Most common heart-related
conditions
- provided by America's leading
cardiologists
Coronary Artery Disease
Coronary artery disease, sometimes called coronary
heart disease, can be caused by high cholesterol,
high blood pressure, cigarette smoking, and other
risk factors. Coronary artery disease can cause
heart attacks, angina, heart failure and abnormal
heart rhythms, but understanding the many differences
between these cardiovascular problems can be confusing.
Select a program below to help keep you informed.
Angina
What is Angina?
Angina pectoris is the name for a chest
pain or discomfort caused by a lack of blood supply
to the heart muscle. Learn more about the signs
and symptoms of this common condition.
Participants:
George A. Beller, MD, MACC
Ruth C. Heed Professor of Cardiology, University
of Virginia Health System, Charlottesville, Virginia
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua
Heart Center,
Piedmont Hospital, Atlanta, GA.
Robert S. Schwartz, MD, FACC
Director of Preclinical Research, Minneapolis Heart
Institute,
Minneapolis, MN
Eric L. Michelson, MD, FACC
Senior Director, Clinical Development, AstraZeneca
Editorial Consultant:
Suzanne Hughes, MSN, RN
Webcast Transcript:
ANNOUNCER: Angina affects over 6 million Americans.
It most often is described as pain or discomfort
in the chest. But why does it happen? And what exactly
is angina?
ROBERT S. SCHWARTZ, MD, FACC: Angina pectoris is
the name for chest pain that’s caused by the
heart when it lacks blood. The most frequent cause
is plaque that builds up inside the arteries of
people’s heart, and when that happens, it
stops blood flowing into the heart. The heart is
a muscle. The heart needs blood. And when it doesn’t
get blood, that lack of blood is manifested as chest
pain, chest pain called angina pectoris, or, for
short, angina.
GEORGE A. BELLER, MD, MACC: When there is a blockage,
there is an impairment of blood flow through that
blockage to the heart muscle, particularly under
situations like exercise stress, where the heart
needs more oxygen, and the only way it gets more
oxygen is by getting more blood flow. And if there
is an impediment to the blood flow, then there is
a sensation of chest pain. It’s the body’s
way of warning the person that there’s not
enough blood getting to the heart muscle, and that’s
actually what is angina.
ANNOUNCER: Although chest pain is common, it’s
not the only sensation a person with angina will
experience.
ROBERT S. SCHWARTZ, MD, FACC: Angina can manifest
itself as many things other than pain. Most common,
patients refer to their pain as a pressure, or a
band-like sensation, or “an elephant sitting
on my chest that makes me short of breath.” Sometimes
it presents as a heartburn or a burning sensation
in the chest, and not really a true pain per se.
Other times it will present as something strange,
such as an arm pain or a neck pain or a jaw pain.
ERIC L. MICHELSON, MD, FACC: The manifestations
of angina, the symptoms that patients have, because
angina is a symptom, vary widely from patient to
patient and are interestingly, even the differences
between what men and women may typically characterize
as being their angina discomfort. Women, for example,
may typically have either a feeling of discomfort
in their abdomen, GI distress, indigestion, feeling
dizzy, feeling shortness of breath, whereas for
men it’s just a little bit more typical for
them to have that sort of squeezing feeling in their
chest.
It’s often a more vague discomfort in both
men and women, but for men it’s particularly
more of that sort of fist in the chest discomfort,
a little less typically for women.
SPENCER B. KING, MD, MACC: Sometimes it’s
a mild discomfort. Sometimes it’s an excruciating
pain. Sometimes it’s a feeling of impending
doom, that something terrible is going to happen.
But it’s a quite variable feeling.
The most important thing in recognizing angina
is for patients or people to understand that if
they have a feeling in the chest, arm, neck that
is totally different from anything they’ve
felt before, that they should pay attention to that.
This could be a manifestation of angina.
ANNOUNCER: For some people, angina is very predictable
but for others, it can appear with no warning
GEORGE A. BELLER, MD, MACC: The two types of angina
that are described are stable angina, where the
chest pain is predictable, like somebody walks from
a parking garage, up a hill or up a bunch of steps,
and every time they reach the tenth step or so they
start feeling this pressure, and they will either
stop or take a nitroglycerin, which is the major
medication to stop the angina pain.
