What is a Primary Angioplasty?

Primary angioplasty is an operation that is performed directly after a myocardial infarction or heart attack, on admission to the hospital. It involves the insertion of a catheter into the blocked blood vessel that caused the heart attack. This opens it up and allows blood to flow again, thus minimizing damage to the heart.

Myocardial infarction usually occurs due to a buildup of plaque in the blood vessels. There are a number of factors that contribute to the risk of heart attack. These include high cholesterol, raised blood pressure and an unhealthy lifestyle, which might include lack of exercise, poor eating habits, smoking and high levels of stress. All these risks can be reduced by lifestyle changes and medication.

If one or more arteries become clogged, it may result in a heart attack. This normally presents with chest pain, sweating and a feeling of anxiety, among other symptoms. Urgent medical assistance should be sought. A heart attack is a medical emergency requiring intervention as soon as possible.

The initial intervention includes the administration of various drugs and, in some cases, primary angioplasty. There are different types of angioplasty. The difference between coronary angioplasty and primary angioplasty is purely in the timing. The procedure is the same, but a coronary angioplasty is performed as planned, and primary angioplasty is an emergency procedure performed in the acute phase after the heart attack.

Primary angioplasty is generally performed in theater, under anesthetic. The procedure involves making a small cut in the groin through which a coronary catheter is pushed and then guided to the artery in which the blockage resides. On the end of the catheter is a small balloon that is blown up at the blockage. This allows the blood to flow freely again. Some catheters have a stent on the balloon, a small piece of metal that remains in place, keeping the vessel open, even when the balloon is deflated.

As with any surgery, primary angioplasty is not without risks. The most common problems include re-stenosis, clots or bleeding. Re-stenosis, or a re-narrowing of the artery, may occur once the balloon is deflated. The placement of a stent may reduce this risk.

Blood clots may occur as a reaction to the stent as a foreign object, so prophylactic blood-thinning agents may be prescribed. Bleeding may occur at the site of entry of the catheter, but this is usually mild and manifests only as bruising. There are a number of less common possible side effects that the doctor will discuss with the patient.

On discharge after a primary angioplasty the patient will most likely be referred for cardiac rehabilitation. This includes regular cardiac check-ups, lifestyle changes and dietary modifications. Any untoward effects warrant urgent medical advice.