Coronary angioplasty....

[stephynic21]

Hello all!

I'm trying to get some information to help me figure out what is going on with my patient. We have clinical tomorrow and i was at the hospital getting her info from her chart when she was taken down to surgery...and so was her chart! She is a 61 year old obese female with history of HTN, DM and CAD.

Anyways, she had a heart cath on 2/26/09 which "showed a 3 vessle CAD but stenosis appeared critical ( 50-60% stenosis in obtuse marginal and 30 % stenosis in circumflex) and stent was placed into RCA." What does stenosis appeared critical mean?? I know i should probably know this, but the way it is worded is also throwing me off.

Also, she went home after the surgery and came back in on 3/7/09 with severe chest pain. She was being taken down to surgery when i was at the hospital, which is why i have hardly any info on this patient. What would be a reason she is going back to surgery?? Complications or failure of the procedure the first time, or is there some type of procedure that follows this up?

I've googled this for the past few hours and i know why she went to surgery the first time, but i really don't understand why she is back there now. Any help would be fantastic and greatly appreciated.

[cardiacRN2006, ADN, RN]

She had a stent, and that stent could easily re-stenose. She probably went back for a repeat cath.

Some of the cardiac nurses around here will be better at talking about the specific coronaries and stuff like that.

[Jennyw45013]

I agree, They would go back in and recheck to be sure there was no restenosis. Usually when the blockage is cricital, it is deemed necessary to put in the stent. Where I am from ususally at 60-75% they will place a stent. If this patient was having an MI or other factors at play could deem it necessary. Good luck!

[Daytonite, BSN, RN]

a stenosis is a narrowing of a passageway. if the stenosis was "critical" then it means the patient was in crisis or danger and something needed to be done. when one of the coronary arteries narrows to 100% an infarction can occur. the idea of stenting is to attempt to keep a vessel open so the heart muscle gets it blood supple and can continue to carry on its function. the physician was describing the percentages of stenosis in the various coronary arteries of the heart. this is how narrowing by atherosclerosis of these arteries is described by cardiologists on their procedure reports. i had to learn the names of these arteries when i was learning to code these procedures for payment when we billed the insurance companies because the docs name them specifically as you see they did in this report. this is the breakdown of the major coronary arteries, the branches coming off of them, their names and some of the abbreviations used for them. i added in red what was in the report for your patient:

• right coronary artery (rca) - stent placed
  
  • right marginal (rm)
    
  • right posterior descending (pda)
    

  [*]left main coronary artery

  • left anterior descending (lca)
    
    • diagonal
      
    • septal
      

    [*]circumflex (lcx) - 30 % stenosis

    • obtuse marginal - 50-60% stenosis
      
    • posterior descending
      
    • posterolateral
      

the heart cath of 2/26 was identifying the condition of the various coronary vessels: "showed a 3 vessle cad but stenosis appeared critical (50-60% stenosis in obtuse marginal and 30% stenosis in circumflex) and stent was placed into rca."

• angiography and complications of the procedure: http://www.vascularweb.org/patients/northpoint/angiogram.html
  
• angioplasty and stenting: http://www.vascularweb.org/patients/northpoint/angioplasty_and_stenting.html - if you click on the link for vascular conditions, tests, treatments you will get an index page of various cardiovascular procedures that you can link into and read about.
  
• tried to find some drawings that showed and labeled these arteries for you:
  
  • http://search.msn.com/images/results.aspx?q=drawing+of+coronary+arteries&form=igre4&p1=onerow&form=igre6#focal=954294287f8e0e929fd16ddb617f39c3&furl=http%3a%2f%2fwww.angelfire.com%2fmd%2fleehh%2fimages%2fcoronary.gif
    
  • http://houstonheartcenter.com/coronary_arteries_blue_large.jpg
    
  • http://www.hsforum.com/stories/storyreader%241480
    
  • http://spectrum-health.org/cs/satellite?c=eha_content_c&cid=1160745007766&pagename=spectrum_health_core%2fspectrum_core_central_template - coronary arteries of the heart
    
  • http://findlaw.doereport.com/generateexhibit.php?id=1692&exhibitkeywordsraw=coronary+arteries+with+angiogram+films&tl=1889&a=42409 - shows you what the different percentages of blockages in a vessel look like anatomically
    

[stephynic21]

Ahhhhh you are the best! Thank you all for helping me!

[stephynic21]

one more quick question if anyone is still around. what is atherosclerosis without mcc mean???

[Daytonite, BSN, RN]

Sorry. Isn't ringing a bell.

[stephynic21]

oh well. just thought i'd ask. I googled it and had no luck and my instructor didn't even know what it meant. Got too busy on the floor and forgot to ask. thanks anyways!