Coronary heart disease is a series of clinical conditions caused by atherosclerosis resulting in narrowing of the lumen of the coronary arteries, which leads to insufficient blood supply to the heart muscle. It includes angina pectoris, myocardial infarction, heart failure, arrhythmia and sudden death.
Stenting is performed by delivering a stent to the vascular lesion after balloon expansion to prevent arterial retraction, maintain lumen patency and increase blood supply. It is currently the most common method of coronary intervention.
Drug-eluting stents have been called another revolution in coronary interventional therapy. The principle is to coat the surface of bare metal stents with trace amounts of drugs, which are slowly released in the tissue of the vessel wall, preventing the creation of scar tissue that re-clogs the artery and further reducing the incidence of in-stent restenosis.
Under what circumstances should coronary intervention be considered?
1.Angina is still unstable after active drug treatment
2. Although the angina symptoms are mild, there is clear objective evidence of myocardial ischemia and significant stenotic lesions
3.After interventional treatment or heart bypass surgery, angina recurs and the coronary artery lumen is restenosed
4, acute myocardial infarction within 12 hours
Three major misunderstandings of coronary interventions.
1, long delay reluctance to do surgery, so that the heart long-term ischemia, cardiac insufficiency, resulting in untimely treatment or miss the best time for treatment.
2, think that after the heart stent is put, everything will be fine, the blood vessels can be kept open forever, so the diet, medication, smoking and drinking, etc. relaxed at will, resulting in the relapse of the disease.
3, excessive fear of coronary heart disease, do not need to perform cardiac interventional surgery but blindly ask doctors to place vascular stents. Interventional cardiac surgery has its corresponding indications, and the treatment method should be selected scientifically according to the condition under the guidance of a doctor.
Is coronary intervention safe?
Due to the continuous development of equipment and technology, the success rate of PCI has reached more than 95%, and the incidence of various complications is less than 5%, with serious complications being less than 1%.
The introduction of drug-coated stents has reduced the incidence of in-stent restenosis by at least 20%, and the percentage of in-stent thrombosis is similar to that of bare metal stents, at approximately less than 1%. Overall, coronary interventions are safe and effective.
In terms of the procedure, the chance of complications resulting from the surgical operation, whether via the radial route in the arm or the femoral route in the thigh, is very low, and safety is assured, especially when performed by experienced surgeons in larger hospitals and catheterization laboratories that are well equipped.
However, it should be reminded that interventional therapy as an invasive diagnostic treatment still carries risks! Each patient’s condition and physical status is different, and many factors such as changes in the condition are sometimes unpredictable before surgery. Therefore, it is important to fully understand the risks and complications associated with the procedure beforehand.
How to prepare for the procedure?
There is no need to be nervous when discomfort occurs during the intervention. During radial artery puncture, some patients can feel pain, numbness and soreness at the puncture site. However, they are not severe and can be tolerated without worry. During the operation, most patients have no discomfort. When the balloon is expanded or the stent is propped up, a few patients can have slight chest tightness, chest distension or pain due to the transient blockage of blood flow, but it is very short, and the discomfort disappears after the balloon is deflated. In individual cases, the stent is placed to squeeze the small branch vessels or the blood flow is slow after the stent is placed, the patient’s chest tightness and chest pain should be longer. Do not worry, the doctor will take appropriate measures to actively treat.
During the operation, the surgeon will apply nitroglycerin in the coronary artery, and some patients may feel slight head swelling.
How can I cooperate with the surgeon to complete the operation?
The surgeon will communicate with you at all times during the operation to ask how you are doing and how you feel. You should follow the doctor’s instructions for cooperation, including deep breathing, breath holding, body position, coughing, etc. If you experience any discomfort during the operation, you should tell the doctor immediately so that he or she can give the necessary treatment in a timely manner.
What should I pay attention to after surgery?
Drink an appropriate amount of water to facilitate the discharge of the contrast agent. Generally, you should drink about 1500-2000 ml of water 24 hours after surgery, and the urine volume should reach 800 ml within 2 hours after surgery.
You can eat after the operation, and your diet should not be too full. Eat more vegetables and fruits rich in fiber and vitamins, and try not to eat a high-protein diet within 24 hours. Keep the bowel movement smooth.
Compression to stop bleeding: If the thigh is punctured by femoral artery, local compression with sandbag is needed for 6-8 hours, lie flat for 8-24 hours, try not to bend and move that side of the thigh to avoid bleeding at the puncture site. If radial artery puncture is used, the forearm should be elevated after the operation, and the bandage pressure can be lifted generally for 6 hours.
