A surgeon’s experience with coronary balloon angioplasty
“Careless in my assumption that the absence of symptoms equated to an absence of disease, I was terribly mistaken. The truth, lurking beneath the facade of well-being, lies in wait, poised to strike when least expected.”
Dr Maiyadhaj Samsen
When it comes to the realm of balloon angioplasty, a procedure that instills terror in many, the thought of inserting a balloon into an artery while the patient remains conscious is enough to induce anxiety. In this edition of MedPark Story, we delve into the firsthand account of Dr Maiyadhaj Samsen, a neurosurgeon experiencing the other side of the scalpel undergoing balloon angioplasty. Fortunate in his early awareness of coronary artery disease, Dr Samsen took swift and decisive action.
As you continue exploring the pages ahead, you will unravel the mystery surrounding whether balloon angioplasty is truly as formidable as its common perception suggests. Join us on this journey to gain insights into the experiences of a seasoned surgeon turned patient, navigating the intricacies of percutaneous coronary intervention (PCI) with balloon angioplasty and stent placement.
Blacking out – like someone flicked a switch to turn the light off
Harking back to the time before the intervention procedure, Dr Maiyadhaj enjoyed seemingly robust health, free from underlying diseases and medication requirements. Weekends sizzled with spirited games of tennis or rounds of golf with friends. Then, the unexpected struck.
“While playing a game of tennis, a sudden loss of sight in tracking the ball occurred. It was as if someone had abruptly dimmed the lights, yet there was no concurrent chest pain or tightness. Oddly, I did not stumble or falter during the blackout. Instead, I clung to the net on the tennis court briefly before regaining my composure. The symptoms were fleeting, but the gravity of the situation lingered in my thoughts. 'Is this the moment?' I pondered. 'Will I be overcome by syncope or nastier, meet my end right here on this court?' Recognizing the heightened risk at the age of seventy, I decided to stop playing, not wanting to exacerbate the potential danger. It seemed like I was past due for a comprehensive heart examination.”
Syncope, a potential indicator of cardiovascular issues, especially in seniors, prompted Dr Maiyadhaj to seek medical advice. Following that unsettling day, he sought the expertise of Dr Piyanart Preeyanont, an interventional cardiologist, to schedule an appointment for the next day. The diagnostic journey commenced with a series of tests, including a blood test, electrocardiogram, exercise stress test, and echocardiography.
Angioplasty for degenerative coronary arteries
The diagnostic journey took an unexpected turn when Dr Maiyadhaj discovered that, despite unremarkable results in many aspects, his coronary calcium score stood at 558, surpassing the range of 300-400, the norm of his age group. This alarming score signified the presence of significant calcium deposits in his coronary arteries, indicating a protracted and unnoticed degeneration.
In light of the elevated calcium score, Dr Piyanart recommended angiography to assess the severity of the blockages in the coronary arteries. The impending procedure required both physical and mental preparation.
“Dr Piyanart advised me to undergo angiography for a definitive diagnosis, acknowledging the associated risks. A period of fasting became imperative, anticipating the possibility of open-heart surgery under anesthesia. As the fast progressed, a steady drip of intravenous fluids counteracted the threat of dehydration.
The wrist area, a designated point for catheter insertion, underwent meticulous cleaning. To prevent emotional spikes from affecting my heart, I received a sedative since elevated heart rate and blood pressure posed potential risks under those circumstances. More significantly, I had to embrace a new heart-healthy lifestyle.”
In cases of critical arterial narrowing, a stent placement becomes necessary to maintain arterial patency, which will entail a lifelong commitment to antiplatelet medication to prevent clotting on the stent. The patients must also exercise caution to avoid injuries or cuts, as the antiplatelets interfere with blood clotting processes. Thus, a patient with heart disease requires a lifelong mission of meticulous care and adherence to prescribed measures.
During balloon angioplasty, the heart arteries and insert stents.
Balloon angioplasty and stent insertion to support and reinforce an artery.
“This body is not mine. It lies at the mercy of the doctors' hands, subject to whatever measures deemed necessary.” The revelation flashed through Dr Maiyadhaj's mind as the impending angioplasty loomed. Trying to quell his rising angst, he focused on calming his mind, catching snippets of conversation between the doctor and nurse.
A chilly surge of contrast media coursed through his artery, signaling the onset of the angiography. In an unforeseen twist, a sudden and oppressive chest pressure enveloped him. On a scale of 1 to 10, it registered at a menacing 6-7. He urgently conveyed the distress to the doctor amidst the dialogue. Dr Piyanart, noting perturbation in the EKG tracing, quickly administered medication, and the chest pain subsided after a mere 2-3 minutes. A coronary artery spasm choked off the vital stream of blood to his heart for a fleeting moment, disrupting its oxygen supply.
Following the examination of each coronary artery, the foreboding diagnosis emerged — one artery had an 80% blockage, while the other exhibited a 70% obstruction. True to the doctor's foresight, the prescription was clear: balloon angioplasty and stent insertion were imperative to restore the compromised passageways.
“In the initial phase, a balloon navigated into the constricted segment of the artery, facing the narrow passage. Under controlled inflation, the balloon widened the arterial confines. However, the specter of collapse lingered once the balloon retreated. Enter the stent, deployed to stand guard, and ensure the long-term patency of the artery. Coated with medicinal fortifications, the drug-eluting stent guards against future constrictions. The intricate procedures unfolded on the constricted sites of my two ailing coronary arteries.”
