Coronary Artery Disease | Dr Raghu

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If you’re trying to lose weight or control your blood glucose levels, you’re likely looking for ways to cut your intake of refined sugar. Artificial sweeteners, such as saccharin, sucralose, and xylitol, are a popular replacement for refined sugar.

heart disease

However, there’s always been controversy around the potential harm these sweeteners can cause in the long run. For instance, long-term consumption can make an individual more susceptible to type 2 diabetes and weight gain. That, in turn, can increase the risk of cardiovascular diseases.

A recent study by the French National Institute of Health and Medical Research substantiates that claim. The report, published in The BMJ, found a higher rate of cardiovascular disease events in participants who consumed higher levels of artificial sweeteners.

A Closer Look at the Study

The study involving more than 170,000 French citizens commenced in 2009 with participants aged 18 years and older. The average age of the participants was 42 years, and a majority of them were females.

The researchers regularly collected information about the participants’ dietary habits, including their consumption of artificial sweeteners. Nearly 37% of participants used such sweeteners and consumed 42.46 mg/day on average.

The artificial sweeteners consumed by the participants included the following:

  • Aspartame
  • Acesulfame potassium
  • Sucralose
  • Saccharin
  • Steviol glycosides (and more)

At the end of the study, the researchers uncovered a direct correlation between the intake of artificial sweeteners and the risk of heart-related ailments. Higher consumers of such sweeteners had a 9% higher incidence of cardiovascular diseases and an 18% higher incidence of cerebrovascular diseases.

While aspartame was associated with an increased risk of strokes, acesulfame potassium and sucralose were linked with a higher risk of coronary heart disease.

What Does That Mean For You?

The recent study of French nationals echoes previous claims about the harmful effects of artificial sweeteners. Long-term consumption of these sweeteners can be detrimental to your cardiac health.

However, that doesn’t mean you should completely steer clear of them. Occasional intake within the permissible limits won’t pose any threat to you. The recommended limit depends on your body weight and the type of sweeteners.

If you’re looking to lose weight, get your blood sugar under control, or embrace healthy eating habits, your best bet is to consult a certified nutritionist. Also, it’s a good idea to consider natural alternatives to refined sugar. These include allulose and stevia. 

Additionally, consider staying away from processed and packaged foods. Many of these items contain artificial sweeteners. Also, they don’t have a high nutritional value and could increase your cholesterol levels.

In Conclusion

Regular consumption of artificial sweeteners like aspartame and sucralose can have an adverse effect on your heart. They increase your risk of coronary heart disease, strokes, and other ailments. 

If you’re looking for ways to minimize your refined sugar intake, consider natural alternatives like stevia. Also, consult a doctor or nutritionist to understand the side effects of different refined sugar replacements.

Dr. C Raghu is an eminent cardiologist with decades of experience. He’s helped countless patients lead healthier lives. If you or anyone you know has been diagnosed with a cardiovascular ailment, feel free to reach out to Dr. Raghu today.

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      Aspirin.jpg

      Doctors devise a customized treatment plan when a patient is diagnosed with a cardiac ailment. Typically, treatment for heart diseases includes a combination of medicines, lifestyle changes, and in some cases, surgery.

      One of the most commonly prescribed medicines for heart-related ailments is aspirin. In this article, we’ll delve deeper into the use of aspirin for heart disease and analyze its pros and cons. Let’s get started.

      What Is Aspirin?

      Aspirin is one of the most widely used over-the-counter drugs in the world. It comes in several forms, but the most common way to take it is as a pill. It belongs to a specific class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs).

      Aspirin

      Besides being an effective anti-inflammatory medication and pain reliever, aspirin has anticoagulant properties. That means it can help prevent heart disease and stroke when taken regularly over time. 

      Aspirin works by preventing blood clots from forming in blood vessels through its effects on platelets, which are cells that help blood clot. There is some controversy about whether or not you should take aspirin to prevent heart disease, given its potential side effects (such as stomach ulcers and bleeding). 

      But if your physician recommends it as part of your overall treatment plan, it may be worth considering.

      How Aspirin Helps Prevent Heart Attacks, Strokes, and Death

      Aspirin’s ability to reduce the risk of heart attacks, strokes, and cardiovascular death stems from its effects on several pathways in the body. The drug helps to prevent blood clots by inhibiting an enzyme called cyclooxygenase (COX). 

      COX is responsible for producing prostaglandins, which cause inflammation and pain. By reducing the production of these substances, aspirin also lowers blood pressure and reduces inflammation in the body.

      Additionally, aspirin is an antiplatelet drug that helps prevent blood clotting by preventing platelets from sticking together. That means taking aspirin regularly can help keep your heart healthy by reducing the chances of a stroke or heart attack caused by a blood clot forming inside your arteries or veins.

