1.Room Rent, 2.Cost of Surgery 3.Consultation by Primary Team in Package days 4. Basic Investigations 5. Routine Pharmacy and Consumables, 6.Patient Food.
1.Overstay more than package days, 2. Any other Speciality Consultations, 3. Special Equipment, 4. Additional Procedure/Surgery.
What is PTCA?
Percutaneous transluminal coronary angioplasty (PTCA) is a procedure to open up blocked coronary arteries, allowing blood to circulate unobstructed to the heart muscle. Angioplasty can be done in an emergency setting such as a heart attack. Or it can be done as elective surgery if a doctor strongly suspects that you have heart disease. Angioplasty is also called percutaneous coronary intervention (PCI).
Arteriosclerosis causes significant narrowing of one or more coronary arteries. When coronary arteries narrow more than 50% to 70%, the blood supply beyond the plaque becomes inadequate to meet the increased oxygen demand of the heart muscle during excercise.
Lack of oxygen (ischemia) in the heart muscle causes chest pain (angina) in most people.
However, some 25% of those with significant coronary artery narrowing experience no chest pain at all despite documented ischemia, or may only develop episodic shortness of breath instead of chest pain.
These people are said to have "silent angina" and have the same risk of heart attack as those with angina.
Risks Involved In Surgery
Bleeding at the site where the catheter is put into the body
Blood clot or damage to the blood vessel from the catheter
Blood clot within the treated blood vessel
Infection at the catheter insertion site
Abnormal heart rhythms
Chest pain or discomfort
Rupture of the coronary artery or complete closing of the coronary artery, needing open-heart surgery
Allergic reaction to the contrast dye used
Kidney damage from the contrast dye
The resting electrocardiogram (EKG, ECC) is a recording of the electrical activity of the heart, and can show changes indicative of ischemia or heart attack.
Cardiac catherization with angiography (coronary arteriography) is a technique that allows X-ray pictures to be taken of the coronary arteries. It is the most accurate test to detect coronary artery narrowing. Small hollow plastic tubes (catheters) are advanced under X-ray guidance to the openings of coronary arteries. Iodine contrast "dye" is then injected into the arteries while an X-ray video is recorded. Coronary arteriography gives the doctor a picture of the location and severity of narrowed artery segments.
A newer, less invasive technique is the availability of high speed CT coronary angiography. While it still involves radiation and dye exposure, no catheters are needed in the arterial system, which does decrease the risk of the procedure somewhat.
Preparation for Procedure
You may need to adjust or stop taking certain medications before angioplasty, such as aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners
Usually, you'll need to stop eating or drinking six to eight hours before an angiography.
Take approved medications with only small sips of water on the morning of your procedure.
Arrange for transportation home. Angioplasty usually requires an overnight hospital stay, and you won't be able to drive yourself home the next day.
The procedure begins with the doctor injecting some local anesthesia into the groin area and putting a needle into the femoral artery, the blood vessel that runs down the leg. A guide wire is placed through the needle and the needle is removed. An introducer is then placed over the guide wire, after which the wire is removed. A different sized guide wire is put in its place.
Next, a long narrow tube called a diagnostic catheter is advanced through the introducer over the guide wire, into the blood vessel. This catheter is then guided to the aorta and the guide wire is removed. Once the catheter is placed in the opening or ostium of one the coronary arteries, the doctor injects dye and takes an x-ray. If a treatable blockage is noted, the first catheter is exchanged for a guiding catheter. Once the guiding catheter is in place, a guide wire is advanced across the blockage, and then a balloon catheter is advanced to the blockage site. The balloon is inflated for a few seconds to compress the blockage against the artery wall. Then the balloon is deflated.
The doctor may repeat this a few times, each time pumping up the balloon a little more to widen the passage for the blood to flow through. This treatment may be repeated at each blocked site in the coronary arteries. A device called a stent may be placed within the coronary artery to keep the vessel open. Once the compression has been performed, contrast media is injected and an x-ray is taken to check for any change in the arteries. Following this, the catheter is removed and the procedure is completed.
After the procedure
If you had a nonemergency procedure, you'll probably remain at the hospital overnight while your heart is monitored and your medications are adjusted. You generally should be able to return your normal routine the week after angioplasty. When you return home, drink plenty of fluids to help flush your body of the contrast dye. Avoid strenuous exercise and lifting heavy objects for at least a day afterward. Call your doctor's office or hospital staff immediately if:
The site where your catheter was inserted starts bleeding or swelling
You develop pain or discomfort at the site where your catheter was inserted
You have signs of infection, such as redness, swelling, drainage or fever
There's a change in temperature or color of the leg or arm that was used for the procedure
You feel faint or weak
You develop chest pain or shortness of breath
Most people who have undergone angioplasty with or without stent placement will need to take aspirin indefinitely. Those who have had stent placement will need a blood-thinning medication, such as clopidogrel, for six months to a year.
Coronary angioplasty greatly increases blood flow through the previously narrowed or blocked coronary artery. Your chest pain generally should decrease, and you may be better able to exercise. Having angioplasty and stenting doesn't mean your heart disease goes away. You'll need to continue healthy lifestyle habits and take medications as prescribed by your doctor.
To keep your heart healthy after angioplasty, you should:
Lower your cholesterol levels
Eat a healthy diet that is low in saturated fat
Maintain a healthy weight
Control other conditions, such as diabetes and high blood pressure
Doctor may check blockages that weren't severe enough to treat when your stent was inserted. This can be done with a single test. You don't usually need yearly tests. You have had multiple heart procedures in the past, such as stents after a bypass surgery.
Doctor may also recommend lifestyle changes. This could include exercise, quitting smoking, and following a healthy diet. Patients who undergo stent placement following a heart attack may have a different recovery. Their hospital length of stay and return to activities will likely be longer.
Disruption of the vein wall allows enlargement of luminal diameter and initiates a vascular remodeling process that will reshape the inner dimensions of the blood vessel. It is important to remember that angioplasty is intended to cause significant damage to the blood vessel at the site of stenosis.
The failure rate for the newer drug-coated stents in the first six months appears to be much lower, about 5 percent, though some evidence suggests that they may fail more frequently than older versions after a year.
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