Why my doctor think I don’t need an angioplasty.
Why does my doctor think I don’t need an angioplasty and stent?
DEAR DOCTOR:
A test showed a 50 percent blockage in one of my coronary arteries. That sounds pretty bad to me. But the cardiologist said I didn’t need an angioplasty and stent. Why?
DEAR READER:
Coronary arteries send needed blood to the heart muscle. That blood flow can be blocked by cholesterol-rich plaques of atherosclerosis. When the blockage seriously reduces blood flow, it increases your risk of a heart attack. An angioplasty and stents can be helpful for restoring blood flow, but the procedure is not risk-free.
Every time a doctor considers whether to order a test or a treatment, he or she balances the likely benefit against the likely risk. When an artery feeding the heart muscle is blocked “just” 50 percent, there still is good blood flow to the heart. So the benefit of reducing that blockage is small.
But I’m getting ahead of myself. Let me describe how an angioplasty and stent work. First, the doctor pushes a soft tube (a catheter) from an artery in your leg or arm up to your heart. Inside the catheter is a thinner catheter that has an inflatable balloon near its tip. And inside that catheter is an even thinner wire with a soft tip.
Once the catheter reaches the heart, the doctor guides the wire down the artery until the wire tip is beyond the blockage and the balloon is right where the blockage is. Then the doctor inflates the balloon. This squashes the plaque against the wall of the artery, making the inside of the artery wider. As a result, blood flows through the area more easily.
Around the catheter, surrounding the balloon, is a tiny, expandable mesh wire tube: a stent. When the balloon is inflated at the blockage, the stent also expands. The balloon is then deflated and removed from the body. However, the expanded stent is left in place, keeping the plaque squashed against the wall of the artery and allowing good blood flow through the artery. Most stents are coated with a drug that helps to prevent re-narrowing of the artery.
Minor risks of angioplasty include discomfort and bleeding at the insertion site. Rare but more serious risks (such as a heart attack) occur in about 3 percent of people undergoing the procedure. And to prevent blood clots at the stent site, people need to take anti-clotting medications for up to a year afterward.
As a result, cardiologists typically don’t do angioplasties with stents unless an artery is at least 70 percent blocked. That’s the point at which the benefit of stenting outweighs the risks.
There are many ways to slow the growth of plaques — in your case, to keep the plaque from increasing from 50 percent to 70 percent blockage. If you are not already doing so, ask your doctor if you should be taking medications, such as aspirin, and cholesterol- or blood-pressure-lowering drugs. You should also exercise regularly and eat a heart-healthy diet. Finally, if you smoke, quit. more
DEAR DOCTOR:
A test showed a 50 percent blockage in one of my coronary arteries. That sounds pretty bad to me. But the cardiologist said I didn’t need an angioplasty and stent. Why?
DEAR READER:
Coronary arteries send needed blood to the heart muscle. That blood flow can be blocked by cholesterol-rich plaques of atherosclerosis. When the blockage seriously reduces blood flow, it increases your risk of a heart attack. An angioplasty and stents can be helpful for restoring blood flow, but the procedure is not risk-free.
Every time a doctor considers whether to order a test or a treatment, he or she balances the likely benefit against the likely risk. When an artery feeding the heart muscle is blocked “just” 50 percent, there still is good blood flow to the heart. So the benefit of reducing that blockage is small.
But I’m getting ahead of myself. Let me describe how an angioplasty and stent work. First, the doctor pushes a soft tube (a catheter) from an artery in your leg or arm up to your heart. Inside the catheter is a thinner catheter that has an inflatable balloon near its tip. And inside that catheter is an even thinner wire with a soft tip.
Once the catheter reaches the heart, the doctor guides the wire down the artery until the wire tip is beyond the blockage and the balloon is right where the blockage is. Then the doctor inflates the balloon. This squashes the plaque against the wall of the artery, making the inside of the artery wider. As a result, blood flows through the area more easily.