Unstable angina is when all of a sudden the patient
starts to experience discomfort without any provocation.
It can occur at rest. Or with very minimal exertion
and not go right away when you stop your exercise
or take a nitroglycerin. And it can come on repetitively,
more frequently and more severe, and that is a warning
to get right to the hospital, because the blockage
has gotten suddenly worse.
ROBERT S. SCHWARTZ, MD, FACC: Typically, when these
pains or these sensations come on with activity
or with exertion, it’s important to get in
to your doctor very rapidly, because this could
mean that the arteries to the heart are developing
plaque and are narrowed and that the heart is lacking
blood during those times that the sensation occurs.
How is Angina Treated?
If you experience chest pain or discomfort,
you may be suffering from angina. Tune in to find
out more about this common form of heart disease.
Participants:
Richard P. Lewis, MD, MACC
Professor of Internal Medicine, Ohio State University,
Columbus, Ohio
Richard O. Russell, MD
Webcast Transcript:
ANNOUNCER: Angina pectoris, often referred to as
angina, is the most common type of heart disease.
It's caused when the heart muscle doesn't get enough
blood, and it can be treated in a variety of ways.
RICHARD P. LEWIS, MD: The bedrock treatment of
angina is drugs. And the main drugs that we use
are beta blockers, which are adrenalin-blocking
drugs that slow the heart rate and prevent the adverse
effects of adrenalin on precipitating heart attacks
and abnormal heart rhythms; statin drugs, which
lower the blood cholesterol, which have been shown
to reduce the incidence of heart attacks and make
people live longer and stabilize the heart artery
disease that's causing the angina; nitroglycerin
for when a person actually has an angina attack;
often we will use aspirin and perhaps other blood
clot inhibiting drugs as well, depending on the
situation; and then we may add high blood pressure
medicines if the person also has high blood pressure,
which can make his angina more likely to happen.
ANNOUNCER: After diagnosis, medication is the first
step in treating angina. But there are other methods
doctors can use, including enhanced external counterpulsation
or EECP.
RICHARD O. RUSSELL, MD: Counterpulsation is the
treatment where cuffs are put on the legs, like
stockings with various compartments in the stockings,
and over a period of about an hour—and there
is a prescribed five days a week, seven weeks of
therapyfor an hour or so—these cuffs are pumped
full of air, relaxed, pumped full of air and relaxed.
And that is pulsation. It doesn't try to keep up
with the heart rate. They are just pumped several
times a minute. We think it helps to increase the
collateral or detour blood flow in the arteries
of the heart themselves to deliver more blood to
the heart. And it's been astoundingly successful.
It doesn't have any complications really. The patients
come each day for five days a week, and this counterpulsation
seems to improve the circulation to the heart and
actually improves angina. It decreases the frequency
of angina pectoris.
Lifestyle change will also play an important role
after you've been diagnosed with angina.
RICHARD P. LEWIS, MD: If a person develops angina,
they must stop smoking first. Smoking accelerates
the process of heart artery disease and makes a
heart attack and sudden death more likely to happen.
In most cases, you need to lose some weight and
change your diet. Getting regular exercise: It turns
out that if you exercise regularly, not only does
it help your blood lipids, but it makes your body
less likely to have a heart attack. It lowers the
level of inflammation in the heart arteries, which
is what makes the disease progress. So exercise
is very important.
I tell people that have angina to listen to their
body. It's amazing. "Some days," people
say, "I can do anything I want to. Other days
I just go up a flight of stairs and I get my angina." I
tell people that if you're feeling well when you're
doing it, it's okay. Your heart will let you know.
Diagnosing Heart Problems
Do you suffer from chest pain while exercising?
If so, you may want to see a doctor. Join experts
as they talk about the various methods used to diagnose
a type of heart problem, known as angina.
Participants:
George A. Beller, MD, MACC
Ruth C. Heed Professor of Cardiology, University
of Virginia Health System, Charlottesville, Virginia
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua
Heart Center, Piedmont Hospital, Atlanta, GA.
Editorial Consultant:
Suzanne Hughes, MSN, RN
Webcast Transcript:
ANNOUNCER: Do you suffer from chest pain while exercising?
