Heart Attack


Cardiovascular diseases (CVDs) also called Heart diseases are a group of disorders of the heart and blood vessels. The numerous problems causing most of the CVD is atherosclerosis (blockages in coronary arteries), a process mainly governed by lifestyle factors. As per World Health Organization, It is estimated that 17.7 million people died from CVDs in 2015, representing 31% of all deaths taking place worldwide; more people die every year from CVDs than from any other cause.  Cardiovascular diseases are showing an increase among the Indian population. CVDs form a significant share of 24% from the 53% of all the deaths attributed to non-communicable diseases (NCDs) in India, as per the nation-wise statistical estimate of the WHO on NCDs.

In older men, nearly all heart attacks are caused by atherosclerotic blockages in coronary arteries. Classical coronary artery disease (CAD) is also dominant amongst young adults. Around 60% of these younger adults are affected by CAD in a single coronary vessel, whereas the older adult patients are more prone to get affected by CVD in multiple arteries. The rate of coronary heart disease in young Indian men is almost twice as high as that in their western counterparts and there is evidence that Cardiovascular diseases (CVD) affect Indians at least 10 years earlier as compared to their counterparts in Europe. CVD stays the number-one danger to the health of women. There is a strong gender difference in CV-related death, with more affected women dying each year as compared to the affected men. The lifetime risk of a woman dying from heart disease is eight times more than that of breast cancer. Also, People with diabetes, particularly type 2 diabetes, may have the following conditions like Hypertension, cholesterol, poor sugar levels etc. that contribute to their risk for developing cardiovascular disease.

Listen to Dr. Nimit Shah as he takes the time to explain the various causes of heart attacks in the country and the different treatments available for the same.

Listen to Dr. Nimit Shah, Interventional Cardiologist in the UK, Dr. Nimit Shah talks about the various risks and benefits of angioplasty, the different kinds of angioplasty procedures, and the different kinds of drug stents available in the country for the same.

Read more about Meril’s  state of the art Drug Eluting Stent Evermine50 here

If you have coronary artery disease then there’s a high possibility that your doctor might suggest you to go for a stent placement surgery. But do you really need it? It’s a call of your doctor, considering your case he will suggest the best treatment for you. Stent placement is helpful but may pose risks in some cases. For those who don’t know what exactly is the purpose behind using stents and what stents are, this blog will help you get better insights.

Stents are tiny mesh tubes inserted to keep coronary blood vessels (arteries) open post angioplasty (a procedure to restore blood flow through narrow or blocked arteries). The coronary arteries supply blood and oxygen to heart muscle cells. If a coronary artery narrows, you may develop signs of angina, shortness of breath, a cold sweat, and light headedness. That’s when a stent can be lifesaving.

DES (drug-eluting stents) release a drug slowly from their outer coating to aid in preventing blockage at the particular site. Hence, DES are preferred over BMS (bare-metal stents) for the majority of the patients as they prevent recurring blockages. Stent technology has progressed over the years. In today’s scenario, stents are easier to implant and cause fewer complications and side effects.

Your doctor normally embeds a stent applying a minimally invasive method. They can help prevent arteries from becoming narrow or blocked again, however, they don’t cure heart diseases. But what is living with stents in your heart like?

Benefits of living with Stents:
  • Saves your life and alleviates damage to your heart muscles at the time of heart attack by replenishing blood flow to your heart.
  • Immediately relieves/decreases symptoms of heart disease.
  • Reduces the risk of heart attack or stroke in future.
  • Stent placement may diminish your requirement of a CABG (Coronary Artery Bypass Grafting).
  • Stenting is comparatively much less invasive versus CABG and also has a much shorter recovery period.
Harms/Risks of Stenting:
  • You may get an allergic reaction because any foreign object introduced inside can cause flaring up of immune reaction causing an allergic response. However, it’s rarer with currently used stents.
  • Angioplasty can lead to blood vessel damage or heart damage. The procedure requires the surgeon to enter the blocked artery via a catheter (tube). The catheter is entered via a distant artery, usually radial (arm) or femoral (leg). To enter an artery in the heart from such a distant site may cause damage to the artery, and when reached the heart artery (coronary), there are chances of damaging the small artery or the heart itself which can be taken care by the surgeon.
  • Rarely, some potential complications such as heart attack, stroke or renal failure (kidney failure) can also happen.
  • A scar tissue formation can happen inside your stent post stenting procedure necessitating another procedure for removing it.
  • Stenting also carries a risk of blood clot formation which needs medicines for prevention.
  • It cannot ultimately cure your CAD (Coronary Artery Disease). You have to continue managing your contributing risk factors for CAD such as hypertension, overweight, diabetes or high cholesterol.

Life after heart stent should return to normal routine a week after stenting. Avoid strenuous exercise and lifting heavy objects for a while. Consult your doctor about any other restrictions.

Consult your doctor immediately if:

  • The place where your stent was inserted starts bleeding or swelling.
  • You feel pain or discomfort.
  • You have symptoms of infection such as redness, swelling, drainage or fever.
  • You feel weak.
  • You experience chest pain or shortness of breath.