      Aspirin Use for Primary Prevention

      Aspirin can be used to minimize the risk of cardiovascular disease in at-risk patients. This is known as primary prevention. According to the American College of Cardiology and the American Heart Institute, a low dose (75 to 100 mg/day) of aspirin can help with the primary prevention of atherosclerotic cardiovascular diseases among at-risk adults in the age group of 40 to 70 years. However, if you have a bleeding disorder, aspirin may not be the best fit for you.

      Aspirin Use for Secondary Prevention

      Besides protecting at-risk patients, aspirin can also be given to patients who’ve suffered a heart attack or stroke, received a coronary angioplasty, or undergone a coronary bypass. The anticoagulant properties of aspirin help minimize the risk of cardiovascular events in the future. This is known as secondary prevention.

      Risks Associated With Taking Aspirin

      The most common side effects of aspirin are related to the stomach and intestines. Prolonged use can lead to gastrointestinal bleeding and stomach ulcers. That, in turn, can cause abdominal cramping, pain, and indigestion.

      Should You Take Aspirin to Prevent Heart Disease?

      Your doctor is in the best position to decide whether you should take aspirin for your cardiac health. You’ll benefit from taking aspirin if you have a history of heart attacks or strokes. However, you should consult your doctor for the proper dosage and duration of treatment.

      Also, if you are pregnant or breastfeeding, talk to your doctor. Aspirin is classified as Pregnancy Category B by the Food and Drug Administration (FDA). That means it is safe for use during pregnancy in animal studies and causes in humans. However, data are limited, so consult with your doctor before taking aspirin while pregnant.

      It’s worth noting that aspirin is a blood thinner and can cause bleeding and bruising. You shouldn’t take it with other blood thinners, such as warfarin (Coumadin), heparin, clopidogrel (Plavix), theophylline (Theo-Dur), or dipyridamole (Persantine).

      Aspirin you should avoid aspirin if you have the following:

      • A bleeding disorder or are taking other medications that increase your risk of bleeding
      • Ulcers on your stomach or duodenum

      In Conclusion

      If you have been diagnosed with heart failure or other cardiac ailments, your doctor may recommend aspirin therapy to help prevent heart attacks and strokes. It’s an anticoagulant that prevents the formation of blood clots. Make sure you talk to your doctor about the potential risks and side effects.

      Dr. C Raghu is an accomplished cardiologist who’s been practicing for decades. If you have concerns about taking aspirin for heart disease, feel free to consult Dr. Raghu today.

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          Care-After-Coronary-Angiography.jpg

          Many people have heart disease, but not all of them know it. Doctors use a variety of tests to identify cardiac ailments and their underlying causes. Coronary angiography is one of the most common diagnostic tests that doctors use.

          While it’s considered a safe and minimally invasive procedure, coronary angiography comes with a few risks. You can read more about the potential risks and complications in our previous blog.

          The good news is that you can avoid side effects with proper care after the procedure. If you’ve recently had coronary angiography or are going through one soon, here is what you need to do after the procedure:

          Avoid Heavy Physical Activity

          It’s important to rest after coronary angiography. Avoid lifting heavy objects or resuming your exercise routine right after the procedure. Make sure you get plenty of sleep and let your body and mind relax for at least a week after angiography. Ask your doctor if you’re unsure when to hit the gym or start exercising.

          Embrace Healthy Habits

          Avoid cigarettes for at least a few days if you are a smoker. Smoking can cause spasms in the coronary arteries, leading to a heart attack or stroke after your angiography. Also, avoid alcohol consumption, and make sure you eat a balanced diet.

          If you are a coffee drinker or have high blood pressure, avoiding all caffeine products (coffee, tea) and salt for several days following your procedure may be a good idea. The most important thing is to listen carefully to what your doctor tells you about caring after coronary angiography to avoid any other complications during recovery or later down the road.

          Be Careful About Removing the Bandage

          A crucial step to caring after coronary angiography is to avoid removing the bandage until the morning of the second day after the procedure. Also, you should not remove it yourself. Let someone else help you remove it. You must consult your doctor or nurse before removing the bandage.

          Expect Soreness and Pain for a Few Days

          Your arm or leg (where the catheter was inserted) might feel sore for a few days following a coronary angiogram. The discomfort you feel is usually caused by the catheter or dye used for the test. 

          The catheter may have been left in place too long, leading to irritation and inflammation. Or it could be a reaction to the dye that was used to take images of your arteries during the procedure. It can also happen if you’re allergic to any component of either one.

          In most cases, the pain and soreness should subside after a few days. If the pain persists or the arm/leg becomes numb, it’s a good idea to reach out to your doctor. Also, if you have a fever or trouble breathing, call your doctor right away. 