If so, it may be a sign of angina.
SPENCER B. KING, MD, MACC: Angina, or angina pectoris,
as it's sometimes called, or angina, which is all
-- all these are correct pronunciations -- is the
feeling, the sensation that a patient has when they
have lack of blood supply to the heart.
GEORGE A. BELLER, MD, MACC: The signs and symptoms
of angina are very straightforward. The patient
experiences a feeling of pain or pressure, particularly
with exertion, that is localized predominantly in
the center of the chest, behind the breastbone.
And it's feeling of a diffuse nature, and it can
move up into the neck and jaw and down either arm.
But some people can experience it only up in the
throat or jaw, and some will experience it way down,
almost at the top of the stomach. But it typically
occurs with physical activity, and then is relieved
by rest.
ANNOUNCER: If you are experiencing chest pain or
other discomfort, it's important to seek medical
attention immediately to receive the correct diagnosis
and care.
SPENCER B. KING, MD, MACC: Since angina pectoris
is a symptom, a sensation, angina is a sensation
that we feel, it may signal blocked arteries or
a lack of blood supply. And when people have that
sensation, it's important to make the correct diagnosis.
That is, is this indeed due to artery disease? Because
every pain we have is not from the heart.
ANNOUNCER: If your doctor suspects angina, a thorough
medical examination will be performed to confirm
a diagnosis.
GEORGE A. BELLER, MD, MACC: Angina is diagnosed
clinically first by getting a good history, where
the characteristics of the pain are thought to be
a high probability by the doctor or nurse interviewing
the patient that it's angina. It is most often confirmed
by a stress test, and this is usually done on a
treadmill, and with monitoring the electrocardiogram
during the exercise stress.
But most often, there has to be a second test done
with the treadmill test, which is an imaging test,
and the most common one used is a nuclear cardiology
test called a spec scan, or a myocardial perfusion
scan, in which the heart blood flow can be visualized
with a special camera when an agent, an imaging
agent is injected during the treadmill test. And
after the test is over, the person is put under
the camera, and areas that didn't get enough blood
flow, that caused the angina, can be actually seen
on the pictures taken with this special camera.
SPENCER B. KING, III, MD: In addition to all that,
there are tests that measure directly the arteries.
The common test is the coronary arteriogram, which
is an invasive test. We put a catheter in and inject
a dye or a contract media, we call it, into the
arteries, use x-ray to create images, and we can
see blockages in the arteries.
More recently, there are noninvasive ways, such
as computerized tomography that help us see the
arteries. There's magnetic resonance imaging (MRI)
that can help us see these. And these evolving techniques
are usually measured against the gold standard,
which is the coronary arteriogram. But there are
a host of ways to investigate angina. All of these
are not always necessary, but they're all available
to help us understand whether this is in fact due
to coronary artery blockage.
How Often Should I Have an Evaluation of My Angina?
If you've been diagnosed with angina, how
often you need to be monitored will depend on the
severity of the angina. Tune in to learn more about
the evaluation process.
Participants:
George A. Beller, MD, MACC
Ruth C. Heed Professor of Cardiology, University
of Virginia Health System, Charlottesville, Virginia
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua
Heart Center, Piedmont Hospital, Atlanta, GA.
Editorial Consultant:
Suzanne Hughes, MSN, RN
Webcast Transcript:
ANNOUNCER: If you’ve been diagnosed with angina,
follow-up visits with your doctor will be necessary.
How often you need to be evaluated will depend on
the severity of the angina.
SPENCER B. KING, MD, MACC: You monitor the patient
in several ways. One is from a symptom point of
view, the patient must be their own physician in
some respects. If the angina is becoming more severe,
if it’s coming with less effort, this is a
reason to have additional evaluation.
In the absence of any of that, periodical evaluation,
usually with stress testing, help us understand
whether the patient’s lack of blood supply
is remaining stable.
GEORGE A. BELLER, MD, MACC: Once someone has diagnosis
of angina, there are two approaches that are often
taken. One is medical treatment, and the other is
getting a stent put in or even having bypass surgery
after the full evaluation is done, even catheterization.
If either one of those are done, medical therapy
or revascularization, it’s called, like a
stent or bypass surgery, patients will have to be
followed up fairly frequently.
