Q.1: What is coronary artery disease (CAD)?
A: Coronary artery disease is the most common type of heart disease. It happens when the arteries that supply blood to heart muscle(coronary arteries) become hardened and narrowed. This is due to build up of cholesterol and other material called plaque, on their inner walls. This build up is called atherosclerosis. This can lead to chest pain (angina) or a heart attack. Most heart attacks happen when a blood clot suddenly cuts off the hearts' blood supply, causing permanent heart damage. Over time, CAD can also weaken the heart muscle and contribute to heart failure and arrhythmias.
Q.2: What are the diagnostic modalities for CAD?
A: Various diagnostic modalities are increasingly used in the diagnosis of CAD which includes ECG, Echocardiography, coronary CT angiography, and cardiac single photon emission computed tomography (SPECT), and coronary angiography.
Q.3: What are the treatment modalities for CAD?
A: (i) Medical Management
(ii)Percutaneous Coronary Intervention- Angioplasty/Stenting
(iii)CABG(By pass surgery)
Depending on the extent and severity of involvement of coronary arteries and left ventricular (LV) function, clinician advises medical management or angioplasty or CABG.
Q.4: What are different types of percutaneous coronary intervention?
A: (i) Balloning(POBA)
(ii) Bare metal stent(BMS)implantation
(iii) Drug eluting stent(DES)implantation
Nowdays, almost all angioplasties are being performed using DES impantation.
Q.5: What is a coronary angiogram?
A: For definitive diagnosis of CAD to find out extent and severity of CAD and for its proper treatment,imaging of coronary arteries is done in cardiac cath lab.This is called as coronary angiography.
Q.6: What is angioplasty?
A: Angioplasty is a procedure that uses a balloon to open up blocked areas of your coronary arteries. It is performed to relieve some of the symptoms associated with CAD. It is also performed during a heart attack to prevent damage to the heart(Primary Angioplasty/stenting).
Q.7: What is the stent used for?
A: Stents are used for relieving obstruction in coronary arteries. The stent is a small metal-mesh tube that is implanted in the area of your coronary artery to help keep it open. Drug eluting stents in addition are designed to deliver medication to the artery. After the stenting procedure, the balloon is removed from your artery, but the stent will remain in your coronary artery.
Q.8: What are the different components of stents?
A: Drug eluting stent is made up of
i) Stent platform (Stainless steel, Cobalt chromium, Platinum chromium, etc.) and Balloon expandable delivery system
ii) Pharmacological agent (Everolimus, Sirolimus, etc.)
iii) Drug Carrier (eg. Polymer- Nonbiodegradable/Biodegradable)
These stents are available in various diameters and lengths . Stents from different manufacturers are available at our hospital. At the time of angioplasty, treating doctor discusses and informs the patient regarding the suitability of the stent according to his/her disease. The information about various kinds of stents along with their costs is available at our website.
Q.9: What is Primary angioplasty/stenting and its cost?
A: Primary angioplasty/stenting is an emergency procedure done during the time of ongoing heart attack.At our hospital,it is being done free of cost.
Q.10: How do I prepare for stenting?
A: Your doctor will give you a complete medical exam and provide you with detailed instructions. When you arrive at the hospital, you can expect to have a series of routine tests, such as an x-ray, electrocardiogram (EKG),echocardiography or blood tests etc.
Q.11: How can I get benefit from Government?
A: One can avail benefits under the Pradhan Mantri Jan Arogya Yojana as per the laid guidelines.
Q.12: How long will I have the stent?
A: Stents are designed to remain within your coronary artery permanently to provide lasting support.
Q.13: Will I feel the stent?
A: No. You will not feel the stent inside of you.
Q.14: Can the stent move?
A: Once the stent is opened and deployed at the inside wall of your coronary artery, it will remain in place permanently..
Q.15: How do coronary stents work?
A: Coronary stents are small, wire mesh tubes that help widen clogged arteries and restore adequate blood flow to the heart.
Q.16: How soon can I go back to work?
A: The majority of people return to work within a few days following a successful procedure.
Q.17: When can I resume my regular activities?
A: Your doctor will advise you on when it’s safe to resume your regular activities. Many patients can follow their normal routine with in a week after their successful angioplasty.
Q.18: Can I exercise and play sports with a stent?
A: Your doctor will tell you what physical activities are right for you and when you can safely resume them.
Q.19: Will my stent set off metal detectors?
A: No, your coronary stent will not trigger metal detector alarms and you can walk through them safely.
Q.20: How long should I take my medications after angioplasty/stenting?
A: The most important thing that you can do to minimize the risk of stent thrombosis(clot in coronary artery at the site of stent implantation) is to take the medications prescribed by your doctor prescribes. Do not stop taking these medicines specially blood thinners(Antiplatelets) until your cardiologist tells you to, even if you are feeling better.If you have a drug-eluting stent, you may need to take your medication for an extended period of time, perhaps a year or longer. Follow your doctor’s instructions exactly.
Q.21: Will I experience the symptoms of coronary artery disease again, such as chest pain?
A: It is possible that you will experience symptoms again, either because of a new blockage in the treated coronary artery or a new blockage in a different place. If you experience these symptoms, notify your doctor immediately.
Q.22: How will I know if my artery re-narrows?
A: Although the stents are intended to reduce restenosis, it is still possible for your artery to re-narrow. If this happens, you may experience symptoms similar to those experienced when you first noticed before your stent procedure. These symptoms may include chest pain or shortness of breath, especially during physical activity. If you experience pain, inform your doctor immediately.
Q.23: How can I help prevent a recurrence of symptoms?
A: While there is no sure way to prevent a recurrence of symptoms, you can reduce the risk through exercise, not smoking and eating a healthy diet. Ask your doctor about lifestyle changes you can make.
Q.24: What if I still have pain?
A: If you experience pain, immediately visit the emergency at our hospital .