Angina, known medically as angina pectoris, manifests as chest pain or discomfort and indicates that the heart requires increased oxygen supply. There are two primary types:

• Stable angina is typically triggered by physical exertion or stress, making it somewhat predictable and consistent in its presentation. It tends to subside with rest or the use of prescribed medication.
• Unstable angina is less predictable and may arise even during periods of rest. It can be more frequent, intense, and prolonged compared to stable angina. Medical professionals often view unstable angina with greater concern as it could signal a blocked artery in the heart. In certain cases, it may be an early warning sign of an impending heart attack.

What is the cause of Angina?

Angina typically arises from the accumulation of plaque in the coronary arteries of the heart. This plaque is primarily composed of fatty substances, including cholesterol, present in the bloodstream. The buildup of plaque is a gradual process, occurring over several years. Over time, the plaque can solidify and constrict the coronary arteries, potentially impeding or obstructing the flow of blood to the heart. This can result in a reduction of oxygen supply, ultimately leading to angina.

Atherosclerosis is the broad medical term used to describe the buildup of plaque that obstructs arteries. Specifically, coronary artery disease (CAD) refers to atherosclerosis occurring in the coronary arteries. Therefore, angina often arises as a consequence of atherosclerosis and CAD.

However, it's important to note that chest pain isn't always linked to a diminished oxygen supply to the heart. There are instances where chest pain may not be angina-related. It could be associated with a pulmonary condition, for example. Alternatively, it might simply be a result of heartburn triggered by spicy foods.

What are the symptoms of Angina?

The sensation of angina varies from person to person. It may be perceived as a sense of heaviness, pressure, constriction, or even a burning feeling in the chest. At times, the discomfort may radiate to the back, shoulder, arm, neck, or jaw.

Typically, angina persists for a few minutes. Should the angina endure for more than 5 minutes, it's crucial not to delay seeking assistance. Immediately dial 911, as this could be indicative of a heart attack. Swift intervention can help prevent or mitigate any lasting harm to the heart.

What tests could I have?

If you're experiencing angina, your doctor may recommend one or more of the examinations mentioned below to determine the root cause. Additionally, the outcomes of these tests will assist your doctor in determining the most suitable treatment options for you.

In certain instances, you might be referred to specialists for further evaluation, testing, and occasionally, treatment. For additional information, please refer to the "Your Treatment Team" section.

• Angiogram
• Cardiac Catheterization
• Chest X-ray
• Echocardiogram
• Electrocardiogram
• Stress Test

What is an angiogram?

An angiogram is an image of your blood vessels, similar to an x-ray. An angiogram shows:

• How well the blood flows through the arteries
• Whether blockages exist-and if so, their location

An angiogram might be ordered if your doctor suspects blockages in:

• Your heart's arteries (called coronary arteries)
• Arteries outside your heart (called peripheral arteries)
• Arteries in your neck (called carotid arteries)

The angiogram procedure commences with a cardiac catheterization. In this process, a slender, pliable tube known as a catheter is carefully inserted into a blood vessel in your groin or arm. Your doctor skillfully guides the catheter toward the affected blood vessel. Once the catheter is correctly positioned, a special dye is injected by your doctor to initiate the angiogram. This dye enables your blood vessels to be visualized on a monitor, much like roads on a map. If the angiogram indicates an obstructed artery, your doctor may perform a treatment right away, such as balloon angioplasty.

What can I expect?

Your examination will be conducted in a specialized facility known as a "cath lab." Upon arriving for your angiogram, you'll change into a hospital gown or be provided with a sheet for cover. You'll then lie down on an examination table, where an intravenous (IV) line will be inserted into your arm. This IV administers fluids and necessary medications throughout the procedure. The medication induces a state of drowsiness, but you'll remain conscious. The doctor will create a small incision for the catheter. The area around the incision will be numbed, so any sensation you feel should be limited to slight pressure as the catheter is introduced.

As the doctor administers the dye, you may experience a sensation similar to:

• Warm flushing feeling, and maybe nausea, for a minute or so
• Metallic taste when the dye reaches the blood vessels in your mouth
• Camera rotating around you to get x-rays from different angles

What is a cardiac catheterization?