The first visit might be at six weeks after the
institution of therapy, or several months. But then
after that most patients will have to be followed
every six months to make sure that the risk factors
that caused the angina are under control, such as
high cholesterol, high blood pressure and so forth.
Risk Factors
Can Cardiovascular Disease be Prevented?
More than seventy million Americans suffer
from cardiovascular disease, which is a disease of
the heart or blood vessels. Tune in to find out if
you're at risk for it.
Participants:
Richard P. Lewis, MD, MACC
Professor of Internal Medicine, Ohio State University,
Columbus, Ohio
Suzanne Hughes, MSN, RN
Education Coordinator, Center for Family Medicine,
Akron General Medical Center, Akron, Ohio
Adolph M. Hutter Jr, MD, MACC, FAHA, FESC
Past President and Editor-in-Chief Conversations
with the Experts American College of Cardiology
Webcast Transcript:
Cardiovascular disease affects all aspects of heart
function, from the arteries that supply it with
blood, to the valves to the heart muscle itself.
RICHARD P. LEWIS, MD: Cardiovascular disease is
the commonest chronic illness in our society, and
I think in the world now. It causes about half of
the deaths in our country today in one form or another,
either as a heart attack or sudden death or dying
of congestive heart failure.
Strokes are also a manifestation of cardiovascular
disease, and a final one is called intermittent
claudication, which is disease to the leg blood
vessels that may lead to an amputation of the legs
if it's severe.
ANNOUNCER: There are factors that can add to a
patient's risk for the disease.
SUZANNE HUGHES, MSN, RN: There are only three risk
factors for heart disease that we can't change.
We haven't found the Fountain of Youth, so we can't
turn back the clock: Age is a huge risk factor for
cardiovascular disease. Being a man early in life
is a risk factor for heart disease, which certainly
is not changeable. And then the third thing is that
we can't choose our parents. Family history is a
risk factor for cardiovascular disease.
ANNOUNCER: Different medications can be prescribed
to help prevent or control cardiovascular disease
ADOLPH M. HUTTER, Jr., MD: There are a number of
medications that are actually very effective in
preventing heart attacks and other forms of atherosclerosis.
One is the simple drug aspirin. Aspirin has been
shown to reduce strokes in women and heart attacks
in men.
Another very important class of drugs are the drugs
called statins. The statins are drugs that lower
the bad cholesterol, the LDL. They lower it very
effectively, and many studies have shown that these
drugs can prevent the onset of heart disease and
the progression of heart disease if you already
have it.
A class of drugs called beta blockers can be very
effective in protecting people who have already
had a heart attack. They're also helpful in controlling
blood pressure and controlling angina, which is
a symptom of chest discomfort due to a blockage
in the artery.
ANNOUNCER: It is also crucial that a patient makes
lifestyle modifications.
ADOLPH M. HUTTER, Jr., MD: Heart disease is very
preventable. You must absolutely stop smoking. You
must have a low cholesterol, particularly the low
bad cholesterol, the LDL. You must have your blood
pressure controlled. You should exercise regularly
and keep a lean weight.
RICHARD P. LEWIS, MD: We have made enormous strides
in treating cardiovascular disease in all types.
We can prevent the progression of this disease or
the occurrence of clinically significant disease
with our modern treatments if people will but do
them. And it's not a disaster, even if you have
the disease.
What Should Women Know About Heart Disease?
Heart disease kills 32 percent of women each
year, meaning that more women than men die from heart
disease. Tune in to learn the facts about women and
heart disease.
Participants:
Suzanne Hughes, MSN, RN
Education Coordinator, Center for Family Medicine,
Akron General Medical Center, Akron, Ohio
Noel Bairey Merz, MD
Webcast Transcript:
ANNOUNCER: Heart disease is the number one killer
of women in the United States, and eight million
women are currently living with this condition.
SUZANNE HUGHES, MSN, RN: People often think that
we're hearing more about women and heart disease
because women are out in the workplace and leading
lives more similar to men. In fact, heart disease
has always been a leading cause of death in women
C. NOEL BAIREY MERZ, MD: One in three women will
die of heart disease in their lifetime, and one
in two women in their lifetime will develop or suffer
from what we call cardiovascular disease, which
includes heart disease, as well as high blood pressure.
