Cardiovascular disease is the leading cause of death in the United States. The American Heart Association estimates that more than 71 million Americans — one in five people — have one or more types of cardiovascular disease, including high blood pressure, coronary heart disease, congenital cardiovascular defects and congestive heart failure.
It is very important to take care of yourself if you've been diagnosed with any type of heart disease. Even though you may have heart disease, you can help control it, reduce your risk of suffering a heart attack and improve your chances of living a long life.
Temecula Valley Hospital, in collaboration with the University of California San Diego Health, help provide cardiothoracic surgery services to residents of the greater Temecula Valley region. Through the experience of cardiothoracic surgeons from UC San Diego, the hospital can provide advanced cardiac and interventional procedures closer to home.
Andrew Ho, MD, Chief of Staff-Elect of the Medical Staff, and Medical Director for Cardiology & Cath Lab at Temecula Valley Hospital, is here to explain when stents are needed and the advantages they provide for the treatment of Cardiovascular disease.
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Cardiovascular Disease: To Stent or Not to Stent
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Learn more about Dr. Ho
Andrew Ho, MD
Dr. Ho is Chief of Staff-Elect of the Medical Staff, and Medical Director for Cardiology & Cath Lab at Temecula Valley Hospital. He is a graduate of UC San Diego School of Medicine, and board certified in Internal Medicine, Cardiovascular Diseases, Nuclear Cardiology and Interventional Cardiology. Dr. Ho has received specialized training in interventional cardiology at the Texas Heart Institute and Baylor College of Medicine. He is a fellow of the American College of Cardiology.Learn more about Dr. Ho
Transcription:
Cardiovascular Disease: To Stent or Not to Stent
Melanie Cole (Host): If you’ve had a heart attack, prompt treatment with angioplasty and possibly stenting can restore blood flow to your heart muscle and minimize damage to your heart. But, what about stable heart disease when your life might not be in immediate danger? How do you know if you even need a stent? My guest today is Dr. Andrew Ho. He is the Medical Director for Cardiology and the Cath Lab at Temecula Valley Hospital. Welcome to the show, Dr. Ho. First, tell the listeners what is a stent and what might it be even needed for?
Dr. Andre Ho (Guest): Melanie, you would be surprised to hear that a lot of my patients who ask me that same question every time I tell them in clinic that I am about to do an angiogram and maybe put a stent into their coronary artery. A stent is simply a mesh tube made out of a special composite metal material. Nowadays, with the latest generation of stents most of them have a coating around the metal part to prevent the stent basically from going bad over the years. Also, some of the latest stent technologies that we have that are coming down the pipeline also include stents that are made out of materials that will dissolve over time and that will also be coming in the near future.
Melanie: So, what might a person need a stent for? If they have heart disease? Blocked arteries? Tell the listeners when you might need to put it in and what would signal – red flags – that they even have heart disease.
Dr. Ho: Every time a patient has a heart attack, one of those where the blood flow through the artery is completely stopped, those patients need a stent on an emergency basis. However, you have a lot of patients that don’t have a heart attack but still have problems with blood flow, through their coronary arteries. Their coronary arteries become diseased to a point where the blood flow through them is no longer sufficient to keep the heart muscle happy. Those patients, fortunately, would do very well with recirculation of blood flow and we do that routinely now by putting in a stent to open up the “blockage” in the coronary artery.
Melanie: Are there some symptoms of a blocked coronary artery that someone might notice?
Dr. Ho: Yes. I can tell you that if I was to sit down and write all the symptoms of patients that I’ve had who have had coronary disease and have blocked arteries, I can literally write a book on the different symptoms that people have. I would say that the symptoms that people have from blocked arteries can be very, very different from one person to the other but, certainly, there are common features that we look for. For example, one of the most common symptoms that patients have would be chest pain or chest pressure or chest discomfort or chest tightness. However, you have a lot of patients who don’t have any chest pressure or tightness but, instead, they have mainly shortness of breath. Also, you have patients that may have no symptoms at all or very, very vague symptoms like fatigue, lack of energy or, believe it or not, even nausea when they exert themselves. So, it’s very different from one patient to the other and as cardiologists we are trained to recognize all of the unique features of symptoms of what we call “angina.”
Melanie: Are there any alternatives to stenting if you determine that’s what’s needed? Can medications do something similar?
