1-7 March 2013 #645

Plumbing the heart

Heart attack patients today are more fortunate than their parents’ generation as they have access to angioplasty.
Dhanvantari by Buddha Basnyat, MD

Heart attack or angina (heart pain) patients in Nepal today are more fortunate than their parents’ generation because state-of-the-art, life saving treatments like angioplasty in the country are available in the country. Although expensive, angioplasty is fairly common and regularly carried out at both government and private hospitals. However, very few patients and their families are aware of the intricacies of the procedure.

Heart attack and angina are usually caused by blockage (which consists of an atherosclerotic plaque) in the arteries of the heart. By using a dye and taking a special picture of the heart and its arteries (a cardiac angiogram), the location and extent of blockage (plaque) is determined.

During the angioplasty, a cardiologist (heart doctor) basically performs a plumbing procedure. She uses a deflated balloon at the end of a thin tube (catheter) which is threaded into a peripheral blood vessel and made to reach the coronary artery where the blockage is located.

The balloon is inflated at the blockage site which compresses the plaque against the wall, which restores circulation of blood into the artery and blood flow into vital heart muscles. Without proper supply of blood the heart muscles cannot pump blood into different parts of the body.

The balloon is then deflated and withdrawn together with the catheter. However, when this procedure was first started, the artery narrowed down over a short time without a ‘scaffolding’ in place. Hence stents (pic, above), which are basically scaffolds, were developed.

These stents, introduced into the same catheter through which the balloon was threaded, were at first bare-metal stents (BMS). But these metals caused a tissue reaction inside the heart artery and re-blocked it. To avoid this problem, entrepreneurs made drug-eluting stents (DES). The same metal stents were now coated with drugs which inhibit the tissue reaction the BMS elicited.

DES is much more expensive than BMS. However, since using DES leads to far less complications it is definitely a better investment in the long-term. DES placement in angioplasty procedures is now a standard procedure in parts of the world where people can afford the treatment.

Cardiac surgeons still perform the more invasive coronary artery bypass graft (CABG) surgery by taking a graft from a peripheral blood vessel and bypassing the diseased segment in the heart arteries. But the less invasive angioplasty with stent placement is the preferred option wherever possible.

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