What is Angioplasty & Bypass surgery

What is Angioplasty & Bypass surgery

We keep on hearing about MUFA, PUFA and Omega – 3.  In terms of preventing heart disease 
how important a role do these play? 

Absence of cholesterol and “cholesterol reduction action” of poly unsaturated fatty acids (PUFA) and mono unsaturated fatty acids (MUFA) present in vegetable oil make them natural choices to keep blood cholesterol levels under check. The PUFA rich vegetable oils are sunflower oil, safflower oil, corn oil, cottonseed and soyabean oil and mono unsaturated fatty acid (MUFA) rich oils are olive oil, groundnut oil, mustard oil, flaxseed oil. So both PUFA and MUFA reduce LDL cholesterol. PUFA if taken in excess may also be detrimental as itroduces the HDL, which is the good cholesterol. Therefore only oils with very high PUFA are not so desirable and the best balance is to take equal quantities of PUFA and MUFA which means that a variety of vegetable oils can be chosen with an ideal mix of PUFA & MUFA. This can be done by cooking one dish in MUFA rich oils and another dish in PUFA rich oils.

How safe is the long-term intake of lipid-lowering drugs? 

Long term intake of lipid lowering drugs like Statins has been shown to be safe and actually beneficial in high risk subjects who have a risk factor for coronary artery disease and have raised bad LDL cholesterol levels. However, once patients have been started on it they have to be monitored through 3-6 monthly liver function tests and CPK levels. If these are monitored regularly there is no risk in taking long term lipid lowering therapy. Infact it can be beneficial in many patients who have a high risk of coronary artery disease.

How does one distinguish chest pain that originates in the heart from chest pain that can 
be traced to other sources? 

The chest pain from the heart is usually a severe, retrosternal, behind the breast bone discomfort which goes down the left arm and usually occurs on exercise and is relieved within a few minutes by resting or stopping exercise. Occasionally the chestdiscomfert may mimic indigestion or dispepsia.  The warning is that if indigestion like discomfort occurs, which is not relieved by antacids, one should always get an ECG done to rule out any cardiac pain. Any discomfort in chest which occurs on exercise and is relieved by rest should be considered as cardiac pain. If the discomfort is prolonged and is not relieved by any antacid or any pain killers one should actually get an ECG done to make sure that is not a heart attack.

Patients with blocked coronary arteries (on Angiography) require either an angioplasty or a bypass surgery. 
How do cardiologists decide the  issue?

There are three major arteries which supply blood to the heart muscle.When these major arteries are blocked angioplasty and bypass surgery can be can be employed and both are well proven, long standing techniques for the treatment of coronary artery disease. Usually when there are multiple blockages in all the three arteries, bypass surgery is considered especially if these are not treatable by angioplasty. In the present day of medicated or drug eluting stents, angioplasty can now be applied safely as well as with good long term results in many patients who were previosly
(some years ago) being considered for bypass surgery. However the best decision is made keeping in mind complete information to the patient, the preference of the patient and the experience of the institution and the operator.

What is ‘Primary Angioplasty’? 
Primary angioplasty is a condition in which angioplasty is performed at the time of heart attack to stop the heart attack.  When an artery gets 100% blocked it starts resulting in a heart attack (which is damage to the heart muscle) which actually takes approximately 12 hours to complete.  The patient should immediately rush to a hospital if a heart attack is occurring. Opening that artery up at that time can lead to a restoration of blood flow and stopping of the heart attack, thereby limiting the damage to the heart muscle and prolonging survival. Angioplasty is the best treatment to be used to open up arteries at that particular time and so can be a life saving procedure.

In terms of clinical outcomes and long term survival rates which of the two procedures – angioplasty and bypass surgery – is better?

It has been shown in many studies including the most recent study called Syntax Trail that even in triple vessel disease and multiple blockages, survival over many years is no different with angioplasty or bypass surgery which means both are equal in terms of survival. The only difference in multiple artery blockages ...... and by this I mean patients with all the three arteries blocked or left main artery blocked ....is the fact that patients who have angioplasty may have lower procedural complication rates but would also have, in the first two or three years, a greater need for having a repeat angioplasty procedure as compared to bypass surgery.  On the other hand bypass surgery has a greater chance of failing over a period of 7-10 years compared to angioplasty which can be repeated very easily. So both procedures for all the three artery blockages are very similar in terms of survival.  As it is, for one or two artery blockages angioplasty is preferred over bypass surgery as a treatment modality.