The 2 main coronary arteries are
The RCA gives rise to the sinoatrial nodal branch of the right coronary artery, the posterior descending artery branch of the RCA, and the marginal branch. The LMCA branches into the circumflex and LAD. The circumflex artery gives rise to the left marginal artery and posterior descending artery in a left-dominant heart.
There are three types of coronary heart disease, including:
Obstructive coronary artery disease, the most common type, is caused by plaque buildup in your arteries.
Nonobstructive coronary artery disease is caused by artery spasms and blood vessel irregularities.
Spontaneous CAD is caused by a tear in the layers of your coronary artery wall.
The stages of coronary artery disease are normal (no plaque), mild, moderate, and severe.
By symptoms, one can notice the CAD Mild symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity.
Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20-100 m).
Comfortable only at rest.
Blockage, of the arteries due to cholesterol, then overexercising may cause chest pain and increase the risk from the underlying condition.
Percutaneous coronary intervention (PCI) coronary artery bypass grafting (CABG) Plain old balloon angioplasty (P0BA)are considered revascularization procedures, but only CABG can prolong life in stable coronary artery disease.
Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. A coronary artery stent is a small, metal mesh tube that expands inside a coronary artery. A stent is often placed during or immediately after angioplasty.
Risks of coronary angioplasty with stent placement may include re-narrowing of the artery.
Re-narrowing of the artery, also called re-stenosis, is more likely to occur if no stent is used. If the stent is coated with a medicine, there is even less risk of narrowing.
Angioplasty risks include:
A diet low in cholesterol and saturated fats can help lower cholesterol levels and reduce the risk of blocked arteries, contributing to a healthy heart and optimal recovery after angioplasty
People who have been diagnosed with atherosclerosis are candidates for an angioplasty
POBA ..Balloon angioplasty is a procedure used to open narrowed or blocked arteries. It uses a balloon attached to a catheter thaws inserted into an artery. At the place where deposits of plaque have closed off or narrowed the channel for blood flow, the balloon is inflated.
About 35O'o to 40O'o of patients who have balloon angioplasty are at risk of more blockages in the treated area. This is called restenosis. Restenosis usually happens within 6 months after balloon angioplasty. Arteries that have stents can re-close, as well.
Balloon angioplasty is a minimally invasive cardiac catheterization procedure used to open narrow and blocked arteries. Heart stents are tiny lattice-shaped metal tubes that serve as scaffolding to keep the artery open.
Balloon angioplasty has several advantages over stenting. It may avoid vessel damage such as perforator occlusion and in-stent thrombosis.
Bypass surgery is also more effective than stenting for diabetic patients. Coronary Artery Bypass Grafting (CABG), also called heart bypass surgery, is a medical procedure to improve blood flow to the heart. It may be needed when the arteries supplying blood to the heart, called coronary arteries, are narrowed or blocked.
CABG uses your veins (usually from the legs) or arteries (usually from the chest or arm) to bypass narrowed areas and restore blood flow to the heart muscle The arteries used for CABG are the Internal Thoracic Artery (ITA), Saphenous Vein (SV), Radial Artery (RA), Right Gastro Epiploic Artery (RGEA), and Occasionally Ulnar Artery (UA)
Possible risks of Coronary Artery Bypass Graft surgery (CABG) include: Bleeding during or after the surgery. Blood clots can cause heart attack, stroke, or lung problems. Infection at the incision site. Irregular heart rhythms are called arrhythmias.
Foods to avoid after heart bypass surgery include:
According to the patient's age, Coronary Artery Disease can be considered temporary or permanent. Patients above 60 to 65 often have atherosclerosis, so their blockage may be considered as permanent and they may need angioplasty or bypass surgery.
Patients below the age of 60 do not typically have age-related coronary artery disease, unless they are smokers, have been diabetic for more than 20 years, or have other factors contributing to aging. Most patients below 60 have temporary blockages due to high triglycerides, LDL, or total cholesterol.
For patients under 60, instead of opting for angioplasty or bypass surgery, it is advised to reduce cholesterol levels through medication and dietary control. Only after reducing cholesterol levels, vigorous exercise should be pursued to avoid the development of LVH and the potential for palpitations and heart failure. Patients should also be aware that medication may need to be continued for life and that complications could develop after 10 to 15 years. In my opinion, angioplasty and bypass surgery are for patients who have developed atherosclerosis.
In cases where a patient develops spontaneous CAD or is in an emergency situation as a young adult, balloon plasty should be chosen as the life-saving treatment. After this, medication and dietary management should be continued followed by a healthy lifestyle and avoiding other medications.
To understand blockages, an angiogram is not always necessary. By using an echocardiogram, the thickness of the heart muscle can indicate a lack of blood flow. An angiogram should only be performed on those who are ready for angioplasty, in order to determine the location and extent of blockages. Only after a patient is 100% committed to angioplasty should an angiogram be done, otherwise unnecessary invasive procedures should be avoided. By assessing symptoms, performing ECGs, echocardiograms, and analyzing blood reports (except for in the above-mentioned conditions like smoking, diabetes, and high uric acid), one can determine if there is a lack of blood supply. The goal is to take medication, follow the prescribed diet, reduce fasting cholesterol profile readings, start exercising, and gradually reach vigorous exercise. FLP should be intermittently rechecked and, once symptoms improve, medication can be slowly stopped. For severe symptoms or emergencies, an angiogram and balloon plasty should be considered, but angioplasty should be avoided.
If a patient has high cholesterol and is exercising. symptoms are likely to occur. These symptoms can help determine the extent of the blood flow to the heart muscle. Patients with high cholesterol should not undergo TMT due to the high risk of a heart attack during exertion.
Understanding how much blood flow is compromised is more important than the extent of blockage. If collaterals are present, as in the case of CABG, there is a lower chance of reduced blood flow to the heart muscle.
The most important point is that if a patient has a heart attack and a stent is placed, there is a high chance of heart dilation and the ejection fraction decreasing. Once the myocardium is damaged, you cannot fully recover.
+91 83049 11000
drpraveena@drpraveena.com
+91 83049 11000
drpraveena@drpraveena.com