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COMMON QUESTIONS ABOUT CARDIAC DISEASES

WHAT ARE CORONARY ARTERIES ?

Each organ in our body needs some blood supply to maintain its function. This blood supply is provided to them by pumping action of heart via small muscular tubes which are called arteries. Every organ has supply of fresh blood rich in oxygen via arteries and drainage of blood via thin muscular tubes called veins to be recycled after oxygenation in lungs. Likewise the heart also needs it supply of fresh blood to maintain it's pumping action and this supply is provided by arteries of heart called coronary arteries. These coronary arteries takes fresh blood from the heart and supplies the heart. There are three main coronary arteries called LAD, LCX and RCA ( Left Anterior Descending, Left Circumflex and Right Coronary Artery respectively ).

WHAT IS CORONARY ARTERY DISEASE ( CAD ) ?

Coronary artery disease is a form of atherosclerosis. Coronary arteries are prone for cholesterol deposition and as a person grews older, cholesterol is gradually deposited into coronaries. Over the period of time, this leads to significant obstruction in them and can lower the supply of oxygen-rich blood to the heart, especially when your heart beats faster, like during exercise. Extra strain on the heart may result in chest pain (called angina) and other symptoms like shortness of breath on exertion. Sometimes when there is sudden blockage In coronaries due to blood clot formation over a cholesterol deposit , there is myocardial infarction commonly known as Heart Attack.

HOW COMMON IS CORONARY ARTERY DISEASE ?

Heart diseases are the leading cause of morbidity and mortality worldwide. India, with one- sixth the world’s population, has one of the highest absolute burden of heart disease related morbidity and mortality. This is attributable to changing lifestyles, stress, sedentary habits and smoking. Prevalence of Coronary Artery Disease is approximately 12% in urban and 4 - 6% in rural population of India. Coronary artery disease in India is more severe and affects younger as compared to western population.

CAD AMONG WOMEN

Heart disease is the leading cause of death in women over 40 years old, especially after menopause. Once a woman reaches the age of 50 (about the age of natural menopause), the risk for heart disease increases dramatically. In young women who have undergone early or surgical menopause, the risk for heart disease is also higher.

What Is Atherosclerosis?

Atherosclerosis is also called hardening of the arteries. When the lining inside an artery is damaged, fat and plaque build up. This causes the artery walls to thicken, and the blood vessel narrows or sometimes gets blocked. Coronary artery disease is a form of atherosclerosis.

What Is Cholesterol?

Cholesterol is a soft, waxy material made in the liver. It’s in foods such as egg yolks, milk fat, organ meats, and shellfish. You can lower your high cholesterol levels by eating foods low in saturated fats, sugar, and calories.

WHAT ARE THE RISK FACTORS FOR CAD?

These risk factors are divided into non modifiable and modifiable risk factors. The major non modifiable risk factors for coronary heart disease are increasing age, male sex and family history. The modifiable risk factors include smoking, hypertension, dyslipidemia, diabetes mellitus, obesity, and physical inactivity. Although nonmodifiable risk factors can not be changed, modifiable risk factors can be changed to achieve risk reduction for heart disease.

What Should I Do If I Have Risk Factors for Coronary Artery Disease?

You can do several things to cut your chances of heart disease. If your arteries are already clogged, you can slow the damage with a healthier diet, exercise, quitting smoking, and reducing stress. With lifestyle changes, you can stop or even reverse the narrowing of arteries. While this is important for those with risk factors for the disease, it is even more important if you have had a heart attack or procedure to restore blood flow to your heart or other areas of your body.

What Dietary Changes Can I Make to Reduce My Heart Disease Risk?

Eating right is a powerful way to reduce or even eliminate some heart disease risk factors. A heart- healthy diet can help cut total and LDL ("bad") cholesterol, lower blood pressure, lower blood sugar, and help you shed pounds.

CORONARY ANGIOGRAPHY

Coronary angiography is an imaging technique which allows us to picture the coronary arteries supplying the heart and diagnose the extent of blockages in them. The angiography is used to determine which treatment option would be best for the patient. Traditionally coronary angiography is done by putting a plastic tube in the femoral artery I.e. The artery supplying the leg. Through this plastic tube called a sheath, small calibre plastic pipes are taken to the heart and dye injected into them to take pictures in cath lab. Now a days most of the coronary angiographies are being performed through radial artery I.e. Artery supplying the hand .

WHAT IS CORONARY ANGIOPLASTY ?

Coronary angioplasty or PTCA i.e. Percutaneous Transluminal Coronary Angioplasty is a therapeutic procedure used to treat the blockage in the coronaries. Through the same procedure as angiography, a long plastic tube known as guide catheter is taken to the coronaries. Through this a wire is taken down to the coronary artery with blockage and put across the blockage. Then a balloon is inflated across the blockage to make appropriate place for stent. Following this a stent is deployed across the blockage which scaffolds the artery and prevent further recurrence of blockage in future. Previously the angioplasties were performed without placement of a stent, but this was associated with high rates of reblockages. This procedure is now called as POBA i.e. Plain Old Balloon Angioplasty. With the advent of stent, this procedure has almost become obsolete now and most of the angioplasties now are being performed with stents and called PTCA +stent.

WHAT IS STENT ?

Stent is a metallic mesh tube which has enough strength to open up the coronary arteries. Most of the modern stents are made of alloys mostly cobalt chromium or platinum chromium and available in different diameters and lengths to suit the size of coronary in a given individual. Previously there were only non medicated stents available. Now for last 15 years we have medicated stents available. These medicated stents release some medicines locally into coronaries after deployment for a limited time period. These medicines do help to prevent reblockages into coronaries. With the advent of medicated stents, the reblockage rate in the stents have come down to around 4 percent from 20 percent in non medicated stents.

WHAT ARE THE SYMPTOMS OF REBLOCKAGE ?

In case of reblockage in coronaries on the stent or in other coronary arteries, patient starts experiencing the original symptoms like chest pain on exertion or rest, shortness of breath on exertion etc. Few patients also present with myocardial infarction I.e. Heart attack. On finding reblockage in the coronary arteries, patient has to undergo repeat stenting or bypass surgery.

WHAT IS BYPASS SURGERY ?

Coronary Artery Bypass Grafting ( CABG) commonly known as Bypass surgery is the surgical way to treat CAD. In this the chest is opened up and new arteries and veins are connected distal to the coronaries having blockages. In this way the segment of coronary having blockage is bypassed and rest of the artery restarts getting its blood supply.

STENTS VERSUS BYPASS ?

There are specific criteria for choosing modality of treatment of CAD in a particular patient however lot of overlapping exists. There is no universal rule that which modality is best for the patient. With technology evolving very fast, stenting is becoming more frequent now a days and more and more patients are opting for stenting due to its ease, excellent long term results with modern stents, less morbidity and option of bypass being kept open in future. However bypass has its role for treatment of diffuse disease, diabetic patients and reblockage after stents. Now a days with evolution of total arterial revascularisation in bypass surgeries and minimal invasive bypass, the long term outcomes are excellent with lesser morbidity. Also there is role of hybrid strategy in which main coronary artery I.e. LAD is bypassed and rest of arteries are stented. This also gives a very good long term results especially when performed by minimal invasive route. The ideal way to decide on mode of treatment is a combined HEART TEAM approach in which both cardiologist and cardiac surgeon collectively takes decision for treatment in a particular case.