Coronary Artery Disease or Ischemic Heart Disease is a condition, where one would experience the symptoms of chest pain or breathlessness due to blockages in the heart vessel.
Sudden onset symptoms are more serious and may be a sign of heart attack.
Am I at risk for heart attack?
Generally, if a person is above 40 years, and has one or more of the following co-morbidity like – Diabetes Mellitus/ Hypertension/ Dyslipidemia or history of smoking or family history of a premature heart attack – then that person is at risk. We need to have regular cardiac screening tests – ECG, ECHO, TMT – to look out for the earliest evidence of an impending cardiac event.
Which one of ECHOCARDIOGRAPHY or TREADMILL TEST should I get it done during my annual health check?
Coronary artery disease – generally manifests as exercise-related chest discomfort or exercise-related breathlessness. ECG and ECHO are generally done at resting state – when you are lying down, hence to assess for exertional symptoms, TMT is needed – which records the changes in cardiac status while stressing your heart.
Also, certain cardiac conditions like critical aortic valve stenosis are a contraindication for TMT, hence an ECHO prior to considering TMT is essential.
ECG, ECHO and TMT are mutually complementary investigations and not exclusive investigations on their own.
How long does the stent last for?
Coronary stents, once placed, are a permanent part of your body. Stents can get occluded by reblockages. Chances of such reblockages with current generation stents are 5-10% over next 10 years, and more commonly occurs in those with uncontrolled diabetes or hypertensives or high cholesterol levels or in those who are noncompliant to medications.
Is bypass surgery a permanent solution for blocks?
Bypass surgery creates an alternative channel of blood supply to the heart muscle, using arteries or veins – which are connected between the aorta and the heart vessels distal to block, thus bypassing the area of the block.
Venous grafts have high occlusion rates compared to arterial grafts. Arterial grafts generally have patency rates of 85% at 10 years of surgery.
Do all heart vessel blocks need stenting or bypass surgery?
Only those blocks which are critical or those resulting in ischemia (generally > 70% blockage) would warrant angioplasty or bypass surgery. FFR/ iFR/ Nuclear stress tests or cardiac stress MRI can be used for objective evidence of ischemia. Blocks which are < 50%, or blocks involving small vessels or small branches or blocks in the vessel which supply very small territory of the heart muscle can be managed with medicines.