A cardiac catheterization is a medical procedure involving the insertion of a small, flexible tube called a catheter into a blood vessel. This catheter is typically placed into a blood vessel in your groin, and sometimes in your arm. Your doctor guides the catheter towards your heart or a potentially blocked blood vessel. It serves as the initial phase for various tests and treatments related to the heart and blood vessels.

For instance, a cardiac catheterization often precedes an angiogram. During an angiogram, dye is injected through the catheter into your arteries to detect any obstructions. Through catheterization, your doctor can also:

1. Assess blood pressure within your heart or lungs.

2. Conduct a small tissue sample (biopsy) of your heart muscle.

3. Evaluate oxygen levels in your blood.

4. Gauge the volume of blood circulating through your heart and blood vessels.

5. Perform an electrophysiology (EP) study to examine the electrical system in your heart.

In the course of a cardiac catheterization, your doctor might also employ one or more of these procedures to enhance blood flow in case of blocked blood vessels:

• An atherectomy using a catheter with a cutting tool to clear plaque from an artery
• A balloon angioplasty using a catheter with a balloon that expands and presses plaque against the side of an artery
• A stent implant inserting a tiny mesh tube into an artery to help keep it open after plaque has been cleared

What can I expect?

"Your cardiac catheterization procedure will take place in a specialized room known as the 'cath lab.' Upon arrival, you'll change into a hospital gown or cover yourself with a sheet. You'll then recline on an examination table, where a skilled medical professional will insert an intravenous (IV) line into your arm. Through this IV, fluids and necessary medications will be administered to you during the procedure. These medications will induce a state of drowsiness without causing complete unconsciousness.

Electrodes affixed to your chest will continually monitor your heart's activity, while a blood pressure cuff on your arm will routinely record your blood pressure. The doctor will make a small incision, typically in the groin area, to introduce the catheter. This area will be numbed to ensure you experience minimal discomfort, although you may feel a sensation of pressure as the catheter is placed. You'll remain awake throughout the test, and your doctor or nurse may ask you questions to ensure your comfort.

Following the procedure, there's a possibility of staying overnight in the hospital. For most individuals, recovery is generally swift."

What is a chest x-ray?

A chest x-ray produces an image of your heart, lungs, and nearby blood vessels. It reveals the:

• Size and shape of your heart
• Presence of fluid around your lungs
• Position and shape of your large arteries

An X-ray is a valuable diagnostic tool that can identify a wide range of medical conditions, including heart-related ailments. In cases where a cardiac device such as a pacemaker is present, the X-ray provides a clear view of both the device itself and the insulated wires (leads) responsible for transmitting energy to the heart.

What can I expect?

During a chest X-ray, you will be asked to undress from the waist up and don a hospital gown. A protective shield made of flexible lead, known as an apron, will be provided to shield you from any additional radiation (X-rays use a minimal amount of radiation to generate the image). You'll stand in front of the X-ray machine and hold your breath momentarily while the image is captured. Typically, your doctor will request two views: one from the back and one from the side.

What is an echocardiogram?

An echocardiogram, often referred to as an echo, provides a dynamic, three-dimensional view of your heart. This imaging technique employs Doppler ultrasound technology, akin to the ultrasound scans performed during pregnancy. The echo machine emits sound waves at a frequency beyond human hearing. These waves traverse through the chest and the heart. As they encounter the heart's structures, they bounce back or "echo," revealing:

What can I expect?

During an echocardiogram, you'll need to disrobe from the waist up and put on a hospital gown. You'll then lie down on an examination table. The technician will apply gel to your chest and side to facilitate the transmission of sound waves. Using a pen-like instrument called a transducer, the technician will move it around on your chest or side, capturing the echoes of the sound waves. Simultaneously, a live image of your heart will be displayed on a special monitor. Throughout the test, you may be asked to change positions, lying on your back or side. There may be moments when you're requested to briefly hold your breath to ensure clear imaging. The procedure is painless, and you'll only feel light pressure on your skin as the transducer moves.

