The dawn of 2020 saw the world battling the worst pandemic of our times. The crisis made us realize the limitations of current knowledge with respect to the constant uncertainties of the future, thus, emphasizing on the value and necessity of innovations. The COVID-19 outbreak drew our attention to some of the most pressing healthcare conditions that need urgent addressal. One of them is heart care. From the days of the first stents, the medical science has progressed from just managing the heart problems to monitoring, restoring and repairing it too. Minimally invasive, next-generation techniques like percutaneous coronary intervention (PCI) are helping patients live better quality of life, bringing precision and accuracy in existing heartcare modalities.
The commonest cause of heart disease today happens due to blockages in the blood vessels of the heart leading to heart attacks, angina or heart failure. These blockages in the heart vessels are usually due to progressive build-up of fat containing plaques over a period of years, which may produce an emergency like heart attack, due to clot formation leading to sudden occlusion of the blood vessel. Per-cutaneous Catheter Interventions (PCI) are non-surgical procedures used to open-up these blocked heart blood vessels, thus saving the heart muscle from impending permanent damage. During the procedure, a balloon-tipped catheter is inserted into the blood vessels in the groin or arm. When the catheter reaches the heart at the point of the narrowed artery, the balloon tip with the stent is inflated, compressing the plaque and expanding the stent. Once placed correctly, the stent stays, and the balloon is deflated and withdrawn.
The minimally invasive procedure restores normal blood flow, decreasing heart related chest pain and giving people better quality of life. In case of heart attacks, a timely PCI can halt the process of heart damage and thus protect the heart and save life. The direct imaging through PCI helps physicians in adding precision to the treatment.
The Need for Innovations in Heartcare
From the time when a technique like PCI was first introduced in 1977 (carrying high risk of complications) to today, when it is not only minimally invasive but has also reduced the risk involved, innovations in heartcare have come a long way. The understanding of diverse patient profiles that require the treatment has also evolved over the years. The burden of CVDs (Cardiovascular Diseases) has almost doubled in past 25 years. Hence, it becomes critical that we identify those at risk and help manage the disease better. Today, we have extensive portfolios in heartcare therapies that are cost-effective, minimally invasive and improve patient outcomes. Precision PCI techniques have evolved in design and improved deliverability so that doctors can access and unblock difficult-to-treat blockages with more flexibility and precision while having confidence in the outcomes and safety. Optical Coherence Tomography (OCT) allows cardiologists to see the inside of an artery in 10 times more detail than if they were using intravascular ultrasound.
The decision between an open-heart surgery or PCI or medical therapy alone, rests on the clinical situation as well as the type and severity of blockages in heart vessels. For instance, PCI is recommended for those suffering from shortness of breath and chest pain due to blocked arteries, especially if the person is having on going heart attack. If, on the other hand, the person does not have any symptoms and the condition can be controlled through medicines, we do not recommend PCI. That said, the severity and extent of blockages may necessitate by-pass heart surgery. Finalizing the best treatment approach for more complex cardiovascular disease manifestation may be a challenge to most physicians. the best treatment option. The ability of an interventional cardiologist to open the blockages in the heart blood vessels and restore blood supply depends not only on their experience but also on the quality of equipment available. Therefore, innovations form the base of any medical care.
Lifestyle Changes for a Healthier Heart
Once the patient is relieved from the hospital, we advise specific lifestyle changes to ensure the functioning of the heart is healthy. For instance, cutting saturated fat to specific limits (this can vary from person to person), limiting sugar, sodium and trans-fat. Many patients feel that being physically active means aggressive workouts that make them break a sweat. It is important to check with your doctor about the kind of exercise regime that would suit your specific condition or need. You must get a plan tailormade for you. While PCI can help a patient live a more fulfilling life, it does not protect from re-building of plaques in the heart vessels. It is the proper lifestyle and medications that will make all the difference.
Given the complexities involved, a whole-hearted approach to complex PCI is key. Precision led imaging and other innovative solutions for intervention have all helped overcome the challenges of complex PCI. and deliver best patient outcomes. Time is ripe to leverage this progression and raise the levels of heart care in India.
Dr. Sanjay Mittal, Director, Clinical and Preventive Cardiology, Medanta Heart Institute, Gurugram
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