To prevent blood clots around your stent, your doctor may prescribe antiplatelet therapy post stenting. Antiplatelets are a combination of medicines that prevent blood cells (called platelets) from sticking together and forming a blood clot. The expected lifespan of a patient post multiple stent implantation really rests with the patient and how they manage their disease.

If you manage your risk factors well as per your cardiologist’s advice, you may live a prolonged and productive life even after getting stent implantation done in your major arteries. However, the most vital aspects which you should consider are diet and regular activities. The type and amount of food you consume can control your risk factors for a heart attack such as diabetes and obesity. Even minor modifications in your dietary habits can make a huge difference in the health of your heart.

The mere thought of getting a cardiac arrest can make your heart beat faster for a moment. But today, even if a heart attack is a perilous event, there are many ways to circumvent the same.

Angioplasty or stenting can be a lifesaver option, mainly when performed right after a heart attack. Putting in a stent helps prevent the narrowing of arteries, which improves your blood flow and prevents further damage to your heart. Once patients are diagnosed with coronary artery disease many of them undergo angioplasty, because for two reasons: a doctor suggests it because of its high success rate and less invasive technique, and secondly, it improves the lifestyle significantly by reducing the risk of getting another heart attack.

Now, let us go deeper into understanding what these stents are and how can they help reduce further problems.

Stents are tiny mesh tubes inserted to keep arteries open post angioplasty. The coronary arteries are responsible for carrying blood and oxygen to heart muscle cells. A heart attack often occurs when plaque breaks open and causes the formation of a blood clot in a partially clogged artery, blocking the blood flow. This is when stenting comes in and is used and can be a lifesaver option. Stents come in various forms but DES (Drug Eluting Stent) is the most commonly used ones during Angioplasty worldwide.

After implantation, DES releases a drug from its outer coating to help in preventing blockage at the particular site. Hence, DES are preferred over BMS (Bare Metal Stent) for the majority of the patients as they prevent recurring blockages in the arteries.  Also, the recent DES are termed to be at least as safe as BMS. However, there are chances blood vessels could again get blocked after stent placement. In the case of BMS, post-implantation as the vessel heals, tissue begins to grow around the stent but in some cases, the scar tissue overgrowth can lead to re-blockage of the vessel. A DES implantation can avoid this from happening as it prevents scar tissue formation thus maintaining proper blood flow. But, you will require to regularly take blood-thinning medicines to avoid blood clot formation in the stent and prevent the blood vessel from getting blocked again. There are various DES & BMS brands available and they come with their own set of benefits and a cardiologist may suggest one to you based on the requirement.

In other words, Drug-Eluting Stent is effective and can reduce the chances of future heart attacks to some extent. But, remember that stenting can be a life-saver option only if you continue with suggested medication and lifestyle modification like eating healthy food, regular exercise, etc. that your doctor has advised you to follow post the angioplasty.

Want to adopt a heart-healthy diet post angioplasty, but aren’t sure where to start?
One way to begin is by giving a complete makeover to your current diet plan. Focus on making meal plans that emphasize vegetables, fruits and other necessary products with an adequate amount of proteins, carbohydrates and other nutrients. We know, that the main question here is about what exactly to consume and what to avoid post implanting a stent as you may not be that well versed with every food category and ingredients benefiting a person. Hence, we have stated below foods to intake and to avoid after implanting a stent.

Firstly, it is very important that you consult a doctor before jumping onto conclusions and making your diet plans, especially after angioplasty. It is important to understand that each one of us is built differently and one particular diet plan isn’t going to work for all of us. And, hence we believe that even minor differences in your diet post angioplasty can make a huge difference to your heart health. Now, let us read more about it.

