Heart Attack


The after effects of finding out that one has a coronary artery blockage can be extremely stressful for both the patient and their families. Coming to terms with one’s illness while dealing with various tests, paperwork and hospitalization are just some things to deal with in the short term. Add to this the thought of what lies next, and the situation becomes quite stressful. Fortunately, the ultimate decision regarding the course of therapy rests entirely with the cardiologist. Depending upon various factors the patient may only be asked to make lifestyle modifications to put them on the path to recovery. However, patients with major blockages in their arteries must necessarily undergo either a Coronary Artery Bypass Grafting or an angioplasty.

Bypass: Coronary Artery Bypass Grafting or CABG involves cutting the patient’s chest open, putting them on a bypass machine that will act as their temporary heart. The surgeon then grafts new arteries from either the arms or the legs on to the blocked arteries. This is an invasive method which requires a long recovery period, thus advocated for complex cases with multiple blockages and complications.

Angioplasty: This is a minimally invasive option that requires less recovery time than a bypass. In this procedure, the cardiologist threads a thin catheter through a blood vessel in one’s arm or groin and inserts a balloon and stent through it. This balloon is inflated once it reaches the blocked area, pushing the plaque to the sides, widening the artery and putting the stent in place. Stents are a wire mesh implant that is made of either metal or polymer, with the latter material gaining more favour these days. Drug-Eluting Stents or DESs are part of the new generation of stents which are rapidly becoming the standard of care. These stents are coated with drugs that prevent clots and are designed to dissolve after a set number of years, thus allowing the artery to recover on its own.

What factors will a cardiologist consider while deciding on the best course of treatment?
Deciding on the best course of action is completely your cardiologist’s prerogative and should be made after proper consultation only. One thing to keep in mind is that not all blockages require surgical intervention. Some minor blockages may simply require lifestyle changes and medicines. These medicines decrease the risk of further plaque accumulation, stabilize the plaque, prevent its breakage and thus prevent total occlusion of the vessel. However, no two patients are the same and what will work for one may not work for the other; therefore individualized treatments are a must. The presence of co-morbid conditions like diabetes, high blood pressure etc, are also major factors that help your cardiologist make the final decision. As mentioned earlier surgery is the only option for major blocks. No matter the course of treatment, medications are a must.

Will my stent completely reduce my chances of getting a heart attack in the long-term?
No option provides a 100% guarantee of preventing heart attacks in the long term. Even stents can experience blockage over time. This occurs when the scar tissue starts to grow around the stent as the artery heals. This phenomenon is most commonly experienced with Bare Metal Stents or BMSs. Drug-Eluting Stents, which are the current standard of care, helps prevent such situations. This is done by coating the outer layer of the stent with a drug that prevents clots. These stents also dissolve after a certain number of years, thus allowing the artery to return to its normal curvature and dilation. No matter the type of stent, one will need to continue taking blood thinners to prevent the recurrence of clots over the course of one’s lifetime.

Experiencing a cardiac event can be terrifying for anyone. However, having a good knowledge of what to expect can reduce the fear and stress to a certain extent. So discuss all your doubts and fears with your cardiologist, no matter how insignificant or trivial they may seem. It may make all the difference to your post-procedure recovery process!

Let’s face it, anything medically related to the heart is a scary experience for most, especially when one is not aware of the procedure in detail. After all, it is one of the most major organs of our body and is responsible for keeping us alive! Most medical jargon can be confusing and thus, liable to make one even more apprehensive, something that should be avoided when one is already suffering from cardiac complications. While most of us are aware of bypass surgeries, stents are something that many people are either not aware of, or are unsure about the exact nature and working of. If you are one of them, then there is no need to worry anymore. Here is your guide to stents and how they help you lead a fuller and healthier life.

To begin with, let us understand what causes heart disease. As most of us are aware, our heart contains many arteries that supply oxygen-rich blood to its muscles and helps it pump. Now, for certain reasons, such as lifestyle, genetic and environmental, these arteries get clogged with fats, specifically, cholesterol. This decreases the blood flow to the heart and makes it pump less efficiently, or worse, causes the blood to clot and leads to a heart attack. This is where stents come into play. These are tiny tubes that are used to keep your arteries wide and blockage free, decreasing the risk of heart disease and to heart ongoing heart attacks. They are usually metallic in nature and are coated with medicines that gradually release into the bloodstream and prevent further blockages.

How does the process work?

To begin with, a small incision is made in a blood vessel located in your abdomen, arm or neck. Your cardiac surgeon will then insert a small tube known as a catheter through the vessel to the artery which is clogged. This tube contains a tiny balloon at its end, that your doctor will inflate in order to widen the artery and restore blood flow. The stent is then placed and the balloon and catheter are removed. The procedure typically lasts an hour and requires an overnight hospital stay for observation. Risks for getting a stent may include: 1) Hemorrhage at the spot of tube insertion. 2) Blood vessel damage at the time of insertion. 3) Infection. 4) Arrhythmia. 5) In rare cases (1-2%), people implanted with a stent may develop a clot at the site of stent placement, increasing the risk of a heart attack or stroke. As this risk is maximum during the first couple of months post-procedure, you will most likely be put on a course of aspirin or some other blood thinners to prevent clot formation.

Is a stent permanent?

In most cases these days, yes. A stent is a permanent wire mesh implant in your artery. While feeling a little worried about having a permanent implant in one’s heart is a scary prospect, the good news is that not all stents are permanent. Dissolving stents are the latest technology available for patients these days. Unlike metal stents that carry a chance of inflammation and resultant blood clots, these temporary stents made of a primer known as polylactic acid, last only about 3-4 years and dissolve into carbon dioxide and water in the end. Instead of the artery being held in place with stiff metal, a dissolving stent lets the artery return to its natural shape and curvature. In fact, stents like those made by Meril, are ultra-thin (50 µm or 65µm) that promote early vessel healing, allow the artery to be flexible and dilate and constrict naturally.

So a dissolving stent is perfectly safe?

There are some drawbacks associated with dissolving stents, namely vessel recoil, the thickness of these stents leading to manoeuvrability and crossing problems, problems in seeing a non-metallic stent through imaging techniques and absence of firm crimping on balloons for delivery. Even with these drawbacks, experts believe that the evidence favours dissolving stents, as they are a rapidly evolving technology. In the near future, dissolving stents will most likely overcome these drawbacks and become the first choice of use for cardiologists.

Can my stent develop a blockage?

Combined with proper diet, exercise and lifestyle changes, your stent implant can last you decades. However, there is a small possibility of the stents developing blockages too. To reduce such occurrences, modern stents are drug-eluting ones that are coated with drugs that reduce the risk of blockages. Even with a stent in place, there are chances that you may develop a coronary artery blockage in other locations or arteries. However, there is no need to live your life in fear. These complications and risks can be easily managed by aspirin therapy, cholesterol and triglyceride control and lifestyle modifications.