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Complex Angioplasty:

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Complex Angioplasty: Why you will no longer need a risky open heart surgery

Article by Dr. YVC .Reddy, Interventional Cardiologist, Apollo Hospitals Chennai

 

Almost every third Whatsapp forward these days is about heart attacks, and identifying symptoms of heart attacks. It is a serious issue, and as Indians we are prone to greater risk - due to our high-fat, cholesterol heavy food, and poor exercise and lifestyle activities. Additional environmental factors also complicate the problem, and as a country we are treating it as a high priority.

The Registrar General of India reports that about 24% of all deaths in India, and about 32% of adult deaths are caused by coronary heart diseases, with the World Health Organisation treating it as an issue of extreme importance. Some estimates say that about 1.6 million Indians have some form of heart ailment.

We know largely what causes heart attack: blocks or clots in the arteries that prevent blood flow into the heart, causing it to go into cardiac shock - that is, it cannot pump blood effectively. What we do not have a great understanding of, is how and when are these blocks formed, and how to effectively treat them. Further, we do not always understand the risks involved in such treatment.

Angioplasty is now a routine, minor procedure. It was not always so, but due to the work of expert doctors like and due to the advances in medical care, and research based, evidence based medical procedures, we have arrived at a point where an accurately diagnosed heart attack can be treated instantly, and effectively.

The best treatment for an acute heart attack - referred to as myocardial infarction - is a procedure called Emergency Primary Angioplasty. In this procedure, even a 100% block in the vessel supplying blood to the heart - known as the culprit artery or culprit vessel, is opened up and a stent is placed inside the vessel, which will “crush” the blocks and allow for free flow of blood. A stent is a small mesh-like tube. This procedure has been a standard of care for a long time now, and in expert hands, it is performed swiftly and gives excellent results. Only 8% of Indians have access to the procedure. Awareness or the lack of it, access to good hospitals with a fully functional Cathlab, and availability of experts being significant reasons.

Is there a role for surgery in acute heart attack management? Yes, there are some instances when the patient may have multiple blocks in all the vessels, which in a stable patient means Bypass surgery is the answer. However, in acute heart attacks, when the patient’s life has to be saved immediately and the time to organise a surgery is limited, the culprit artery is opened up with angioplasty, and if possible any other severe blocks are also removed at the same time.

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