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World Heart Day is celebrated on 29th September every year, to spread awareness on Cardiovascular Diseases and other heart conditions, while emphasizing the importance of heart health and how to maintain it.

Cardiovascular Diseases (CVDs) are the leading cause of death globally, and claim about 17.9 million lives approximately every year, according to the World Health Organization (WHO). World Heart Day provides an ideal platform for those suffering from CVDs to fight against it and reduce the global burden of the disease.

Created by the World Heart Federation, World Heart Day is a global campaign that informs people about the risk of cardiovascular diseases and highlights the actions one can take to keep heart diseases at bay.

World Heart Day 2021

This year, the theme of World Heart Day is Use Heart to Connect, which urges everyone to use their knowledge, influence, and the power of digital media to connect to the global community and ensure that everyone gets a chance to live a heart-healthy life. 

COVID-19 has brought about a drastic change in the world and has posed a serious threat to everyone, making us increasingly aware of the importance to protect our health as well as that of our loved ones. For those living with CVD, COVID-19 has put them in a compromising situation, as they are at a higher risk of contracting the virus.

The goal of World Heart Day 2021 is to harness the power of digital health to improve awareness of the prevention and management of CVD, on a global level, with the help of three key pillars – equity, prevention, and community

Equity:

Due to the lack of internet facilities among half the world’s population, awareness on CVD prevention, treatment, and control are unavailable. It is important to use technology and data to bridge this gap with the use of digital tools and enable better prevention, diagnosis, and treatment of heart-related diseases.

Prevention:

Prevention is better than cure, To maintains a healthy heart, follow a healthy diet, avoid alcohol and tobacco abuse and follow a regular exercise regimen. If you are diagnosed with an underlying health condition such as diabetes, high blood pressure, obesity, or more, ensure regular check-ups with your medical practitioner.

 Community:

According to the World Heart Federation, over 520 million people are living with CVD across the globe, and have been severely affected due to the COVID-19 pandemic, as they are highly prone to the infection, and have to be isolated. This has resulted in missing medical follow-ups and appointments, lack of contact with people, and reduced exercise. Through digital networks, those who are vulnerable can easily connect with their families, friends, and even doctors for support.

What are Cardiovascular Diseases (CVDs)?

Cardiovascular Diseases (CVDs) refer to the set of conditions that affect the functioning of the heart and blood vessels such as:

Arrhythmia:

Arrhythmias refers to abnormal heart rhythms. In this condition, the heart either beats too slow or too fast. Bradycardia occurs when the heart rate is too slow (less than 60 beats per minute) and Tachycardia occurs when the heart rate is too fast (more than 60 beats per minute). When an arrhythmia occurs, the heart may not be able to pump enough blood required by the body.

Aortic Disease:

Aorta is the large artery through which oxygen-rich blood flows to the rest of the body. Sometimes, the aorta may widen or tear, which leads to a condition called Atherosclerosis. This condition develops when plaque builds up in the walls of the arteries, making blood flow difficult. This may even lead to a heart attack or stroke.

Heart Attack:

This occurs when blood flow to a part of the heart is blocked by a blood clot, leading to a lack of oxygen.

What are the risk factors of CVDs?

Some of the major risk factors of Cardiovascular Disease include:

  • High cholesterol levels
  • Diabetes
  • Lack of physical activity
  • Tobacco consumption
  • COVID-19

How can you prevent Cardiovascular Diseases?

There are several risk factors associated with CVDs such as the family history of heart diseases, that cannot be prevented or helped. However, certain risk factors such as high blood pressure, diabetes, cholesterol levels can be treated on time, reducing the risk of CVDs. If you are a frequent consumer of tobacco and alcohol, reducing the consumption of these can also help prevent heart diseases. It is also important to make several lifestyle changes such as a regular physical activity routine and incorporating a healthy diet, which will also help keep heart diseases at bay.

Some tips to keep the heart healthy

Now that we know the importance of keeping the heart healthy and how CVDs can affect our health drastically, here are some tips one can follow to ensure that the heart remains in a good shape. They are:

Eat Healthy: Avoid foods that are extremely rich in fat content, and eat fiber-rich foods. Also, make sure that you eat in moderation.

