It is performed in an operating theatre under general anaesthetic. The surgeon will open the sternum to allow good access to the heart. This creates a bypass, or a secondary circulation, through which the blood can reach the heart muscle without any obstructions.
Stents are spring-like metal tubes that are placed inside the obstructed coronary artery by means of coronary angiography or a coronary catheterisation. A stent is placed to prevent an artery from becoming obstructed again shortly after it has been unblocked.
When platelets circulating in the blood come into contact with the metal stent they tend to clump together aggregate and form a clot. The clot can occlude the artery once again and lead to a heart attack. Patients therefore take platelet aggregation inhibitors to stop platelets from sticking together and forming clots inside the stent. There is a very high risk of thrombosis in the first few weeks after stenting and so the recommended treatment includes two different platelet aggregation inhibitors.
Treatment duration depends on multiple factors, including the type of stent implanted. After placing a stent, cells in the coronary artery start to grow towards the inside of the stent until they cover it completely; this process is known as endothelialisation.
However, if the cells continue to grow towards the middle of the stent they may eventually start to obstruct the artery and the symptoms of angina will reappear. Bare metal or uncovered stents. These are usually made from steel or cobalt chromium. Stents are essentially metal meshes formed into the shape of a tube. They are available in several different diameters and lengths, providing a good fit inside any artery. Artery cells grow over the inside of bare metal stents more quickly than they do drug-eluting stents; therefore the risk of thrombosis lasts for less time, but there is a greater risk of restenosis.
After receiving a bare metal stent, patients must take two platelet aggregation inhibitors for at least one month, after which they should continue indefinitely with a single anti-aggregant. Drug-eluting or covered stents. They have the same basic cylindrical mesh structure as bare metal stents, but the metal surface is coated with a drug. The drug inhibits the progress of artery cells growing towards the middle of the stent and therefore reduces the likelihood of stent restenosis.
On the other hand, this means the metal surface of the stent remains in contact with the blood for more time, hence the risk of thrombosis extends over a longer period. Therefore patients must take a combination of two platelet aggregation inhibitors for longer 3, 6 or up to 12 months. The essential objective of long-term treatment is secondary prevention, i.
This requires a combination of lifestyle changes and drug therapy. Lifestyle modification is the key to avoiding or preventing Ischaemic Heart Disease as it is much more effective than any pharmaceutical or surgical treatments and does not have any contraindications.
Unfortunately, despite this, it sometimes proves to be the most difficult point to achieve. Stop smoking. Although it is sometimes difficult, making every effort to quit is always worthwhile. Eat a balanced diet. Patients must take into account both the amount and type of food they eat.
Firstly, you should maintain a suitable weight according to your age and height. Secondly, it is important to follow a diet rich in fruits, vegetables, pulses and fish. Regarding meats, you should preferably eat chicken, turkey and rabbit as they have a lower fat content. Finally, only occasionally eat red meats beef, duck, lamb , cured meats, confectionery and pastries.
Exercise regularly. Physical exercise improves cardiac muscle tone and function. Exercise helps control other risk factors, such as obesity , high blood pressure or diabetes. You do not need to perform intense physical exercise, but it should be done on a regular basis. Choose an activity that you like, e. Stressful situations, often related to work or family problems, have a negative impact on our health. The fact that you have suffered a heart attack can also produce a great deal of anxiety and depression.
It is important you learn to relax and dedicate a part of each day to looking after yourself. If you find it difficult, then seek help from a professional. Control the risk factors. Maintaining the diseases associated with atherosclerosis obesity , diabetes , high blood pressure or hypercholesterolemia under good control helps improve your prognosis. Moderate alcohol consumption. Recommendations are two glasses of wine per day for men and one glass per day for women. The consumption of distilled drinks can have negative repercussions on your cardiovascular health.
Some medical centres offer cardiac rehabilitation programmes for patients with Ischaemic Heart Disease or cardiac insufficiency a weak heart. These programmes are based on regular physical exercise performed under supervision, together with diet and lifestyle recommendations adapted to each individual. They have proven very useful in terms of improving patient evolution and are recommended in the vast majority of cases. This will help determine how high your cardiac risk is.
The type of stress test your doctor orders will depend on many things, including whether you can exercise strenuously and how high your cardiac risk is estimated to be before the test.
The most common option is ECG exercise stress testing, but your doctor may also order a stress test that uses echocardiography ultrasound for the heart or nuclear scanning. Your doctor may also choose cardiac computed tomographic angiography CCTA to examine your heart and blood vessels.
This resting test is usually done for patients who have previously had a heart attack, have signs of heart failure, have a complex arrhythmia, or a heart murmur. Resting tests may also be done using nuclear imaging. Refer you to an invasive cardiologist for cardiac catheterization angiography. In this test, dye is injected into the arteries of your heart so that blockages can be seen on X-rays.
Your Treatment Plan To keep you healthy, your doctor may recommend: Participation in a cardiac rehabilitation program, to support you in making healthy lifestyle changes and in managing medications. Healthy lifestyle habits that include: Eating a diet that is low in cholesterol, saturated fats, trans fats, and salt, and that includes lots of fresh fruits and vegetables, and whole grains.
Maintaining a healthy body weight. Exercising 30 to 60 minutes at moderate intensity, such as brisk walking, at least 5 days a week. Taking steps to reduce stress and relieve depression.
Stopping smoking and avoiding second-hand smoke. Limiting alcohol intake to 1 to 2 drinks a day for men and 1 drink a day for women. Getting an annual flu shot. Medications that: Keep blood levels of cholesterol and other lipids under control usually statins. Prevent heart attack, including daily low-dose aspirin 75 to mg , clopidogrel Plavix if you are at high risk, beta blockers, and angiotensin-converting-enzyme ACE inhibitors or angiotensin-receptor blockers ARBs. Relieve chest pain and other symptoms, including beta blockers and nitroglycerin tablets to put under your tongue in case you suddenly develop chest pain.
To reduce your risk for silent ischemia, you should reduce your risk for heart disease in general. Here are some things you can do:. If you are diagnosed with silent ischemia, your treatment plan will be developed based on several factors, including your age and overall health, your lifestyle, and your risk factors. Treatment options may include:. Silent ischemia may be treated by internal medicine doctors; however, most doctors will refer their patients to a cardiologist, heart surgeon, cardiovascular surgeon, or cardiothoracic surgeon for diagnosis and treatment of silent ischemia and the underlying cause.
Other doctors may also be part of a multidisciplinary team of experts to treat your heart disease. Find a Beaumont cardiologist near you today, or call for a referral. What is silent ischemia?
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