What is an ECG?

An electrocardiogram (ECG or EKG) provides insights into the functioning of your heart's electrical system. It detects and records your heartbeats, or heart rhythms, and displays the results on a paper strip.

Through an ECG, your doctor can assess:

• Presence of arrhythmias
• Effectiveness of your heart medication
• Whether blocked coronary arteries are impeding blood and oxygen supply to your heart muscle
• If blocked coronary arteries have led to a heart attack

There are three types of tests that capture your heart's electrical activity, each spanning different durations:

• Electrocardiogram (ECG) - conducted in the doctor's office, recording heart rhythms for a few minutes.
• Holter monitoring - preserves all heart rhythms in its memory over a period of 24-48 hours.
• Event recorder - continuously captures heart rhythms, but saves them in its memory only when you activate it by pressing a button.

What are the parts of an ECG strip?

The electrocardiogram (ECG) strip displays various waves that provide vital insights into the functioning of your heart:

1. The P-wave illustrates the contraction of your heart's upper chambers (atria).

2. The QRS complex showcases the contraction of your heart's lower chambers (ventricles).

3. The T-wave signifies the relaxation of your heart's ventricles.

What can I expect?

During an electrocardiogram (ECG), you'll need to remove clothing from the waist up and put on a hospital gown. You'll then lie down on an examination table. About 12 small patches known as electrodes will be affixed to various areas on your chest, neck, arms, and legs. These electrodes are linked to wires on the ECG machine and they pick up the electrical signals generated by your heart. The machine proceeds to chart your heart's rhythm on a strip of graph paper.

What is a stress test?

A stress test, which is a form of Electrocardiogram (ECG or EKG), assesses how your heart responds to physical exertion or stress, as opposed to regular ECGs that analyze your heart's performance at rest. There are various types of stress tests, but their primary objective is to determine if your heart is receiving an adequate supply of blood and oxygen.

These tests are frequently conducted to replicate symptoms like chest pain or breathlessness, examining factors such as heart rate, blood pressure, and the heart's electrical activity. They can provide insights into conditions like Coronary Artery Disease (CAD), assess the risk of a heart attack, identify the cause of symptoms like angina or irregular heart rhythms (arrhythmias), and evaluate the effectiveness of treatments, be it medications or implanted devices.

In a basic form of stress test, you'll walk on a treadmill or use a stationary bike, starting at an easy pace and gradually increasing the intensity. You'll continue until you experience symptoms or fatigue. This test is also known as an exercise test, treadmill test, or exercise ECG.

During a nuclear stress test, a small amount of a radioactive substance called thallium is injected into your bloodstream through an IV line. This is typically done in conjunction with a regular stress test to provide additional information about your heart's blood and oxygen supply. If you're unable to exercise, a medication can be administered to simulate the effects of physical exertion. Following the injection, you'll lie on a table beneath a specialized camera that captures images of your heart. Areas receiving insufficient blood and oxygen appear lighter in color on the images due to reduced thallium absorption.

What can I expect?

During a stress test, you'll be asked to undress from the waist up and put on a hospital gown. About 12 small patches, known as electrodes, will be strategically placed on your chest, neck, arms, and legs. These electrodes are connected to wires linked to the electrocardiogram (ECG) machine, which records the electrical activity of your heart from each electrode.

Additionally, a blood pressure cuff will be applied to your arm, and your blood pressure will be regularly measured. In the case of a nuclear stress test, an intravenous (IV) line is usually inserted, typically in your arm.

While a stress test doesn't typically cause pain, it may sometimes replicate painful symptoms. The test is designed to challenge you physically, so you'll exercise until you reach a point of exhaustion. Throughout the test, a nurse will communicate with you and provide instructions. After you finish exercising, the nurse will continue to monitor your symptoms, blood pressure, and heart rate for about 10-15 minutes.

What are the treatment options?

Since lifestyle choices can impact angina, a key aspect of your treatment may involve adopting a healthier way of living. For instance, if you're experiencing stress-related issues, your doctor or nurse can offer guidance, make recommendations, or refer you to a specialist for further assistance. For additional information, please refer to the Risk Factors section.