Get Active: It is also important to have a regular exercise routine and stay physically active. Also incorporate regular movement if your job requires you to sit at a desk for long hours, and maintain a healthy weight.

Quit Smoking: It is a well-known fact that smoking is one of the main causes and risk factors of heart disease. If you are a regular smoker, quit smoking immediately and avoid the risk of CVD.

Overall, it is extremely necessary to maintain your health and go for regular follow-ups if you have underlying conditions such as diabetes or high blood pressure. Though there are several treatment methods for different types of heart diseases, making certain lifestyle changes will ensure that you don’t develop the risk of CVDs at all. Remember, prevention is always better than cure!

Our heart is a complex organ with the hardest working muscle. Every heartbeat pumps out 2 to 3 ounces of blood. This function is mainly carried out by coronary arteries.

The primary function of Coronary arteries is to supply oxygen-rich blood to your heart muscle to keep it pumping. There are four main coronary arteries

  • The right coronary artery.
  • The left coronary artery.
  • The left anterior descending artery.
  • The left circumflex artery.

A blockage of the artery can lead to symptoms such as chest pain, shortness of breath, and damage of the heart muscle. This can lead to Coronary artery disease. When the arteries that supply blood to the heart become narrowed or blocked, due to the build-up of fatty deposits or plaque, it increases the chances of a fatal heart attack.

Some major symptoms of coronary artery disease are chest pain, shortness of breath, Difficulty in breathing after normal light physical activity like walking,  climbing stairs. Symptoms of a heart attack can manifest as chest discomfort or angina, i.e heaviness, pressure or burning in the left shoulder, neck, back, or jaw, tiredness, dizziness, nausea, weakness, lightheadedness, and more. Women can experience slightly different symptoms of a heart attack. For example, for women, discomfort or pain can be felt in the shoulders, neck, abdomen, and back and/or cold sweats.

Coronary artery disease is caused due to many different factors. Some of the most common ones include:

  • Having a high cholesterol level
  • Suffering from high blood pressure
  • Family history of heart disease
  • Existing comorbidities like Diabetes
  • Smoking, Obesity and Sedentary Lifestyle

What are Coronary stents?

Coronary stents are used to treat blockages in the coronary arteries and open them up, relieving the blockage and restoring normal blood supply. A small metal mesh is inserted into the artery that is blocked to widen the vessel and restore the blood flow.

The recovery period for angioplasty and stent implantation is as fast as 24 hours. While there might be some bruising, it will disappear within a few days.

Some problems associated with traditional or non-dissolvable stents

Although traditional heart stent procedures are a breakthrough and very often have a high success rate, they are not entirely without problems.

  • Heart stents are metallic, which means that the patients will be required to take life-long blood-thinning medication, as the presence of heart stents can disrupt the process known as remodeling.
  • Some patients might suffer from an allergic reaction to the medications or the dyes used in the procedure or even the material of the stent.
  • Vessels expand and constrict in response to stimuli which is prevented by metallic heart stents.

The difference between traditional and dissolvable heart stents

Normally stents are made of metal. However, dissolving stents are made of polylactide. It is similar to the natural material that is used in dissolving stitches. Generally, stents are no longer needed once the blood flow is normalized and restored.

The stent dissolves in three stages before it disappears. Revascularization, restoration, and reabsorption.  Revascularization is when the stent implantation takes place thereby restoring blood flow in the vessel. The second phase is when the stent begins to degrade while the vessel regains its natural properties and the final phase, the reabsorption phase is when the stent completely dissolves leaving a natural vessel behind.

The procedure for both heart stents is similar. Just like traditional heart stents, dissolving heart stents are placed into the artery using a catheter with a balloon on the end. Once expanded into place by inflating the balloon, the stent is pushed against the artery wall, after which the catheter and the balloon are then removed. Both traditional as well as dissolving stents contain medication that slowly releases into the body to treat the diseased area.

