Dr Anand Subramaniyan, Senior Interventional Cardiologist, Kauvery Hospital HeartCity explains the role of advanced technologies in cardiac care
The average age of heart attacks striking younger men has decreased drastically in the last one decade. The recent demise of a celebrity who died at the age of 40 due to heart attack has sparked conversations in this direction. As per global reports, a surge in heart attacks among people in their 30s and 40s is majorly attributed to unhealthy lifestyle. To address the burgeoning cardiovascular disease burden, scientists and researchers are developing heart-care technologies that make the treatment less invasive and provide accurate information through advanced imaging. Despite the remarkable breakthroughs, people continue to fight heart problems.
A heart attack is a condition in which blood flow to the heart is restricted. The most common cause of this blockage is the accumulation of fat, cholesterol and other substances called plaque that build-up in the arteries. This brings our attention to ‘acute coronary syndrome’. Acute coronary syndrome is a blanket term used to describe several conditions related to reduced and sudden blood flow to the heart. Heart attack is one such condition in which the death of cells leads to damaged heart tissue. Due to the sudden complete blockade of heart blood supply, heart loses its oxygenated blood and hence leads to cell death and tissue loss (called as ‘infarct’). This lowers heart functions and subsequently leads to complications like heart failure and rhythm disturbances which poses huge risk to one’s life. Also, future risk of heart attacks is high with an index event. It’s NOT the gradual accumulation of cholesterol deposits which lead to a heart attack, rather the sudden rupture of a plaque (which could be minor) leading on to clot formation in the blood vessels which occludes the vessel completely leading to massive heart attack. It’s worthwhile to note that fatty streak or build-up of fatty plaque inside the heart blood vessels(coronaries) is said to be more often genetic, with lifestyle factors added determining the speed of accumulation. Hence no one is immune to heart attack which can even strike at a young age. A person’s tendency to accumulate fatty plaque accumulation in coronaries is determined in infancy and can start from early childhood. So, it has become imperative to keep us evaluated regularly for any risk factors which could lead to heart attack.
The risk factors of acute coronary syndrome include aging, high cholesterol, high blood pressure, smoking, lack of physical activity, unhealthy diet, heavy alcohol consumption, obesity, diabetes, genetic factors like family history of heart disease, and recently the COVID-19 infection. Asian Indians have higher preponderance to this problem more often than not compared to western counterparts. Symptoms may begin abruptly. They include chest pain or discomfort, pain spreading from the chest to the shoulders, arms, upper abdomen, neck, jaw or back, nausea, shortness of breath, heavy sweating, dizziness or fainting, unexplained fatigue and feeling restless. The most common sign is chest pain; however, the symptoms can vary depending on the individual’s age, gender, and other medical conditions. Women, older adults, or the ones with diabetes usually do not experience chest pain but have other atypical symptoms like breathlessness, belching, sudden pain in neck, upper abdomen, back or shoulders or unusual sweating alone.
Symptoms of acute coronary syndrome indicate a medical emergency and chest pain can be a sign of life-threatening conditions. Therefore, getting medical intervention at the earliest is the key.
How advanced technologies give a better quality of life
For years, angioplasties with stenting (occasionally open-heart surgeries) have been carried out to treat patients with acute coronary syndrome. Not all acute coronary syndrome patients require stenting. With the use of potent drugs (clot busters), many a times we see the clots getting cleared with drugs. A coronary angiogram is used to diagnose blockages in blood vessels but may be inconclusive in certain circumstances causing dilemma whether to stent or not. Certain plaque characteristics noted on IVUS or OCT helps the doctor to confirm the need for stenting even if the lesion does not look significant on coronary angiogram.
Newer technologies like FFR, IVUS and OCT have been widely used to determine whether to stent or not, where to stent, how long the stent should be and how well we have stented. Fractional flow reserve (FFR) aids to determine whether a patient with acute coronary syndrome requires stenting or not. The procedure measures pressure within a coronary artery before and beyond the occlusion using a specialised pressure transmitting guide wire. The score received after FFR helps the doctor recognise whether stenting needs to be done. In fact, FFR is the first line of assessment tool in developed countries such as Japan and USA with the highest level of clinical evidence and it is also a part of ESC International guidelines. According to a study that reviewed 17,989 patients, FFR improved one-year mortality rates in adults with stable ischemic heart disease.
Besides helping with decision making, technologies are helping in precision treatment as well.
Advanced imaging techniques like optical coherence tomography (OCT) address the gaps we face with conventional angiography. During the procedure, a 3D view is generated of the artery that enables the doctor to make accurate measurements of the stent before and after the placement.
Cardiac problems are silent at times and symptoms are not visible unless the disease is in the advanced stage. Therefore, cardiac care begins with being vigilant about the signs your body gives and follow a lifestyle that would help prevent such ailments. Heart healthy lifestyle changes are an integral part of preventing acute coronary syndrome. Recommendations include eating a heart healthy diet, checking cholesterol and blood pressure regularly, being active, quitting smoking, maintaining a healthy weight, managing stress, and drinking alcohol in moderation.