Dr. Ho: Yes, depending on the patients that we have. Certainly, patients with lesions or with symptoms or without the critical characteristics that make it so that they are not good candidates for medication. However, I do have a large number of patients that I do feel that medication is the better way to go. You would be surprised. Some of these patients who come in thinking that they are better off with a stent but they do excellent with just medication. The results will speak for themselves.
Melanie: What’s involved with putting in a stent, Dr. Ho? Is it something that would need to be done again or is one time enough?
Dr. Ho: The first question is, what is involved with putting in a stent? Traditionally, what we do is we find an artery in the groin area called the “femoral artery” and we gain access to that artery. We put a small plastic tubing through that artery and then through that tubing, we tunnel more tubing. Ultimately, a stent is tunneled in through that tubing in to the heart, down the coronary artery. Where the blockage is, we deploy or we open the stent and that opens the blockage and keeps the blockage open. Nowadays, physicians like myself who have converted to a much better and, essentially a safer approach by going through the artery in the wrist instead of the femoral artery. This artery is smaller, so it certainly takes a lot more diligence and more learning to do. However, once you are able to gain access to this artery and tunnel your equipment through the artery, the results are essentially the same. You get to the heart just as well as through the femoral artery. In addition to that, in some cases the bleeding risk is a lot less. Certainly, the patients like it better. The overall patient experience is better because they don’t have to lay in bed for several hours after the procedure. After the procedure, they can get up immediately and walk around, walk to the bathroom, say “hi” to their family. Overall, I’ve noticed it’s much, much more an enhanced patient experience to do this procedure. So, I’ve converted from doing 100% through the femoral to I would, essentially, I would say 95% to what we call the radial pulse or through the wrist artery.
Melanie: How does a person feel after they have had the stent put in? How soon can they return to an active lifestyle?
Dr. Ho: It generally depends on the patient, of course. Some patients, you feel like they really ought to take a few weeks off from whatever they are doing. It also depends on what they do in their normal life. Some patients want to go back to a very, very active lifestyle. Some patients’ lifestyle is not so active. I think the time varies. What I do say is, if I was to do the stent procedure through the wrist, I would tell them to take it easy on the wrist or don’t do any kind of strenuous activities for at least a week. After that, I would tell them to gauge how they do and progressively increase their level of activity beyond a week.
Melanie: What about prevention? What do you tell them about living a healthy lifestyle after stent procedure?
Dr. Ho: Once the patient has a stent placed, things change a lot about their lifestyle and what we tell them. Of course, after the stent is placed, we follow them as a patient on a much more regular and consistent basis and, also, I ask them to seek moderation in terms of their overall diet – eat less red meat, eat more vegetables. At the same time, on the other side, we also control what we can with medication. For example, if they have a history of high cholesterol before and have never been on cholesterol medication, we aggressively control their cholesterol. That’s one of the many ways we do to improve the long-term outcomes of the stent and prevent them from having to come back to the cath lab to have the stent fixed.
Melanie: In just the last few minutes, Dr. Ho, please tell the listeners what people with heart disease and might need a stent should think about when seeking care. Why should they come to Temecula Valley Hospital for their care?
Dr. Ho: I think, just like any procedures in medicine, certainly there is a wide variation between one physician to the other. I think when it comes to the question about stent placement, it’s not just the overall skill of the physician but also how a physician thinks through whether or not the patient needs a stent. I think it takes a lot of thought to place a stent. It’s not simply if the patient has a blockage, you put in a stent. It’s definitely not like that at all. You really have to look at the patient overall; not only as a heart disease patient but as a person in general. You weigh the patient’s overall physical activities, you weigh the patient’s quality of life, you weigh the disease’s outside events and, also, you balance all that with the actual risks that you have to put the patient through when attempting to put in the stent. Once you’ve taken all that into consideration, then you can decide and make a good decision on whether or not this patient needs a stent. When someone considers putting in a stent, generally, the physician that they choose, they have to feel comfortable with that physician and how that physician thinks and how that physician looks at the patient, in general. I think that Temecula Valley Hospital, certainly with me being head of cardiology there, I impart that kind of philosophy on all of the cardiologists that work at Temecula Valley Hospital. I certainly promote a lot of preparation and thought into the stent procedure just to make sure that the patients that get the stent actually get it for exactly the right reason.
