Revolution in Coronary Artery Disease Management
Coronary artery disease (CAD), the most common form of heart disease, is the leading cause of death in India. CAD is a condition in which plaque (unhealthy fat deposits) buildup causes narrowing or blockage of coronary blood vessels that supply blood to the heart muscles. This reduces the flow of blood to the heart.
CAD may further lead to other forms of heart diseases like heart attack, heart failure, and arrhythmia. Depending on the severity of the disease, people suffering from CAD may benefit from Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Grafting (CABG). PCI, commonly known as angioplasty is a minimally invasive procedure used to open blocked blood vessels; while
…show more content…
FFR is a procedure that accurately identifies the blood flow blockage in a coronary blood vessel and helps cardiologists to diagnose CAD. FFR measurement aids cardiologists in deciding whether or not to perform surgical intervention (angioplasty or stenting) on the blockages. If the FFR measurement shows that the flow of blood in a vessel is not significantly obstructed, then the blockage may not need to a surgical intervention (angioplasty or stenting). In such cases, patients may be treated with medical therapy.
How is CAD diagnosed using FFR?
FFR test is performed by guiding a thin wire (with a pressure sensor at the tip) into the blocked blood vessel through a catheter (thin hollow tube), to measure the pressure gradient in the blocked vessel. The FFR value is the ratio of the pressure gradient before and after the blockage. (See illustration)
How is it determined if a blockage requires surgical intervention?
In a normal blood vessel, FFR value equals 1. When the FFR value is ≥ 0.80, it indicates a non-significant blockage and does not require surgical intervention. In contrast, if the FFR value is ≤ 0.80, it indicates a significant blockage and hence requires a surgical
Angiograms are for diagnostic purposes so in the x-ray imaging one would look for a narrowing of the artery/vein. The x-ray moves takes 2-5 second videos from five different angles of the heart. During this time they surgeon and those in the control room look for any potential plaque blockages where the vessel becomes restricted and the color of the dye is not as dark. Of the eight angiograms five needed stents or valve replacements. They also pump a large amount of dye into the left ventricle of the heart to see the strength at which it is pumping. The first angiogram procedure I saw was on this 350lb man who was having heart arrhythmias and through this procedure they were able to determine that there was a 70% blockage in one of his arteries. However, Dr. Reichard wanted to do further investigation to see how much blood was getting through to determine if
ngiography is a test used to detect blockages of the arteries or veins. It is
Diagnosis is done with the help of diagnostic techniques like CT or magnetic resonance angiogram (MRA).
To diagnose a coronary artery disease (CAD) the doctor will use a coronary angiogram procedure to find the percentage of blockage or narrow in arteries, the angiogram results will help the doctor to decide a decision on patient treatment depends on the percentage of blockage on coronary artery, age, weight, and whether patients have other medical conditions, like diabetes . In cases with obstructive average a 50% or slightly more are treated by medications and Balloon angioplasty, but what about the cases with more than one artery completely blockage or the medication and stent do not help them? The doctor will choose a coronary artery bypass grafting surgery (CABG) to restore blood flow in the heart, CABG is a surgery done through replacement
• Cardiac catheterization. In this procedure, a thin tube (catheter) is put into a blood vessel that goes to the heart. Then, tests can be done to measure the oxygen and pressures inside the heart. Pictures can also be taken of the blood vessels by injecting a type of dye.
Multiple Vessel Coronary Artery Disease (i.e. Ischemic Heart Disease), Diagnostic Code 414.00, I25.10 – “Patients had a high comorbidity burden [of stroke] … ischemic heart disease” [5]
Through this sheath, a long, flexible, soft plastic tube called a “guiding catheter” is pushed. The tip of the guiding catheter is placed at the mouth of the coronary artery. The guiding catheter also allows for radio-opaque dyes to be injected into the coronary artery, so that the disease state and location can be readily assessed using real time X-ray visualization.
