What causes coronary heart disease?
Coronary heart disease occurs due to the deposition of fatty substances, such as cholesterol, in the wall of a coronary blood vessel. These fatty deposits in the coronary blood vessels are called atherosclerotic plaques or lesions. As deposition progresses over time, the vessel’s inner wall thickens, the blood vessel narrows, and the flow behind the narrowing slows down.
Heart is a pump that supplies the body with blood, and for its normal functioning, it needs oxygen which comes through the coronary arteries that enclose it.
A blood vessel narrowed by atherosclerotic plaque cannot supply the heart muscle with enough oxygen, especially in increased oxygen demand, such as in exercise or stress. The heart muscle, which is not sufficiently supplied with oxygen, weakens its function, and you feel moments of poor oxygen supply as pain, i.e., angina pectoris.
These plaques are said to narrow the blood vessel but can even block blood flow through it, which (if left untreated) can lead to dire consequences such as myocardial infarction or even death.
Symptoms of coronary heart disease
Coronary heart disease is a disease that progresses slowly, often without symptoms. Your first sign of the patient’s existence is usually episodes of chest pain, which can occur in physical activity and at rest.
Pain can also exist in the form of tightness, pressure, and shortness of breath and can spread to the arms, especially the left, shoulders, back, or jaw, and may be accompanied by nausea, vomiting, and profuse sweating. As stated, pain may be the only symptom of the disease, but it may also be combined with the other listed symptoms.
Any of the following risk factors increase the chance of developing coronary heart disease:
if you are male
if you have high blood pressure or diabetes
if you are a smoker
if you are overweight
if any of your close relatives have coronary heart disease
if you are physically inactive
if you are under constant stress
How is coronary heart disease diagnosed?
If you have an increased risk of developing coronary heart disease, or some of the previously mentioned symptoms, the first step in making a diagnosis is ergometry, i.e., a stress test. The load test permanently records the ECG in the load and immediately after it and records any changes that speak in favor of the existence of coronary heart disease.
The next step is angiography of the coronary blood vessels or imaging of the vessels that supply the heart if such changes exist. This procedure is called coronary angiography. Coronary angiography is the most useful and, in fact, the most important procedure in diagnosing coronary heart disease because it allows the doctor to see exactly where the coronary arteries are narrowed or closed.
Coronary angiography is performed by first puncturing the groin’s femoral artery (usually, the puncture is in the right groin). Before the sting itself, the patient receives local anesthesia (painkiller) so that the sting or puncture itself is practically painless. After the puncture, the so-called introduction serves to facilitate catheter manipulation.
A catheter is a long narrow tube (about 2 mm) that leads through the aorta to the heart or coronary blood vessels. The next step is to inject a contrast agent that allows the coronary blood vessels to be displayed on an X-ray screen and accurately show possible narrowing or blockage sites. On several occasions, you may be required to take a deep breath and hold it during the procedure to better view your blood vessels.
One of the minor inconveniences during the procedure is the appearance of heat in the head and body, which occurs due to giving a higher amount of contrast when imaging the heart cavity (ventriculography).
Can coronary heart disease be treated?
The doctor advised every patient with coronary heart disease to stop smoking, save from heavy physical loads, low-fat diet, etc…
In addition to these general measures, there are other ways to treat coronary heart disease.
Most patients use medications that prevent angina pectoris attacks, medications to lower blood fat levels, and possibly medications to regulate blood pressure and diabetes. However, none of the existing drugs can eliminate coronary artery narrowing.
Until a few years ago, cardiac surgery was the only option to treat the coronary arteries’ narrowing. It is commonly used today in angioplasty (dilatation, balloon dilation of the coronary artery) as a non-surgical method of treatment. This procedure’s full name is Percutaneous transluminal coronary angioplasty ( PTCA ). The purpose of this procedure is to open the occluded artery. During angioplasty, a small balloon is placed through a catheter at the narrowing of the coronary artery, after which the balloon is carefully inflated. This compresses the fatty deposits of atherosclerotic plaque, which results in dilation of the coronary artery and improved blood flow.
In some cases, narrowing of the coronary arteries cannot be resolved with angioplasty, so in these cases, coronary stent implantation is recommended, or surgery is necessary. Your doctor will advise you which procedure is best for you.
Where and how is angioplasty performed?
Preparation before the procedure
Angioplasty is performed in specially equipped laboratories and hospitals.
Your doctor will give you some instructions before angioplasty.
You will be asked not to eat or drink anything the night before the procedure.
Upon admission to the hospital, you will have routine blood sampling, ECG, X-ray of the heart and lungs. You will also be given a small introduction (braille) into a vein, which, if necessary, allows for rapid administration of intravenous injections (medicines or infusions).
Angiolasticity is not performed under general but under local anesthesia. The night before the procedure, your doctor will prescribe a mild sedative that will reduce your tension.
Step by step angioplasty
Local anesthesia is injected into the groin, where a small incision is made in the skin.
