Dr. Rahul Gupta, Chief Interventional Cardiologist at Apollo Hospital, Mumbai, discusses the symptoms of a heart attack, the difference between acid burn and heart pain and the immediate steps to take in case of a heart attack.
Dr. Rahul Gupta, Chief Interventional Cardiologist at Apollo Hospital, Mumbai, talks about the different kinds of heart attacks, the available treatment options, and their success rates. He also sheds some light on how to live a healthy life to avoid any of these circumstances.
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!
Angioplasties are increasingly recommended for uncomplicated cases with minimum blockages as they are less invasive and require shorter recovery time. However, as with any surgery, there are quite a few precautions that one must undertake to ensure a complication-free recovery. This handy primer is a supportive document to your cardiologist’s advice. In case of any doubts, consult your cardiologist. For your ease, let us break down the recovery period into what one can expect at the hospital after the procedure, the actual recovery, and general precautions.
What to expect at the hospital after the procedure:
1. In the case of groin catheterization, one will need to lie straight with unbent legs while the groin sheath is in place. In some situations, a sheet may be placed across your legs to help you keep them straight.
2. You are advised to stay lying in a flat position for at least 6 hours post sheath removal. This is to prevent hemorrhage. If you are uncomfortable, you can have your head elevated after 2 hours.
3. Moving out of bed will depend on the nature of your recovery and the nursing staff’s advice.
4. It is best to avoid consuming anything other than clear liquids while the sheath is in place. This will help prevent nausea. Remember to stick to a heart-healthy diet once the cardiologist gives the all-clear sign to resume solid food.
5. In case you experience chest pain, swelling, pain at the insertion site or bleeding; call your cardiologist immediately.
6. In case you have had a stent placed in your heart after your angioplasty, you will be required to take certain medicines to reduce the chances of blood clot formation.
7. In the case of arm catheterization, a specialized bandage will be placed to ensure proper healing.
During the recovery period:
1. In case your angioplasty was done without you undergoing a heart attack prior to it, you can be back in the driver’s seat just after 2 days. If you have had a heart attack though, you will need to wait till your cardiologist gives you the green signal.
2. Even though an angioplasty is less invasive, it is still a major procedure so take care and rest to avoid all strenuous activities. Avoid lifting heavy objects (more than 5 kg) preferably till 1 week after the procedure.
3. Getting enough rest does not mean that one can turn into a couch potato though. Regular exercises recommended by the doctor will not only speed up your recovery but also will help in preventing further cardiac incidences. Your diet will also play a major role in your recovery. Consuming a heart-healthy diet that is low in sodium and fats is crucial to your long-term wellbeing.
1. Don’t be in a hurry to resume your routine activities after your angioplasty and stent implantation. Resume them gradually to avoid strain.
2. One major point to remember is that angioplasty won’t cure your disease. It only serves to keep your arteries open. To truly prevent future incidence, you will need to change your lifestyle and diet.
3. Ensure that your diet mainly consists of fruits, vegetables, whole grains, nuts, etc. to decrease your heart disease risk.
4. Reduce and control your salt consumption as well as sugar intake.
5. Most importantly, do NOT skip or neglect your medication. Consume your prescribed medicines such as blood-thinners, lipid-lowering medicines, such as statins or anti-hypertensive as recommended by your cardiologist, depending on your condition.
6. Exercise regularly and maintain a healthy body weight.
7. Do follow-up regularly with your cardiologist.
8. Always carry a stent implantation card with you to avoid unforeseen problems.
1) Stop smoking immediately. Consume alcohol only if your cardiologist says it is ok to do so.
2) Avoid taking on too much stress.
Now that you are on the journey towards healing, here’s wishing you a happy and complication-free recovery period! Get well soon!
With over 13 years of experience as an Interventional Cardiologist in the UK, Dr. Nimit Shah takes the time to explain the various causes of heart attacks in the country and the different treatments available for the same.
Increasingly recommended for those with minimum blockages and low complications, angioplasties are now the standard of care for those with coronary artery disease. As the cardiologist may have already explained to you, this minimally invasive surgery has the surgeon thread a stent bearing balloon catheter through a blood vessel in your groin or arm till it reaches the blocked artery. The balloon is then inflated to push the plaque to the sides of the artery and the stent is put in place. The balloon is then deflated and removed and a bandage or groin sheath is put in place to prevent the patient from bleeding out. The other alternative is open-heart surgery or Coronary Artery Bypass Grafting where arteries from one’s arms or legs are grafted on to the existing coronary arteries. As this surgery is more invasive and requires a longer rehabilitation time, it is advocated only for cases where there are multiple or severe blockages or other complications are present.
Recovery after your procedure
The road to recovery after your angioplasty or bypass surgery can be long and at times frustrating. However, with a little precaution and care, one can improve their recovery process and sometimes even speed it up. Remember, self-care is critical after your procedure.
- Pain management: Dealing with the mental and physical after-effects of angioplasty or bypass can be aggravated by poor pain management. Therefore, staying on top your pain management schedule is vital for your recovery. Remember to regularly take your pain medication if so advised by your cardiac surgeon at the appointed times. Alleviating your pain can also help speed up the healing process.