According to an article published by Health Matters, the U.S. Food and Drug Administration after a study of 2,008 patients over a year found that it was comparably safe to traditional metal stents.

The benefits of dissolvable stents

  • A vessel needs to expand and contract to increase the flow of blood to and from the heart. By using a dissolvable stent, the flow can remain unrestricted because once it is put in, the stent, as the name suggests, dissolves.
  • It allows for more flexibility for treatment and future diagnostic options
  • It may reduce the long-term need for anti-clotting medication

If you’re suffering from a condition that requires you to undergo stent implantation, it is important to discuss all your options with your doctor to be better prepared and make an informed decision about the medical procedure.  . It is also important to understand the nature of the stents, the materials, and only after a proper evaluation,  one should move forward with the procedure.

A coronary artery disease or CAD occurs when there is a build-up in the arteries. In such conditions, it can interrupt the flow of blood to your heart. Plaque causes narrowing or blockage which can result in a greater risk of having a heart attack. Symptoms could include chest pain, discomfort in breathing and shortness of breath.

Cardiovascular diseases are the leading cause of death globally, according to World Health Organisation, it takes an estimate of 17.9 million lives each year. More than four out of five deaths are due to heart attacks or stroke. The most important behavioral risk factors are unhealthy diet, physical inactivity, tobacco use and harmful use of alcohol. If you have CAD your doctor might suggest using a stent to treat it. It’s a procedure called Coronary Angioplasty in which the doctor will insert a stent into your coronary arteries. A stent is a small tube made up of metal mesh that is designed to support your artery walls and prevent plaque from blocking your blood flow. It helps the blood flow more freely to your heart. During angioplasty, a thin tube known as a guiding catheter is inserted through the groin or wrist and is then moved towards the site of the blockage. A small balloon at the tip of the balloon catheter is inserted through the guiding catheter near the blocked or narrowed area of the coronary artery. When the balloon mounted with the stent, is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened (dilated) to increase blood flow to the heart. Once the plaque is compressed and the artery is opened sufficiently, the balloon catheter is deflated and removed. The stent will remain as a permanent implant in the coronary artery.

Your doctor may use a bare-metal stent(BMS), Drug-eluting stent (DES), or BioResorbable Scaffold (BRS). A drug-eluting stent is the most common type of stent used lately. The new and improved versions of drug-eluting stents are considered safe and effective in most cases. They have ultra-low strut thickness that promotes early vascular healing, the variable strut width, and variable crown design ensure adequate radial strength. However, BRS is a next-generation bioresorbable technology with a low strut thickness of 100 microns which fully resorbs naturally in the artery within 2-3 years, thus restoring the vessel to its true form and nature.

In this blog, you will learn more about Drug-Eluting stents and their benefits.

So what is a Drug-eluting stent? 

DES is a standard metallic coronary stent that has a polymer coating and an antiproliferative drug. It allows drug elution into the coronary wall for weeks and months after stent implantation. It releases medication directly into your artery which helps the scar tissues from forming within the stent and narrowing your blood vessels again. That’s how Drug Eluting stents work you might need to take additional medications including blood thinners after the procedure. 

Benefits of Drug-Eluting Stent 

They can prevent plaque build-up, relieve chest pain, and promote good blood flow to your heart. They may also lower your chances of having a heart attack. 

As it’s a less invasive procedure than coronary bypass surgery, which is recommended to people who have more than two narrowed arteries. So most people recover within few days of inserting the stent. A stent helps you get back to your regular schedule faster. In contrast, coronary bypass surgery takes six weeks or more to recover. 

With Benefits, Drug-Eluting Stents even have risks: 

Like any medical procedure, coronary angioplasty or stenting do involve risks, including: 

  • Bleeding or clotting 
  • Damage to your blood vessel
  • Infection 
  • Kidney damage caused by the dye 
  • Allergic reaction to the anesthetic, dyes, or other material used 
  • Scarring of your blood vessels 
  • Heart attack and stroke, which is rare

If you form scar tissue after stenting, the doctor may need to repeat the procedure. In case you have chest pain report to your doctor immediately as it could be a sign of serious complication. 

