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Understanding CAD Treatment Options

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Dr Punish Sadana

Here’s an insight into Heart Disease and its treatment, both, individualised and balanced:
Coronary artery disease is the condition in which the arteries which supply blood to the heart muscle get a deposition of calcium and cholesterol, leading to plaque and atheroma formation. The prevalence of CAD in India is 9 to 10% in urban population.
The main risk factors are hypertension, diabetes, abdominal obesity, physical inactivity and unhealthy diet.
Symptoms depend upon the extent, intensity and acuteness of blockages. Chronic stable angina is the term used for chest heaviness, breathlessness, sweating may be associated with suffocation on activity, which is typically resolved on rest. Acute heart attack is the term used for similar symptoms at rest which don’t resolve with the usual medication. Treatment of these is standard though has to be individualised depending upon the extent, type of disease. The modalities include:
 Lifestyle modification and medication.
 Lifestyle modification and intervention.
 Lifestyle modification and non interventional therapeutics.

A stable CAD patient can be taken up for angioplasty with stenting for discrete lesions. Bypass is for lesions not amenable to angioplasty and ECP (external counter pulsation) for patients unfit for bypass and lesions unsuitable for angioplasty.
Patient having angina not adequately relieved by medications, having recurrent evidence of fluid retention and dyspnoea (breathlessness) due to weak heart function, have already undergone invasive procedure, but chest pain remains or has come back and cardiologist has determined that you are no longer a candidate for any invasive procedure or the risk involved is too much to take, then the patient can be a candidate for enhanced external counter pulsation. EECP is a non invasive outpatient treatment for heart disease that is used to relieve or eliminate angina. During the treatment, blood pressure cuffs are wrapped around your legs, and squeeze and release in sync with your heart beat, promoting blood flow throughout your body and particularly to your heart in the process EECP develops new pathways around blocked arteries in the heart by expanding networks of tiny blood vessels (collaterals) that helps increase and normalise blood flow to the heart muscle. For this reason, it is often called the natural bypass.
The standard course of treatment is one hour per day five days per week for seven weeks (a total of 35 one hour sessions). Some patients have two treatments in one day in order to complete the programme more quickly, while some patients extend the programme beyond 35 treatments, depending on their particular medical situation and goals.
Most patients begin to experience beneficial result from EECP between their 15th and 25th day of treatment. These benefits include increased stamina, improved sleeping pattern, decreased angina, and less reliance on nitroglycerin and other medications. There is variation certainly and some patients start to feel better as soon as in their first week of treatment. With ever increasing incidence of heart disease, lots of innovations are happening in the treatment modalities. The patients of stable angina, heart failure now have ECP to relieve their symptoms on outdoor basis.
(Dr Punish Sadana is DM, MD (Cardiology), FSCAI, [Principal Consultant Cardiology], Max Hospital, Dehradun.)