Dr. Grant William Reed, MD, MSC

During angioplasty, a patient is given a sedative while lying on a table under an x-ray machine. A catheter (a thin, flexible, and hollow tube) is inserted into the patient's skin in the arm or groin and guided into the blocked artery. Dye is injected via the catheter, and x-rays are used to position the tip of the catheter exactly at the blockage. The tiny balloon is guided through the catheter and inflated with saline. It pushes the plaque out of the way, squishing it against the walls of the artery. The balloon may be inflated and deflated several times to let blood pass by. A stent, a tiny tube of metal mesh like a spring, may be inserted to help keep the artery open. Then the x-ray is used again to check that blood is flowing properly, the catheter is removed, and the tiny incision is bandaged.

There are no nerves within veins and arteries, so an angioplasty is generally not painful. However, there may be some discomfort at the site of the incision and when the balloon is inflated. Overall, angioplasty is a very effective and low-risk procedure, useful for helping patients avoid more difficult bypass surgery.

Heart attacks typically feel like pain or pressure in the chest that can radiate out to the back, arm, or jaw. Some other symptoms can include fatigue or weakness, shortness of breath, sweating, and nausea.

Treatment aims to increase blood flow to the heart muscle by opening up blocked blood vessels. Medications are sometimes used to dissolve clots in the arteries. Aspirin and other medications such as Plavix can thin the blood and make clots less likely to form. Dilators can widen blood vessels to make room for more blood to flow. Doctors can also use a procedure called catheterization to look at the blood vessels around the heart directly, place stents, or widen vessels using angioplasty. In extreme cases bypass surgery can be used to help blood flow better. After recovery, it is important to lead a healthy lifestyle and take any prescribed medications in order to protect the heart.

An intra-aortic balloon pump is a small, sausage-shaped balloon at the end of a catheter, or very thin, flexible tube. An incision is made (usually in the groin), and the deflated balloon and catheter are threaded through an artery to the aorta, the large main artery that takes oxygen-filled blood from the heart to the rest of the body. The pump can also be placed during open-heart surgery. If this is the case, it is positioned directly into the aorta. Once in place, the balloon inflates and deflates in rhythm with the heart. When it inflates, it pushes blood back towards the heart to help the heart muscle get enough oxygen and fill correctly. When the IABP deflates, just before the heart contracts, it lowers the pressure in the aorta slightly. This helps move blood away from the heart and into the body.

An IABP is a short-term solution, used for only hours or up to a few weeks at most. The pump is powered and controlled by a computer outside the body, so during treatment patients must remain lying down in their hospital bed. Insertion of the device is performed at a cardiac catheterization lab or operating room, and patients with an intra-aortic balloon pump often stay in the intensive care unit (ICU). While it is not a particularly painful treatment, it is common for patients to hear and feel the balloon inflating and deflating within their chest, which can be unsettling. However, IABP is a safe and effective treatment for supporting the heart.