Treatment of Coronary Artery Disease
Coronary artery disease is the narrowing or blockage of the coronary arteries, usually cased by atherosclerosis. This is the buildup of cholesterol and fatty deposits (plaques) in the arteries. Plaques can restrict blood flow to the heart muscle by physically clogging the artery. Without adequate blood supply to the heart, it becomes starved of oxygen and vital nutrients it needs to function properly. When the blood supply to a portion of the heart muscle is cut off a heart attack (myocardial infarction) may occur.
Sometimes the atherosclerosis and/or blood clots may break apart and blood supply is restored. In other cases, it may suddenly block the blood supply to the heart muscle causing one of the following Acute Coronary Syndromes which are very serious conditions: Unstable angina, Non-ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI).
Unstable Angina - This may be a new symptom or a change from stable angina. The angina may occur more frequently, occur more easily at rest, feel more severe, or last longer. Although this can often be relieved with oral medications, it is unstable and may progress to a heart attack. Usually more intense medical treatment or procedures are required to treat unstable angina.
Non-ST segment elevation myocardial infarction (NSTEMI) - This type of heart attack or MI, does not cause major changes on an EKG. However, chemical markers in the blood indicate that damage has occurred to the heart muscle. In NSTEMI, the blockage may be partial or temporary, so the extent of the damage is relatively minimal.
ST segment elevation myocardial infarction (STEMI) - This type of heart attack or MI, is caused by a prolonged period of blocked blood supply. It affects a large area of the heart muscle, and causes changes on the EKG as well as in the blood levels of key chemical markers. Some people have symptoms that indicate they may soon develop an acute coronary syndrome and others may have no symptoms until something happens.
Angioplasty is used to:
- Restore blood flow to the affected area of the heart by treating narrowed coronary arteries.
- Provide prompt relief of chest pain and/or shortness of breath after procedure
- Potentially reduce the risk of heart attack and prolong life compared to no treatment
Angioplasty is a widely used procedure that is performed for patients with cardiovascular disease. The procedure involves inserting a medical device, such as a stent, into your heart to open the heart artery(ies) narrowed by plaque(s). Stents are tiny, expandable tubes made of metal mesh designed to open a blood vessel that is blocked by plaque. The angioplasty procedure opens the artery, and stents are placed and expanded to fit the size, shape and bend of the artery. The stent remains in the artery after the procedure to help keep the artery open. Over time, the artery wall heals around the stent. There are two kinds of coronary artery stents.
- Bare-metal stents help keep the cleared artery open after angioplasty by supporting the artery wall after angioplasty. Bare-metal stents help to prevent the artery from re-narrowing.
- Drug-coated stents are bare-metal stents with a special drug coating. These stents are also called drug-eluting stents or DES. DES has the same support benefits as a bare-metal stent for keeping the artery open after angioplasty. In addition, the stent releases a drug over time to further reduce the change of re-blockage.
- Arteries commonly become blocked again about 7% of the time with drug-coated stents, compared to 25% for bare-metal stents.
Recovery from a cardiac intervention procedure is usually quick. Many people are able to resume most of their normal activities 24-36 hours after the procedure. As the insertion site heals, some people experience bruising and feel a small, hard lump. This is normal and will go away in a few days.
If any of the following are experienced, it is very important to call our office or go to the emergency room.
- Bleeding at the insertion site
- Increased pain
- Any complaint of chest pain (call 9-1-1)
- Shortness of breath
- Feeling cold, have swelling, or numbness on the arm or leg of the insertion site
- The bruising or lump at the insertion site gets larger
- Fever over 100o F
- Return of arrhythmia symptoms
Be sure to talk with your doctor so that you thoroughly understand all of the risks and benefits associated with the catheterization procedure.