Interventional cardiologists are physicians who specialize in angioplasty and stenting and other catheter-based procedures used to treat cardiovascular disease. Should you, a loved one, or a friend face a cardiac condition, the more you know about how interventional cardiologists determine if you will benefit from angioplasty and stenting or other treatment, the more comfortable you will feel during this time.
Please use the information below to assist you in having a conversation with your doctor about stents. If you are having a heart attack, undergoing angioplasty could save your life and prevent the death of heart muscle. If you have blockages in the arteries of your heart and are suffering from chest pain, shortness of breath, or other symptoms of heart disease, being treated with angioplasty and stents may be the best choice to relieve pain and to improve your quality of life.
Much of the information about angioplasty and stents -- on the news and even what you might hear from friends and family -- may be outdated, incorrect, and even dangerous. Understanding your options and understanding the alternatives for your specific case can only happen with the physician who knows your situation.
If you have been diagnosed with heart disease, you will have many questions. Here are some questions to get you started and some background information to help as you talk with your doctor.
Question 1: Do I have a life-threatening blockage?
If your interventional cardiologist answers “yes” to this question, then you should undergo angioplasty and stenting immediately. This means your test results indicate that blood flow to your heart muscle is being severely restricted by a blockage in one of your heart arteries. You may be having a heart attack or a heart attack may be developing. In this situation, angioplasty is the recommended treatment. In fact, being treated promptly with angioplasty could save your life. If you are suffering a heart attack, do not delay care. Every second counts.
If the answer to this question is “no” and your heart arteries are NOT dangerously blocked, then you have more time to ask questions discuss a range of treatment options with your doctor.
In order to answer this important question, your interventional cardiologist will analyze the results of tests to determine whether you have a blockage in your heart arteries and, if you do, how dangerous the blockage is. This information will be essential to your doctor in recommending the right treatment option for you.
In making recommendations, your interventional cardiologist will consider a number of factors, including --
- Your test results, including past stress tests, angiograms, and others
- All of the symptoms you have had and what steps relieved or exacerbated them
- Whether or not your symptoms have been successfully treated with medications in the past, or if medications are no longer working for you
Question 2: How will I know if I have a life-threatening blockage?
Become familiar with the warning symptoms of a heart attack or other important blockages. Disregarding the symptoms of a heart attack and delaying treatment can lead to death or irreversible damage to the heart muscle. Call 9-1-1 if you are suffering any of these symptoms:
- Chest discomfort: Many heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness, or pain.
- Discomfort in other areas of the upper body: Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
- Shortness of breath with or without chest discomfort.
- Breaking out in a cold sweat
- Feeling nauseous or lightheaded
Here’s a key thing to remember about a common misconception: Not all people with heart attacks experience chest pain. In fact, many women do not experience chest pain when they are having a heart attack, and they are more likely than men to die from a heart attack.
Question 3: What will happen if I don’t undergo angioplasty and stenting?
If you have stable heart disease, then you will be fine. Angioplasty and stents have helped many patients, including some whose stories are featured here, but the procedure is not the right option for everyone in all situations. Many patients can do well if they make heart-healthy lifestyle changes and take medications. Other patients may have several blocked arteries or other complicating conditions that make open-heart surgery (coronary artery bypass graft surgery) a better option for them.
If you do not undergo stenting or bypass surgery, in most cases you will continue to live your life as you are. Patients with heart disease who are treated without stents live just as long as those treated with stents. This may not be a life time recommendation. Patients with stable heart disease should work with their cardiologists to make periodic adjustments to their medications, with the goal of relieving the symptoms of heart disease.
But for patients whose symptoms are not relieved, or for those whose symptom pattern has changed (becoming unstable), angioplasty and stenting may be the right advice. If you have had chest pain or other symptoms of a blocked artery for some time and
- You are still suffering symptoms after trying to make lifestyle changes and taking heart medications; or
- You are unable to take heart medications needed to relieve your symptoms because of side effects or interactions; or
- Heart disease symptoms are affecting your quality of life and keeping you from participating in the activities you enjoy,
then angioplasty and stenting may be right for you.
Question 4: Would medication alone work just as well for me?
For most patients the answer is yes, if you have stable heart disease. This question has been the subject of extensive research. If your tests indicate you are not having a heart attack, taking medications and sticking to a heart-healthy lifestyle is effective in treating the accumulation of cholesterol and other materials (called plaque) in the heart arteries.
However, if you are having a heart attack, then angioplasty and stenting is the standard for care. It is without question the best therapy and could save your life.
Studies have shown that today's stents do not prolong life for patients who are not suffering a heart attack and are not at risk for a heart attack. For these patients, the potential benefits of angioplasty and stenting are --
- Reduced chest pain, shortness of breath, and other symptoms,
- Taking fewer medications to manage heart disease symptoms, and
- Improved quality of life, including being able to participate in favored activities without symptoms.
Question 5: What should I do if I have more questions?
Ask them. Any time you have a healthcare decision to make, the conversations you have with your doctor are the key to successful results. Be sure your doctor is aware of all of your symptoms as well as all of the medications, vitamins, and supplements you may be taking. And ask every question you have.
We hope you will also use this website to learn more about your cardiovascular health and treatment options. SecondsCount.org was developed by the Society for Cardiovascular Angiography and Interventions (SCAI), the medical society for interventional cardiologists. Learn more here about interventional cardiologists.