FORM # W-00500 NOVEMBER 2017 Coronary Angiogram or Coronary Angioplasty/ Stent Procedure Discharge Information after a Directives à la sortie de l hôpital après une Coronarographie, une angioplastie coronaire ou la pose d une endoprothèse coronaire FORMULAIRE No W-00500 NOVEMBRE 2017
Discharge Information after a Coronary Angiogram or Coronary Angioplasty/ Stent Procedure Please follow these guidelines to help you recover at home. What to Watch for: Heart Symptoms - Do Not Ignore If you have chest pain or discomfort that you think is due to your heart: 1) STOP whatever you are doing and sit or lie down. 2) Place one nitro tablet or give 1 nitro spray ONTO or UNDER the tongue, and leave it there. DO NOT chew or swallow the nitro tablet, or inhale or swallow the nitro spray. If the pain or discomfort is NOT relieved after 5 minutes, repeat the dose. If the pain or discomfort continues after 2 doses of nitro (10 minutes), use a third dose and IMMEDIATELY call 911 or your local emergency number to take you to the nearest hospital (DO NOT drive yourself and DO NOT delay). 1
The Catheter Site You may have a bruise where the tube was put into your groin or wrist. This will go away on its own in the next few weeks. It is common to be sore at this site for the next few days. You can take the bandage off the site 24 hours after the test. Keep the area clean and dry to avoid infection. See your family doctor or care provider (example health centre, nursing station or urgent care facility) if you have any signs of an infection. Signs of infection may include pain, swelling, drainage, redness, chills, or fever. Signs of Bleeding Blood from the site (groin or wrist), a lump under your skin that is growing, or new belly or back pain are all signs of bleeding. If you are bleeding please follow these steps: Groin site: Lie down and have someone press down on the site with his or her hand for 5 to 10 minutes, they should use a clean cloth. If you are alone apply firm pressure yourself to the site. If the bleeding has stopped stay laying for 1 hour. When the bleeding stops you may take off the old bandage and place a clean one on. Wrist site: Sit down and press the site with the tips of 2 or 3 fingers for 5-10 minutes. After the bleeding stops, do not use your wrist for the next 48 hours. When the bleeding stops you may take off the old bandage and place a clean one on. 2
CALL 911 OR YOUR LOCAL EMERGENCY NUMBER FOR ANY OF THE FOLLOWING (DO NOT DRIVE YOURSELF): 1) Signs of an allergic reaction such as a new itchy rash (hives on your skin) with swelling of the throat or tongue and/or difficulty breathing 2) Any sign of heart pain, pressure, or discomfort that does not go away after 10 minutes with 2 nitro tablets or nitro spray 3) Bleeding from the groin or wrist that does not stop after 10 minutes of firm pressure. MAKE SURE TO KEEP FIRM PRESSURE ON THE SITE until the ambulance staff arrives 4) Severe pain, cold, numb, or a blue foot or hand on the same side as your test 5) A growing bruise, a new bruise with pain, or a lump in your groin or wrist that is getting bigger 6) At any time if you see a lump in your wrist that is pulsing. Do not put pressure on the site; this may be a sign of a problem with the artery 7) New belly and or back pain Once your health emergency has been taken care of please call the Heart Catheterization Lab at 204-235-3834 to tell them of the problem which sent you to the emergency room. 3
WHAT TO DO: Take your Pills Take your usual pills unless you have been told not to by the doctor. If you are asked to take a new pill(s) and you do not know what they are for please talk to a doctor, pharmacist or nurse before you go home. Metformin DO NOT take your Metformin on the day of your test or the next day. You may start taking this drug 48 hours after your test unless a doctor or nurse has told you not to. Antiplatelet Pills Take Acetylsalicylic Acid (Aspirin /Entrophen /Novasen ) as your doctor or nurse has asked you to. This pill helps to stop clots from forming in your heart arteries and stents If you have been started on an anti-platelet pill such as: Clopidogrel (Plavix ), Prasugrel (Effient ), or Ticagrelor (Brilinta ), take it the WHOLE TIME that you are told to. These pills help to stop clots from forming in your heart arteries and stents DO NOT STOP ANY ANTI-PLATELET PILLS AFTER YOU HAVE AN ANGIOPLASTY OR STENT UNLESS YOU ARE TOLD TO BY YOUR ANGIOPLASTY DOCTOR. THESE PILLS PREVENT CLOTS FROM FORMING ON YOUR HEART ARTERIES AND STENTS 4