Observe the changes in skin color, temperature, and sensation at the puncture site, and whether there is severe pain. Pay attention to the puncture compression area for any blood oozing and hematoma. After the operation, make sure to take the medication on time as prescribed by the doctor and do not increase or decrease the dosage without authorization. Cardiac monitoring and intravenous fluids are also required due to treatment needs.
What may happen in the 24 hours after surgery?
The 24 hours after surgery are critical. If you feel uncomfortable, please communicate with your healthcare provider immediately.
1.Mild pain at the puncture site: No need to be nervous.
2. Chest discomfort: You can continue to observe after excluding myocardial ischemia, and most of the symptoms can be relieved by themselves in a short time.
3.Symptoms such as abdominal distension, lumbar pain, nausea and vomiting, difficulty in urination, insomnia, etc.: may be related to restricted activities and the use of contrast media, which can be relieved after 1~3 days of treatment.
4, subcutaneous petechiae or hard nodules at the intervention puncture site: If you find that the hard nodules at the puncture site suddenly increase in size and pain is obvious with pressure, you need to notify the doctor immediately at this time, re-compress the bandage to stop bleeding, then lie flat for 12-24 hours, and discontinue some anticoagulants if necessary.
5, bleeding: after the intervention, for unexplained panic, sweating, weakness and pale, heart rate increase block, blood pressure decrease should be considered the possibility of bleeding, should immediately notify the doctor. Patients with previous peptic ulcers must provide the doctor with as much information as possible before the operation to facilitate the doctor’s choice of treatment plan and adjustment of drug dosage.
6. Drug allergy: Individuals may be allergic to the contrast agent. It is manifested as light symptoms such as eye itching, rash, skin flushing and skin itching, which can be controlled with general desensitization treatment.
How should I recover after discharge from the hospital?
After your hospitalization is over, home recuperation is the key to recovery. Stent placement is only a measure for your most serious areas, and the surgery cannot fundamentally inhibit the progression of atherosclerosis. After stenting, you still need to strengthen the control of risk factors, such as hypertension, hyperlipidemia, diabetes, smoking, obesity, etc. It requires adherence to medication, regular follow-up, diet, exercise and good mind adjustment as prescribed by the doctor.
Education and psychological adjustment.
1.Education.
Knowledge is the key to reduce complications and save lives. Active control of risk factors is fundamental to the prevention and treatment of coronary heart disease.
2.Psychological adjustment.
Establish a healthy outlook on life, always keep a happy mood, be calm, optimistic and cheerful, and avoid emotional excitement. In case of unhappy things, appropriate venting, can be moderate relief of stress, is also helpful to health. Heart disease patients’ hearts are inherently more fragile than normal people, too much anger and rage are harmful, self-adjustment, if necessary, you can seek help from a psychologist.
When should I have a post-operative review?
After coronary intervention, patients are given medications for anticoagulation, lipid regulation, dilation and treatment of complications in order to consolidate the treatment effect. Post-discharge review is a continuation of in-hospital treatment to further review the efficacy of the procedure, adjust the dose of medication, and detect and manage new conditions as early as possible.
It is recommended to review once a month for 1-6 months after discharge, and after 6 months, it can be extended to once every 3 months.
Post-stenting asymptomatic patients should also be reviewed at 9-12 months to clarify the presence of restenosis and new coronary lesions in the stent so that appropriate treatment can be given. If you have symptoms, you should always go to the hospital for examination.
How to take long-term scientific medication?
1. Drugs to prevent thrombosis.
Combined taking of clopidogrel and aspirin
Aspirin: It has the effect of preventing platelet aggregation thrombosis and can prevent restenosis after surgery. Generally, it should be taken for life. 100mg/day of enteric aspirin is recommended.
Clopidogrel: It is recommended to be taken for 1 year or more after the drug stent is placed. The recommended dose is 75mg/day.
Long-term oral antiplatelet drugs may cause a drop in blood cells, and regular blood tests are required.
2.Drugs to prevent the progression of atherosclerosis.
Statin drugs. There are atorvastatin, simvastatin and so on. These drugs not only lower blood lipids, but also fight inflammation. They have an important role in preventing the process of atherosclerosis in coronary heart disease combined with diabetes and hypertension, which severely damage the blood vessel wall.
