In recent years, there has been a great revolution in the treatment of people with myocardial infarction and coronary artery stenosis. You must have heard terms such as angioplasty or ballooning! In this article, we want to introduce you to the scientific title of these procedures.
Percutaneous coronary interventions
PCI is a valuable achievement in saving the lives of patients. For the first time in the world, a Swiss radiologist named Dr. Andre Grotzing used a simple balloon to open the stenosis of a vessel. Subsequently, with the advancement of knowledge and related sciences, various types of balloons and stents were invented and used.
Drug stents or absorption stents gradually limited the need for open heart surgery
You will read more about angioplasty or PCI below
Myocardial infarction and the need for PCI
Sometimes the only way to save and cure a person who has had a heart attack is to open a closed and narrowed artery.
Heart attacks and strokes occur when the blood vessels in the heart muscle are unable to get enough blood and oxygen to the heart muscle due to tightness and obstruction. In these cases, often with the onset of strenuous physical activity or anger, or after eating a heavy meal, the narrowed arteries will no longer be able to supply oxygen to the heart muscle, and suddenly the blood flow to the heart muscle is cut off.
The most common cause of obstruction or narrowing of the blood vessels of the heart muscle is known as atherosclerotic plaque, which is simply the deposition of fat and hardening of the inner wall of the artery.
These plaques are full of fat and prone to rupture. Following the rupture of these plaques, the clotting mechanism in the vessel is activated and a blood clot will form and the vessel will become blocked.
Our heart muscle cells have no food supply and must get all their nutritional needs directly from the flowing blood, so with a sudden cessation of blood flow, the function and activity of the heart muscle cell that does not reach the blood supply is immediately cut off and undergo changes in its shape and structure
Will the damage to the heart be permanent?
In temporary blockages of arteries, by removing the blockage and restoring blood flow, the heart recovers after a week and can return to its previous activity, but in prolonged blockages and prolonged interruption of blood flow, the heart muscle cell suffocates and dies, With the death of cells in a part of the heart muscle, it is often a permanent complication and can be associated with acute and dangerous consequences such as fatal arrhythmias and severe heart failure.
So what is the main goal in treating a person who has been to the emergency room with a heart attack?
The main purpose is to open the blocked vessel or vessels immediately.
Methods of removing vascular obstruction
Doctors use the following modalities based on your condition to achieve this goal.
Clot dissolving drugs (fibrinolytic drugs)
Removal of clots inside the blood vessels of the heart muscle (coronary arteries) with non-surgical intervention, namely angiography and angioplasty, which doctors call primary PCI, is the subject of this article.
There are advantages and disadvantages to both methods
- Anticoagulants or fibrinolytic drugs:
Fracture and dissolution of the clot is called fibrinolysis
Fibrinolytic or thrombolytic drugs are given by injection into a vein in an emergency room. After the clot disappears, the blocked blood vessel opens. But the point is that these drugs need a certain amount of time to be effective.
Doctors say that if a person with a heart attack, severe stenosis and coronary occlusion receives medication within the first three hours of the attack, the best treatment results will be obtained.
Between three and six hours the result is relatively satisfactory
From six to twelve hours, the results are relatively positive
And after twelve hours, the drugs will practically not have good results
Some of these drugs are:
- Streptokinase or SK,
- Octylase t-PA,
Complications and risk factors
One of the most important side effects of these drugs is internal bleeding, especially gastrointestinal and cerebral hemorrhage, which can be potentially dangerous.
Therefore, in certain groups, like the following people, you must inform the doctor about the condition:
- People with active bleeding
- People with a history of cerebral hemorrhage
- People with a history of stroke
- People with tumors and brain masses
- History of a major accident or trauma in the previous three months
- Uncontrolled high blood pressure
- Surgery a month before
- Internal bleeding in the previous month
- Taking certain medications such as warfarin or NOAC such as rivaroxaban
- be pregnant
- Specific blood diseases such as factor 8 deficiency
- PCI in the treatment of acute myocardial infarction:
The standard and approved method for treating acute myocardial infarction is to perform emergency angiography, identify narrowed or blocked coronary artery or vessels, and remove a blood clot, or open the stenosis and obstruction with a balloon or stent
This was a summary of the primary PCI angioplasty process
This is because this method is actually a type of coronary artery intervention that enters the body through percutaneous skin through diagnostic and therapeutic tools.
Catheters and wires are inserted through the skin through the groin or wrist veins and are directed to the heart while the path of the wire is visible on the monitor screen in front of the medical team.
In a person who arrives at the hospital with a heart attack, both atherosclerotic plaque and a blood clot can prevent adequate blood supply to the heart muscle.
So it is quite clear why PCI or emergency angioplasty saves a person’s life.
During angiography during the PCA process, in addition to the main vessel responsible for a recent acute myocardial infarction called the culprit vessel, other coronary vessels that have stenosis are identified. And the reopening of these arteries will reduce the risk of recurrence of heart attacks in the future and thus increase patient survival. This is one of the highlights of PCA.
Patient age, number and amount of detected stenosis, physical condition and underlying health of the patient, etc. are involved in determining the time of opening of irresponsible narrow vessels in stroke.
For example, some centers perform angioplasty again in the same initial PCA and some in the following days of hospitalization.
Other advantages of primary angioplasty or primary PCIs are:
Allows the doctor to see the heart vessels
By looking at the condition of the coronary arteries, doctors can determine the general condition of the patient
They remove blood clots directly and with direct and relatively complete vision
In addition to removing the blood clot, the stenosis of the artery is dilated with a balloon or stent
If stenosis of other coronary arteries is also observed, treatment is planned
There is no longer a risk of fatal bleeding following the administration of thrombolytic drugs and clot solvents.
These procedures are performed in a sterile area called a cat lab.
Disadvantages of PCI
We talk about the benefits and advantages of PCA now it is better to talk about the problems of PCA
Primary PCA is an emergency procedure in which the physician and the patient do not know each other, and the general condition of the patient, who is sometimes transferred to the emergency department with a decrease in level of consciousness, will not be such that a history and a list of medications are possible.
Some patients after primary PCI may need open heart surgery, or CABG, to undergo coronary artery bypass grafting.
The final words
Unfortunately, despite all the benefits for the PCI, which is really life-saving, not all equipment centers and specialist doctors do this, so if you take your patient to the best-equipped medical center possible, you have been a great help in rescuing him.
Doctors say the golden time for successful treatment of acute myocardial infarction, from the time the patient is exposed to emergency personnel to the opening of a narrow and blocked vessel, is only one hundred and twenty minutes, and unnecessary measures should not waste this golden opportunity.
This means that it should take a maximum of one hundred and twenty minutes from the emergency room to the PCI.