There are many known medicines which may prevent angina attacks and the development of such complication as myocardial infarction. Medical treatment of angina is based on two different groups of medicinal products:
1. Medicines reducing the risk of cardiovascular disease:
2. Medicinal products for symptomatic treatment:
These products help relieve any negative symptoms. In addition, some of them improve metabolism in the heart muscle.
If the symptoms cannot be relieved by medical treatment or you angina becomes unstable, you cardiologist will recommend you to have coronary angiography (X-ray scan of coronary arteries). This is an invasive test where a dye visible in X-rays is injected into your coronary arteries to see if they are narrowed or blocked. You doctor will choose the most appropriate revascularization method considering the number, severity and location of stenosis. Revascularization aims at restoring healthy (adequate) circulation in the heart area with narrowed arteries to relieve the symptoms of angina and prevent myocardial infarction.
There are two main revascularization techniques in angina:
1. Angioplasty (percutaneous coronary intervention (PCI) or percutaneous transluminal coronary angioplasty (PTCA));
2. Coronary artery bypass graft (CABG).
1. Angioplasty (PCI or PTCA) is an invasive (interventional) procedure to expand blood vessels. It is widely used in patients with minor blockages of one or two coronary arteries. During angioplasty, a vascular surgeon inserts a catheter (a thin tube) into the radial artery of the arm or the femoral artery of the leg and threads it through your vessels until it reaches the heart.
A special dye enters blood through a catheter visualizing the coronary arteries, and the entire process can be seen on the monitor screen. The doctor may wake you up during the procedure, and you may talk to him/her while he/she is working. As soon as the catheter reaches a blocked coronary artery, the vascular surgeon removes the blockage or flattens it inside the artery using different techniques. These techniques include:
These two techniques are used together. After these procedures, you will be prescribed medicines to make you blood thinner and prevent clot formation at the site where the stent was placed. These medicinal products also increase the risk of bleeding; therefore, if you notice bruises on your skin after minor injuries, you should contact your doctor
2. Coronary artery bypass graft surgery (CABG) is a procedure in which a part of blood vessel (usually from the patient’s leg) is “grafted” to the heart to create a “bypass” around the narrowing of a coronary artery. Just like angioplasty, this procedure improves blood flow to the heart significantly reducing the risk of myocardial infarction. The CABG technique is normally used when all three main coronary arteries are blocked (the so- called triple vessel disease), when there is a significant blockage of the left main coronary artery, or when the blockage is diffuse and not amenable to angioplasty. Bypass surgery is a more aggressive technique compared to angioplasty: it is an open-heart surgery performed by a cardiac surgeon under general anesthesia (i.e., you will be unconscious).
Today, bypass surgery is a widely used technique; however, there are still some risks both directly associated with the surgical procedure and related to the patient’s general health. You cardiologist can explain possible risks and benefits in each particular case.
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