Treatment approaches may vary based on your specific test results. Your doctor may recommend a combination of medications or procedures tailored to your needs.

Medications

• ACE inhibitors
• Anticoag uIants
• Beta Blockers
• Calcium Channel Blockers
• Vasodilators

Procedures

• Atherectomy
• Balloon Angioplasty
• Bypass Surgery
• Stent Implant

Medications

Tips for Taking Heart Medications

If you're managing a heart or blood vessel condition, it's essential to have a good understanding of the medications you're prescribed. This section provides detailed information about commonly prescribed medications for heart and blood vessel conditions, along with helpful tips on adhering to your medication regimen.

Always inform your doctor, especially if it's a new physician prescribing medication for you, about all the medications and supplements you're currently taking. This ensures that you receive the maximum benefits from your medications and helps prevent any potentially harmful interactions between them.

Whenever you receive a new prescription, it's a good practice to discuss the following points with your doctor or nurse:

• The purpose of the medication, its anticipated benefits, and possible side effects.
• Proper administration and timing of your medications.
• Any other medicines, vitamins, supplements, or over-the-counter products you're using.

Keep in mind that it may take several months for your heart to acclimate to new medications, so immediate improvement might not be noticeable. Determining the correct dosage can also take time, and your doctor will monitor this process.

For individuals on heart medications, periodic blood tests may be necessary. These tests assist your doctor in determining the right dosage, thus minimizing the risk of adverse side effects.

It's crucial never to alter your medication dosage or stop taking it without consulting your doctor, even if you believe it's no longer necessary, seem to be working well, or feel fine without it.

If you encounter any of the following situations, be sure to discuss them with your doctor or nurse:

• Queries regarding how your medications function.
• Experiencing uncomfortable side effects.
• Difficulty remembering to take your pills.
• Financial challenges in obtaining your medications.
• Any other factors impeding your adherence to the prescribed regimen.
• Questions about the administration of any of your medications.

Feel free to consult your pharmacist if you have inquiries about the correct way and time to take your medications.

ACE Inhibitors

"ACE" stands for "angiotensin-converting enzyme." ACE inhibitors are drugs designed to regulate the production of a natural chemical known as angiotensin II in the body, preventing its excessive buildup.

Some generic (and Brand) names

The following medications have received approval from the Food and Drug Administration (FDA) for specific patient groups or conditions:

• Benazepril (Lotensin)
• Captopril (Capoten)
• Enalapril (Vasotec)
• Fosinopril (Monopril)
• Lisinopril (Prinivil, Zestril)
• Moexipril (Univasc)
• Perindopril erbumine (Aceon)
• Quinapril (Accupril)
• Ramipril (Altace)
• Trandolapril (Mavik)

It's crucial to consult your doctor to determine which of these medications, if any, is appropriate for your specific situation.

What they're used for

These medications are prescribed for the following purposes:

• Managing high blood pressure.
• Treating heart failure and associated conditions like Low Ejection Fraction (EF).
• Minimizing damage post a heart attack and aiding in the prevention of future heart attacks.

How they work

ACE inhibitors function by inhibiting an enzyme required for the production of angiotensin II. This natural chemical is vital for regulating blood pressure and fluid levels in the body. However, angiotensin II can exert detrimental effects on the heart and blood vessels over time, leading to narrowed blood vessels and elevated blood pressure.

The benefits of taking ACE inhibitors include:

• Dilating the arteries
• Reducing blood pressure
• Enhancing the efficiency of the heart's functioning

Anticoagulants (Blood Thinners)

You can understand the purpose of anticoagulants by looking at the root words of the term. Anti = counter or against; coagulant = thicken or clot.

Some Generic (and Brand) Names

• Aspirin
• Clopidogrel (Plavix)
• Ticlopidine (Ticlid)
• Warfarin (Coumadin)

Remember, all medications are approved by the Food and Drug Administration (FDA) for specific patient groups or conditions. Your doctor is the best person to determine which medications are suitable for your particular situation.