Cardiac catheterization is often referred to as coronary angiography or a coronary angiogram. It is a radiographic procedure that is used to look at and visualize the heart and the coronary arteries. During a cardiac catheterization it is possible for the cardiologist performing the procedure to see how effectively blood is flowing through the coronary arteries. In addition, this procedure allows the cardiologists to see how blood is moving through the chambers of the heart and how effective the heart valves are functioning. A cardiac catheterization can also allow for the visualization of the movement of the walls of the heart to see if the pumping action of the heart is normal.
Mr. Harry Bright has undergone a procedure called percutaneous transluminal coronary intervention (PTCI) via femoral approach for the treatment of his progressive unstable angina. Femoral artery is the most common access site used for PCI because of its size and its direct passageway to the heart (Young, 2014 p.431; Cosman, Arthur, Bryant-Lukosius, Strachan, 2015 p.180). In this procedure, a cardiac catheter followed by a stent is inserted to the artery to dilate the occluded blood vessel and improve blood flow (Young, 2014 p.430). The occlusive atherosclerotic plaque are usually associated with Mr. Bright’s diabetes, hypetension and smoking history. Contrary to the positive effect of PTCI, bleeding and hematoma formation are the most typical
The following summary is an updated case study of a 47 year old male patient, Jim who was diagnosed with Coronary Artery Disease. The patient did receive information on what CAD is and was informed that test were needed to fully diagnose and be evaluated for underlying conditions (high blood pressure, high blood cholesterol levels, diabetes and blockage. I will discuss the type of test needed for this condition and tests for any underlying conditions that are related to this disease. The type of treatment needed to control and lower his risk factor. I will also give the patient information about complementary and alternative medicine so the patient will be well informed about different types of treatment. The patient will be informed about the prognosis of the disease, and the options that the patient has to succeed in the changes in his lifestyle that are needed.
(Mayo Clinic, 2013) Some surgical procedures used to treat CAD are angioplasty and coronary artery bypass surgery. (Mayo Clinic, 2013) The angioplasty surgery is when your doctor inserts a catheter to the blockage in the artery and threads the wire through the narrowed arteries. (Opening blocked coronary arteries: New questions about the old answer, nd., p.2) Once the balloon is in place, at the sight of the blockage, the balloon inflates which causes the plaque to crack and the artery to become free from blockage. (Opening blocked coronary arteries: New questions about the old answer, nd., p.2) The other surgical opinion for CAD is coronary artery bypass surgery is a procedure done by a doctor using a graft. (Mayo Clinic, 2013) The doctor will construct a graft to direct the blood flow around the blockage using existing blood vessels in the body. (Mayo Clinic, 2013) Due to the fact that this procedure requires open heart surgery, it is usually used for patients with several partial or full blockages. (Mayo Clinic, 2013)
In this type of cardiomyopathy, the wall of the RV is replaced by fibrotic tissue. CMR is used for assessing the right ventricular volume and the systolic function. It can also be used to characterize tissue which enables identification of fibrotic or fatty tissue in the RV.
CAD is an artery disease where the blood vessels that supply blood to the heart becomes hardened or narrowed due to the build-up of cholesterol and plaque in the inner wall; this causes a reduced blood flow to the heart muscles. Hence, if the arteries become severely narrowed or blocked, the heart becomes deficient for nutrients and oxygen.
is coronary artery disease, which involves the collection of cholesterol at inflamed sections of the arteries within the heart (Wedro). These accumulations of cholesterol then harden, forming plaques which narrow the vessels and restrict blood flow to the heart.
appear similar to conventional stents.”8 Middleton, Teefey and Darcy8 note that the use of PFTE endografts will likely become standard as their performance outweighs the early stent materials used. Color Doppler as well as pulsed Doppler should be used to interrogate the stent and supporting vessels. Velocity measurements are taken using angle correct and spectral waveforms are recorded. Careful examination of the liver vasculature is imperative to verify proper stent function. Specifically, thrombosis or occlusion can be assessed with color and Doppler ultrasound. Velocity parameters may vary from patient to patient and also will change from immediate post procedure velocities to those obtained during long term follow up. Universal Doppler