Coronary Artery Disease Diagnosis and Advanced Treatment Options, part 2


Welcome back you’re watching McLaren Port Huron today’s health and I’m talking with board-certified Interventional cardiologist B. Ramesh ready, and we’re going to be talking about heart attack. Okay, dr. Reddy. What are the symptoms of a heart attack? heart attacks can present in a multiple ways But the commonest symptom is a uncomfortable Feeling in the chest if pressure or a heaviness that seems to persist and doesn’t go away Sometimes you can break into a sweat You can have just shortness of breath sometimes women have a slightly different Presentation they may just have nausea or just a discomfort in the upper Lower chest or upper stomach area So a variety of manifestations But the most important thing is an uncomfortable feeling in the chest or chest pressure that occurs either at rest or with activity So it’s it’s either if you get up and move around it’s the same as when you sit down. It’s still always there It could get worse when you get up and move it down But mostly it presents itself as a heaviness and pressure in the chest that doesn’t go away and woody What should you do if you think you’re having a heart attack? You’ve if those symptoms come on. I think the best thing would be to call 9-1-1 sit down and if you have an aspirin take an aspirin and wait for the EMS to arrive and Probably a good idea to open the front door so they have no problem having Access to coming and get you if you’re alone if you have a family member have them make the phone call leave the door open Take an aspirin and just lie down and rest that would be the best way to go And is there ever a time that your family member or someone should even think about CPR if you if you stop breathing or Fall over how do you handle those situations no CPR? saves lives But it has to be done by somebody who’s comfortable familiar with it Sometimes in moments of panic even a family member who knows may not be able to do it, but yes it does help have somebody laying flat on a flat surface and initiate your CPR and calling 9-1-1 Sometimes the EMS also can guide you if they are able to on the telephone so that would be a reasonable approach But I would go ahead with an aspirin open the door Wait for the EMS to come and get you and they’re pretty quick in this county well You know you have I’m guessing you would have so much anxiety that If I’m close to the hospital Why don’t I just jump in the car or have my husband put me in the car and off I go You know that’s a very valid question heart attacks present not only with chest pain But they also present with arrhythmia when you say arrhythmia. It’s a very irregular rapid heartbeat That could be fatal so if you’re driving yourself to the hospital. There’s a good chance Unfortunately that you may have one such area that goes along with the heart attack and you may actually pass out hurt yourself Hurt the person on the on the other side of the road so driving yourself is not a good idea 9-1-1 and have the family member be with you while 9-1-1 is Doing the action of you know dispatching what happens once you get to the emergency center then We have a very good system at mclaren once the patient is actually picked up by 9-1-1 EMS comes to the house and picks up they have the ability to perform an EKG on-site or even in the truck That EKG is transmitted immediately to the emergency room the ER physician looks at the EKG And if it is indeed a heart attack then he alerts the team we have a STEMI call alert in the hospital that goes out to the cardiologist on call and The entire team is alerted in fact They literally greet the patient as they come in and they take him straight to the cath lab if the lab is open Otherwise they do the preliminary work starting an IV and things like that and then send him up to the cath lab Why is time so important? See every unlike a lot of other tissues in the body for example like the liver Heart muscle is very precious once it dies once the damage occurs it cannot come back so time is muscle And that’s why it’s so important to move fast Once you get to the cath lab. Can you describe for us the? angioplasty procedure Basically, it’s a blockage. Maybe we have some slides if you can run them through for us this is a picture that tells you how the arteries are one on the right and one on the left, and we actually have a Angioplasty images coming up. This is a normal looking artery with blood flowing through This is a small tear in the inside of the artery initiating a clot formation, which you can see it here and here there is a clot that has found extensively blocking the artery now when Angioplasty is performed. You will see how that is addressed you have a critical stenosis here in the artery and You will see one more picture of that right here is where the blockage is So we actually advanced a wire under the x-ray guidance to go through the blockage beyond the blockage and We open it up with a balloon, and then we advanced a stent you can see the stent coming there It is at the site of blockage opens up Improves the blood flow and there you can see the more Improvement in blood flow so this is really a good depiction of how an angioplasty and stent is deployed It’s really very dramatic how soon do you know if this treatment is successful? Right in the lab on the artery is open Do you know that you have improved the blood flow? But the actual recovery of the heart muscle although you have a pretty good idea it takes four to six weeks to come back to its full force so Immediate results you know that the artery is open. There’s improvement in chest pain there’s improvement in EKG, but the total You know coming back of the heart muscle will take a few weeks. Do you always put a stent in? Stent is really our first choice. We first open it up we go through with the wire open with a balloon and put a Stent stent is far superior to a balloon so that is our goal Almost every heart attack that we come and do the intervention and how long did the stents last then No, one’s a stent is put in there is about there 95 to 93 percent chance of the artery remaining open So there is a five to seven percent chance the blockage can come back, and if that happened generally eight months to maybe a year Now after eight months to hear if the artery is open Just like any other area in the heart arteries This area is also susceptible to have another blockage so the risk is pretty much the same but there is a 93 to 95 percent chance of remaining open So stent is a pretty good reliable Methodology to open up the artery can you open up more than one artery at a time during the cath procedure you can it depends on the circumstances Which is the artery that is blocked that we are working on how much heart muscle is being Supplied by that how serious are the other blockages which we call them as important, but not culprit as we call them It’s not the culprit blockage most important blockage, so that’s a decision we make during the procedure but yes It is possible to open more than one is it sometimes does the patient have to come back and have it when their heart has Recovered a little bit, maybe have another standard We call that as a staged Intervention and we find that there’s another blockage we already recognize It and we allow this one to heal up settle down and we bring him back. Yes. That is a Reasonable approach to do do you still have to manage your risks? After the heart attack yes, I think it’s that’s called secondary prevention You know you already had a heart attack you had an intervention now it’s all the more important to prevent another damage because whatever heart muscle is left is very precious heart muscle so as Aggressive as you can keep your cholesterol down the bad one under 70 exercise take your medications regularly if you’re a smoker quit and Make all the lifestyle changes Necessary your efforts should be very intense in preventing another heart attack and that happens by modifying the risk factors that I just said So you it’s not possible if you have three or four Stents and to just say well, I’ve got these stents in now and so I’m I can eat what I want and and I’m not going to be at risk anymore because I have these deaths no that send stents are excellent But they are not intended to infuse a false sense of security for patients. No that’s not the intent Strengths are providing you the relief it is important that you make the lifestyle changes risk factor modification No, you should really not be indulging in indiscriminate eating, and you know sedentary lifestyle That’s really not the intent of doing intervention They need a picture their heart on the refrigerator to whether there’s Some patience do we give them a picture before and after how it was in fact? They tell me it serves as a very nice reminder for them, and as they make their lifestyle changes So that’s not a bad option Yeah It’s not a bad idea are there is there ever a time when you go into places Standard that you’re unable to open the vessels and the person has to have further intervention it does happen we We have a success rate of over ninety five percent almost ninety seven percent But there are some situations when you cannot open the artery If you’re unable to open the artery your option is bypass surgery But we like to stabilize the patient before rushing them through bypass surgery so that option exists It’s infrequent, but yet That’s a option that we sometimes take on if necessary, but happens less than three percent of the time You’ve given us such great information. Do you have any closing comments for our viewers? Heart attack. This is a major killer number one Cause of death in men and women in this county in the state and in this country Do everything possible not to be a victim of this lifestyle changes risk factor modification? Active lifestyle and enjoy every day that comes your way Thank you so much for joining us. Thank you for having me.

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