What They're Used For

To reduce the risk of blood clots that could lead to Stroke and other medical conditions

How They Work

Anticoagulants are often referred to as blood thinners, although they don't actually thin the blood. Instead, they work to prevent the formation of clots in the blood.

These medications are used to address conditions associated with atherosclerosis, a condition where arteries are blocked by plaque buildup. This buildup can potentially lead to the formation of blood clots.

A blood clot occurring in the coronary arteries, which supply blood to the heart muscle, can result in angina (chest pain). This blockage in the coronary arteries is medically termed Coronary Artery Disease (CAD) and could lead to a heart attack. Additionally, a blood clot in the neck's coronary arteries can travel to the brain and cause a stroke. In the vessels of the arms or legs, known as Peripheral Vascular Disease (PVD), a blood clot can lead to pain.

Taking anticoagulant medications can:

• Reduce the viscosity or stickiness of the blood.
• Lower the likelihood of blood clots forming.

Beta Blockers

Beta blockers get their name because they "block" the effects of substances like adrenaline on your body's "beta receptors."

Some generic (and brand) names

"Please note that all medications receive approval from the Food and Drug Administration (FDA) based on specific patient groups or conditions. Your physician is the best person to determine which medications are suitable for your individual needs.

• Monitan (acebutolol)
• Tenormin (atenolol)
• Kerlone (betaxolol)
• Zebeta (bisoprolol)
• Cartrol (carteolol)
• Coreg (carvedilol)
• Trandate (labetalol)
• Lopressor, Toprol (metoprolol)
• Corgard (nadolol)
• Levatol (penbutolol)
• Visken (pindolol)
• Inderal (propranolol)
• Betapace, Sorine (sotalol)
• Blocadren (timolol)"

What they're used for

• Used for the treatment of high blood pressure.
• Employed to regulate fast arrhythmias, which are abnormal heartbeats or rhythms.
• Prescribed to forestall angina, which is chest pain arising from blocked blood flow to specific parts of the heart.
• Administered to mitigate long-term damage post a heart attack.
• Utilized in the management of heart failure and associated conditions, including low ejection fraction (EF).

How they work

"These medications inhibit the activity of the sympathetic nervous system, which is activated during periods of stress or in certain health conditions. When this system is triggered, the heart beats more rapidly and forcefully, leading to an increase in blood pressure.

Beta blockers work by intercepting signals from the sympathetic nervous system. This, in turn, decelerates the heart rate and prevents blood vessels from constricting. These dual effects can lead to:

• Reduced heart rate
• Lowered blood pressure
• Alleviation of angina (chest pain associated with heart issues)
• Decreased occurrence of arrhythmias (irregular heartbeats or rhythms)"

Calcium Channel Blockers

Calcium channel blockers help relax the heart muscle and blood vessels.

Some generic (and Brand) names

"All medications are endorsed by the Food and Drug Administration (FDA) for a specific patient group or medical condition. Your doctor is the best person to determine which medications are suitable for your unique situation.

Here is a list of some approved medications:

• Amlodipine (Norvasc)
• Diltiazem (Cardizem, Dilacor, Diltia, Tiazac, Taztia)
• Felodipine (Plendil)
• Isradipine (DynaCirc)
• Nicardipine (Cardena)
• Nifedipine (Adalat, Procardia)
• Verapamil (Galan, Covera, Isoptin, Verelan)"

What they're used for

"These medications are prescribed for several purposes:

• Managing elevated blood pressure.
• Addressing angina (chest pain), which can arise due to atherosclerosis (narrowed blood vessels) and Coronary Artery Disease (CAD).
• Treating specific types of arrhythmias, particularly those characterized by rapid heart rhythms."

How they work

"Calcium channel blockers impede the entry of calcium into certain cellular regions within blood vessels. By blocking calcium access, these medications induce relaxation in both the blood vessels and the heart.

This leads to the following effects:

• Reduced strain on the heart, enabling increased blood and oxygen flow to the heart muscle.
• Decreased heart rate.
• Lowered blood pressure.

Vasodilators

Vasodilators serve a primary purpose of reducing blood pressure. To grasp their mechanism, envision the flow of the same amount of water through hoses of different diameters: one with a 1-inch diameter and another with a 2-inch diameter. The larger hose exerts less pressure on its walls.