Around the catheter, surrounding the balloon, is a tiny, expandable mesh wire tube: a stent. When the balloon is inflated at the blockage, the stent also expands. The balloon is then deflated and removed from the body. However, the expanded stent is left in place, keeping the plaque squashed against the wall of the artery and allowing good blood flow through the artery. Most stents are coated with a drug that helps to prevent re-narrowing of the artery.
Minor risks of angioplasty include discomfort and bleeding at the insertion site. Rare but more serious risks (such as a heart attack) occur in about 3 percent of people undergoing the procedure. And to prevent blood clots at the stent site, people need to take anti-clotting medications for up to a year afterward.
As a result, cardiologists typically don’t do angioplasties with stents unless an artery is at least 70 percent blocked. That’s the point at which the benefit of stenting outweighs the risks.
There are many ways to slow the growth of plaques — in your case, to keep the plaque from increasing from 50 percent to 70 percent blockage. If you are not already doing so, ask your doctor if you should be taking medications, such as aspirin, and cholesterol- or blood-pressure-lowering drugs. You should also exercise regularly and eat a heart-healthy diet. Finally, if you smoke, quit. more
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Mr. S.P JAIN I also submitted my problem in getting approval of my claim for the expenses incurred in taking treatment of EECP/EDTA as Oriental Insurance Co did not approve it , so I seek yr inputs for it too. Submitted for your kind perusal pl. Mr. S.P.Jain for your claims take it up with the Consumer Courts after giving a Notice to the Insurance Co. more
Jul 13
Even for blockages more just than 70 % the cardiologist may ask for further test(s) called stress tests to determine the significance of the blockage. Stress tests are typically TMT or Stress ECHO or stress Thallium. Dr Asit Khanna (Cardiologist, Max) more
Jul 10
Dear Dr. Neelam Nath Ji , Namaskar Thank you so much for yr. encouraging mail , answering all my queries . So now I will not think any further about knowing present status or to opt for Homocysteine Test which I read on net . Your views are exactly same as my niece who onlearning my Angiography results & LVEF value advised me to explore Noninvasive alternates to CABG as earlier I hd visited only Cardio Surgeons only incl Dr O.P.Yadav gain on my insisting for Ct Scan Angiography she only advised with logic to wait patiently for few mths . before repeating angiography & is totally against CT Scan being recommended by my treating Dr. As for the treatment taken by me I am pretty sure it will be successful , looking to the logic which influenced me max as in sUgar Factory where I worked for 45 yrs we were using EDTA for Sugar Juice Evaporator Tube Descaling I will keep in touch with you & give feed back after every 3mths as I wish maximum people to know about & benefits of ZERO Oil Cooking which many in our Family hv. now adopted & finding great relief & benefit pl. During in the intervening period is after angiography till now I had accumulated lot of Information from various Sources & put up it the form of an article & put on Cardiology Circle for information of everybody to know about our Body , heart pulse qty of blood being pumped , various alternatives for declogging etc etc . In case you hv seen it pl. advise yr views & comments With regards S.P.JAIN more
Jul 10
Sh. S P Jain ji- Happy to see your reports & your lifestyle not affected by 3 vessels blockages. Please do not Expose yourself to more radiations through CT scan or other tests just to know the status of coronary vessels, let status quo be maintained. your clinical symptoms like breathlessness on climbing few stairs ( God Forbid) will give an idea of status of blocked vessels.Most probably the collaterals have got strength to cope with extra load & to replace the 3 blocked vessels. If this therapy has worked for you , do let us know about a positive feed back after winters. There is no specific blood test to know status of blocked heart vessels but a test does determine the damage caused to heart muscle only. May You Never Need This Test. This test is done in emergency room along with ECG when a person is suspected to have a heart attack. Just Sharing with others for the sake of information only. Troponin Test is done on a strip , a drop of blood is placed on strip, if 2 lines are visible , it is a heart attack Only. cost-200/- only. test only shows damage to heart muscle and gives no idea about blockages or amount of damage caused due to a heart attack. Wisking you a Long & Healthy Life Sh. S. P. Jain ji. more
Jul 10