          If you are bleeding from the incision site, apply direct pressure with a gauze dressing until the bleeding stops. Don’t remove the dressing unless instructed by medical staff at the hospital.

          Conclusion

          Coronary angiography is a safe and effective procedure that can give you a better understanding of your heart health. If you follow your doctor’s instructions, you’ll be on the road to recovery in no time.

          Dr. C Raghu is a renowned cardiologist who has treated thousands of patients with cardiac ailments. If you have any concerns or questions about coronary angiography, feel free to reach out to Dr. Raghu today.

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            Care After Coronary Angiography – Blog

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              cardiac_catheterization1.jpg

              In our previous blogs, we’ve discussed various tests doctors use to monitor cardiac health and diagnose conditions like coronary artery disease and heart failure.

              It’s worth noting that commonly used diagnostic tests like coronary angiography rely on a procedure called cardiac catheterization. In this blog, we’ll discuss the procedures in greater detail to help you understand the benefits and risks.

              Cardiac catheterization is a procedure in which doctors insert a thin, flexible tube called a catheter into your heart through an artery. 

              What Is Cardiac Catheterization?

              Cardiac catheterization is a procedure that uses a thin tube (called a catheter) to examine the heart and blood vessels. The catheter is inserted into a blood vessel in the groin or arm. Thereafter, it’s advanced through the blood vessels and into the heart to measure pressures within different chambers of your heart.

              cardiac catheterization

              The test lets doctors see if there’s any blockage in the blood vessels that supply blood to your heart. Also, they can assess whether the cardiac muscles and valves are in proper working condition. Also, it may be used to insert wires (called stents) in coronary arteries if they become narrow due to plaque buildup or after an injury.

              To perform balloon angioplasty, the doctor inflates a tiny balloon at one end of the catheter inside one of the blocked coronary arteries. It creates more space for oxygen-rich blood flow through your coronary arteries and helps improve symptoms like chest pain caused by a heart attack

              How Does Cardiac Catheterization Work?

              In this procedure, a doctor inserts the catheter into a blood vessel in your arm or groin. The catheter is guided through the blood vessels to the heart, where it’s used to look for blockages or other problems in the coronary arteries that supply oxygen-rich blood to your heart muscle.

              Afterward, a dye is injected into your bloodstream from an intravenous (IV) line connected to your vein. It helps doctors see how well blood flows through different parts of your heart on X-rays taken during the procedure.

              Why Do Doctors Use Cardiac Catheterization?

              Cardiac catheterization can be used to diagnose or treat various heart ailments. It can help your doctor determine if your heart is getting enough blood and if there are any blockages in the arteries that supply blood to the rest of your body. Also, it can help identify any problems with the heart muscles and valves.

              What Are the Risks of Cardiac Catheterization?

              While the risk of complications from cardiac catheterization is low, there are some things you should know before your procedure. For example, you might also experience bleeding or bruising around where the cut was made.

              The most severe risk is having a stroke due to excess pressure in the brain caused by increased blood flow due to plaque shaving off from arteries. Other risks include allergic reactions to dyes, bleeding at the puncture site where the catheter was inserted, and infection.

              Conclusion

              Cardiac catheterization is a standard procedure that can be done in a cath lab or hospital. It allows doctors to check for problems with your heart and blood vessels. Ask your doctor any questions about how long it will take and whether there are any risks associated with cardiac catheterization before scheduling an appointment for this test.

              Dr. C Raghu is an accomplished cardiologist with decades of experience in interventional cardiology. If you or anyone you know is experiencing symptoms of cardiac ailments, book an appointment with Dr. Raghu today.

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                Cardiac Catheterization – Blog

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                  CT-Coronary-Angiography.jpg

                  Doctors use various diagnostic tests to assess cardiac health and diagnose conditions like coronary artery disease and heart failure. While a coronary angiogram is commonly used to identify these conditions, your doctor can prescribe other tests like CT coronary angiography. 

                  In our previous blogs, you can read more about the use cases and risks of coronary angiography. In this article, we’ll delve deeper into CT coronary angiography and understand why it’s crucial for people with cardiac ailments.

                  What Is CT Coronary Angiography?

                  CT coronary angiography is a type of CT scan that uses special dyes to evaluate the heart’s blood vessels. It can detect blockages in the coronary arteries that supply blood to the heart. It can identify blockages that are too small for other methods, such as a regular angiogram or an electrocardiogram (ECG), to pick up.

                  CT Coronary Angiography

                  A CT coronary angiography scan aims to find any abnormal areas in your coronary arteries that could be causing stenosis (narrowing) or occlusion (blockage). It helps doctors identify underlying heart-related ailments and determine the right course of treatment.

                  How Does CT Coronary Angiography Work?