  • Consume more whole-grain foods every day: Eating whole grains is associated with various benefits, including a lower risk of diabetes, heart disease, and high blood pressure. They are rich in nutrients, minerals, fibers, antioxidants and has also proven to reduce the risk of a heart attack.
  • Eat more quantities and varieties of fruits and vegetables: People who eat more vegetables and fruits as part of an overall healthy diet are likely to have a reduced risk of some chronic diseases like stroke, cancer, diabetes, influenza or any respiratory disease. They provide nutrients vital for health and maintenance of your body.
  • Reduce salt and sugar intake: Salt and sugar are needed for health. However, we require very little of it to survive. While salt is essential for the transmission of nerve impulses and normal cell function, sugar is a real source of energy with glucose being the most important of all. But, due to rapid urbanization and changing lifestyles, dietary patterns have seen a major shift and processed foods are being consumed more which is indirectly increasing the risk of heart diseases and strokes due to the high amount of salt and sugar content in it. And, for a person who has just undergone Angioplasty, it becomes highly important to maintain a healthy balance of salt and sugar to avoid any further heart illnesses.
  • Cut down on the consumption of fatty foods, rich in LDL, trans fats and saturated fats: Eliminate fatty meats like pork, lamb or fried items, butter, or coconut oil from your diet. There are two main types of potentially harmful dietary fats, trans fat and saturated fat. These types come mainly from animal sources of food, such as red meat, poultry and full-fat dairy products especially whole milk. They raise high-density lipoprotein (HDL or “good”) cholesterol and low-density lipoprotein (LDL or “bad”) cholesterol levels, which may increase your risk of cardiovascular disease.
  • Include good fats in your diet: Dietary fats are important for your body as it is responsible for supplying energy and to support cell growth. They also help in protecting your organs and help in absorbing nutrients and produce important hormones. The simplest way to differentiate good and bad fats is, good fats remain in liquid form at room temperature. Monounsaturated fats and polyunsaturated fats are known as “good fats” because they are good for your heart, cholesterol, and overall health. Some of these sources are nuts, olives, flax seeds, fish oils, etc. Bad fats are of two types, Saturated fat and Trans fat and these have been identified as potentially harmful to your health. Most of the foods that contain these types of fats are solid at room temperatures, such as butter, coconut/palm oil, margarine, beef or pork fat, etc.
  • Fish and lean meat are good options for individuals taking non-vegetarian meals: Lean meats and fish have relatively low-fat content and have high amounts of protein. Protein is an essential part of a balanced diet. Beyond protein’s essential roles in building and maintaining muscle and tissues in your body and helping regulate many body processes, it also promotes satiety fullness and may help in managing your weight.
  • Avoid consumption of red meat: Red meats (beef, pork and lamb) have more saturated (bad) fat than chicken, fish and vegetable proteins such as beans. Saturated and trans fats can raise blood cholesterol and make heart diseases worse.

Finally, remember that a healthy diet is a mixture of all foods you eat and not only power foods that you think are filled with necessary nutrients. Having the right mix of everything (protein, fats, carbohydrates and other nutrients) after Angioplasty is always regarded as healthy. So, speak to your cardiologist, get expert advice on it and work towards building meals that are aimed towards a better and faster recovery.

Undergoing a stent implant is daunting for most people, but having information at hand can demystify the process and make the situation a tiny bit less scary. While most of your questions can and should be answered by your cardiologist, here are a few things you should know about before getting a stent.

What is a stent made of?
After all, in some situations like metal stents, it is likely to be a permanent part of your body going forward. To understand what stents are made of, let us quickly go over what stents are and what they do. As the cardiologist may have already informed you, our hearts are supplied blood by a network of arteries known as coronary arteries. With age and improper lifestyle, these arteries narrow and become filled with plaque deposits which can lead to Coronary Artery Disease, heart attacks, or even death. A coronary artery stent is simply a small, self-expanding, metallic mesh tube meant to be inserted inside the artery post a procedure referred to as balloon angioplasty. The stent keeps the artery wide open and the blood flow, continuous. Now as to their make, stents were traditionally made of a metallic or plastic mesh-like substance; however, stent-grafts are manufactured from fabric. These metallic stents are classically composed of medical-grade metal alloys including stainless steel, nitinol (nickel-titanium alloy), cobalt-chromium alloys (L605). However, these stents are fast falling out of favor. The most common type of stents in use these days, in fact, the ones that are the standard of care presently, are DES or Drug-Eluting Stents. These stents are not only made of polymers that dissolve in one’s blood after a few years but are also coated with drugs that reduce the risk of blockages.

Why is DES the standard of care?
The biggest advantage of DES is that they have thinner struts which can be as thin as < 100 μm, with some ultrathin struts reaching approximately 60 μm. This is vital as the thinner the strut, the lesser chance there is of restenosis or the recurrence of abnormal narrowing of an artery. Thinner struts have also been found to cause a lower inflammatory response which could potentially lead to clotting.
The other benefits of these stents are that they allow the artery to return to its natural shape and curvature, promote early healing, and allows for flexibility and normal dilation and constriction.

Advantages of stents
1) First and foremost, stents literally save lives by alleviating the damage that happened to one’s heart muscles during the heart attack. It does so by replenishing blood flow to one’s heart.
2) Immediately relieve/decrease symptoms of heart disease.
3) Reduce the risk of heart attack or stroke in the future.
4) Getting a stent placement may diminish the need to undergo a CABG (Coronary Artery Bypass Grafting).
5) Stenting is not only comparatively much less invasive versus CABG it also boasts of a much shorter recovery period.

Disadvantages of stents
1) One can get an allergic reaction from one’s stent
2) Angioplasty can result in hemorrhage of a blood vessel or even heart damage, or arrhythmia.
3) In rare cases, complications such as heart attack, stroke or renal failure can also occur.
4) Post-stenting scarring may occur that may require another procedure to remove it.
5) There is a risk of further blood clot formation; however, the cardiologist will already have you on blood thinners for prevention.
6) Stenting is not a cure for coronary artery disease. One needs to be vigilant about one’s diet and exercise while managing the contributing risk factors for coronary artery disease such as hypertension, higher body weight, diabetes, or high cholesterol.

So there you have it, a short primer on stents, how they are made and what you should be aware of while getting them implanted. Hope it has been of help!