Similarly, medications like vasodilators aid in the relaxation and dilation of blood vessels that have undergone constriction or narrowing.

Some generic (and Brand) names

"All medications receive approval from the Food and Drug Administration (FDA) for specific patient groups or conditions. Your doctor is the best person to determine which medications are suitable for your unique situation.

Here is a list of some approved vasodilators:

• Doxazosin (Cardura)
• Guanabenz (Wytensin)
• Guanfacine (Tenex)
• Hydralazine (Apresoline)
• Isosorbide dinitrate (Dilatrate, Isordil, Isochron)
• Isosorbide mononitrate (Imdur, ISMO, Monoket)
• Methyldopa (Aldomet)
• Minoxidil (Loniten)
• Nitroglycerin (Minitran, Nitro-Bid, Nitro-Dur, Nitrogard, Nitrolingual, NitroQuick, Nitrostat)
• Prazosin (Minipress)
• Reserpine (Serpalan)
• Terazosin (Hytrin)

You might have come across other types of vasodilators. Beta blockers, a common medication for heart and blood vessel conditions, belong to this category. Another type is calcium channel blockers."

What they're used for

"These medications are prescribed for two primary purposes:

• Managing elevated blood pressure.
• Treating or preventing angina, which is chest pain associated with heart conditions. This pain can arise from atherosclerosis, where blood vessels become blocked, or from Coronary Artery Disease (CAD)."

How they work

"Vasodilators aid in the relaxation and dilation of blood vessels, facilitating smoother blood flow. This results in:

• Reduced blood pressure.
• Decreased workload on the heart.
• Alleviation of angina, or chest pain."

Atherectomy

What is an atherectomy?

"An atherectomy is a minimally invasive procedure performed under local anesthesia to clear blocked blood vessels by removing plaque buildup. Unlike other surgeries, it typically doesn't require general anesthesia.

By eliminating the plaque, the artery is opened up, enabling smoother blood flow. This can lead to a reduction in:

• Risk of heart attacks in the coronary arteries.
• Pain levels in the legs or arms for peripheral artery conditions."

How is the procedure done?

The atherectomy procedure initiates with a catheterization. This involves the insertion of a small, flexible tube, known as a catheter, through a blood vessel in either your groin or, on occasion, your arm. Your doctor guides the catheter towards the blocked vessel. The introduction of dye through the catheter enables your blood vessels to be visualized on a monitor, akin to roads on a map. This segment of the procedure is referred to as an angiogram, and it's typically an integral part of an atherectomy.

Once a clear image of the blockage is obtained, the atherectomy commences. Using a specialized catheter equipped with a minuscule cutting tool at its tip, your doctor meticulously scrapes away the plaque lining the interior of the artery. This tool is designed to exclusively target the plaque, ensuring no harm to the blood vessel. By removing the plaque obstruction, blood flow may potentially become more unobstructed.

What can I expect?

Typically, you'll receive instructions not to consume food or beverages for several hours prior to the procedure. The atherectomy is conducted in a specialized room known as a 'cath lab.' You'll recline on an examination table, and an intravenous (IV) line will be inserted into your arm to administer fluids and medications throughout the procedure. These medications induce drowsiness but do not render you unconscious.

To insert the catheter, the doctor makes a small incision. The area will be numbed, minimizing any sensation of pain. However, you may experience some pressure as the catheter is placed. Throughout the atherectomy, your doctor or nurse may inquire about your comfort to ensure you're not experiencing discomfort. While some individuals may stay in the hospital overnight, many people experience a relatively swift recovery.

Following the atherectomy, your doctor might employ another catheter to implant a stent. This is a diminutive mesh tube that supports the open position of your artery. The stent serves to deter the recurrence of artery blockage.

Balloon Angioplasty

What is a balloon angioplasty?

"A balloon angioplasty is a minimally invasive procedure that unblocks narrowed blood vessels by compressing plaque against the arterial wall. It typically involves local anesthesia, and general anesthesia is seldom necessary.