                  The test is usually done in a hospital or clinic. To begin with, the doctor or radiologist will start an intravenous (IV) line to administer the contrast dye. As the contrast flows through your veins, it will appear on the scan as bright white areas on a black background. It’ll help the doctor see your heart and coronary arteries. 

                  The test usually lasts about 30 minutes to one hour. The CT coronary angiogram procedure involves two scans: one with diastolic blood flow and another with systolic blood flow

                  When Is CT Coronary Angiography Used?

                  CT coronary angiography is used to diagnose a heart attack and evaluate blood flow in the heart. Also, doctors use it to detect blockages in arteries that supply blood to the heart muscle.

                  What Are the Risks of CT Coronary Angiography?

                  While CT coronary angiography is a non-invasive and safe procedure, it can cause the following side effects:

                  • You may have an allergic reaction to the contrast dye.
                  • Your body will be exposed to high levels of radiation, which can increase your risk of developing cancer.
                  • You might have to pay out of pocket because the test isn’t always covered by insurance.
                  • You might experience more anxiety and stress if the scans indicate blockages in your arteries.

                  What Should I Expect When Having CT Coronary Angiography?

                  If you are planning to get a CT coronary angiography, you should be prepared for the following:

                  • The radiologist will ask you to change into a hospital gown.
                  • The radiologist will give you an injection of a contrast dye.
                  • You will lie on a table, and the table will move into the CT scanner.
                  • The scan is painless and takes about 20 minutes.

                  Conclusion

                  CT coronary angiography is a painless and safe test that can help determine if you have blocked arteries. If you have chest pain, you should consider getting the test done as soon as possible because it may save your life.

                  Dr. C Raghu is a renowned cardiologist with decades of experience. He specializes in interventional cardiology and has treated thousands of patients with cardiac ailments. If you or anyone you know is experiencing symptoms like chest pain, breathlessness, palpitations, etc., reach out to Dr. Raghu today.

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                    CT Coronary Angiography – Blog

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                      What Is Coronary Angiography?

                      Coronary angiography is a procedure that uses X-rays to visualize and inspect arteries. It shows if there are any blocked arteries and how well your heart muscle is working.

                      During this procedure, a catheter is inserted into an artery in your arm or groin and advanced into one of your coronary arteries. Thereafter, contrast dye is injected into the coronary artery to make it visible on X-ray images.

                      The procedure can help identify blockages in the heart’s blood vessels and guide treatment decisions for patients at risk of developing heart disease or having a heart attack due to narrowed or blocked blood vessels that supply oxygenated blood to various organs.

                      When Is Coronary Angiography Performed?

                      Coronary angiography is typically performed if you have chest pain or other symptoms that suggest the presence of heart disease. If you have had a heart attack or have been diagnosed with coronary artery disease. It can be used in conjunction with an exercise stress test.

                      How Is Coronary Angiography Done?

                      If you’re scheduled for coronary angiography, here’s what you can expect:

                      • The doctor will give you a sedative, usually in the form of an injection, at the start of your procedure.
                      • They’ll insert a catheter into one of your arteries, either in your groin or wrist, and guide it through your blood vessels to reach your heart.
                      • They’ll inject a special dye (contrast agent) into the coronary arteries that supply blood to your heart muscle so that they can see them clearly on X-rays taken after injecting this contrast agent.

                      Where Is Coronary Angiography Performed?

                      Coronary angiography is performed in a cath lab (catheterization laboratory). The cath lab is a room with special equipment for performing coronary angiography and other procedures that entail inserting a long, thin tube (called a catheter) into the blood vessels of your heart.

                      Why Is Coronary Angiography So Common Nowadays?

                      Advancements in medical science have made coronary angiography more accessible to patients. The procedure has become simple and the risk has reduced significantly. Also, unhealthy diets and lifestyle choices put more people at risk of developing cardiac ailments. That’s why coronary angiography is commonly performed now-a-days.

                      What are the risks involved in Coronary angiography?

                      In expert hands coronary angiography is a near-zero risk procedure. The risk of complications can be broadly categorized into:

                      Less severe complications

                      • bleeding under the skin at the wound site (haematoma) – this should improve after a few days, but contact your Cardiologist if you’re concerned. Application of ice packs would be helpful.
                      • bruising – it’s common to have a bruise in your groin or arm for a few weeks. Application of ice packs would be helpful.
                      • allergy to the contrast dye used, causing symptoms such as a rash and a headache – this is uncommon, but you should discuss any allergies with your cardiologist before having the procedure

                      Severe complications

                      The chance for developing a serious complication during coronary angiogram is 1 in 1000. People with serious underlying heart problems are most at risk. Discuss with your cardiologist about the risks before the procedure.

