Friday 19 September 2014

FAQ's

FAQ's

CONTENTS

WHAT IS CORONARY ARTERY DISEASE?

  • Coronary artery disease (CAD) affects the coronary arteries that supply blood to the heart muscle (Fig.1)
  • The most common cause of CAD is artheroselerosis, commonly called hardening of arteries.
  • Risk Factors : Diabetes, Hypertension, Smoking, High Cholesterol, Ageing, etc.
  • Fats, cholesterol and other elements carried in the blood get accumulated in the inner wall of the arteries to form a plaque.

WHAT ARE THE EFFECTS OF CORONARY ARTERY DISEASE?

What is Angina?
Narrowed coronary arteries restrict the amount of blood, that can reach the heart muscle. Fatigue, tightness in the chest or a peculiar crushing type chest pain called angina, may accompany the decreased blood flow.
What is Heart Attack?
If a coronary artery suddenly closes, blood flow to a part of the heart may stop completely. In these cases, some of the heart muscle may be permanently damaged. This is often accompanied by severe chest pain that won't go away. This is called a myocardial infarction or a heart attack (Fig 2).
Test to Detect CAD : -
  • Echo / Color DopplerStress Test
  • Stress EchoThalliumStress test
  • Coronary CT AngioCoronary Angiography

WHAT IS ANGIOGRAPHY?

This procedure is done to see where and to what extent the coronary arteries are blocked. A fine tube is passed along artery in the right thigh or forearm upto the heart (Fig. 4).
A dye is injected and a serial X-ray films are taken to study the flow of dye in the coronary arteries. The pictures will let your doctor see any narrowed or blocked arteries.
Your doctor will inject x-ray dye through the catheters. You may need to take a deep breath when the picture is taken.
When the angioram procedure is over, you will go to a recovery area. The introducer shealth will be taken out before you to go your hospital room or go home.

WHEN WILL YOUR DOCTOR RECOMMEND ANGIOGRAPHY?

Your doctor will recommend angiography under the following circumstances :
  • When you have chest pain called Angina on walking or at rest.
  • When ECG or Stress test shows chances suggestive of ischemia.
  • After a heart attack.
  • During a heart attack, in unstable patients with a view to coronary intervention.
  • Sometimes, you may have no symptoms called 'silent ischemia' which may be detected or rest or by Stress test. This is no prevent silent heart attack or sudden collapse.

WHAT ARE THE PROCEDURES TO RELIEVE CORONARY ARTERY DISEASE?

When the disease is localized in one or tow arteries, the blockage can be opened by stretching or dilating. This is done by using a small balloon on a tube inside the artery, this procedure is called percutaneous transluminal coronary angioplasty.

HOW WILL THE DOCTOR KNOW THAT YOU REQUIRE SURGERY?

When the blockage is more complicated and involves more coronary arteries, coronary artery by pass surgery is recommended.

WHAT IS PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY?

PTCA is non surgical procedure designed to dilate narrowed coronary arteries. PTCA is similar to your coronary angiogram procedure. IT is performed in the cath lab. In a PTCA, a small catheter with a small balloon attached is passed into the artery, From here, it is passed into the coronary artery (fig.6). The balloon is passed through the blockage. The balloon is inflated to expand the opening in the artery. More blood can flow through the artery, when the balloon is removed.
Your doctor may recommend placing a coronary stent. The coronary stent is designed to help keep the treated area in the artery open and prevent recurrence.
If you need a stent, you may need to take special medications like Aspirin and Clopidogrel before it is placed.

HOW IS PTCA DIFFERENT FROM BYPASS SURGERY?

Both operations achieve the same result. They increase the blood flow to the heart muscle.
In the PTCA the obstructed part of the coronary artery is widened with a balloon catheter and a stent is placed.
It is non surgical, no incision is made and can be done during angiography.
In coronary artery bypass surgery a detour around the narrowed or blocked part of the coronary artery is constructed using a length of vien or artery taken from inside the chest. It is a major surgery involving opening of the chest. It is a major surgery involving opening of the chest, putting the heart on the heart - lung machine, using octopus in beating heart surgery, a prolonged hospital stay and a greater risk and morbidity.

WHAT ARE THE TYPES OF ANGIOPLASTIES AND HOW DOES YOUR DOCTOR RECOMMEND WHICH ONE IS BEST FOR YOU?

The types of Angioplastics :
  • Balloon
  • Bare Metal Stents
  • Medicated Stents
  • Lasers
  • Rotablators

WHAT ARE STENTS? WHY IS STENT SO IMPORTANT FOR YOUR TREATMENT?

A coronary stent remains in your body. It is shaped like a small round tube. A stent is usually made of medical - grade stainless steel. The coronary stent is designed to support the wall of the coronary artery.
The stent is placed on a balloon catheter like the one used for a PTCA. The stent and the balloon catheter are passed through the blockage. The balloon is tehn inflated. This causes the stent to extend inside the artery.
After the stent has been expanded, the balloon is deflated and removed. The stent stays inside the artery to help keep the artery open. This improves the blood flow to the heart and helps relieve chest pain.