There are also few other things you should consider before getting a drug-eluting stent.  

For patients with a history of bleeding problems, a drug-eluting stent might not be a good option. Apart from this, you might need to take blood thinners for the rest of your life to prevent your blood from thickening and causing the risk of clots in the stent. Your doctor would give you additional information on what to expect before and after angioplasty. 

How to live with a stent? 

Having a stent doesn’t mean you have to live differently. But you will have to take extra care of your heart by eating right and healthy. Be active and take your medications. Follow few precautions such as: 

  • Take your blood-thinning medication this would prevent heart attack and stroke. After stenting, you will take aspirin plus another antiplatelet for at least 6 months. If you are at a high risk of bleeding your doctor with shortening the duration of these medicines. Work with your doctor to decide how long you will be needing the medications. The decision depends upon your risk of having a heart attack, risk of bleeding, and your preferences about taking the medicines. 
  • Stent identification card- Your doctor will provide you with a stent identification card that you can show to your health professionals so that they know you have a stent.    

Protect your heart health

You can lower your risk of developing blocked arteries or having a heart attack by practicing healthy habits. Common risks for heart disease include high cholesterol, high blood pressure, and being overweight. All of which can be managed with a healthy lifestyle. For example, having a balanced diet and regular exercising can go a long way towards keeping your heart healthy and strong. Smoking would put you at risk. If you are a smoker then now would be a good time to call quits. 

If you are diagnosed with CAD, to prevent complications follow your doctor’s instructions and treat it. Drug-eluting stents are a good option for patients with CAD but they are only one part of the solution. You may have to take statins, aspirin, or other medications. 

Follow your doctor’s advice and take their prescribed medicines and also follow their recommended lifestyle which will keep your heart healthy. 

Heart disease often involves a problem with the valve, coronary arteries, or muscles all of which causes the heart to not function normally. The common heart disease among patients is CAD which arises from a build-up of plaque on the inner surface of the arteries. In the worst cases, it blocks the artery. Stents are instered to open the blocked artery and restor the blood by increasing the lumen area of the artery which got compromised due to plaque formation,it becomes even more important in the emergency like situation when patients suffer from the Heart Attack as due to thrombus a blood flow is totally stopped or compromised leading to the death of cardiac muscles due to lack of oxygen this need a immediate action to remove the thrombus or clot with help of medicines or angioplasty.

The idea of cardiovascular stents revolutionized the treatment of coronary-related diseases. Since then, stents have been used in coronary and peripheral procedures for decades. Let’s take a look at newer kinds of stents, their evolution and understand why better stents are needed.­­­­­­­­

What is the function of stents? 

The main purpose is to open the blocked coronary arteries which occurred due to plaque formation. A stent is a tiny mesh tube inserted into a blocked passageway to keep it open, it restores the flow of blood. It is usually needed when plaque blocks blood vessels. Commonly used heart stents  are made up of materials like stainless steel,cobalt chromium or platinium. It can be coated with medication to facilitae optimal healing.

Evolution of early stents

The first used stents were successful at reducing the risk of restenosis following angioplasty by about half, from 20% to 10% in the 12 months following the procedure. The first generation of stents was called bare-metal stents (BMS) as they were mostly fabricated from metal. These permanent frameworks are made from chrome steel and cobalt-chromium alloys for balloon-expandable and Nickel-titanium for self-expanding stents. This revolution was considered the turning point in the field of angioplasty however it had its disadvantages of increased risk of restenosis.

Stent developers started to coat bare-metal stents with polymers containing drugs that were aimed at inhabiting extra tissue growth at the site of the stent to reduce the rate of restenosis. These stents are called drug-eluting stents (DES). DES has been constantly developed by using several drugs.

DES has bought its advantage to overcome the limitation of BMS. Despite the influence in the clinical practice in vascular intervention, the major subject of the debate was incomplete endothelialization and hypersensitivity reactions to the polymer coating. The first-generation DES had all these drawbacks which had them failed. Due there coating material not being biodegradable or biocompatible their long-term efficiency was questioned. The potential risk associated with DES were late thrombosis and delayed healing.