WARNING ** If you are asked to stop your anti-platelet pill (even for a short time) by another doctor MAKE SURE THE DOCTOR HAS TALKED WITH YOUR ANGIOPLASTY DOCTOR BEFORE YOU STOP. The doctor should call the angioplasty doctor who did your test during the day (Monday to Friday) or the angioplasty doctor on call (interventional cardiologist - Evenings and Weekends) before you stop taking these pills. Hygiene You may gently wash around the bandage with soap, rinse, and pat dry. You may take the bandage off and shower 24 hours after you go home. Showers are fine. Do not take a bath or go in a hot tub until your groin or wrist has healed (about 5-7days). 5
Helping Your Site Heal The following are guidelines to help your site heal: Groin Site: For the next 5 days: 1) Avoid lifting heavy items (over 5 lbs), bending for long periods of time or straining (including bowel movements) 2) Avoid bending at the hip (squatting) 3) Limit the use of stairs 4) Avoid hard exercise e.g.: skiing, running, cycling 5) Avoid sitting for long periods of time You may go back to your normal activities after 5 days unless your doctor told you not to. Wrist site: 1) For the first 48 hours treat your wrist like it is broken. Do not do anything that uses your wrist such as knitting, typing, computer work, driving a stick shift, vacuuming, or wringing clothes 2) DO NOT lift, carry, push or pull anything over 5 lbs for the next 5 days Activity 1) It is safe to walk right after your procedure 2) The doctor or nurse will talk with you about when it is safe to restart other physical activities (example: biking, swimming, sports or having sex). 6
Driving Do not drive any vehicle or operate machines for 24 hours after the test. The doctor or nurse will tell you when you are allowed to drive. Return to Work Please speak to the doctor about when you can go back to work. It will depend on your test results, your heart condition, and your type of work. Note: You should not sign any legal papers for at least 24 hours after the test because of the drugs that were given to you to help you relax during the test. 7
Diet If you do not have heart failure, drink lots of water to flush the dye through your kidneys. If you have heart failure you should stay within your daily fluid limit. Do not drink alcohol (including wine and beer) the night of your test. You should be able to go back to your normal diet once you go home unless your doctor has told you not to. If you are constipated try to eat bran, drink prune juice, or take a stool softener. Follow-up For follow-up care, we ask that you make an appointment with your family doctor for about 2 weeks after your test (or as close to 2 weeks as possible). Because you have heart disease it is important to have a family doctor. If you do not have a family doctor please call in Winnipeg 204-786-7111 or toll-free 1-866-690-8260 to find a doctor in your area. This sheet is for general information only. If any of your symptoms come back or get worse you need to see your family doctor or go to your local emergency room. 8
How to Prevent Future Problems: Prevention of Heart Disease To help prevent more problems with your heart there are four key areas to focus on: medications, diet, exercise, and quitting smoking. Cardiac Rehabilitation Programs offer education and support to people who have heart disease. Depending on the results of your angiogram you may be called by staff from a cardiac rehabilitation program. The staff will tell you about the program and the services that you can use to help improve your heart health. Local programs include: Reh-Fit Centre in Winnipeg.................................. 204-488-8023 Wellness Institute in Winnipeg............................... 204-632-3907 Brandon Heart Program...................................... 204-578-4204 Or 204-578-4225 Rehabilitation and Health Lifestyle Program Thunder Bay..... 807-684-6780 The Pas...................................................... 204-627-6418 9
Quit Smoking By quitting smoking NOW, your health will start to improve right away. Ask your doctor or nurse for a referral to the Smokers Helpline (1-877-513-5333). For a list of resources to help you quit smoking please go to http://www.wrha.mb.ca/healthinfo/preventill/tobacco/resources.php. To learn more, information can be found on the Internet: Heart and Stoke Foundation - Google Heart and Stroke Foundation - Select heart from the top menu Cardiac Sciences Program Winnipeg - Google WRHA Cardiac Sciences Program-select for the public tab If you have any questions or concerns, please discuss them with your family doctor. 10