Heart Attack Treatment (cont.)
Coronary artery stents
Coronary artery stents are small hollow cylinders that can be deployed over the
angioplasty balloons and left within the coronary arteries to keep the arteries
open. Stents help prevent abrupt closure of arteries shortly after PTCA.
They also prevent restenosis (recurrent narrowing of the arteries) several months after
PTCA.
Coronary stents decrease the risks of arterial dissections, elastic recoil,
and artery spasm that can occur after PTCA and cause re-occlusion of the artery.
Studies have shown that the incidence of abrupt coronary artery closure after
PTCA has declined dramatically with the introduction of coronary stents.
Coronary stents also help to keep the coronary arteries open in the
longer-term. After a successful PTCA, as many as 30-40% of patients will develop
recurrent narrowing (restenosis) at the site of inflation of the balloon,
usually within six months following PTCA. Restenosis may or may not be accompanied
by symptoms such as angina. Thus, restenosis often is detected by exercise
stress tests performed four to six months after PTCA. The widespread use of coronary
stents has reduced this incidence of restenosis by as much as 50%. The recent
introduction of coated stents (stents that are coated with chemicals to further
reduce restenosis) has reduced the incidence of restenosis to well under 10% and
has been a major improvement in treatment.
Patients with coronary artery stents usually are maintained on full doses of
daily aspirin. For the first 4-12 weeks after the placement of stents, patients
are given an additional anti-platelet drug such as ticlopidine or clopidogrel
because the metal surface of the stents may promote the formation of blood clots
in the first several weeks after the stent is inserted. With the newer medicated
stents, aspirin and clopidogrel are continued for a year or longer.
Nitrates
Nitroglycerin is the most common nitrate used in the treatment of heart attacks. It
can be given sublingually (under the tongue), as a spray, as a paste applied
over skin, and intravenously. Intravenous nitroglycerine has a rapid onset
of action and is commonly used in the initial (first 48 hours) treatment of
heart attacks. Nitroglycerine is a vasodilator (blood vessel dilator), which opens
arteries by relaxing the muscular wall of the artery. Nitroglycerine dilates
coronary arteries as well as other blood vessels throughout the body. By dilating
blood vessels, nitroglycerine lowers blood pressure, decreases the work
that the heart must do, lowers the demand by the heart for oxygen, prevents
coronary artery spasm, improves blood flow to the heart muscle, and potentially
minimizes the size of the heart attack. Nitroglycerine is especially helpful in
patients with heart attacks who also have heart failure or high blood pressure.
The common side effects of nitrates are headaches and low blood pressure. Low
blood pressure can cause weakness, dizziness, and, sometimes, even fainting.
Nitrates should not be given in patients who have taken medicines for erectile
dysfunction such as sildenafil (Viagra) and vardenafil
(Levitra) in the
preceding 24 hours, since severe low blood pressure may result. Nitrates should
not be given in patients who have taken tadalafil (Cialis) in
the preceding 36-48 hours
because the effects of Cialis last longer than either sildenafil or
vardenafil .
Next: ACE Inhibitors »
- ACE Inhibitors - Read about ACE inhibitors like Altace, lisinopril, enalapril, ramparil, Zestril and more. Information includes side effects, drug interactions, and pregnancy safety information.
- Coronary Artery Bypass Graft - Read about heart bypass surgery (coronary artery bypass graft surgery, CABG) including how coronary artery disease is diagnosed, treated, recovery time, risks and complications, and the long term results after CABG.
- Congestive Heart Failure - Read about congestive heart failure symptoms like fatigue, abdomen, leg and ankle swelling, shortness of breath, sleeplessness, increased urination, nausea, abdominal pain, and decreased appetite.
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