The formation of a grume within the artery at the location of the stent is stent thrombosis. It is different from restenosis. Restenosis is the regrowth of tissue, it is a problem but it grows gradually so when it occurs there is time to treat it. In contrast, stent thrombosis tends to occur suddenly without warning, it commonly leads to the complete occlusion of the artery that then tends to produce a myocardial infarction (Heart attack) or sudden death.

In the youth of stenting, the matter of early thrombosis was recognized and successfully addressed by administering powerful antiplatelet or blood thiner for a couple of months after stenting. But within few years of the widespread use of DES the problem of late thrombosis was discovered. Late thrombosis may be a sudden thrombosis within the site of the stent that happens a year or two after the procedure. It is as catastrophic as early stent thrombosis. Hence the cardiologists started prescribing antiplatelet therapy for up to a year or for longer period of time. The strong use of anti-platelet drugs carried the risk. The problem of late stent thrombosis led stent developers to a challenge to develop a new type of stent that reduces this problem or eliminates it.

Researchers now believe that the polymer coating on DES may themselves increase inflammation and delay healing. Now several companies are identifying the problem and trying a general approach keeping this in mind.

Advanced stent technology  

Better durable polymers DES appear to cause less inflammation and also allow better healing at the site of treatment. These stents are referred to as second-generation DES, the newer stent design use cobalt-chromium which has greater radial strength per thickness and is radio-opaque, and thus allows thinner struts.

Bioabsorbable polymers

DES has been available for several years, they employ a polymer coating which is absorbed within few months leaving just the bare stent. These stents offer the benefits of DES for several months then they become BMS. This reduces the risk of late thrombosis. As compared to the first generation DES the risk of late thrombosis is reduced with both second-generation DES and bioabsorbable polymers DES. But there is no indication that bioabsorbable polymer performs better than the second-generation DES. They both still require very prolonged therapy and anti-platelet tests.

Bioresorbable stents

Bioresorbable stents also called as bioresorbable scaffold, biodegradable stent, or naturally- dissolving stent they are made from a material that may dissolve or be absorbed in the body. The main purpose of the bioresorbable stents is to overcome the drawbacks of DES and BMS. Currently, A metallic drug-eluting stent remains in the body as a permanent implant which can lead to an increased risk of complications year on year. It may pose a hindrance if the future procedure needs to be performed in the same artery. But on the other hand, BRS provides a temporary scaffold to the lesion to restore the blood flow, once the blockage is treated and healed completely BRS dissolves on its own leaving the artery in its natural state with no foreign residue. Hence providing both physicians and patients the room to explore further treatment, if required in the same blood vessel.    

We get to see all these extraordinary engineering in stent technology, it seems like sooner or later we might develop stents that would be able to eliminate the risk of both restenosis and thrombosis. But you need to make sure that before you agree to a stent talk to your doctor and explore options whether it will be helpful for you.

The news that one might be suffering from a heart condition that requires a heart stent can be stressful to process. It is important to understand the reasons why your doctor might have recommended a stent in the first place.

Arteries are blood vessels that carry out the function of circulating blood away from the heart to the rest of the body. They are shaped like tubes and the pumping contractions of the heart propel the blood through the arteries.

When a buildup of plaque i.e cholesterol, fat, and other substances collect in the bloodstream, it sticks to the walls of the arteries, and over time, this buildup narrows the arteries, limiting the amount of fresh blood that can be circulated to the body. 

Over time, people with narrowed coronary arteries may begin to notice symptoms such as chest pain. This buildup of plaque in the coronary arteries is a cause of coronary heart disease. People with this condition may be at a higher risk of many serious complications such as a heart attack or a stroke if they do not receive treatment.

What is Coronary Artery Disease? Coronary Artery Disease (CAD) is the most common form of heart disease. It occurs when one or more of the coronary arteries becomes narrow, thus restricting the flow of blood to the heart muscle. Without adequate blood, supply the heart becomes starved of oxygen and vital nutrients required for the proper functioning of the heart muscle which may lead to chest pain called angina. The process is often called hardening of the arteries or atherosclerosis.