- Get enough sleep: The old adage that sleep is the best medicine holds for those who have undergone bypass or angioplasty. It may be difficult to fall asleep in the first few days or weeks after your procedure, but there are some things that you can try to get the optimum amount of shut-eye. Things, like staying on top of your pain medications and avoiding caffeine in the evenings, can go a long way in helping you relax.
- Seek help: Experiencing a cardiac event can be a traumatic event for even the strongest people. It is quite normal to find yourself feeling vulnerable, anxious or depressed. If your feelings don’t go away or start affecting your day to day life, then it is best to consult a psychologist.
- Go to rehab: Going to a properly designed and comprehensive rehab programme can do wonders for your recovery process. So sign up for one if available.
- Remember that your journey is unique: Undergoing a major surgery or procedure is a life-changing event. It is best to be patient and focus on your journey and milestones instead of focusing on someone else’s. Depending on your situation it may take you six months or even a year to fully recover from your procedure. Be patient.
- Exercise and modify your lifestyle: Surgery won’t cut down your risks of getting another blockage or experiencing another cardiac event. Exercise and modified dietary and lifestyle habits are the only things that can reduce your chances.
- Avoid smoking and limit your alcohol intake.
A point to note at this point is that an angioplasty is not a complete cure. Blockages may still occur if the proper precautions like following your doctor’s dietary and exercise recommendations are not followed. A diet rich in fruits, vegetables, whole grains, nuts, etc and low in salt, sugar and oil is the one to follow. Medications like blood-thinners, statins that lower lipids and hypertension drugs should be consumed as per advice and not discontinued at whim. Smoking should be cut out of your life and include a daily exercise regimen of minimum 30 minutes instead. This will help manage your weight and other co-morbid conditions like hypertension, diabetes and high cholesterol too. A happy heart is a healthy one so keep stress at bay by taking up new hobbies and activities; these will elevate your mood and help your recovery process too. Last, but not least, don’t forget your regular check-ups with your cardiologist.
Undergoing a cardiac procedure is a huge event in one’s life. Taking the right precautions and care is a vital step towards one’s recovery and healthier life.
We have all heard the story. A relative or an acquaintance experiences chest pain and immediately rushes to the hospital only to find out that it was severe gas. A more morbid one has the relative ignore the chest pain as gas till it intensifies and upon being rushed to the hospital is found to have suffered a severe heart attack. All these stories underscore the symptomatic similarity between heartburn and heart attack but the truth is that while both are chest pains; they do differ in how they manifest and in symptoms. In fact, 50% of heartburns are mistaken for heart attacks in Emergency Rooms.
So what does one do when faced with debilitating chest pain? The first thing to do is calm down and figure out one’s symptoms.
Classic symptoms of heartburn are:
- A burning sensation in the breastbone or lower part of the chest or in the upper part of the stomach
- Radiating pain towards your throat instead of shoulders and arms
- Feeling of regurgitation or food coming back into your mouth or a bitter taste.
- Worsening pain when lying in a prone position
- Occurring after a heavy meal
Heart attacks, on the other hand, exhibit the following symptoms:
- Chest pain that feels like pressure, squeezing, tightness or heaviness
- The pain comes in waves and continues only for a few minutes at a time
- Felt in the central or central left of the chest and radiates to the arms, neck, jaw or back
- Accompanied by cold sweat, shortness of breath, nausea, vomiting, fatigue and dizziness.
It is advisable to rush to the doctor if these symptoms occur for more than 15 minutes. Unfortunately, not all heart attacks are accompanied by symptoms or if present are mild. Sometimes heart pain is not always a heart attack but simple heart pain or angina. In any case, any pain that is accompanied by the above symptoms warrants an immediate visit to the hospital.
The first hour after a heart attack is crucial for long term
recovery and better outcomes.
Think you have had a heart attack? There are some things that you should do at home before rushing to the hospital or while waiting for the ambulance. They are:
- Immediately consume aspirin, unless allergic to the same. This will thin your blood and prevent further clotting.
- If prescribed, then take a dose of nitroglycerin
- Ask someone knowledgeable with CPR to begin the same and start chest compressions
- Use an Automatic External Defibrillator (AED) if one is
available on hand.
While these methods may better your chances of survival and long term recovery in case of a heart attack, they will not prevent one. The best ways to prevent a heart attack are:
- Avoiding smoking, both firsthand and secondhand
- Keeping your BP and cholesterol levels under control. This can be accomplished with dietary and lifestyle changes. Consult your doctor if you require medications for the same and remember to take them regularly.
- Go for regular health check-ups as the factors that contribute to heart disease, like high BP, cholesterol etc are usually asymptomatic in the early stages.
- Include regular physical activity. Even something as light as 30 minutes of walking, 5 times a week can go a long way in improving and maintaining your cardiac health while also keeping your weight in check.
- Reduce stress and take up hobbies that help you relieve the stress of your work and personal life.
- Consume alcohol only in moderate quantities.
Maintaining a healthy lifestyle is not only important for your cardiac health, but it is also a great way to prevent heartburn as well. Be aware of your body and don’t hesitate to go to the hospital if you are feeling any severe chest pain or accompanying symptoms. After all, it is better to be safe than sorry.
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.