By performing this procedure, the artery is expanded, promoting smoother blood flow. This can lead to a reduction in:

• Risk of heart attacks in the coronary arteries.
• Levels of discomfort in the legs or arms for peripheral artery conditions.
• Risk of stroke in the carotid arteries."

How is the procedure done?

A typical balloon angioplasty procedure commences with a catheterization. In this process, a small, flexible tube, known as a catheter, is inserted through a blood vessel, often in the groin or sometimes in the arm. Your doctor guides the catheter toward the blocked vessel, aided by a dye injected through it, which renders your blood vessels visible on a monitor, akin to roads on a map. This phase, termed an angiogram, is an integral part of the procedure. Once a clear image of the blockage is obtained, the angioplasty begins.

Using a specialized catheter equipped with a small balloon at its end, the doctor inflates the balloon near the arterial blockage. This inflation causes the plaque to be pressed against the artery wall, facilitating improved blood flow.

Following the balloon angioplasty, your doctor might employ another catheter to insert a stent. This mesh tube helps maintain the openness of your artery, potentially averting future blockages.

What can I expect?

Typically, you'll receive instructions not to consume food or beverages for several hours prior to the procedure. The angioplasty is conducted in a specialized room known as the "cath lab." Here, you'll recline on an examination table, and an intravenous (IV) line will be inserted into your arm. This IV administers fluids and medications throughout the procedure, inducing a groggy state but not rendering you unconscious.

The doctor creates a small incision for the catheter. The area is anesthetized, ensuring you won't experience pain, although you may feel some pressure as the catheter is introduced. Throughout the angioplasty, your doctor or nurse may inquire to confirm you're not experiencing any discomfort. While some individuals may stay overnight in the hospital, most experience a relatively swift recovery.

Bypass Surgery

What is bypass surgery?

When one or more of your coronary arteries are blocked, it hinders the flow of blood and oxygen to your heart. If a minimally invasive procedure, such as a balloon angioplasty, isn't deemed effective for opening your arteries, your doctor might suggest bypass surgery. This surgical intervention involves creating new pathways to redirect blood flow around the obstructed vessels.

Bypass surgery, technically known as a coronary artery bypass graft (CABG), is a form of open-heart surgery that necessitates general anesthesia.

Where are the new vessels from?

During bypass surgery, your doctor harvests a segment of a healthy blood vessel, typically from areas like your chest, arm, or leg. This harvested vessel serves as the new route for blood to bypass the blocked artery. The selection of the healthy vessel(s) is based on factors such as the size and location of the obstructed artery. Typically, doctors consider three options for bypass grafts:

• Internal mammary artery - located within the chest wall.
• Radial artery - extending from the elbow to the wrist.
• Saphenous vein - spanning the length of the leg.

Removing sections of these blood vessels for bypass is permissible because other vessels in the body compensate for their absence. Arteries are the preferred choice for grafts as they are less prone to reblockage compared to veins, which can occasionally experience this issue when attached to heart arteries.

How is the surgery done?

In traditional bypass surgery, the procedure commences with an incision made in the breastbone (sternum). To facilitate this form of bypass surgery, your heart needs to be completely still. Medications are administered to halt your heart, after which a heart-lung machine takes over the functions of both the heart and the lungs:

1. It oxygenates your blood, akin to the role of your lungs.

2. It propels the oxygenated blood back into your body, ensuring circulation, mimicking the action of your heart.

Your doctor attaches one end of the healthy blood vessel just below the blocked artery, and the other end is affixed above it. This enables blood to flow through the new vessel, circumventing the blocked area - this detour constitutes the bypass graft. Post-surgery, your blood experiences smoother flow through your coronary arteries, thereby reducing the risk of a heart attack.

A single bypass creates an alternative route around one blocked artery. Likewise, a double bypass addresses two blockages, and so forth.

Newer types of bypass

In addition to traditional bypass, some less invasive kinds of bypass surgery now exist. Neither of these two types of surgery uses the heart-lung machine. Your doctor can tell you whether either of these less invasive surgeries might work for you.

