Interview

Lifestyle to Blame for Blocking of Arteries

Dr Anil Dhal,

Dr Anil Dhal, Director and Head, Cardiology, Sarvodaya Hospital, in conversation with Shahid Akhter, ENN, talks about angioplasty is a much easier medical procedure compared to surgery

Dr Anil Dhal,

Dr Anil Dhal,
Director and Head, Cardiology, Sarvodaya
Hospital,

People prefer angioplasties as compared to surgeries. Why this shift and surge in angioplasty?

Angioplasty is a medical procedure that opens up blocked or narrowed blood vessels without surgery. During angioplasty, the interventional cardiologist inserts a very small balloon attached to a thin tube (a catheter) into a blood vessel through a very small incision in the skin, about the size of a pencil tip. The catheter is threaded under X-ray guidance to the site of the blocked artery. When the balloon is in the area of the blockage, it is inflated to open the artery, improving blood flow through the area.

What are the risks attached to angioplasty?

Angioplasty is safer than surgery, thanks to modern technology and techniques which makes complications infrequent. However, because the procedure involves stretching one of your arteries, and includes the use of catheters and contrast injection, there is some risk.
Placing a catheter in your artery can damage the artery and may result in bleeding. Even when the artery has not been damaged, you may have a bruise or a small lump where the catheter was inserted. The bruise or lump may be sore, but will go away in a few days to a week. Because everyone is different, there may be risks associated with angioplasty.

What is Rotational Athrectomy Rotablation?

A rotational atherectomy is a type of percutaneous coronary intervention (PCI) that uses a revolving instrument to break up calcified plaque clogging a coronary artery in order to restore blood flow to the heart.Rotational atherectomy uses a tiny rotating cutting blade to open a narrowed artery and improve blood flow to or from the heart. Often a stent”a small tube made of metal mesh”is put in the artery to prevent it from re-narrowing.

What are the risks involved with this procedure?

The risks of rotational atherectomy are extremely low. They include the same risks as balloon angioplasty, as well as heat-produced damage to the arterial walls, temporary slow blood flow, and most rarely, temporary impaired blood flow down the artery. This can generally be corrected with medicines in the catheterization laboratory before the procedure is completed.

What does sudden cardiac death mean? What are the causes and can it be reversed?

Sudden cardiac death refers to the sudden loss of function of the heart. This is often labeled as cardiac arrest. The problem emerges due to an abrupt disturbance in the hearts rhythm which results in the heart not beating or beating too little to keep the person alive. The rhythm disturbances are of different types. Asystole is where there is no electrical activity and thus no heart beat. Complete heart block is where the heart rate is too slow to keep the patient alive for long. In each case, it occurs suddenly or shortly after the onset of symptoms.
Disease of the coronary arteries is the most common cause of sudden cardiac death. This may occur after a heart attack or after an episode where there is reduced blood flow to the heart. Heart muscle conditions such as cardiomyopathies may also cause cardiac arrest. In some individuals with normal hearts, cardiac arrest can occur with certain drugs, both legal and illicit, with lack of oxygen, with chemical disturbances in the blood stream or following a chest injury.
If one can get to the patient within the first few minutes after a cardiac arrest, it is possible to restore the patients circulation by cardiopulmonary resuscitation (CPR) . In addition, CPR alone may restore a normal heart rhythm but often this requires the administration of medicine or the use of direct cardioversion using a defibrillator.

“Although coronary arteries adapt initially to plaques, they eventually narrow the artery and reduce its ability to provide blood to the heart”

What is Coronary artery chronic total occlusion and how is it treated?

Coronary artery chronic total occlusion (CTO) is total or almost complete blockage of the coronary artery for 30 or more days. This is caused by heavy build-up of atherosclerotic plaque within the artery.
Traditionally, patients with CTO who have symptoms as noted above required coronary artery bypass graft (CABG) surgery to clear the blockage. However, with the advent of advanced technology and innovative percutaneous (performed through a needle stick through the skin) techniques, interventional cardiologists are improving the outcomes of percutaneous coronary intervention, making it a viable option for some patients who are experiencing symptoms related to their CTO.
Interventional cardiologists now are able to gently steer special guide wires and catheters across the block- ages. In the last few years, the success rate of the combined percutaneous approach has increased from about 60 percent to 80 to 85 percent. Although the percutaneous approach has potential complications, the complication rate is comparable to that of standard angioplasty (about 1 percent).

What is an aortic aneurysm and how is it managed?

The aorta is the main blood vessel leading away from the heart which is the vessel that distributes blood to all body parts. Its walls can become weakened due to atherosclerosis or to an inherited condition such as Marfan syndrome. The aneurysm usually occurs in the abdominal area below the diaphragm and mostly below the arteries supplying blood to the kidneys (abdominal aortic aneurysm or triple A (AAA) as it may be referred).
In most instances, simply monitoring aneurysm growth is the best management. If an aneurysm is sufficiently large or there is evidence that it is weak or already partially ruptured, your doctor will have it treated urgently. Treatment of a brain an- eurysm is by securing a metal clip around the base of the aneurysm. Treatment of an aortic aneurysm is either surgical during which a patch or artificial piece of blood vessel is sewn in place where the aneurysm was or by an endovascular procedure where a pre-made patch is passed through the artery in your groin and positioned inside the aneurysm which protects it from rupture.

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