Treatment of Coronary Disease
Prevention of Atherosclerosis
Not smoking and not being in smoking environments, eating foods rich in vegetables and fruits, containing moderate amounts of protein, A high-calorie-free diet containing fiber, adequate calcium and minerals. Preventing obesity and increasing physical activity. Intermittent checking of blood pressure and blood lipid values. Early detection and treatment of possible diabetes, fat metabolism disorders and hypertension. Changing psychological and social situations positively. Taking 80-300 mg/gunaspirin every day should be recommended to all patients who have no contraindications.
It has been recommended not to use hormone replacement therapy in post-menopausal female patients who have had myocardial infarction. On the other hand, it has been reported that post-menopausal women who are under hormone replacement therapy while having an infarction can continue the treatment and there is no need to discontinue it.
Those with chronic atrial fibrillation, those with thrombus in the left ventricle, those who have had an infarction who cannot take aspirin, those with paroxysmal atrial fibrillation attacks. It is recommended to start anticoagulant treatment in patients with post-infarction or widespread wall motion disorder.
Angina Pectoris Treatment
Prevention of Acute Attacks:
Predisposing factors should be determined. Cold, hypertension, arrhythmia, and heavy exercise may be the cause. One or more of different medications can be added to the treatment.
Aspirin can be given to prevent clot formation, especially in areas of obstruction.
- Nitroglycerin, which can be given as an oral spray over the skin. It widens the arteries. Sublingual nitrate is the first option and is given for 1-2 minutes. It shows its effect inside. The dose can be repeated with an interval of 3-5 minutes. Chest pain that does not respond to 3 tablets or lasts longer than 20 minutes indicates that an infarction is developing.
- During stress, your body sends a message to your heart to work harder. In times of physical and emotional stress, Beta-blockers block chemical or hormonal messages to your heart.
- Calcium channel blockers keep your arteries open and reduce your blood pressure by relaxing the muscles around the artery.
My Treatment of ocardial infarction:The patient is monitored with devices in the intensive care unit, oxygen is given, laboratory examinations are requested.
Percutaneous (through the skin) interventions and Surgery
Drugs cannot open a blocked artery; severely narrowed coronary arteries require other treatments to prevent a heart attack. There are two important options: Percutaneous interventions (transcatheter interventions)or coronary artery bypass surgery.
In carefully selected patients, both treatments have good results. Personal factors such as how much stenosis there is, how many arteries are involved, the location of the stenosis, how much heart muscle is at risk, and the patient's age and general health condition help decide which treatment to apply.
Percutaneous Coronary Interventions.
Angioplasty, which opens blocked vessels, is performed by interventional cardiologists. They use a long thin tube called a catheter with a small balloon at the end. They inflate the balloon in the blocked area of the artery, squeezing the plaque against the artery wall and flattening it. Angioplasty is also known as“Percutaneous Transluminal Coronary Angioplasty”(PTCA).
How is it done?
A thin wire (guide wire) is inserted through the artery in the leg. The catheter is advanced through the guide wire to the occluded coronary artery. The catheter is slid over the guide wire and the balloon is inflated there. After the treatment, the wire catheter and balloon are removed from here. Hospital stay and recovery time are shorter than bypass. However, it may further increase obstruction in approximately 35% of patients. Re-occlusion (Restenosis) may occur 6 months after angioplasty.
Stent procedure is applied together with balloon angioplasty. A mesh-shaped metal piece is placed around the balloon. When the balloon is inflated, this wire opens and settles on the vessel wall. The catheter and balloon are removed, the stent remains inside. The open wire also ensures that the vein remains open. The restenosis rate is approximately 15% to 20% after this procedure. Efforts are being made to reduce restonosis rates with some drug-containing stents.
Atherectomy may be an option for patients who cannot undergo balloon anjoplasty. A high-speed drill at the tip of the catheter removes the plaques from the vessel. It is used for shaving from the wall.
Laser ablation: It is performed with a catheter with a fiberoptic or metal probe at the tip. By burning the plaque with the laser, an opening is created for the balloon to enter, then the opening is widened with the balloon.
Percutaneous Transluminal Myocardial Revascularization (PTMR)
After the area is anesthetized, A catheter is inserted into an artery in the leg and advanced towards the heart. It is supported by a laser catheter and thin holes are created in the heart muscle with the laser. Through these holes, channels are created to the oxygen-hungry heart regions. Researchers believe that this procedure will cause new vessels to form, which will reduce angina pain. PTMR is currently performed on patients who have not responded to treatments such as medications, angioplasty or bypass surgery.
Surgery
Coronary artery bypass surgery:
The purpose of coronary bypass operation; It is to eliminate chest pain, if any, and to prevent a heart attack that may occur in the future. In this way, it is done with the aim of improving the patient's quality of life and prolonging his life. "Bypass" is the circulation of blood flow around one or more narrowed vessels. To do this, the surgeon often removes a vein from the leg (saphenous vein) or an artery in the upper chest. (internal mammarian artery). Sometimes, an artery from another part of the body can be used. Radial artery (removed from the forearm)It is the second most preferred artery graft. These new vessels removed to carry blood flow behind the stenosis are called grafts. Before the operation, the patient is given general anesthesia. During the procedure, the sternum is opened with a special device, the heart is stopped and the function of the heart and lungs is provided by a machine outside the body. After the operation, the heart is restarted and the patient is separated from the machine. The sternum is restored to its previous state by stitching with special steel wires.
In case of multi-vessel disease, coronary bypass should be planned and the frequency of death in this operation is around 3%. Surgical intervention should not be postponed in a person who develops angina after infarction, because infarction and sudden death may occur in the meantime.
Minimal in invasive coronary artery bypass
It is a less invasive surgical technique. The incision is smaller and the procedure can be done while the heart is working. This also reduces the risks of complications. The procedure will also reduce the patient's recovery time and costs. This operation can only be performed in patients with low risk and complications, usually in cases of stenosis in the anterior descending branch of the heart (LAD), where bypass can be performed with this small incision.
Transmyocardial laser revascularization (TMLR)
In this technique, laser is used to create thin channels in the lower parts of the heart (left ventricle) that will increase blood flow inside the heart. The surgeon makes a small incision on the left side of the chest. While the heart is still working, the surgeon uses a laser to open 20 to 40 thin (one-millimeter wide) channels over the oxygen-starved heart muscle to the left ventricle. These channels redirect blood to the heart muscle and can reduce angina pain. TMLRis generally considered a less aggressive procedure than open heart procedures. It is performed with only a small incision, and patients usually do not require a blood transfusion. And since it is performed on a working heart, the surgeon does not need a heart-lung machine. Although the procedure has been approved by the American FDA, TMLRis only performed on patients who do not respond to other treatments.
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