Minimally invasive bypass surgery-this requires a smaller incision near your ribs instead of the large incision through the breastbone.

Off-pump bypass surgery- a tool holds part of your heart still while the doctor operates. The rest of your heart beats as usual during this type of surgery.

Bypass surgery outside the heart

Coronary bypass surgery is the predominant form of vessel bypass, primarily addressing blockages within the heart. However, peripheral vessels outside the heart can also become obstructed, leading to a condition known as peripheral vascular disease (PVD), or peripheral artery disease. In some cases of PVD, a bypass becomes necessary for treatment.

The peripheral vessels in the legs are the ones most commonly affected by blockages. When performing a bypass surgery on leg arteries, the healthy vessel used is typically either another vessel from the leg or an artificial vessel. Unlike heart surgery, peripheral artery bypass still requires general anesthesia, but the heart-lung machine is not employed in this procedure.

What can I expect?

Before your surgery, you'll be instructed not to eat or drink for several hours. Once on the exam table, an IV line will be inserted into your arm to deliver fluids and medications during the surgery. In the operating room, you'll receive medication that induces unconsciousness for the duration of the procedure. Following surgery, a few days in the intensive care unit (ICU) are typically advised to monitor your heart function and chest healing. Most patients leave the hospital within a week. While you may experience incision site discomfort for a few weeks, pain medication will be provided. Recovery at home usually spans 4-6 weeks.

After bypass surgery, your doctor might suggest cardiac rehabilitation. This program involves a team of healthcare experts who assist you in your recovery journey. They'll:

• Guide you on the most suitable exercises

• Recommend dietary adjustments

• Prescribe medication to alleviate symptoms

• Aid in reacquiring or acquiring new lifestyle and coping skills

• Provide counseling on lifestyle changes, such as smoking cessation or stress reduction

Stent Implant

What is a stent?

A stent is a minute mesh tube that assists in maintaining an open artery. It's implanted by your doctor after a newly opened artery to lower the risk of recurring blockage or narrowing following an angioplasty. Stents are commonly placed in arteries that supply blood to the heart (coronary arteries) or neck (carotid arteries). This implantation procedure involves local numbing, and general anesthesia is typically unnecessary.

There are two types of coronary artery stents: bare metal and drug-coated. A drug-coated stent is a bare-metal stent with a specialized medication or drug coating to help reduce the likelihood of the artery getting blocked again. The drug coating is gradually released from the stent during the period when a new blockage is most likely to occur.

Opting for a drug-coated stent implant may lessen the necessity for a subsequent procedure, such as another coronary stent procedure or bypass surgery, to reopen the artery.

How is the implant procedure done?

Before a stent implantation, your doctor may first open the blocked artery through procedures like atherectomy or balloon angioplasty. These procedures, along with the stent implantation itself, involve a catheterization process. During catheterization, a small, flexible tube (catheter) is inserted through a blood vessel, typically in your groin or arm. Your doctor guides the catheter towards the blocked vessel.

A contrast dye is injected through the catheter, enabling your blood vessels to be visualized on a monitor, akin to roads on a map (referred to as an angiogram). This catheterization and angiogram are usually part of the stent implantation procedure.

After clearing the blockage, a specialized catheter is used to position the stent in your newly opened artery. The stent serves to:

• Maintain the artery open, facilitating free blood flow.

• Prevent the accumulation of plaque that could lead to re-blocking of the artery.

What can I expect?

Before the stent implantation procedure, you're typically advised to refrain from eating or drinking for several hours. The procedure is conducted in a specialized room known as the "cath lab." As you lie on the examination table, an intravenous (IV) line is established in your arm. This IV delivers essential fluids and medications throughout the procedure, inducing a state of grogginess without causing unconsciousness.

The doctor initiates the procedure by making a small incision to insert the catheter. The area is numbed to mitigate any pain, although you might experience some pressure as the catheter is introduced. Throughout the stent implantation, your doctor or nurse may ask you questions to ensure you're not experiencing any discomfort. While some tenderness at the incision site is normal, most individuals experience a relatively swift recovery. In certain cases, an overnight stay in the hospital might be recommended.