Cardio Care

When you experience symptoms or if your physician suspects that you have coronary artery disease, several tests can be undertaken to make a diagnosis. Initially the cardiologist would undertake an electrocardiogram (ECG), first while you are resting and then again while you are walking or running on a treadmill. If the ECG suggests abnormality then the next step would be to undertake an angiogram. This procedure involves the injection of a dye into the coronary arteriesthrough thin plastic tubes (catheter) which is visible by x-ray. The catheter is introduced into the groin or to the arm. The x-ray is in the form of a video allowing the cardiologist to see the arteries and the presence of any narrowing or blockages. Using this information the physician will recommend a course of treatment.

The cardiologist will discuss with you the various treatment options. If medication therapy or bypass surgery is not recommended at this stage, then angioplasty and possible stenting are the most likely alternatives. These procedures involve the widening of the blocked (stenosed) vessels in order to restore the flow of blood.

Percutaneous Transluminal Coronary Angioplasty (PTCA) is a minimally invasive technique used to open the narrowed vessels by expanding a balloon within the constricted section. This procedure is undertaken in a catheterization laboratory (cathlab).

The catheter is introduced under local anesthesia through a small puncture in the groin or the arm. A small sheath is inserted into theopening and this makes possible the placement of a guiding catheter, which is fed through the sheath to the aortic root and engaged into the coronary artery opening. A dye is injected into the guide catheter, which allows the physician to visualize the coronary arteries on a continuous x-ray machine (fluoroscope).

Your doctor may use a mild sedative to help you to relax during this procedure. You are kept awake as most people may find that they can cope fairly well with the procedure. In addition the physician may ask you to move or breathe deeply to improve the quality of the x-ray pictures. If during the angiography procedure your cardiologist sees a blockage in your coronary arteries he or she may choose to open the blockage with a balloon catheter and then keep the blockage open by implanting a small scaffold-likedevice called a “stent”. The tiny balloon and stent are maneuvered through the coronary arteries to the site of the narrowed vessel. Once in place the balloon is inflated which expands the stent to form an open support structure. The balloon is then deflated and withdrawn, leaving behind the stent, which holds the vessel open and thereby improves blood flow to the heart, thus relieving the symptoms of heart disease. The procedure usually takes approximately an hour or two, during which time you will need to remain quite still. For the most part you will be perfectly comfortable. However, when the balloon is inflated you may experience some pressure or chest pain. This will quickly fade away when the balloon is deflated.

Currently two types of stents available: bare metal and drug eluting. Bare metal stents have no coating and are made of sophisticated biocompatible materials like medical grade stainless steel or cobalt-chromium.

Drug-eluting stents have a very thin coating into which polymer (as a vehicle to carry drug) and a small amount of drug is impregnated, which gets released into the vessel wall immediately after implantation. Your doctor will choose one of these devices based on your type of blockage and other medical parameters. When a stent is implanted the process of pushing back the plaque materials towards the vessel wall causes an injury to the vessel wall. In the majority of cases this injury heals with no negative effects. However, in a small percentageof cases (depending on a number of factors such as the volume of plaque, the length and diameter of the blockage, calcium content, trauma), the healing of the injury may cause excessive scar tissue which re-blocks the vessel. This is called restenosis (re-blockage). Restenosis is not fatal but it may result in you having a repeat procedure within the next year. Drug-eluting stents were developed to prevent restenosis by delivering a very small quantity of drug into the surrounding tissue that limits the neo-intimal growth (scar tissue). These devices have been shown to be very effective in most cases. However the drugs are very powerful and can sometimes prevent any healing for a long period. This places the stent at risk of developing clotting with blood. In a very small percentage of cases this can lead to a heart attack.

To overcome this risk the doctor will advise you to take an anti-platelet (blood thinning) drug, normally Clopidogrel together with Aspirin. This drug is normally prescribed for a period of six months to one year (or may be more), during which time you would be advised not to undergo any form of surgery, as you would need to stop the drug to avoid excessive bleeding.

It is important that you understand the risks and benefits of each of these products and discuss them with your cardiologist before the procedure.

After the PTCA procedure your heart will be carefully monitored. This will be done by frequent blood pressure tests, and you may also be attached to an ECG machine for constant monitoring of your heart function. If the insertion point was in the groin area you can expect to stay in bed for several hours. The introducer sheath is normally removed after the procedure and when it is removed a nurse will apply pressure to the puncture site for 20 to 30 minutes, or until there is no bleeding. You will be asked to walk within 12 to 24 hours of the procedure. You will also be asked to drink lots of fluids to help your kidneys get rid of the dye more easily. Mild chest pain is common after the procedure, but this should gradually disappear within a couple of hours. If your chest pain increases, additional x-rays may have to be taken.

After a successful PTCA and stenting procedure you are likely to be sent home from hospital within one or two days. It is likely that the physician will advise you to avoid strenuous activity for at least a week.

1. Stop smoking
Nourish yourself with a handful of sunflower seeds and a cup of nettle or oat straw infusion daily for 4 to 6 weeks before quitting. Sunflower seeds reduce the body’s craving for nicotine by filling the nicotine Receptor sites. The infusions strengthen blood vessels and nerves and cushion the impact of withdrawal.

2. Touch and be touched
Many scientific studies have shown that people who were touched lovingly every day had significantly fewer heart problems than the control group.

3. Eat seaweeds
They have been shown to stabilize blood pressure, regulate levels of tryingly, phospholipids and cholesterols, they dissolve fatty build-ups in the blood vessels, they can restore cardiac efficiency and prolong the life of the heart muscle, and they encourage a steady heart beat.

4. Eat foods rich in beta-carotenes

They can cut your risk of a stroke by 40 percent. Foods rich in beta-carotenes include carrots, cabbage, winter squash, sweet potatoes, dark leafy greens, apricots, and seaweed.

5. Eat Garlic
Study after study has confirmed garlic’s abilities to lower blood pressure, reduce phospholipids and cholesterol, strengthen heart action, increase immune response, reduce platelet clumping and clotting (thus reducing strokes) and stabilize blood sugar levels. Eat garlic raw or lightly cooked, several cloves a day.

6. Eat foods rich in essential fatty acids
Fresh pressed oils of wheat germ or flax seed are especially nourishing.

7. Drink Lemon balm Tea
It is so strengthening to the heart that there’s an old saying about it: “Those who drink lemon balm tea daily will live forever!” You can also steep a handful of fresh leaves in a glass of white wine for an hour or so and drink it with dinner. Or make lemon balm vinegar to use on your salads.

8. Move !
Go for a walk, jump rope, swim, or do leg lifts and arm raises from your bed or wheelchair: however you can do it, do it! Regular exercise is key.