There are five major risk factors that determine
the majority of heart disease risk. Number one is
cigarette smoking. Number two is high blood pressure.
Number three is high blood cholesterol. Number four
is diabetes. And number five is a family history
of premature coronary heart disease.
ANNOUNCER: Another risk factor for women is age.
Nearly 35 percent of women over age 45 have some
form of heart disease. And the risk for heart disease
increases in postmenopausal women.
SUZANNE HUGHES, MSN, RN: We know that after menopause,
women do have a much higher incidence of heart disease.
There's been so much controversy around the area
of postmenopausal hormone therapy. And, from a heart
disease standpoint, the current message is very
simple: that postmenopausal hormone therapy should
not be considered a tool for heart disease prevention.
ANNOUNCER: With hundreds of thousands of women
suffering and dying from heart-related issues each
year, what can women do to prevent heart disease?
SUZANNE HUGHES, MSN, RN: The message about prevention
in women is so important. We know that women tend
to take care of everybody else before they take
care of themselves. So women who make sure that
their spouse or their significant other gets the
important preventive maintenance checkups are the
same women that might not follow that same advice
in themselves.
C. NOEL BAIREY MERZ, MD: There are five health
habits that are associated with an 82 percent risk
reduction of heart disease for women in their lifetime.
They are: not smoking; doing some type of physical
activity 30 minutes per day; eating a heart-healthy,
nutritional regimen filled with things like fish,
legumes, which are nuts or beans, fruits and vegetables,
multiple daily servings, and complex carbohydrates.
The fourth health habit is avoid being obese, defined
as being 20 percent over your ideal body weight.
So we're not talking about 10, 12 pounds. We're
talking about 30, 40, 50 pounds overweight. And
the final health habit, speak with your own health
care provider, is a single serving of alcohol per
day. So these are simple things, hard to do every
day, but things that you can do in your own life
that dramatically can reduce your risk of heart
disease as a woman.
What are the Consequences of High Cholesterol?
Learn the basics of high cholesterol, and
it's consequences on the cardiovascular system.
Participants:
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory
University School of Medicine, Atlanta, Georgia
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua
Heart Center, Piedmont Hospital, Atlanta, GA.
Webcast Transcript:
ANNOUNCER: Most people are aware that there are
different types of cholesterol, but many don't know
about the serious consequences surrounding high
levels of LDL.
NANETTE KASS-WENGER, MD: High cholesterol—and
here I would like to talk about high bad cholesterol,
or LDL, low-density lipoprotein cholesterol—means
that there is deposition of this fat in the arteries.
In the arteries of the heart, in the arteries of
the brain, all through the body, in the arteries
of the kidney. And the consequences can be what
we call atherosclerosis, meaning a narrowing and
a deposition of cholesterol and all the fibrous
tissue that goes in there.
SPENCER B. KING, III, MD: The consequences are
that heart attack, stroke, peripheral vascular disease,
blocked arteries in the legs and so forth, can occur.
Cholesterol has multiple components. Some parts
of cholesterol are more dangerous than others. Some
parts of the cholesterol, the HDL, the high-density
lipoprotein, is actually somewhat protective, and
parts of that are even more protective.
On the other hand, the low-density lipoproteins
are the ones that we really worry about. And when
we talk about high cholesterol, we're really more
worried about the high level of the LDL, the low-density
lipoprotein. That is the one that is most dangerous
for the progression of artery disease.
What Are the Implications of Metabolic Syndrome on Heart Disease?
Metabolic syndrome is a cluster of conditions
that can increase a person's risk of developing heart
disease. Learn more about this syndrome and how it
affects the heart.
Participants:
George A. Beller, MD, MACC
Ruth C. Heed Professor of Cardiology, University
of Virginia Health System, Charlottesville, Virginia
Suzanne Hughes, MSN, RN
Education Coordinator, Center for Family Medicine,
Akron General Medical Center, Akron, Ohio
Editorial Consultant:
Suzanne Hughes, MSN, RN
Webcast Transcript:
ANNOUNCER: Metabolic syndrome is a cluster of conditions
affecting the body's metabolism.