                      • damage to the artery in the arm or groin in which the catheter was inserted, with the blood supply to the limb possibly being affected 
                      • heart attack – a serious medical emergency where the heart’s blood supply is suddenly blocked 
                      • stroke – a serious medical condition that occurs when the blood supply to the brain is interrupted 
                      • damage to the kidneys caused by the contrast dye 
                      • tissue damage caused by X-ray radiation if the procedure is prolonged 
                      • death

                      In Conclusion

                      Coronary angiography is used to diagnose and treat heart diseases, before cardiac surgery, angioplasty-stent procedures as well as other conditions such as aneurysms in blood vessels. It helps doctors identify underlying causes of heart failure and determine the proper course of treatment.

                      Dr. C Raghu is a renowned cardiologist with decades of experience in interventional cardiology. He is one of the pioneers of trans-radial procedures in India. Consult him if someone is in need for coronary angiogram.

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                        Coronary Angiography Blog

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                          Coronary angiography is a common diagnostic test used by doctors to identify conditions, such as coronary artery disease and aneurysms. In our previous blog, we discussed how the procedure is carried out and when it’s used. Click here to check it out.

                          coronary angiography

                          Angiography is a minimally invasive procedure, which makes it extremely safe. However, it can involve a few minor side effects. The benefits outweigh the risks for most patients. However, in some cases, coronary angiography can result in serious complications.

                          In this article, we’ll delve deeper into the risks and side effects associated with coronary angiography.

                          Common Side Effects of Coronary Angiography

                          If you’re planning to visit the doctor for an angiography, you can expect one or more of the following side effects:

                          • Bruising
                          • Swelling
                          • A buildup of blood (resulting in a bump)

                          All these symptoms are localized to the area where the cut was made for inserting the catheter. Most patients experience a gradual improvement in these side effects without medical intervention. You can take painkillers to relieve discomfort after the procedure.

                          Complications of Coronary Angiography

                          If you’re lucky, you’ll come out of coronary angiography with minor bruising and swelling. However, some patients develop the following complications:

                          • An infection near the cut :- It makes the area around the cut red, swollen, and tender.
                          • An allergic reaction to the dye :- It usually results in an itchy rash.

                          In both cases, proper use of medications can help control the side effects. For instance, antibiotics can be used in the case of an infection. Similarly, your doctor might prescribe antihistamines if you experience an allergic reaction.

                          It’s worth mentioning that coronary angiography comes with a few potential serious complications. These include:

                          • Kidney damage (from the dye)
                          • Cardiac arrest or stroke
                          • Internal bleeding (due to damaged blood vessels)
                          • Anaphylaxis (due to severe allergic response to the dye)

                          The good news is that these complications are extremely rare (affecting less than one in every 1000 patients). Also, kidney damage due to angiography is usually temporary. Moreover, internal bleeding can be contained with the help of catheter based approaches.

                          Seeking Medical Help

                          Complications from coronary angiography are rare. Nevertheless, it’s a good idea to consult your doctor if you notice anything unusual after the procedure. For instance, if the leg or arm where the cut was made looks pale or feels numb, it’s a cause for concern. Similarly, if you notice bleeding, redness, or a firm lump near the cut, it could indicate a potential infection. It’s always a good idea to watch out for these signs and consult your doctor for timely treatment.

                          In Conclusion

                          Coronary angiography is a safe and minimally invasive procedure. It can cause minor side effects, such as pain and swelling. However, in extreme cases, it can also lead to a heart attack or kidney damage. It’s crucial to talk to your doctor about the potential risks before going in for the procedure.

                          Dr. C Raghu has more than two decades of experience in treating patients with different heart conditions. If you have queries or concerns about coronary angiography, feel free to reach out to Dr. Raghu today.

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                            What Are the Risks of Coronary Angiography? – Blog

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                              Coronary-Bifurcation-Lesions.jpg

                              Coronary arteries are the vessels which supply blood (oxygen and nutrients) to the heart; this supply may be disrupted due to buildup of cholesterol and fatty deposits, called plaques, on the inner walls of the arteries (atherosclerosis) causing narrowing of the vessel lumen.

                              Coronary lesions branch out as they progress to supply various cardiac structures. A bifurcation lesion is a stenosis or abnormal narrowing of greater than 50% that occurs in a coronary artery at the origin of the side branch or adjacent to the origin of the side branch. Branching points a.k.a bifurcation points in the coronary arteries are prone to develop atherosclerosis as the shear stress is higher at the branch points.

                              The figure shows how a bifurcation stenosis appears schematically as well as on angiography.

                              bifurcation lesion

                               

                              Why bifurcation lesions are important?

                              A vast majority of coronary arteries obstructions happen at the branching point. About 15-20% of patients of referrals for bypass surgery are because of the presence of coronary narrowing at bifurcation location. They are considered a tough lesion to treat by angioplasty and stent.

