Heart Disease – Know Your Options

Every year, millions of people are asked to go in for angiograms – some may have no symptoms and others may exhibit discomfort or breathlessness during exertion.

The angiogram will inevitably show blocks in one or more arteries because atherosclerotic plaque begins accumulating before the third decade of life. Many men and women who are symptom-free and healthy have been found to have 75% or more arterial blockage when autopsied after accidental death from causes unrelated to arterial disease.

Based on the angiogram findings, you may be told you must have angioplasty/stents or bypass surgery because your coronary arteries are blocked and you are at risk for a heart attack. You may also be told that angioplasty or bypass surgery is the only option and it must be carried out immediately.

Research shows that surgery is rarely necessary, and even when necessary, doesn’t need to be carried out immediately.

Consider the following...

Limitations of an angiogram

The coronary angiogram is the "gold standard" of cardiovascular diagnosis and cardiologists consider it the final word in determining if bypass surgery is needed.

However, the patient must realize that angiograms cannot pick up the small arteries that make up the heart's microcirculation. An artery may appear to be obstructed, but the heart muscle it feeds often functions normally and is in no danger because its blood supply comes from the microcirculation or from collateral vessels too small to be imaged by the angiographic technique. (Collaterals are small capillary-like branches of an artery that form over time in response to narrowed coronary arteries).

Some facts about bypass surgery

The Coronary Artery Surgery Study (CASS) reported that regardless of whether one, two or more of the major coronary arteries were blocked—patients progressed very well without surgery, having the low fatality rate of 1.6% per year and a corresponding survival rate of 98.4%. During the same time period (over 2 decades), those who received bypass surgery had a fatality rate of slightly over 10%, or about one death for every 10 operations.
The same study showed that the most critical factor in determining whether or not a person will benefit from bypass surgery seems not to be the number or extent of blockages, but rather how well the left ventricular pump is functioning. This is assessed by measuring the total amount of blood pumped with each beat, known as the ejection fraction. A healthy heart generally has an ejection fraction of 50% or greater. Studies have shown that almost 90% of all bypass surgeries are performed on patients whose ejection fraction is over 50%.
Cardiac bypass procedures can lead to long-term cognitive brain impairment. In addition to this, because bypass surgery alters arterial blood flow, that portion of the artery upstream from the bypass graft site accumulates plaque at 10 times the rate of an un-grafted artery. Because of this, bypass patients must also face the possibility that one operation may not be enough. Reports indicate that 15% to 30% of vein grafts become re-blocked within one year of surgery.
Lastly, let’s not overlook the psychological trauma. It would be difficult to find anyone who is not terrorized by the operation.
Because of these facts, rushing patients in for emergency surgery because of a severely narrowed coronary artery is usually unwarranted and needlessly frightens patients and their families.
The good news is that the disease can be treated with non-invasive approaches.

Comparision of Invavsive vs. Non-Invasive Therapies

There are 39 major studies comparing bypass surgery or angioplasty with conservative medical treatment using only drugs. Many of the studies have what is called a selection bias (i.e. the patients were selected in such a way so as to favor a predetermined type of treatment).
In spite of these selection biases heavily favoring surgical intervention, almost every single study clearly and unequivocally demonstrates that invasive treatment, be it bypass surgery or angioplasty, fails to reduce heart attacks and mortality when compared to patients who have been conservatively treated with medication. In addition, there is a clear increase in mortality, heart attack rate, cardiovascular events, repeat angioplasty and bypass surgery in the invasively treated patients.
Still, many doctors scoff at non-interventional approaches because these methods are unable to eliminate or unclog the obstructed coronary artery.
But you don't have to unclog arteries. Proper medication can restore blood flow to that section of the heart by dilating other blood vessels in the same area that are not blocked while other medicines simultaneously reduce the workload of the heart so that the heart muscle requires less blood.
Removing the block becomes IRRELEVANT. Moreover, atherosclerosis is a systemic disease. It occurs throughout all the coronary arteries. If you fix one segment, a year later it may be another segment that leads to a heart attack. So systemic therapy, with medication has the potential to do a lot more.
Once blood flow is adequate for the work load of the heart, chest pains will disappear. So will the risk of a heart attack or death. (A non-interventional cardiologist can be your best bet).

Choose your treatment based on knowledge, not on fear.