Cardiovascular disease is also called ‘heart and circulatory disease’. It means all diseases of the heart and circulation. This includes coronary heart disease (angina and heart attack), and stroke.
Coronary heart disease
Coronary heart disease begins when coronary arteries- the arteries that supply blood and oxygen to the heart muscle- become narrowed by a gradual build-up of fatty material within their walls. This condition is called atherosclerosis and the fatty material is called atheroma.
In time, the artery may become so narrow that it cannot deliver enough oxygen-containing blood to the heart muscle when needs it- such as when you are doing exercise. The pain or discomfort that happens as a result is called Angina.
Sometimes, the atheroma may break off and cause a blood clot to form. If the blood clot blocks the coronary artery, the heart muscle is starved of blood and oxygen, and may become permanently damaged. This is known as a heart attack. During a heart attack, life-threatening heart rhythms may develop. This is why a heart attack is a medical emergency.
Many people live with stable angina. This is when the symptoms of angina don’t vary much and can be controlled by using medicines. Most people with stable angina-if they take medicines for their heart and make certain lifestyle changes-live a normal or good-quality life for may years.
For other people, a cardiologist or a heart surgeon may advise ‘ revascularisation treatment’. As explained earlier, revascularisation involves making the blood vessels wider, or bypassing blockages, so that the blood flow through them more easily. Revascularisation treatment, along with medication, can control the angina symptoms more effectively and can greatly improve your quality of life.
There are different types of revascularisation treatment. They include:
Coronary angioplasty with a stent (or, very occasionally, coronary angioplasty without the stent), and coronary bypass surgery. Deciding what treatment you need Before the doctors decide what treatment to advise, they will ask you to have a coronary angiogram.(This is sometimes called cardiac catheterisation.) This test shows where your arteries are narrowed and how narrow they are.
Three out of every ten people who have a coronary angiogram go on to have an angioplasty. Of the others, some will not need treatment, some may need coronary bypass surgery, and some will need treatment with drugs.
Sometimes, the doctors will do a coronary angioplasty immediately after the coronary angiogram. However, some people may be asked to return in a few months for the procedure. If you have a silent ischaemia
Angioplasty is used to treat the symptoms of angina. If you have a condition called silent ischaemia- that is, if you have a narrowing of your arteries but you don’t have any symptoms-an angioplasty may not be the right treatment for you. You should discuss your treatment options with your specialist.
Coronary angioplasty is a technique that ‘squashes’ the atheroma (fatty tissue) in the narrowed artery, making the inside of the vessel wider and allowing the blood to flow through it more easily.
Coronary angioplasty is also called balloon angioplasty, balloon dilatation, PTCA(percutaneous transluminal coronary angioplasty), or PCI (percutaneous coronary intervention). Coronary angioplasty as a planned treatment or an emergency procedure
Sometimes coronary angioplasty is done as a treatment that is planned beforehand, and sometimes it is done as an urgent or emergency treatment
As a planned treatment
Coronary angioplasty cannot be used for everyone who has angina. Before you are accepted for coronary angioplasty, you will need to have a coronary angiogram. You can have an angioplasty treatment more than once. Also, angioplasty can sometimes be used if you have already had coronary bypass surgery but your angina has come back or got worse because one of the grafts has become narrowed or blocked.
As an emergency treatment
Coronary angioplasty is also used, in an emergency, to treat some people who have acute coronary syndrome. Acute coronary syndrome is a general term which covers the following conditions.
A heart attack-This is sometimes called a coronary thrombosis or myocardial infarction.
Unstable angina- This means angina that comes on with less and less physical activity, or even while you are resting.
When someone gets a chest pain or chest discomfort, at first it is sometimes difficult for the doctor to tell whether the person is suffering from unstable angina or having a heart attack. So, if this happens to you, your doctor may say that have acute coronary syndrome. (‘Syndrome’ means a set of symptoms that happens together, and ‘coronary’ means to do with the heart.) The technique involved in an emergency coronary angioplasty is the same as for a planned coronary angioplasty. However, if you have acute coronary syndrome, you may be given extra drugs when the angioplasty is carried out.
Before you have the angioplasty, you will be given a local anesthetic. A catheter (a fine, flexible, hollow tube), with a small inflatable balloon at its tip, is passed into an artery in your groin or wrist.
A radio-opaque dye (one that shows up on X-rays) is injected into the arteries so that the doctor can see where the blocked or narrowed arteries are. The dye can sometimes cause a hot, flushing sensation which lasts a few minutes. The operator then uses X-ray screening to insert the catheter to the affected coronary artery until the tip of the catheter lies across the narrowed or blocked section. The balloon is then gently inflated so that it squashes the fatty tissue that is causing the narrowing. As a a result, this widens the artery. For a few seconds while the balloon is being inflated, you may experience angina, but the pain eases very quickly when the balloon is let down again.
A second catheter, with a stent on its balloon, is then moved into position in the widened part of the artery. A stent is a short tube of stainless-steel mesh. As the balloon is inflated, the stent expands so that it holds open the narrowed blood vessel. The balloon is then let down and removed, leaving the stent in place.
Sometimes the angioplasty can be carried out using just one catheter instead of two. In this case, the stent can be inserted at the same time as the vessel is widened.
In the past, angioplasty was done without using stents, but stunting is now routine and is used in about 94 in 100 angioplasty procedures.Although it sounds simple, angioplasty can be technically difficult to do. The first part is similar to the coronary angiogram. However, it can take much longer to get the balloon catheter and stent into exactly the right position.
Heparin-During the procedure you will be given an injection of a blood thinner-usually an anticoagulant drug. It stops the blood from forming clots. The effect of heparin last for just a short time and you will need other medication to reduce the risk of clots forming in the long term. more.
Stents are used in most angioplasties. Two types are used:
Bare Metal Stents(or uncoated stents), and Drug-Eluting Stents (also called coated stents).
Bare Metal Stents have been available for many years and are the most commonly used. Drug-Eluting Stents are coated with a drug which reduces the risk of the artery becoming narrow again after the angioplasty. However, there is a slightly greater risk of clots forming with this type of stent. So, if you have a drug-eluting stent, you will have to take clopidogrel for longer. more.