Know Heart Treatment - in the case of tube blockage

Know Heart Treatment - in the case of tube blockage

One serious health problem associates with the overweight person especially the elderly one is the narrowing of one or more of the coronary arteries (blood vessels which supply blood to the muscle of your heart). This narrowing will result in insufficient blood supply to the heart muscle causing the symptoms of chest pain. In order to improve the blood flow and to relieve your pain, the artery must be widened.

One commonly used medical treatment is to insert a balloon into the part of the narrowing vessels and then inflate the balloon to expand the vessels diameter. This is called Percutaneous Transluminal Coronary Angioplasty (PTCA).

During this procedure, often time a stent is implanted in the artery. A stent is a small, tubular metal device that is placed in the narrow section of the artery and is intended to serve as a support to hold the arterial walls open. Once the stent has been implanted, it cannot be removed. As stent implantation is part of a PTCA procedure, one may not notice any extra discomfort from the additional implantation.

However, stent does not prevent a natural process which occurs over time where tissue grows into the stent. Subsequently, it narrows the treated tube at a later time. This process is known as restenosis. Fortunately, a new technology is now available to deter restenosi. This is by applying a small amount of drug to the stent to prevent or delay this building of fat.

Currently, there are three drug-eluting stents that are commercially available in the advanced medical world markets. A new deterring drug is in the final stage of testing and will be launched soon in the medical market. All of these drugs - eluting stent have the attribute of reducing the effect of re-narrowing the arteries effectively.

The Drug Eluting Stent is coated with a mixture of a biodegradable polymer and the drug Biolimus A9. The polymer [poly-lactic acid (PLA)] acts as the carrier for the drug and controls the release of the drug from the stent. PLA is a biomaterial often used in wound closure, prosthetic implant and drug delivery systems.

Treatment steps

As with any illness, we will need to seek medical help. In the case of heart complication, doctor will begin with a general medical diagnosis. This will follow with ECG check (an electrical recording of the activity of the heart.),

In a repeating visit, doctor may conduct a second ECG check. He will also obtain about 1 teaspoon of blood to do a blood test and make an appointment for an angiographic procedure.

In the subsequent visit, doctor will evaluate all the medical check-up, the ECG, the blood tests, and do the scheduled angiographic images (a film of the heart vessels). If the results show a narrowing of the coronary heart vessels, there will not be much choice but to adopt a treatment of either the traditional bypass graft surgery or the newer balloon angioplasty with a different type of stent.

The stenting operation is an extension of a balloon angioplasty procedure. Angioplasty is a technique that uses a catheter with a small balloon mounted on the end. The balloon is placed in the narrowed portion of the coronary artery and inflated. It pushes apart the narrowed walls of the artery. The stent mounted on the balloon will expand when the balloon inflates and opens up the artery that is being blocked.

Ultrasonic technique is used to direct the stent to the blocked area. It will help to detect the exact location to place the stent and inflate the balloon to open up the stent. The stent will remain expanded keeping the artery opens.

After the stent implantation, it will necessary to remain in the hospital for recuperation and further medical diagnosis with more ECG and blood test before being discharged in about 10 days time.

It is imperative to dose aspirin for an on going time under the supervision of the doctor. It is also be required to continue taking anticoagulation/antiplatelet medications (restenosi deterrent drug) for about a year. It is important that you do not miss any dosage.

A re-visit to your doctor is done in 30 days, 6 months, 12 months and every year after for ECG check and general heart evaluation.

Potential Risks

There is some element of side effects and risks in all medical treatment. Here is a list potential risk related to the stent implantation.

Risks that may be associated with a standard angioplasty procedure and the use of any stent in the coronary arteries include but are not limited to:

• Abrupt stent closure
• Acute myocardial infarction (heart attack)
• Allergic reaction
• Aneurysm (bulge in artery wall)
• Angina (chest pain)
• Arrhythmias, including ventricular fibrillation (VF) and ventricular tachycardia (VT) (irregular heart beats)
• Arteriovenous fistula (channel between artery and vein)
• Cardiac tamponade (fluid collecting in sac around heart)
• Coronary artery occlusion
• Cardiogenic shock (severe drop in blood pressure)
• Death
• Dissection (tear)
• Drug reactions to antiplatelet agents/anticoagulation agents/ contrast media
• Emboli (blockage), distal (air, tissue, or thrombotic emboli)
• Embolization, stent (blockage)
• Emergent Coronary Artery Bypass Surgery (CABG)
• Failure to deliver the stent to the intended site
• Fever
• Fistulization (abnormal communication between two vessels)
• Heart Failure
• Hematoma (bruise)
• Hemorrhage (bleeding)
• Hypotension/ Hypertension (Low Blood Pressure/High Blood Pressure)
• Incomplete stent apposition (stent not touching artery)
• Infection, including infection and/or pain at the access site
• Myocardial infarction (heart attack)
• Myocardial ischemia
• Perforation (hole) or Rupture
• Pericardial effusion (fluid collection around heart)
• Prolonged angina
• Pseudoaneurysm (outpouching of blood vessel)
• Renal failure (kidney failure)
• Respiratory failure
• Restenosis of stented segment
• Rupture of native and/or bypass graft
• Shock/Pulmonary edema (fluid in the lungs)
• Spasm
• Stent compression
• Stent migration
• Stroke/ cerebrovascular accident/ TIA
• Stent thrombosis (acute, subacute, or late)/ occlusion
• Ventricular fibrillation (irregular heart beats)
• Vessel perforation
• Vessel spasm
• Vessel trauma requiring surgical repair or reintervention

There are also potential risks that may be associated with the Biolimus A9 (drug to minimize the likelihood of clot formation at the stent site) drug coating which may include, but are not limited to the following:

• allergic/ immunologic reaction to drug (Biolimus A9 or structurally-related compounds) or the polymer stent coating (or its individual components)
• anemia (low red blood cells)
• headache
• hepatic enzyme changes
• nausea,
• hyperglycemia and mouth ulcers

The saying of "healthy is better than wealthy" may not be agreed by all, but it does contain truth and wisdom to remind us to stay healthy. But if we do fall ill, there is always a medical cure. In the case of heart artery blockage, the best medical treatment available now is enhanced stent treatment.