GEORGE A. BELLER, MD, MACC, MACC: Metabolic syndrome
is a medical entity which involves being overweight,
but predominantly in the abdomen, having a lot of
fat in the abdominal, you know, area, as opposed
to just being fat everywhere. It's associated with
high blood pressure, an elevated cholesterol with
high triglycerides, it's called, and a low HDL cholesterol,
which is the good cholesterol. And it also is associated
with -- it can be associated with an abnormal blood
sugar that predicts ultimately that that person
may get diabetes.
ANNOUNCER: Any one of these conditions alone can
be dangerous but when combined, the risk of developing
further health complications increases very quickly.
SUZANNE HUGHES, MSN, RN: Now, the implications
of this for heart disease is that having the metabolic
syndrome effectively doubles one's risk of developing
cardiovascular disease.
GEORGE A. BELLER, MD, MACC: And so the implications
of having it is that you have to reverse these abnormalities
to reduce the risk of, then, heart disease with
appropriate medications and lifestyle changes.
If someone is diagnosed with the metabolic syndrome,
the first intervention is lifestyle change, and
we would advise patients with this problem to reduce
their calories, to get on a good diet and to start
exercising so they could lose that weight. Because
even losing just 10% of your weight will result
in a marked reduction in the risk of a heart attack.
We also put patients on medications to lower the
blood pressure. We put them on medications to lower
the bad cholesterol and to raise the good cholesterol.
And we essentially will follow those patients carefully,
and if they develop any symptoms of heart disease,
we will go on with stress testing and other treatments.
A Combination of Problems That Endanger Your Heart
Metabolic syndrome
Your risk of developing heart disease, stroke
or diabetes is greatly increased if you suffer from
a combination of health problems, known as metabolic
syndrome. Learn what you can do to fight back.
Participants:
Suzanne Hughes, MSN, RN
Education Coordinator, Center for Family Medicine,
Akron General Medical Center, Akron, Ohio
Editorial Consultant:
Suzanne Hughes, MSN, RN
Webcast Transcript:
ANNOUNCER: Metabolic syndrome is characterized by
a group of conditions that greatly increase a person's
chance of developing heart disease, stroke and diabetes.
The definition of this syndrome differs among experts,
however they all agree; aggressive measures should
be taken to treat each disorder associated with
it.
SUZANNE HUGHES, MSN, RN: Metabolic syndrome is
getting quite a bit of attention, both in the professional
literature as well as in the lay media in the recent
past.
Metabolic syndrome is a cluster of abnormalities
that tend to occur in the same people, and by definition
the metabolic syndrome means that you have three
of the following five abnormalities:
The first one his high blood pressure or hypertension.
And this means a blood pressure that's greater than
140/90. That meets the criteria for hypertension.
The next one is an abnormal level of blood glucose.
This may or may not be associated with diabetes,
depending on how high the blood sugar is. But this
would include a blood sugar that in the fasting
state is greater than 100 mg/dL. And a lot of people
do have what we call prediabetes, so not a high
enough level to be called diagnostic, but high enough
that it's no longer considered normal or optimal,
and that's an area between 100 and 125. So those
are the first two.
The next one is a tendency to carry one's weight
around the waist. So it's a waist measurement where
a person tends to be kind of apple-shaped rather
than pear-shaped. For women it's a waist measurement
greater than 35 inches, and for a man, a waist measurement
greater than 40 inches. And so where we carry our
weight tends to be probably even more important
than what our overall body weight is.
The last two characteristics are those associated
with the cholesterol profile. And the first one
is a triglyceride level greater than 150, and the
second one is an HDL or a good cholesterol level
that's less than 40 in men or less than 50 in women.
So we have five characteristics: Hypertension, abnormal
blood glucose, an increased tendency to carry the
weight around the waist, a high triglyceride and
a low HDL. And any three of those five qualifies
one for metabolic syndrome.
Corinary Bypass
What is Bypass Surgery?
Coronary bypass is a form of heart surgery
that uses new arteries to "bypass" and replace
clogged heart arteries. Tune in to learn more about
this important type of heart surgery.
Participants:
Lawrence I. Bonchek MD
Webcast Transcript:
ANNOUNCER: A coronary bypass is a type of heart
surgery that re-routes blood vessels around heart
arteries that have become clogged with cholesterol
build-up.
