One of the commonest procedures performed around the world is called stinting. It’s where doctors open up a blocked artery in the heart, put in a little sliver of metal to keep it open, but they’ve been allegations that far too many stents have been put in when medications and lifestyle change could do the job.
Just as well, if not better, and in fact a cardiologist in the United States has recently been suspended for putting in too many stents.
So what is the story here? I spoke to a leading cardiologist associate professor David Playford standing in the setting of a heart attack.
Is beyond question, so nobody would ever argue if somebody came in with symptoms consistent with a heart attack, going straight to the lab, getting features and fixing up the artery as quickly as physically possible in the setting of somebody who comes in with unstable symptoms or even Symptoms that have rapidly increased again opening the artery up quickly is beyond question.
The question comes in when somebody comes in with minimal symptoms or symptoms that are not clearly due to angina and then looking for narrowed arteries, and if you find one, then opening that artery up there’s, no evidence whatsoever that that’s beneficial.
If anything, there was evidence that that can cause harm, and then there’s this grey area called stable angina.
What is stable, angina and what’s the gray area so stable angina is reproducible symptoms with exercise so much creep up on you right.
It’s due to it they progressive narrowing of an artery that comes up over over sometime plaque or cholesterol, deposition in the artery.
They can slowly narrow it down to a point where there’s insufficient blood going through there.
At times of stress, usually there are no symptoms at rest, because there’s still enough flow down the artery for the metabolic demands of the muscle, but with exercise that fixed, narrowing doesn’t allow enough blood to go down there to meet the demands of The muscle, and so that’s when the symptoms occur with exercise so it’s a very important symptom with stable angina is that it’s reproducible, and it goes every time with the same level of exercise and what you’re talking about. Mostly is chest pain, it’s, usually a discomfort.
Even the word pain is not often used.
It’s, often across the chest.
It may go up into the neck or the jaw or even the teeth or the gums, and it can sometimes go down.
The left arm can be associated with other symptoms like nausea, a bit of sweating and often in some breathlessness, but those symptoms are classical and a lot of people.
Don’t have classical symptoms.
That is any symptom that’s, reproducible with exercise could be angina.
So why are so many cardiologists is pretty in stents for stable angina.
The key issue here is in relation to the underlying Anatomy.
If you’ve got stable or unstable anatomy. So if you come in with with symptoms that are reproducible in the same every time or if you come in with symptoms that have suddenly occurred or suddenly worsened or if you come in with a heart attack underlying there is still the same disease.
Atherosclerosis but atherosclerosis is, is a slow and progressive development of cholesterol, buildup within the wall of the artery associated with inflammation.
So information is an essential part of the process of development of atherosclerosis, and the artery initially starts out with this thing that we call a fatty streak which is really just the arteries still the same size.
There’s, no narrowing of the size of the artery itself, or the amount of blood going through is completely normal, but eventually, as this progresses through you get formation of actual plaque, which is cholesterol.
Deposits within the artery wall that’s almost like a semi liquid form associated with the with inflammatory cells, and it’s almost like a sore it’s hot it’s, inflamed it’s, almost like it.’s got a scab on the top of it, and this you still don’t know you.’ve got it.
So, even though there may be a number of these throughout the body, there might be a number in the coronary arteries in the arteries that supply the the brain you don’t know you,’ve got it, and the scary thing about atherosclerosis is that it? You may not have any knowledge that there is a problem until the first complication, which is could be a heart attack, could be a stroke and, of course, the reason for talking about the underlying causes is that the stent is more appropriate for one situation than the Other yet cardiologists are pretty instance, for both stinting is a very effective treatment for relieving angina, but what you’re doing by standing, is you’re putting in a piece of metal your scaffolding, this artery and the scaffolding itself is not an inert substance.
It’s like a bare metal barrier inside of this coronary artery, and the risk is that you can form a plot on there or that that that scaffold can get covered over by tissue and get in growth.
Now, in order to stop the in growth, new stents were developed, which are called drug coders deaths.
They, have this coating on the outside of the stent to stop the? Tissue from growing back. Into it and, the trouble? With the drug code, incidence is that were selfic different stopping tissue growing into it that the tissue never grew in so there was this bear.
Scaffold that was exposed to the blood, and so, if you stopped one of your medications to thin your blood, there was a significant risk of developing sudden blockage of that stent in a heart attack.
If you’ve got stable symptoms if they’ve come on over a period of time and you’ve got what we call stable angina.
Most of the time you don’t need a stent, but if you come in with sudden symptoms that have appeared at risk, most of the time you do need a stent again.
Going back to criticism of cardiologists is that they treat the artery and not the person, because, presumably, if you’ve got one artery, this disease, you’re, going to have far more than that in your body and you’ll never have enough stench to Be able to stand every artery that’s sick in your body, what’s the story in terms of holistic care, for somebody who’s got one artery that’s gone wrong.
Well, I think the the key thing is that you haven’t just got one artery, that’s gone wrong in the city or in the situation of somebody who comes in with symptoms of some sort and it doesn’t have to be angina it Or a heart attack it could be a stroke or a transient ischemic attack, which is like a mini stroke or some other abnormality.
If there’s any symptom related to the vascular system, it means that problem is widespread, arose.
Grossest, doesn’t affect just that.
One artery and leave the others cleaned all arteries will be affected.
So that means that whatever the processes that’s gone on to develop the narrowing over the last time of this individual, we have to address everything in order to slow down the process. And if anything, we try to stop the process from getting any worse.
In the long term, what has been very clear is that an improvement of weight and improvement of diet, improvement of exercise levels do actually make a difference in the long term, as well as reducing your cholesterol, teen aspirin.
Even if you can get good lifestyle changes, there is very good evidence.
The that long term therapy once you’ve got atherosclerosis.
You need the cholesterol lowering and maybe aspirin Music .