Although this blog is focused on what individuals can do for themselves to prevent,
and sometimes to treat various diseases, a mention of some other therapies that may
be prescribed by your healthcare provider for CVDs may be helpful.
When a patient has greatly obstructed coronary arteries, a revascularization procedure
may be undertaken with the goal of relieving angina or preventing a heart
attack.
The main surgical approaches are angioplasty and bypass surgery. Angioplasty
(percutaneous coronary angioplasty or intervention—PCI) is carried out
under local anesthesia. A cardiologist threads a balloon into the narrowed area of
one or more coronary arteries and then inflates the balloon to compress plaques and
widen the partially blocked area. It is usually carried out with the insertion of a permanent
stent to keep the expanded portion of the artery open. In a small proportion
of patients, less than one percent, the artery being operated on will block because
of a blood clot, spasm, or tear. This can cause a heart attack or require emergency
bypass surgery.
Even when angioplasties are successful in opening up an artery, narrowing or closure
(restenosis) occurs after about six months in about 10% of patients with a
drug-releasing stent, 15% of those with a bare-metal stent, and 30% of patients who
do not have a stent inserted. Although angioplasty will often temporarily relieve
the symptoms of angina, it is no more effective than intensive medical treatment in
the prevention of heart attacks or extension of life expectancy. Angioplasty is
performed more than one million times a year in the U.S., and a number of studies
suggest that it is overused. Leading medical societies, including the American
Heart Association and the American College of Physicians, recommend a combination
of lifestyle and drug therapy as the best treatment and the best way to prevent
heart attacks among those with stable coronary heart disease.
A surgical revascularization procedure, angioplasty or coronary artery bypass grafting
(CABG) may be appropriate to prevent a heart attack when atherosclerosis has
narrowed multiple coronary vessels or causes unstable angina—also called acute
coronary syndrome.
A person may be developing unstable angina if they experience chest discomfort or
pain that:
• Feels different, is more severe, comes more often, or occurs with less activity
or while they are at rest.
• Lasts longer than 15 – 20 minutes.
• Occurs without cause (for example, while asleep or sitting quietly).
• Is not relieved by rest or respond well to the medicine nitroglycerin.
• Occurs with a drop in blood pressure or shortness of breath.
Unstable angina is a medical emergency that should be treated immediately because
it is a warning sign of an impending heart attack. The use of angioplasty may
prevent a heart attack. If an arteriogram reveals plaque that is so severe that angioplasty
cannot be carried out or if there are blockages in all three major coronary
arteries or the left main coronary artery, a coronary artery bypass graft (CABG) may
be recommended. This is a major procedure that requires opening the chest and
may also require placing the patient on a heart-lung machine that oxygenates and
pumps blood while the operation is underway. The surgeon takes arteries or veins
from other parts of your body and uses them to bypass coronary artery blockages or
provide a source of arterial blood flow from an artery in the chest. If necessary, a
patient may undergo one, two, three, or more bypass grafts.
More than 400,000 bypass surgeries are carried out each year at the cost of $100
billion. Only in a portion of patients receiving the procedure, high-risk patients
with the most severe coronary disease, does CABG surgery reduce the risk of a
heart attack and prolong life. CABG surgery carries important risks, and recovery
takes six to 12 weeks. Major complications such as a heart attack or stroke occur
in 2% to 10% of patients, and there is a 1% to 2% chance of death from the procedure.
CABG surgery does reduce the incidence and severity of angina, but lifestyle
changes often work just a well at a fraction of the cost and essentially no risk.
This blog presents opinions and ideas and is intended to provide helpful general information. I am not engaged in rendering advice or services to the individual reader. The ideas, procedures and suggestions in that are presented are not in any way a substitute for the advice and care of the reader’s own physician or other medical professional based on the reader’s own individual conditions, symptoms or concerns. If the reader needs personal medical, health, dietary, exercise or other assistance or advice the reader should consult a physician and/or other qualified health professionals. The author specifically disclaims all responsibility for any injury, damage or loss that the reader may incur as a direct or indirect consequence of following any directions or suggestions given in this blog or participating in any programs described in this blog or in the book, The Building Blocks of Health––How to Optimize Your Health with a Lifestyle Checklist (available in print or downloaded at Amazon, Apple, Barnes and Noble and elsewhere). Copyright 2021 by J. Joseph Speidel
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