 355

Mid Yorks Cardiac Rehab Service

Normanton Office: 01924 543 460
Dewsbury Office: 01924 816 129

What do you think of your care?

Please click on the link below to give us your hospital experience.
Your views matter.

Leave Your Friends & Family Test Feedback Here

Cookie settings

Aches and pains

‘The 10-minute rule’

Introduction

Explain my procedure

Key take home messages

You and your treatment

What are coronary arteries?

Model of the heart

Why have my coronary arteries become narrowed?

How do I know I have narrowed coronary arteries?

What is angina?

What is a heart attack?

What is a coronary angiogram?

What is coronary intervention and how does it work?

A coronary stent

Complex coronary intervention

Coronary intervention benefits and risks

What are the risks of coronary intervention?

Serious problems

Risks

Complications which can occur at the time of the procedure or shortly afterwards

Complications which may occur later after the procedure

Notes

Acute admission to hospital

What to expect when you have an unplanned admission to hospital

Acute coronary syndrome

Types of acute coronary syndrome

Other tests which we may carry out while you are waiting for your procedure include:

Planned procedures

Information for day case patients undergoing planned procedures

Clinic visit before your planned procedure

Use the checklist below to prepare for your planned admission

The groin area

Patients should avoid wearing:

On the day of your procedure

After your procedure

Going home and your recovery

Feeling emotional

Aches and pains

‘The 10-minute rule’

Making lifestyle changes

Risk factors for heart disease

Smoking

From the minute you stop smoking there are health benefits.

Nicotine replacement therapy (NRT)

The use of medications to stop smoking

The use of e-cigarettes to stop smoking

High blood pressure

Cholesterol

Cholesterol

Diet: getting the balance right

Five easy ways to five a day

Cardioprotective diets

Fat

Salt

Foods high in sugars

How do I understand food labels?

Being overweight

BMI Chart

Diabetes

What is diabetes?

What effect does diabetes have on the heart?

What can I do about diabetes?

What are the health risks associated with having diabetes and what can be done to keep healthy?

Alcohol

Alcohol units

Exercise and physical activity

Cardiac rehabilitation

Medication after your procedure

Antiplatelets

Examples: Aspirin, Clopidogrel, Prasugrel, Ticagrelor.

Are there any side-effects?

Proton Pump Inhibitors

Lansoprazole, Omeprazole, Esomeprazole, Rabeprazole, Pantoprazole

How Do Proton Pump Inhibitors Work?

Unwanted effects

Beta-blockers

Statins

ACE inhibitors