                              How are bifurcation lesions diagnosed?

                              Bifurcation lesions are identified on coronary angiography. Only lesions affecting side branch blood vessels more than 2.25 mm is considered important and called bifurcation lesions. The main vessel that gives branches is called main vessel and the branches that originate from it are called side branches. The point at the division of the main vessel and side branch is called a bifurcation point.

                              How is a bifurcation lesion unique?

                              Bifurcation lesions can involve the coronary artery either before or after the bifurcation point. In addition, side branches could be either diseased or free from disease. Based on the location and severity of the cholesterol plaque at the bifurcation point, sub types of bifurcation lesions have been identified.

                              The challenge of performing angioplasty and stent for a bifurcation stenosis lies in the ability to preserve the main vessel and the side branch. Stents being metallic tubes risk occluding the side branch when placed across the side branch. This apprehension of losing the side branch, is one of the primary reasons for patients to be sent for bypass surgery instead of angioplasty and stent.

                              Coronary-bifurication

                              Can angioplasty and stent be performed for a bifurcation lesion?

                              Angioplasty and stent can be eminently performed for a bifurcation stenosis. Over the last 2 decades numerous techniques in stent implantation have been developed to treat the bifurcation lesions. Some of these techniques include:

                              • Provisional T stent technique
                              • Tap technique
                              • Double kiss crush technique
                              • Culotte technique

                              Advent of these techniques enabled experienced operators to perform angioplasty and stent successfully with chances of repeat narrowing seen in 3-6% patients at the site of stenting. Risk of losing a side branch after stenting is reduced to 1% once the new techniques are employed.

                              Dr. C Raghu is an expert in bifurcation lesion angioplasty and the center where he has been trained, ICPS Paris France is considered the “Mecca” for bifurcation lesion angioplasty techniques development. 

                              How does a bifurcation lesion angioplasty differ from a normal angioplasty?

                              Bifurcation lesion angioplasty, involves utilization of novel stent techniques mentioned above. In addition, angioplasty operator experience is a major factor in determining  outcomes. Choosing the “right” stent that allows side branch access, use of specialized technologies such as fractional flow reserve (FFR), expertise in deploying 2 stents especially the process of “stent crush” and the handling of two balloons through a single catheter – kissing balloon are key points for the best results in a stent procedure.

                              What are the chances of side branch occlusion in a bifurcation lesion angioplasty?

                              Contemporary bifurcation angioplasty using Intravascular imaging employing contemporary stenting techniques in the hands of expert bifurcation angioplasty operators carries a 99% success rate with a chance of losing side branch in 1% and repeat narrowing at the end of 9 months being 3-6%. These results are comparable and if not superior to bypass surgery as angioplasty entails a short hospital stay and fast recovery.

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                                  cci-coronary_angioplasty.jpg


                                  Coronary arteries are the blood vessels that delivers oxygenated blood to the heart muscle. But, sometimes these blood vessels may get narrowed or blocked due to accumulation of cholesterol plaque. To open the blockage and restore the function of arteries, coronary angioplasty is performed.

                                  A coronary angioplasty involves the temporary insertion of a tiny balloon inside the artery to open the blockage. It is usually combined with the placement of a stent (a metal mesh tube) to widen the artery and prevent the further chance of narrowing.

                                  coronary angioplasty

                                  Why is coronary angioplasty done ?

                                  Coronary angioplasty is done to treat narrowing or blockage of the heart’s blood vessels:

                                  • during or after a heart attack.
                                  • Blood vessel narrowing leading to poor heart function.
                                  • For relief of chest pain (angina) due to reduced blood supply to heart.

                                  Risks of coronary angioplasty

                                  Usually, it is a safe procedure, but like all other procedures, it also carries certain risks like:

                                  Common Issues/Risks after angiography
                                  Bruising Common to have bruise at groin or arm Lasts for few weeks Not to be worried about
                                  Allergic reactions Usually related to contrast medicine used History of previous allergy – higher risk Present as rash and headache
                                  Bleeding at the site of entry (Hematoma) Usually subsides in a few days But in case swelling is increasing and painful contact your physician immediately

                                  Serious complications after coronary angiography Less than 1 in 1000 chance People with severe heart disease are at high risk Discuss with Cardiologist before procedure
                                  Heart attack A serious medical emergency where the heart’s blood supply is suddenly blocked
                                  Stroke A serious medical condition that occurs when the blood supply to the brain is interrupted
                                  Loss of blood supply to limb Damage to the artery in the arm or groin in which the catheter was inserted, with the blood supply to the limb possibly being affected
                                  Kidney injury Damage to the kidneys caused by the contrast dye
                                  Radiation injury Tissue damage caused by X-ray radiation if the procedure is prolonged

                                  What happens before the procedure?