A long, thin tube called an inlet is inserted into an artery that protects it from damage during the search, and an even narrower thin, long tube called a guide catheter is inserted through the inlet to the heart.
The contrast agent is injected through a catheter and allows the doctor to see what is on the x-ray called a fluoroscope (the dose of radiation you receive is minimally needed to get an accurate diagnosis).
When the arteries are shown on an X-ray screen, the doctor inserts a thin wire into the diseased artery through a catheter.
The doctor then inserts a balloon catheter over the wire and places it at the narrowing site.
Once the balloon catheter is placed at the narrowing site, it expands (inflates), and thus the fat deposits are compressed into the blood vessel wall.
When the balloon catheter is deflated and the lesions are removed, it remains compressed, and normal blood flow is established in the coronary artery.
Narrowing can also occur after angioplasty
In about one-third to one-half of successfully performed dilatations (PTCA), re-narrowing may occur over time (usually within 3-6 months) at the same site called restenosis. To reduce the chances of restenosis, Your doctor, During the angioplasty itself, can recommend another new procedure called coronary stent implantation, which he will do in the same procedure if he deems it necessary. Experience has shown that the use of PALMAZ-SCHATZ stents reduces the incidence of restenosis and improves angioplasty success.
What is a coronary stent?
A coronary stent is a small, mesh steel tube inserted into your artery on a balloon catheter. While maneuvering the catheter, the doctor placed a stent at the narrowing site and carefully inflated the balloon. When the balloon inflates, the stent expands and expands into the artery’s inner wall. Afterward, the balloon is deflated and pulled out, and the stent remains permanently in place and keeps the artery open.
A stent is a permanent implant that stays in your artery. It helps keep the artery open, increases blood flow, and thus reduces coronary heart disease symptoms.
How is a coronary stent implanted?
A coronary stent can be implanted after angioplasty before the guide catheter and glands are removed.
A stent mounted on a balloon catheter is inserted into the coronary artery and placed at the narrowing site.
When the balloon and stent are precisely positioned, the balloon inflates, and the stent expands. Depending on the constriction’s length, one or more stents may be implanted.
The balloon catheter is deflated and pulled out with a wire and a guide catheter.
The stent stays in the artery permanently and keeps it open.
Preparation before your treatment
Days before the procedure, you need:
take all prescribed medications
tell your doctor if you are taking any other medication
tell your doctor if for any reason you are not taking aspirin (Andol)
Remind your doctor if you are allergic to anything
refrain from eating and drinking after midnight the night before your procedure
follow all instructions given to you by your doctor or nurse
During the procedure
You can get a mild sedative to relax you a bit, but by no means to put you to sleep. There are two reasons for this. The first is that most people tolerate any discomfort they experience quite well. The second is that you will need to work with your doctor during the procedure; when he tells you to take a deep breath, you will take a few deep breaths and hold your breath to give the doctor a better picture on the screen, also if you feel any pain or discomfort you should tell yours to the doctor.
When you enter the cardiology lab, you will lie on an X-ray table and be covered with a sterile sheet. Medical staff will wash the groin’s puncture site with a special liquid, and you will receive local anesthesia.
We explained the procedure of PTCA and coronary stent implantation on the previous pages. The procedure if PTCA alone is performed can take about 60 minutes, and if a coronary stent is implanted after PTCA, it can take up to 90 minutes. You will feel comfortable for most of the procedure, but when the balloon inflates, you may feel discomfort and chest pain – this is a normal part of the procedure and stops as soon as the balloon inflates.
What happens after the procedure?
After dilatation and stent placement, you will be transferred to a coronary or postcoronary unit for a few hours until you return to your room. At that time, the groin insertions will be removed outside, and the puncture site will be compressed until the bleeding stops (10-15 min).
The nurses will monitor your heart rate and blood pressure and often monitor the puncture site for bleeding. When you return to your room, you can eat and drink and receive visits. Drink as much fluid as possible so that the contrast you received during the test is excreted through your kidneys.
The first few days after you receive a stent, you will reduce your physical activity. On the first day, you must not get out of bed. You must lie down and keep your leg straight out, punctured until tomorrow morning.
You can also get medication to help maintain blood flow through the stent. Your blood will often be monitored to regulate the medicine you are receiving. The next day you will get out of bed, and your doctor will gradually allow you to increase physical activity.
After being discharged home
Your hospital stay will last between three and eight days. Contact your family doctor after you are discharged home. If you feel any discomfort, pain, or bleeding after returning home, contact your doctor or cardiologist at the hospital.<
Your family doctor will follow you further, and after six months, you can consult your cardiologist for a load test (ergometry).
Finally, you should return to your normal activities, but be sure to ask your doctor before more physical exertion. It would help if you drew the attention of any doctor you are referred to have a coronary stent implanted and the convenience of carrying your stent card with you.
Taking medication is very important!