Lipid-regulating drugs can protect the endothelial function of blood vessels and slow down the progress of plaque, which is very important for patients with coronary heart disease and must be taken consistently without wavering.
It is important to listen to the doctor’s guidance and adjust the dose of the drug based on the laboratory results, and never stop the drug hastily.
3. Drugs to prevent and control hypertension and diabetes and to reduce the burden on the heart.
Receptor blockers: there are bisoprolol, metoprolol, etc. The main role is to control the heart rate, reduce myocardial oxygen consumption, inhibit arrhythmias and lower blood pressure. It is the basic drug for the treatment of angina pectoris and myocardial infarction. The main side effect is slow heart rate. Reduce or stop the drug when the heart rate is <50 beats/min or blood pressure is reduced.
Angiotensin-converting enzyme inhibitors: There are ramipril, perdopril, etc. They are mainly used to improve the structure of the heart muscle and blood vessel wall and slow down the process of atherosclerosis, especially for patients with combined diabetes, kidney disease, hypertension, etc. They should be taken for a long time. The main side effect is cough, and serious cases can be considered to change the drug.
Nitrates: mainly improve angina symptoms by dilating coronary arteries, and also protect endothelial function, which is beneficial to keep coronary arteries open after hematologic reconstruction.
Balanced diet.
Experts suggest that heart patients should do “three more and three less” in their daily diet. The general dietary principle is low salt, low fat, that is, a light diet.
”Three more”, that is, eat more fresh vegetables and fruits, coarse grains, brown rice, etc.; eat more soybean products; eat more unsaturated fatty acids (fish, vegetable oils, etc.).
”Three less”, that is, less fat, less food, less salt.
Less fat, that is, less fatty meat, animal offal and other high-fat food, to avoid causing obesity, hyperlipidemia and other risk factors.
Less food, that is, the total daily calorie should be controlled to achieve or maintain the appropriate weight, and eat fewer meals to avoid increasing the gastrointestinal burden and cause heart disease.
Less salt, that is, daily salt intake <6 grams, less or no pickled food, to avoid increasing the burden on the heart. In addition, quit smoking and limit alcohol. Moderate exercise
In order to maintain the stent from re-clogging and prevent new lesions from occurring in the coronary arteries, it is important to adhere to a healthy lifestyle, one of which is to adhere to regular exercise.
Time and manner of exercise.
The stent itself does not have any effect on activity, and normal exercise can generally be resumed 1 to 2 weeks after stenting.
Choose slower, softer exercises, such as: walking, jogging, slow swimming, tai chi and other aerobic exercises.
Exercise precautions.
The amount of exercise should be appropriate, according to their own heart condition to decide, the end of exercise to not feel fatigue is good, do not deliberately, rigidly by the book requirements of the heart rate target and time to exercise, barely adhere to only increase the burden on the heart, so that the heart function deteriorates or induce angina. Exercise should be measured, gradual and long-lasting.
1, do not exercise in the morning, preferably in the afternoon or evening, avoiding the peak time of the good attack of cardiovascular disease.
2, do not eat too much before exercise, do not exercise immediately after meals, so as not to cause coronary artery blood supply deficiency.
3, the ambient temperature should not be too hot or too cold, inducing angina attack.
4.Reasonable arrangement of work
Those without myocardial infarction can resume normal work after 1-2 weeks after stenting.
Those with myocardial infarction can resume light work 1 month after stenting, depending on their physical ability, work intensity and pressure and other comprehensive factors. If needed, transfer to a job with less heavy physical activity.
There are some types of work that are no longer suitable and should be transferred to a different position, such as work at height, pilots, drivers, heavy physical labor and strong stimulation of highly stressful occupations. Work must be measured and should be stopped as soon as physical discomfort occurs.
Alarm signals of heart attack.
1, chest discomfort.
Most heart attacks are preceded by discomfort in the precordial region, with chest pain, chest tightness or tightness in the throat, lasting several minutes, or recurring.
2. Discomfort in other areas.
Pain may radiate to the back of the left shoulder, ring finger, little finger, neck, jaw and stomach discomfort.
3. Shortness of breath and breath-holding.
This sensation is mostly accompanied by chest discomfort and occurs mostly before the chest discomfort.
4, other signals.
Sudden cold sweat, nausea or dizziness and headache or even fainting, etc.
If you or someone around you has chest discomfort, especially if there is one or more other symptoms, please call the emergency number immediately within five minutes to go to the hospital emergency room immediately. (Calling the emergency number is usually the fastest way to save a life and get help quickly.)