                                  A physical examination and blood test are done to evaluate the overall health condition. The person needs to follow instructions provided before undergoing the procedure:

                                  1. Inform the doctor about:

                                  • Any allergies
                                  • The use of current medicines, including vitamin and mineral supplements
                                  • Any blood disorder
                                  • Any surgery you may had
                                  • The past and present medical condition

                                  2. Medicines:

                                  Tell the doctor if you are using blood thinners or any anti-diabetic medicines. The doctor will either advise you to stop or change the dose of the medication.

                                  3. Food and fluid restrictions:

                                  • Avoid heavy meals, such as meat, fried or fatty foods eight hours before the procedure. Take light foods such as toast and cereal.
                                  • Fast for six hours before the procedure.
                                  • Stay hydrated, drink plenty of fluid up to two hours before the procedure.

                                  In most of the cases, you will be discharged on the same day of the hospital, so ask someone to accompany you to the hospital.

                                  What happens during the procedure?

                                  Local anaesthesia would be administered to numb the area where the catheter would be inserted. Mostly, a catheter is inserted through the wrist, and sometimes through the groin. Under fluoroscopy (a type of X-ray), the catheter will be guided to the diseased artery. Then a special medicine (called contrast or dye) will be injected into the blood vessels supplying the heart. This will delineate the presence of obstruction to blood flow. 
                                  Then a wire is passed across the obstruction and a balloon is inflated at the site of obstruction to compress the obstructing plaque in the artery. The balloon expansion will compress the plaques into the wall of the blood vessel and improve the blood flow. Once the blood flow is improved, the catheter will be removed, and a stent would be placed to prevent the risk of further blockage. Finally, the catheter will be removed and the puncture site is sealed.

                                  What to expect after the procedure?

                                  The nurse will check the vitals of the patient. Depending on the condition, the doctor would advise you the hospital stay. You will be advised not to bend or cross the leg for a few days if the procedure is performed through the groin region. Additionally, some other tests like X-rays and an electrocardiogram (ECG) would be done to check the condition. Before discharge, the doctor will give you certain instructions regarding wound care, medications and lifestyle.

                                  Recovery after coronary angioplasty

                                  Recover quickly and keep your heart healthy by following these tips:

                                  • Quit smoking.
                                  • Limit the intake of alcohol.
                                  • Take the prescribed medicines.
                                  • Check the cholesterol levels regularly.
                                  • Maintain a healthy body weight.
                                  • Have a healthy and well-balanced diet.
                                  • Exercise regularly.

                                  Know your numbers

                                  It’s important to periodically monitor and maintain the following numbers to prevent future cardiac events

                                  • LDL cholesterol – less than 55 mg/dL
                                  • Blood pressure – less than 120/80 mm Hg
                                  • Blood sugar – HbA1C less than 7.0%

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                                      disease-condtions-coronary_artery_disease.jpg


                                      Coronary artery disease (CAD) is the most common type of heart disease, in which the coronary arteries ( blood vessels that supplies oxygen and nutrients to the heart muscle) become rigid and narrowed due to buildup of plaque (deposition of cholesterol) in the inner walls of the heart. This restricts the flow of oxygen rich blood to the heart muscle, which may result in angina (chest pain) and shortness of breath. If the plaque ruptures or due to a complete blockage in the artery, it may result in heart attack or sudden cardiac death.

                                      Causes:

                                      Build of cholesterol plaques within the blood vessels is termed atherosclerosis.

                                      The plaque makes the inner walls of the artery sticky, so that the inflammatory cells, lipoproteins, and calcium travelling through the blood stream and adhere to the plaque. The plaque gradually enlarges, narrowing the blood vessel lumen, restricting blood flow to the heart muscle and thus reducing the supply of oxygen and nutrients to the heart.

                                      Signs and symptoms:

                                      • Angina (chest pain) – on exertion and in severe cases even at rest
                                      • Shortness of breath – on exertion and in severe cases even at rest
                                      • Palpitations (irregular heartbeats or skipped beats)
                                      • Tachycardia (fast heartbeat)
                                      • Weakness or dizziness
                                      • Nausea
                                      • Sweating
                                      • Fatigue, mainly after exercise or any activity

                                      Risk factors:

