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For Patients

Heart

The heart is a muscular pump that provides the force necessary to circulate the blood to all the tissues in the body. Normal adult heart pumps about 5 liters of blood every minute throughout life. Its function is essential as tissue need a continuous supply of oxygen and nutrients and metabolic waste products have to be removed. Blood is the transport medium and heart is the organ that keeps the blood moving through the vessels.

The heart beats an average of 75 times per minute. The size of the heart varies from person to person; average size is 5" (12 cm) long and 3.5" (9 cm) wide—about the size of an adult fist. The heart can weigh 9–12 oz (250–350 gm).

The oxygenated blood flows out from the heart through aorta, which is largest artery in the body. All the major arteries, which supply blood throughout the body, arise from aorta. Blood vessels called veins return the blood to the heart. After picking up oxygen from the lungs, the blood is pumped out to the body again.

Coronary Arteries:

he heart receives its own supply of blood from a network of arteries called the coronary arteries.

Two major coronary arteries branch
off from the aorta are

Right coronary artery

(RCA) - Which supplies 20 – 30 % of the hearts blood.

Left main coronary artery, which again branches into:

The circumflex artery, which supplies 20-30 % of the hearts blood. The left anterior descending artery (LAD), which
supplies 50 % of the hearts blood.

These major arteries branch into smaller arteries that supply blood to every part of the heart muscle.

What Is CAD

Coronary artery disease is the narrowing or blockage of the coronary arteries caused by atherosclerosis. Atherosclerosis
(sometimes called “hardening” or “clogging” of the arteries) is the buildup of cholesterol and fatty deposits (called plaque) on the inner walls of the arteries that restricts blood flow to the heart.

Without adequate blood, Without adequate blood, the heart becomes starved of oxygen and the vital nutrients it needs to
work properly. This can cause chest pain called angina. When one or more of the coronary arteries are completely blocked,
a heart attack (injury to the heart muscle) may occur.

Symptoms of CAD

The most common symptom of coronary artery disease is angina (also called angina pectoris). Angina is often referred to as chest pain. It is also described as chest discomfort, heaviness, tightness, pressure, aching, burning, numbness, fullness, or squeezing. It can be mistaken for indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the left shoulder, arms, neck, back or jaw

1. Pain or discomfort in other areas of the upper body including the arms, left shoulder, back, neck, jaw, or stomach

2. Difficulty breathing or shortness of breath

3. Sweating or “cold sweat”

4. Fullness, indigestion, or choking feeling (may feel like “heartburn”)

5. Nausea or vomiting

6. Light-headedness, dizziness, extreme weakness or anxiety

7. Rapid or irregular heart beats

Remember:

1. Learn to identify your symptoms and the situations that cause them.

2. If your chest pain (angina) last for more than 5 minutes and if you don’t have prescription for nitroglycerin – call for emergency help.

3. If you have been prescribed nitroglycerin and you experience angina, stop what you are doing and rest. Take one nitroglycerin tablet and let it dissolve under your tongue, or if using the spray form, spray it under your tongue. Wait 5 minutes. If you still have angina after 5 minutes, call your doctor.

4. Call your doctor if you begin to have new symptoms or if they become more frequent or severe.

Risk Factors

here are several risk factors for heart disease; some are controllable, others are not.

Risk factors which are Uncontrollable are:

1. Sex (Male or Female)
2. Older age
3. Family history of heart disease
4. Post-menopausal

Still, there are many risk factors that can be controlled. By making changes in your lifestyle, you can actually reduce your risk for heart disease.

Controllable risk factors include:

1. Smoking.
2. High LDL, or "bad" cholesterol and low HDL, or "good" cholesterol.
3. Uncontrolled hypertension (high blood pressure).
4. Physical inactivity.
5. Obesity (more than 20% over one's ideal body weight).
6. Uncontrolled diabetes. Uncontrolled stress and anger.

Here are some ways you can reduce your risk of heart disease

1. Quit Smoking
2. Improve cholesterol level
3. Control high blood pressure
4. Control diabetes
5. Get Active
6. Eat right
7. Achieve and maintain a healthy weight
8. Manage stress

Here are some ways you can reduce your risk of heart disease

Doctor may take various methods to diagnos CAD

1. Electrocardiograph tests, such as an electrocardiogram (ECG or EKG) or exercise stress tests, to evaluate the electrical activity generated by the heart at rest and with activity.

Echocardiogram, involves a use of transducer which works on a sound wave to detect the problem with your heart; sound waves produced by the transducer are reflected back from the chest surface which are recevied again and sent to computer to generate report.

2. Laboratory Tests: include a number of blood tests used to diagnose and monitor treatment for heart disease.

3. Coronary angiography performed by a cardiologist in a cardiac catheterization; involve inserting catheters into the blood vessels of the heart in order to get a closer look at the coronary arteries. (most confirmatory test among all)

These tests help your doctor decide how to treat you.

Treatment of CAD

Treatment of coronary artery disease is aimed at controlling symptoms and slowing or stopping the progression of disease. The method of treatment is based on many factors determined by your symptoms, a physical exam, and diagnostic testing. You may be asked to change the life style, physical activity and diet control. If the blockage is less than 70 percent, medications may be the first line of treatment and if greater than that you might be asked for angioplasty with or without stent or coronary artery bypass surgery (CABG).

To prevent damage to your heart muscle, do not delay seeking medical treatment.

Angioplasty

Procedure in which a thin tube known as guiding catheter is inserted through a groin or wrist and is then moved towards the site of blockage.

A small balloon at the tip of the balloon catheter is inserted through the guiding catheter near the blocked or narrowed area of the coronary artery. (See figure below)
Balloon when inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened (dilated) to increase blood flow to the heart.

Once the plaque is compressed and the artery if opened sufficiently, the balloon catheter is deflated and removed.

Stent Implantation

Stent is introduce into the blood vessel through the femoral or radial artery on a balloon catheter and advanced to the blocked area of the artery.
The balloon is then inflated; which causes the stent to expand until it fits the inner wall of the artery.

The balloon is deflated and withdrawn.Stent stays in place permanently, holding the vessel open and improving the flow of blood.

Coronary Artery Stents

A stent is a small, metal mesh tube that acts as a scaffold to provide support inside the coronary artery. The shape and material of the stent results in a flexibility which can be expanded by a balloon to adapt to the shape and curves of the artery. Once placed stent remains in the artery. During a period of several weeks, the artery heals around the stent.

Restenosis:

Re-narrowing of coroary artery after it has been treated with either balloon or with the stent. The renarrowing can be caused by vessel recoil and formation of tissue growth in the treated area. The rate of restenosis in the patient treated with balloon is upto 30 to 50 % and with the stent (without drug) is upto 10 to 30 %.

What happens after the Angioplasty Procedure?

After the Angioplasty Procedure, patients are taken to an intensive care unit with special monitoring equipment. Blood pressure, pulse monitoring and ECGs are performed routinely after Angioplasty procedures and do not signify any special problems. You may be asked to stay in hospital for 3 to 5 days depending upon the speed of your recovery.

Important Note:

Angioplasty is not a cure, but a treatment to reduce the effects of Coronary Artery Disease. It is extremely important to follow your medication regimen exactly and control your risk factors.

We wish you a happy and healthy leaving.
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