Health Related Q & A : Cardiovascular Diseases

Q1. What is Angina Pectoris?

A1. Angina is the chest pain or discomfort that occurs when your heart doesn't get as much blood and oxygen as it needs. Over time, the coronary arteries that supply blood to your heart can become clogged from a buildup of fats. Cholesterol and other substances. This buildup is called plaque. If one or more arteries are partly clogged, not enough blood can flow through and you can feel chest pain or discomfort.

Q2. How to Identify Angina?

A2. Angina occurs typically on exertion and is retrieved at rest or by certain medications called "nitrates."

It is typically described as tight or heavy sensation in the chest and may spread to the left arm, neck or jaw. Some individuals may only complain of shortness of breath on exertion.

Patients with angina will often be able to tell you that after walking a particular distance or climbing a fixed number of flight of stairs then begin to have chest pain, then goes away within five minutes upon resting. When the chest pain begins to occur at shorter distances or at rest it is termed as "unstable angina" which is a condition warrants urgent intervention.

Q. One of my relatives has done angiogram and it was found that one of his main heart vessel has 90 per cent block and he has been advised to get balloon stent. They say that there are two type of stent, a normal one and a medicated one. The medicated one is according to the doctors, expensive and more effective. My questions are :

Q1. What is a Stent and Why It is Implanted?

A1. A stent is a wire mesh tube used to prop open an artery that's recently been cleared using angioplasty. The stent is collapsed to a small diameter and put over a balloon catheter. It's then moved into the area of the blockage. When the balloon is inflated, the stent expand, locks in place and forms a scaffold. This holds the artery open. The stent stays in the artery permanently, holds it open, improves blood flow to the heart muscle and relieves symptoms of chest pain.

Q2. What are Medicated Stent and What Sort of Medication is Used?

A2. Drug eluting stents (DES) are metal stents which are coated with medications which works by inhibiting cell proliferation and scar formation inside the stent. Most stents use are coated with a substance called paclitaxel ((Taxus stent) or sirolimus (Cypher stent).

Q3. Are Medicated Stents Much Better and Effective Than Normal Stents?

A3. Bare metal stents (non medicated stents) usually have a 15-20 per cent chance of have restenosis (or re narrowing ) of the arteries within sixth months. With DES the rate of restenosis is reduced to

Q. I Am 58 Years Old, Diabetic and Have Hypertension. I am Also a Regular Smoker. I Recently Suffered Chest Pain and Had to Be Hospitalised. The Doctors at The Hospital Did ECG and Told Me to Do Coronary Angiogram As They Have Found Positive Signs of Block. Now How Confirmatory is Coronary Angiogram? My Second Question is What is The Risk of Fatality in Undergoing Coronary Angoigram?

A. The coronary angiogram is the "Gold standard" test for assessing blockages in the coronary arteries. It outlines the lumen of these vessels but may not need any intervention yet (except risk factor control). In any case, the treatment of coronary arteries depend on findings during your angiogram. Some patient with diabetes may also have microvasular disease (disease in the very small arteries) which may not be seen on the angiogram. the risk of an angiogram is death

Q. It is Said That Heart Disease is No Longer a Disease for The Wealthy People and Stress Also Increase The Risk of Heart Disease. How True is It?

A. Heart disease is a worldwide pandemic that "respects no boundaries," and isn't just a disease of affluent countries. World Heart Federation statistics indicate that 80 per cent of deaths caused by cardiovascular disease occur in low- to middle-income countries such as Russia, Poland and China to name a few.

Children who have had a stressful childhood has been shown to have a 30-70 per cent chance of developing heart disease that can be accounted for by traditional risk factors. Recently it has also been shown that acute mental stress can induce electrical instability in the hearts of those with those with coronary disease which may confer higher vulnerability for malignant heart rhythms.

Some recent epidemiological evidence suggest that those born first in the family, those who have a combination of anger and fatigued states and those who assume non traditional family roles (eg house husband) have increase risk for developing coronary artery disease. It's hard to quantify one's level of emotional or psychological stress. All people feel stress but they feel it in different intensities and ... to it differently. More research is required on how stress can contributes to heart disease risk.

Q. I am a 50 Year Old Teacher of Active Habit. I am Moderate Smoker And Non Vegetarian. I have been Suffering From High Blood Pressure and Occasionally Feel Heavy in The Chest With Left Side Chest Pain. This Usually Occurs When I Take A Long Walk or Undergo Physical Strain. My Doctor Has Suggested to Go for A Cardiac Check Up in an Advanced Cardiac Care Centre. Can You Tell Me What are The Procedures to Be Undertaken.

A. It sounds like you have risk factors (smoking and hypertension) and history which is suggestive of angina pecloris (See Question 1). If your doctor is convinced that this is truly angina, he may send you immediately for a coronary angiogram to assess what needs to be done. If the blockage is in a minor vessel and the symptoms are not too troubling, than sometimes medications will suffice. If the blockage is in an important vessel (eg proximal left anterior descending artery) than angioplasty ro surgery may be offered.

If he is not convinced by your symptoms, he may opt to do some form 'stress test" first, which in its simplest form is an exerise ECG test. Variations of this test to improve its accuracy may include the use of echocardiography or Nuclear imaging. An abnormal stress test usually means that a coronary angiogram is needed to evaluate the blocakges better and to decide the means of treatment. Some elderly individuals or those with kidney failure (but not on dialysis yet) may opt not to have an angiogram because of its attendant risk, may simply be treated with medications first.

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