                                      • Age: Risk for damaged or narrowed arteries increases with age.
                                      • Gender: Men are at greater risk of developing CAD. In women, risk increases after menopause.
                                      • Family history: Risk increases if any family member has coronary artery disease.
                                      • Smoking: People who have the habit of smoking and who are exposed to smoke are at increased risk of CAD.
                                      • High blood pressure: It results in the narrowing and hardening of the walls of arteries.
                                      • High blood cholesterol levels: It can increase the risk of atherosclerosis.
                                      • Diabetes: High degree of association – 2 to 4-fold greater risk
                                      • Obesity: Overweight increases the risk of CAD.
                                      • Life style activities: Reduced physical activity, high stress and unhealthy diet also contribute to the development of CAD
                                      • Mental Stress: Responsible for young heart attacks Other possible risk factors, according to research, include:
                                      • Sleep apnea: It is a condition in which the person may experience intermittent cessation of breathing during sleep, resulting in reduced oxygen levels in the blood. Sleep apnea may cause an increase in the blood pressure and high strain on the heart, leading to CAD.
                                      • Increased C-reactive protein (CRP) levels in blood: CRP levels are increased mostly if there is any inflammation in the body. It is a risk factor for CAD.
                                      • High triglycerides (a type of lipid).
                                      • High homocysteine (amino acid) levels.
                                      • Preeclampsia (high blood pressure during pregnancy).
                                      • Alcohol use can lead to heart muscle damage.
                                      • Autoimmune diseases such as Rheumatoid arthritis and Lupus.

                                      Complications:

                                      If left untreated, CAD can lead to life threatening complications such as:

                                      • Angina:  Due to narrowed blood vessels, the heart muscles receive inadequate oxygen laden blood, causing chest pain or shortness of breath.
                                      • Heart attack: The plaque may rupture forming a clot and blocking the blood flow to the heart muscle.
                                      • Heart failure: Due to reduced oxygen and nutrient rich blood flow, the heart is unable to pump enough blood, thus increasing its workload. Over time, it may lead to weakening of heart muscle, also called heart failure.
                                      • Arrhythmia: Reduced amount of blood supply may lead to abnormal heart rhythms
                                      • Sudden cardiac death

                                      Diagnosis:

                                      The diagnostic work up includes a physical examination, in addition to medical history, family history, risk factors and any signs and symptoms of CAD. Further diagnostic tests may be recommended:

                                      • Electrocardiogram (ECG): It records the heart’s electrical activity and helps to determine the blood flow in the heart as well as heart muscle stress.
                                      • Echocardiogram: It uses sound waves to produce clear images of the heart and helps to identify the damaged heart muscles and valves.
                                      • Stress test: The test involves performing any high intensity activity like walking fast on a treadmill or bicycling under medical supervision, and close monitoring of heart function during the physical activity. Symptoms, ECG, blood pressure and heart rhythm are closely monitored during the test. Based on the findings the probability of having significant coronary artery disease would be determined. This test has many limitations and fallacies.
                                      • Cardiac catheterization and angiogram: A special medication called contrast is injected into the coronary blood vessels using a thin, flexible tube called catheter. The catheter is inserted through a small incision at the groin or through the wrist to visualise the blood vessels supplying the heart.
                                      • Heart scan: Computerized tomography (CT) technologies are used to identify the calcium deposits in the blood vessel of the heart, which indicates CAD.

                                      Coronary Artery Disease Treatment:

                                      Lifestyle changes:

                                      • Quit smoking
                                      • Avoid processed foods and eat high protein and fiber rich diet
                                      • Exercise regularly and lose excess weight
                                      • Manage stress
                                      • Control diabetes and blood pressure

                                      Medications:

                                      The doctor may prescribe medications, which help in reducing symptoms and severity of disease such as:

                                      • Dyslipidemic agents such as statins, ezeimibe to lower the blood cholesterol levels
                                      • Aspirin, a blood thinner, to prevent blood clots’ formation that might obstruct the coronary arteries
                                      • Beta blockers decrease the heart rate and blood pressure and reduce the oxygen demands of the heart.
                                      • Calcium channel blockers to lower blood pressure and improve blood supply to the heart.
                                      • Trimetazidine and Ranolazine are anti-anginal drugs to reduce chest pain
                                      • Nitroglycerin to dilate the coronary arteries and reduce chest pain
                                      • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) to decrease blood pressure and improve heart efficiency.

                                      Surgical procedures:

                                      • Angioplasty and stent placement: It is also called as percutaneous coronary revascularization, and involves inserting a thin, flexible tube (catheter) into the narrowed coronary artery, followed by a wire with deflated balloon to the narrowed area. The balloon is inflated to widen the blood vessel; a stent may also be placed to keep the artery patent.
                                      • Coronary artery bypass surgery: A graft is created using any blood vessel in the body, to bypass the blocked coronary arteries.

                                      Prevention:

                                      To maintain healthy arteries and to prevent coronary artery disease, some measures need to be taken such as lifestyle modifications which includes avoiding smoking and alcohol use, exercising regularly to maintain healthy weight, controlling sugar and cholesterol levels in blood and also eating a healthy diet.

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                                        Coronary Artery Disease Blog

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