Dr Maiyadhaj found himself whisked away to the Critical Care Unit within a mere hour after the procedure, embarking on a two-day vigil under watchful eyes. After this crucial period, the mandate of cardiac rehabilitation became paramount. Clear directives echoed in his ears – a steadfast commitment to medications, unwavering hydration, the avoidance of stress, and a cautious approach to activities that could strain the mending heart. Even the seemingly mundane act of climbing stairs became a deliberate endeavor, one step at a time, punctuated by brief respites after each set of 5 steps. Such meticulous care became the essence of his recovery.
Do not disregard coronary artery disease even in the absence of overt warning signs.
“After confronting the ominous warning signs of coronary artery disease and recognizing the fragility of life, a profound transformation in lifestyle becomes paramount – an embrace of healthful nutrition and enhanced exercise for a healthier body and an improved quality of life, irrespective of the length of the remaining life journey.”
Dr Maiyadhaj, the current Chief Operating Officer and Executive Secretary of MedPark Hospital shares his musings on seeking treatment within the institution he helped shape. In a position of leadership and vulnerability, he emphasizes the crucial role of trust in his decision.
“I chose MedPark Hospital for treatment based on trust. Since its inception, I have been intricately involved in its construction, participated in planning, and played a role in selecting medical equipment. Above all, the unwavering commitment and expertise of the medical professionals here provide me with assurance. Despite being entitled to free medical treatment at any public hospital due to my retired government officer status, I have entrusted my healthcare predominantly to this institution.”
Dr Maiyadhaj extends a cautionary note to everyone, urging vigilance about their health. Pondering on his journey, he underscores the insidious nature of coronary artery disease, emphasizing the imperative of early screening for those without symptoms.
“For those yet to experience symptoms or remain unaware of their underlying conditions, heed this warning: coronary arteries inexorably progress over time. Left untreated, they may culminate in complete blockage, leading to sudden and fatal outcomes. I implore everyone to undergo early screening, examine the severity of arterial blockages, and initiate treatment if necessary. I, too, was once flying blind, believing the absence of symptoms equated to a clean bill of health. The truth is that diseases, particularly of the heart, can lurk in the shadows until they manifest symptoms.”
How do blocked coronary arteries pose dangers to life?
The human heart is surrounded and nourished by three main coronary arteries, each branching into smaller vessels that extend into the heart muscles, providing energy for pumping blood to nourish the brain and various organs throughout the body. Substantial accumulation of fat or calcium deposits within the arterial walls can constrict or block blood vessels, disrupting the rhythmic contractions of the heart muscle and potentially leading to congestive heart failure or, in severe cases, death.
A stark report from the Ministry of Public Health reveals that coronary artery disease, a prevalent threat also known as ischemic heart disease or coronary artery obstruction, claims the lives of countless Thais, ranking as the fourth leading cause of death in the nation. Males aged 45 and females 55 and above, as well as those with conditions such as diabetes, high blood pressure, high cholesterol, or a family history of heart disease, are considered at higher risk for this condition.
A balloon angioplasty for a blocked coronary artery
Dr Piyanart Preeyanont, an interventional cardiologist with the medical team and nurse, conducted a diagnostic examination of Dr Maiyadhaj's coronary arteries within the Catheterization Laboratory (Cath Lab).
“I inserted long, slender plastic tubes through the radial artery at the wrist, then injected contrast dye or radiopaque substance. Under X-rays, I could see the images of Dr Maiyadhaj's coronary arteries. For the first artery, I noted a high-grade constriction, which caused a reduction in blood flow to the heart muscle, leading to insufficient oxygen supply.”
“As for the arteries that supply the left side of the heart muscle, we found some minor roughness but no severe blockages. The next artery that supplies the right side of the heart showed significant constriction at its origin. In summary, there were two constricted arteries out of the three examined. We treated it by performing two balloon angioplasties and stent insertions.” Said Dr Piyanart.
Dr Piyanart Preeyanont
For the procedure, the medical team threaded a small wire through the artery, advanced the balloon catheter -- sheathed with a stent -- over the guide wire until it reached the narrowed site, inflated the balloon to expand the stent covering the balloon, and adhered it to the blood vessel wall. The process helped open the narrowed blood vessel, preventing it from constricting again. Dr Piyanart concluded with an explanation of the intervention steps.
“Typically, we have specific and targeted treatment options for each patient. The first approach is balloon angioplasty to expand the heart arteries and insert stents. The second approach, in cases of severe multiple constrictions, is coronary artery bypass surgery. No matter what treatment method, patients need to take medications continuously. Dr Maiyadhaj has been following the advice diligently, taking medications, controlling his diet, and taking better care of himself. As a result, he has recovered rapidly, improved his ability to exercise, resumed golfing and playing tennis, and no longer experiences easy fatigue or shortness of breath.” Dr Piyanart concluded.
For those concerned about undergoing coronary angiography and balloon angioplasty, there is generally nothing to worry about. Patients may experience slight chest discomfort briefly due to temporary reduced blood flow during angioplasty. After the procedure, this discomfort should not recur. In the case of Dr Maiyadhaj, he has a good recovery due to collaborative efforts between the cardiologists and cardiac rehabilitation specialists. Post-PCI, patients should be patient and refrain from rushing headlong into strenuous sports, as the heart needs time to adapt to the newly altered blood circulation pattern. Once the heart fully adjusts to the new blood flow pattern, it will mark a clear win for this treatment.
