What is Coronary artery disease?
The heart muscle receives oxygen-rich blood through the coronary arteries. Over time, the inner lining of these arteries becomes thick and rigid and may get blocked by cholesterol plaques. These plaques are mainly made up of calcium and cholesterol, along with other substances that float in the blood.
The plaques narrow the inside of the arteries and block them either partially or completely. This condition is called as coronary artery disease (CAD). If the heart muscle does not receive enough blood supply, these blockages can cause a heart attack or myocardial infarction.
Causes of CAD
- High cholesterol levels
- High blood pressure
- Family history of CAD
- Sedentary lifestyle
- High calorie diet
Symptoms of CAD
The commonest symptom of a heart attack is Angina or chest pain. The patient may complain of one or more of the following sensation in the chest area:
The pain might radiate into the left lower jaw, left upper back or left arm. Angina is often mistaken for heartburn and indigestion. Experiencing chest pain that lasts longer than a few minutes, and typically reduces on taking rest is a sign of impending heart attack and thus, a medical emergency.
Rush the patient with the chest pain to the closest hospital or a certified healthcare provider. An angiography is performed to identify the blockages in the heart’s arteries. If blockages are detected, then either an angioplasty or a cardiac bypass is suggested by the physician.
Criteria for Coronary Angioplasty
- Mild to moderate block in coronary arteries.
- Angina that only occurs with physical activity or emotional stress and subsides with medication, called stable angina.
An angioplasty is a short procedure, lasting about 30-90 minutes.
- The blocked artery is identified through coronary angiography.
- A guide wire, inside a soft, thin catheter is inserted into a blood vessel in the patient’s arm, wrist, or groin after giving local anesthesia.
- The catheter is carefully guided through the blood vessels up to the heart, to the site of the blocked artery. This is monitored on a large fluorescence X-Ray screen.
- The guide wire and a small balloon are introduced into the blocked portion of the artery. The balloon may be placed inside an expandable stent. The stent is a mesh-like structure that is held in place by the arterial cells that grow around it.
- The balloon is slowly inflated, causing the stent to expand. This flattens the plaque against the walls of the artery, opening up room for blood to flow. It pushes the metal stent in place against the inner walls of the artery.
- The balloon is slowly deflated and removed, along with the guide wire and the catheter.
Nowadays, various types of stents are available. The stent may be a plain metal stent or one that is coated with a drug to keep the blood vessel patent.
Advantages of Angioplasty
- It opens up and keeps the artery patent after the Stent is installed.
- It improves blood flow by flattening the plaque against the arterial walls.
- If bits of the plaque break off and block the vessel, it can trigger a heart attack. The stent helps prevent this.
- It prevents the artery from collapsing again, restenosis.
- The stent also seals any tears in the arterial walls.
Recovery after the procedure is quick. You will be shifted to the recovery room and usually discharged after a night’s stay for observation in the hospital. Avoid driving and exercise for a few days, and consult your doctor about what activities you are allowed to do.
You will have to take Aspirin and other anti-platelet drugs for about a year, followed by aspirin daily to prevent a stroke or heart attack. Your doctor will explain these to you during discharge from the hospital.
This is a multidisciplinary program where doctors, physiotherapists, nurses, psychologists, and nutritionists work with you, in order to help you stay fit after the procedure. It includes lifestyle changes, counseling, diet monitoring, and a tailor made exercise program, which includes low impact aerobics, swimming, cycling on a stationary bike, and walking. It is adjusted according to your needs. This will prevent formation of new blockages and worsening of any minor existing ones.
A heart attack does not always mean the end of life. With the right treatment and a change in lifestyle, diet, and exercise, it could be the beginning of a new, healthier chapter in your life.