AFTER YOUR STENT PROCEDURE

Your stay in the hospital can be from one to three days. For the first eight to twenty-four hours after your procedure, it is very importance not to bend your 'procedure leg'. You should also remain flat in bed. The nursing staff will check your leg for warmth and color. They will also look for any bleeding. After the introducer sheath is removed, you will be allowed out of bed.
You will also take a daily dose of Aspirin and clopidogrel as well as a combination of drugs. Some of these medications also help to thin the blood and prevent blood clots.
It is very important that you take all of your medications until your doctor tells you to stop.

GOING HOME FROM THE HOSPITAL

You will be given instructions by your doctor about your physical activites, you will receive information on how to reduce the risks of further coronary atherosclerosis.
The need for PTCA may be reduced or avoided by :
  • Changing eating habits and reducing fats and cholesterol in your diet.
  • Participating in a regular physician - approved exercise program.
  • Reducing or stopping smoking.
  • Taking the medicines Aspirin and Clopidogrel regularly as prescribed by your doctor.
After several months, your doctor may want you to have a stress test, This procedure monitors the result of your PTCA and stent placement.

WILL I NEED TO HAVE ANOTHER PTCA?

There are chances. The dilated part of the coronary artery may be narrowed in some patients, within the first six months. After the first six months. After the first six months, if there is no recurrence, then it is not a problem.
What are Medicated Stents (Drug Eluting Stents)?
Stents medicated with drugs like Sirolimus, Paclitaxel, etc on a polymer have virtually eliminated the chance of recurrence. It is very important that you take Aspirin and Clopidogrel along with your other medications under supervision of your doctor. Never stop it without consulting your physician.

LIFE AFTER PTCA

PTCA is performed to restore a person to an active and full life. The goals of the procedure are to enable a person to improve the quality of his life and prevent heart attack. It makes sense to reduce the risk factors by controlling high blood pressure, high blood sugar, maintaining a low fat diet, keeping weight down, to give up smoking and having a sensible exercise and diet program.
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WHAT ARE THE NEWER INTERVENTIONS PERFORMED IN THE CATH LAB?

  • Angioplasty in acute Heart Attack.
  • Angioplasty in acute coronary syndrome (Unstable Angina/non-Q wave MI) Multivessel stenting in triple vessel CAD.
  • Drug Eluting Stents with various drugs like rapamycin, paclitaxel, etc. have virtually eliminated the chance of recurrence.
  • Rotablation, cutting balloon, coated stents, brachytherapy, intravascular ultrasound, excizer, use of Reopro/Integrilin, IABP, percussage protection device, drug eluting stents etc.
  • Angioplasty in post bypass patients with occulded grafts (venous & arterial)
  • Carotid artery stenting in stoke/TIA patients.
  • Renal artery stenting in renovascular hypertension / renal failure.
  • Aorto-iliac, femoral, popliteal, peroneal, subclavian angioplasty and stenting in peripheral vascular disease.
  • Septal ablation in hypertrophic obstructive cardiomyopathy.
  • Biventricular pacing (cardiac resynchronization device) in dilated cardiomyopathy.
  • Aortic, pulmonary, tricuspid and mitral valvuloplasty.
  • IVC filter and local thrombolytic therapy in pulmo thrombo - embolism with deep vein thrombosis.
  • Umbrella closure device in ASD, PDA shunts.
  • Permanent pacemaker implantation VDD, dual chamber pacemaker.
  • Electrophysiologic studies with radio frequency ablation in tachyarrythmias and AICD devices.

CAN ONE REDUCE THE PROGRESSION OF ATHEROSCLEROSIS CHANGE IN LIFESTYLE TO REGRESS CORONOARY ARTERY DISEASE

  • Low fat vegetarian diet consist of : -
    70-75% complex carbohydrates (starches - grains, beans, vegetables, fruits)
    10% Fats (yogurt or non-fat milk, cooking oil)
    15-20% Protein (beans, egg white)
  • Aerobic Exercise
    Moderate paced walks 30 mins a day or 1 hour every alternate day
  • Stress Management Techniques
    • Stretching Exercises (Yogic Asanas)
    • Deep breathing (Pranayama)
    • Meditation
  • Quit Smoking
  • Sr Cholestrol < 150, LDL < 80, HDL > 45, TG < 100 mg/dl
  • Maintain body weight to ideal body weight.
  • Control of Risk Factors : diabetes, hypertension etc.
  • Regular medicines as prescribed.
    • Aspirin and Clopidogrel (blood thinners)
    • Statins (cholesterol lowering drugs)
    • Nitrates (arterial vasodilator)
    • Beta Blockers, ACE-Inhibitors, Angiotensin Receptor Blocker, Calcium Channel Blockers
    • Newer anti-anginal drugs : Nicorandil, Ivabradine, Ranolazine
    • Regular Cardiac Fitness Evaluation : Clinical & risk factors assessment, ECG, 2-D Echo, Stress test, Stress Thallium, CT Angio, Sr lipid profile.
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