LAWRENCE I. BONCHEK, MD: Bypass surgery is done
in order to route blood around obstructions in the
coronary arteries, which are the arteries that supply
blood to the heart. They're actually very small
arteries, so it doesn't take a lot of cholesterol
buildup in the wall of the artery to block an artery
that size.
Surgeons will take a healthy blood vessel like
an artery from the chest wall or a vein from the
leg, and then connect the blood vessel above and
below the blockage to bypass it.
LAWRENCE I. BONCHEK, MD: There are two major ways
that bypass surgery is done nowadays, and people
will hear the terms off-pump and on-pump bypass
surgery. Traditionally, bypass surgery has always
been done with a heart-lung machine so that the
heart could be stopped and the lungs are not being
inflated, and the heart-lung machine is doing those
functions while the heart is absolutely stationary
to allow very precise, meticulous sewing while the
bypasses are being attached.
But in recent years, with advances in technology,
there have been pieces of equipment developed that
allow you to stabilize a small area of the heart
that you're working on, and to do the bypass operation
without the heart-lung machine. And that's known
as off-pump bypass surgery.
ANNOUNCER: Lifestyle modifications are important
after surgery so that the new blood vessels don't
become blocked as well.
LAWRENCE I. BONCHEK, MD: The most common lifestyle
modifications are correcting all the bad things
that people have been doing beforehand, such as
not smoking. They should lose weight. They should
watch the salt in their diet. They should eat a
healthier diet.
ANNOUNCER: Bypass surgery is still a major procedure,
but most people can be fully recovered and active
in as little as two months.
LAWRENCE I. BONCHEK, MD: My advice to anyone who
has had bypass surgery is to enjoy life, because
that's the purpose of having the surgery so that
they can get back to full and normal activity.
Stents
What Medicines Do I Take After a Stent?
After a stent is placed in an artery, there
is a chance that a blood clot may develop. To help
prevent clots, antiplatelet drugs are often prescribed
after the stenting procedure.
Participants:
Spencer B. King, MD, MACC
Fuqua Chair of Interventional Cardiology, Fuqua
Heart Center, Piedmont Hospital, Atlanta, GA.
Adolph M. Hutter Jr, MD, MACC, FAHA, FESC
Past President and Editor-in-Chief Conversations
with the Experts American College of Cardiology
Webcast Transcript:
ANNOUNCER: A common question asked by people who
have stents is why they need to continue taking
drugs like Aspirin, Plavix or Coumadin.
SPENCER B. KING, III, MD: After stenting, the blood
platelets—these are little particles within
the blood that help us stop bleeding, if we cut,
they collect and form a clot—those platelets
can be detrimental after you have a stent placed.
They can actually build up on the stent and may
cause a clot to form there.
ADOLPH M. HUTTER, JR., MD: We need to use some
drugs that prevent blood clots from forming in the
stent or from restenosis. And the most effective
drugs have been shown to be the antiplatelet drugs:
That's Aspirin or clopidogrel, called Plavix. These
are the anti-platelet drugs. They work very well.
Coumadin, which is a blood thinner against clots
formed by thrombin doesn't work very well for stents.
So you need to be on aspirin and Plavix, but you
don't need to be on Coumadin just for a stent. You
might need Coumadin for another reason, but you
don't need it just because you have a stent.
SPENCER B. KING, III, MD: Coumadin is an anti-clotting
drug that people know about, but it is not routinely
used after stenting. It has different uses, in atrial
fibrillation and in preventing clots in the legs
and all sorts of things. But when stents are used,
it's the combination of aspirin and the clopidogrel
that is critical.
ANNOUNCER: Determining which drug a patient should
use depends on the type of stent they have.
ADOLPH M. HUTTER, JR., MD: If you have a bare metal
stent, then you should be on aspirin 325 mg/day,
and Plavix 75 mg/day, for a month. If you have a
drug-eluting stent, we know that those events can
occur many, many months after a month, and so most
people recommend that you be on aspirin 325 mg/day,
and Plavix 75 mg/day indefinitely, at least for
six months.
The information
published on this page has been provided by the
Heart Authority
in collaboration with Cardiosource – American College of Cardiology
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