Symptoms of CAD may include

Early warning signs such as

  • A squeezing, suffocating, or burning feeling in your chest tends to start in the center of your chest but may move to your arm, neck, back, throat or jaw.
  • fatigue
  • pain
  • dizziness

Symptoms in women are comparatively non-traditional:

  • vague chest discomfort
  • fatigue
  • indigestion
  • Anxiety
  • sleep difficulties

If left untreated, CAD can lead to other serious problems such as heart attack, stroke, or even death.

When a coronary artery is narrowed by a buildup of fatty deposits called plaque, it can reduce blood flow, causing chest pain. If a clot forms and completely blocks the blood flow to part of the heart muscle, it can result in a heart attack.

Therefore if the artery is at risk of collapsing or becoming blocked, doctors may recommend inserting a stent to keep it open.

What is a stent?

A stent is a tiny wire mesh tube that your doctor can insert into a blocked artery passageway to keep it open. Its function is to open the blocked artery and post-treatments stents remain permanently in the body. Stents are made of either metal or plastic. Stents can also be coated with medication to help keep a blocked artery from closing.

How are stents used?

The stent is mounted on a balloon catheter. It is tracked through the artery to the narrowed segment/blockage which is then moved into the area of the blockage. The balloon is then inflated resulting in the stent expanding and locking in place, forming a scaffold that holds the artery open. The balloon is then deflated and withdrawn.

The stent stays permanently and improves blood flow to the heart muscle. Stents are used based on the features of the artery blockage such as the size of the artery and where the blockage is.

What are the advantages of using a stent?

  • After balloon angioplasty or other procedures that use catheters, certain patients may experience a re-narrowing of the artery. Stents help to reduce the re-narrowing.
  • Patients who have angioplasty and stents have less discomfort and also recover faster from these procedures as compared to patients that choose to undergo coronary artery bypass surgery (CABG)

How long will a stent last? Are stents permanent?

Commonly used metallic stents are permanent and stay in the body for lifelong.

Re-narrowing (Restenosis) of the treated coronary artery can occur in some cases and may require a re-intervention in the future. However, with the latest generation, the drug-eluting stents’ restenosis rate has reduced significantly.

Bioresorbable scaffold or stent is the latest innovation in the field of stent technology. Unlike metallic stents, they don’t stay permanently inside the patient body. Post healing, they dissolve naturally in 2-3 years thus leaving the artery in its natural state.

What happens after stent insertion?

Depending on the insertion site, there may be soreness, for which mil painkillers are usually given. Your doctor might prescribe medication to prevent clotting, and might want you to remain at the hospital overnight. This helps ensure that there are no complications. In cases of coronary events like a heart attack or a stroke, you might be asked to stay for a longer time. Depending on the severity of the cause of the stent insertion, such as a heart attack, recovery might take a while. Until then it is advised to take it easy for a couple of weeks, avoid heavy lifting, etc.

Are there any risks involved in the insertion of stents?

Like any other medical procedure, Stenting may also involve risk, but with the latest advancement in technology and the treatment procedure, it has been minimized significantly. One should discuss and understand with their Physician about the common risk factors which is involved with stenting.

Some of the common risk factors may include bleeding from the treatment site like groin from where the catheter was introduced, allergic reaction to dye or stent, re-narrowing of the artery or clot formation, etc

Insertion of a foreign body in your blood, there is a one in 50 chance of blood clots forming on the stent. Your physician may prescribe certain medications to lower the risk of blood clots. 

While a stent can result in remarkable improvement of your condition, it is not a cure for heart disease. You will need to address the contributing factors like high blood pressure, cholesterol, and being overweight as well. Eating a well-balanced diet, exercising regularly, even quitting smoking can lead to a heart-healthy lifestyle.

Disclaimer: This blog is only for awareness purposes. We do not intent to promote any medications given in the blog. Please consult your physician before taking any medication.