Wednesday, January 20, 2016

Are the stents necessary in heart care?

Are the stents necessary in heart care?

Human longevity has been increased from 40Y to 80Y in 60 years with the help of better medical and health care. Body die through the death of its organs. Therefore, like a repairing or replacement of car parts, human has started repairing or replacing different parts of the body and adding more and more years to the life.

Heart the most powerful pump always get disturbed with emotional attacks and cholesterol depositions. And one day angina rings the alarm bell with; chest pain, brethlessness, fatigue, left arm, left shoulder pain, left  jaw pain, epigastric pain, backache, etc, with vomiting, off and on perspiration, etc, symptoms. 

Physician after clinical examination, will advise for chest X-Ray, ECG, Lipid Profile, Sugar, LFT, RFT, etc. If ECG suggests IHD (Ischaemic Heart Disease), then the patient has to go through TMT (Cardiac Stress Analysis) and 2D Echo. If LVEF is less than 35 p.c., and regional wall motion found abnormalities at rest, then CAG (coronary angiography) is asked for. If CAG suggests CAD (Coronary Artery Disease) then cardiologist will proceed for Myocardial Viability Studies either by Radionuclde Isotope Studies or Dobutamune Stress Studies or Thallium scan. For true assessment of CAD by FFR, IVUS (Intravenous Ultrasound) & OCT (Optical Coherence Tomography), etc, last three studies are genuienly evaluate coronary arteries by both anatomical & physiological methods whether patient requires PCI (angioplasty with or without stent) and/or  CABG (Coronary arteries bypass surgery). 

Now common man after visiting a cardiologist, starts narrating the blocks of arteries in percentage to the family, friends and relatives. Conservative physician opt for care through medicines but aggressive care taker will promptly suggest either PCI or CABG. Both are expensive treatment and the stents is a commodity of doctors market. Commission on sale of stents is discussed in inner circles.

But do all the patients having blocks arteries require PCI with stents? It is not the final answer. Now new studies revealed that even if there are blocks and if myocardial viability is good, then no need of stents. Because coronaries have collaterals so during diastole (in relaxing phase of heart), they are getting O² even blocks are present. 

My physician advised me to take aspirin regularly. He says after the PCI or CABG, medicines are not going to leave you, in fact it will add on, why not to take aspirin at present and delay the stent or surgical intervention?

Risk of stents has been decreased as they are coated with drugs or biodegradable materials. But after CAG with stent another drug Clopidogrel/ Prasugrel/Ticagrelor add in the list.

The production cost of stent may not be more but its application to heart make it expensive. Life costs for the patient and the income for the manufacturer and the doctor.

Daily exercise (walking, yoga) and relaxing heart (detachment, meditation) may be the better options than aspirin and stents. Each moment gives life and death together. Till life is more, death is away. And when the life will diminish, death will take over.

Heart Health is the Real Wealth.

20 January 2016

NB: Do consult your doctor.


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