Pathology Coronary Interventional Cardiology

Written by: Dr. Salvatore Brugaletta
Edited by: Top Doctors®

¿What is interventional cardiology


Interventional Cardiology is a subspecialty of cardiology dedicated to the diagnosis and treatment of atherosclerotic disease coronary arteries and some structural disease heart through very thin tubes, called catheters. Unlike surgery, which requires an open wound and chest to get to the heart, interventional procedures in these catheters are inserted through an artery or vein in the leg or arm. The catheter access to the heart following the path of the artery / vein and allows the therapeutic diagnostic procedure and / or your arteries and structures. Since this type of procedure does not involve open heart surgery is considered minimally invasive. Being a sub - specialty of cardiology, the cardiologist physician receives special training in the use of catheters, contrast media, fluoroscopy and techniques angioplasty balloon and stent implantation of the coronary arteries, which is the procedure most frequently performed.

¿What types of procedures are


We can classify the interventional cardiology procedures in two main types: coronary and non-coronary, depending on whether they focus on the diagnosis and treatment of atherosclerotic disease of the coronary arteries or


Coronary procedures consist of diagnosing the presence of a disease of the coronary arteries, which are those that supply blood to the heart to function normally and should be sick can produce angina or attack. Besides the ability to diagnose coronary artery disease, coronary procedures give the possibility to treat. The treatment is based on the introduction into the diseased artery of a mesh of metal or polymer, called stent or scaffold, which widens the diseased segment and keeps the vessel open. This particular procedure is called angioplasty coronary, representing 90% of all procedures in interventional cardiology.

The non-coronary procedures include the treatment of structural heart disease, such as the closure of anomalous communications between two parts of the heart (closure of inter-atrial communication of patent foramen ovale transcatheter implantation of prosthetic aortic insufficiency or reduction valve mitral implant through the clip, called“MitraClip&rdquo ;). In particular percutaneous aortic prosthesis implantation is a promising procedure in the treatment of stenosis without aortic heart surgery and, although currently performed in patients with high surgical risk, in promises coming years to extend the treatment of younger patients.

¿Since problems are treated in the coronary arteries


The problems in the coronary arteries are treated with a procedure called percutaneous transluminal coronary angioplasty (PTCA ), which is a form of non-surgical treatment very effective for patients with certain forms of heart disease. Basically consists of dilatation of the stricture (narrowing ) located in the arteries supplying the heart ( coronary arteries), which have previously been identified by diagnostic cardiac catheterization. Such strictures imply the existence of blockages in the coronary arteries that prevent blood normally access the heart and can cause a angina or even a heart attack. The mechanism to solve the coronary obstruction with PTCA is highly variable. In almost all cases, a very thin catheter is used with a balloon at the tip, which is placed through the stenosis. Pressure to inflate the balloon, the plaque ruptures and narrow relieved. Very often it is necessary to complement the procedure successfully, the placement of a metallic or polymeric mesh, called stent or scaffold, which supports the vessel walls and ensures a good result. The route of approach ( puncture at the groin / arm / elbow) is identical to that used for the procedure if catheters are generally of a slightly higher caliber. Angioplasty is often an alternative to diagnostic catheterization procedure, although it can be made immediately after this so you should consider this possibility.

The stent / scaffold ( metal mesh / polymeric intracoronary ) is an integral part of treatment with angioplasty and consists of a thin tube of metal or polymer, which implanted within the coronary artery at the site of the obstruction will dilate, provides support to the arterial wall and helps keep the artery open.

From the description of the technique of coronary balloon angioplasty in 1977 by Dr. Andreas Gruentzig, percutaneous coronary balloon angioplasty has caused a huge impact and has been established as a minimally invasive alternative to surgery Bypass. Following the introduction of the first stent to prevent the closure of the coronary artery, which had already been dilated with balloon in 1982 by Dr. Ulrich Sigwart, interventional cardiology has progressed very quickly. Over the years, the design of stents has improved, reaching as of today its fourth generation with fully resorbable polymeric stents within two years after placement, compared with metal stents, which are lifetime within the artery.

Risk factors in coronary heart disease

Risk factors for coronary heart disease are divided into two categories: modifiable and non- modifiable. The non-modifiable risk factors include age and being male or female, and are factors over which you can not act with any conduct of life or medication. Furthermore modifiable risk factors are factors over which doctors and patients can act especially with changes in lifestyle or medication to keep them under control and then reduce the risk of heart disease, both in primary and secondary prevention. These modifiable risk factors are the hypertension Blood, the high level of cholesterol, snuff, diabetes Obesity and sedentary. It is important to note that maintaining a healthy lifestyle sometimes gets to keep under control these risk factors without taking any medication. This requires abstaining from snuff and alcohol, make daily physical activity ( walking 30 minutes / day ), a diet rich in fruits and vegetables and reduced fat (especially avoiding meats and red meat), and maintain an optimal weight. In cases where despite a healthy lifestyle gets not control these cardiovascular risk factors, there are currently drugs with high efficacy as anti-hypertensives and statins, for example.

*Translated with Google translator. We apologize for any imperfection
Dr. Salvatore Brugaletta

By Dr. Salvatore Brugaletta

This specialist Cardiology has extensive training in prestigious national and international centers. He is an expert in the treatment of atherosclerosis. Throughout his career he has performed over 4,000 coronary angiographies and about 1,500 percutaneous coronary interventions. Currently developing its specialist medical care as the Hospital Clinic of Barcelona activity.

*Translated with Google translator. We apologize for any imperfection

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