Melanie: Thank you so much. It is fantastic information. Thank you so much, Dr. Ho, for being with us today. You’re listening to TVH DocTalk with Temecula Valley Hospital. For more information please visit TemeculaValleyHospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Cardiovascular Disease: To Stent or Not to Stent
Melanie Cole (Host): If you’ve had a heart attack, prompt treatment with angioplasty and possibly stenting can restore blood flow to your heart muscle and minimize damage to your heart. But, what about stable heart disease when your life might not be in immediate danger? How do you know if you even need a stent? My guest today is Dr. Andrew Ho. He is the Medical Director for Cardiology and the Cath Lab at Temecula Valley Hospital. Welcome to the show, Dr. Ho. First, tell the listeners what is a stent and what might it be even needed for?
Dr. Andre Ho (Guest): Melanie, you would be surprised to hear that a lot of my patients who ask me that same question every time I tell them in clinic that I am about to do an angiogram and maybe put a stent into their coronary artery. A stent is simply a mesh tube made out of a special composite metal material. Nowadays, with the latest generation of stents most of them have a coating around the metal part to prevent the stent basically from going bad over the years. Also, some of the latest stent technologies that we have that are coming down the pipeline also include stents that are made out of materials that will dissolve over time and that will also be coming in the near future.
Melanie: So, what might a person need a stent for? If they have heart disease? Blocked arteries? Tell the listeners when you might need to put it in and what would signal – red flags – that they even have heart disease.
Dr. Ho: Every time a patient has a heart attack, one of those where the blood flow through the artery is completely stopped, those patients need a stent on an emergency basis. However, you have a lot of patients that don’t have a heart attack but still have problems with blood flow, through their coronary arteries. Their coronary arteries become diseased to a point where the blood flow through them is no longer sufficient to keep the heart muscle happy. Those patients, fortunately, would do very well with recirculation of blood flow and we do that routinely now by putting in a stent to open up the “blockage” in the coronary artery.
Melanie: Are there some symptoms of a blocked coronary artery that someone might notice?
Dr. Ho: Yes. I can tell you that if I was to sit down and write all the symptoms of patients that I’ve had who have had coronary disease and have blocked arteries, I can literally write a book on the different symptoms that people have. I would say that the symptoms that people have from blocked arteries can be very, very different from one person to the other but, certainly, there are common features that we look for. For example, one of the most common symptoms that patients have would be chest pain or chest pressure or chest discomfort or chest tightness. However, you have a lot of patients who don’t have any chest pressure or tightness but, instead, they have mainly shortness of breath. Also, you have patients that may have no symptoms at all or very, very vague symptoms like fatigue, lack of energy or, believe it or not, even nausea when they exert themselves. So, it’s very different from one patient to the other and as cardiologists we are trained to recognize all of the unique features of symptoms of what we call “angina.”
Melanie: Are there any alternatives to stenting if you determine that’s what’s needed? Can medications do something similar?
Dr. Ho: Yes, depending on the patients that we have. Certainly, patients with lesions or with symptoms or without the critical characteristics that make it so that they are not good candidates for medication. However, I do have a large number of patients that I do feel that medication is the better way to go. You would be surprised. Some of these patients who come in thinking that they are better off with a stent but they do excellent with just medication. The results will speak for themselves.
Melanie: What’s involved with putting in a stent, Dr. Ho? Is it something that would need to be done again or is one time enough?
Dr. Ho: The first question is, what is involved with putting in a stent? Traditionally, what we do is we find an artery in the groin area called the “femoral artery” and we gain access to that artery. We put a small plastic tubing through that artery and then through that tubing, we tunnel more tubing. Ultimately, a stent is tunneled in through that tubing in to the heart, down the coronary artery. Where the blockage is, we deploy or we open the stent and that opens the blockage and keeps the blockage open. Nowadays, physicians like myself who have converted to a much better and, essentially a safer approach by going through the artery in the wrist instead of the femoral artery. This artery is smaller, so it certainly takes a lot more diligence and more learning to do. However, once you are able to gain access to this artery and tunnel your equipment through the artery, the results are essentially the same. You get to the heart just as well as through the femoral artery. In addition to that, in some cases the bleeding risk is a lot less. Certainly, the patients like it better. The overall patient experience is better because they don’t have to lay in bed for several hours after the procedure. After the procedure, they can get up immediately and walk around, walk to the bathroom, say “hi” to their family. Overall, I’ve noticed it’s much, much more an enhanced patient experience to do this procedure. So, I’ve converted from doing 100% through the femoral to I would, essentially, I would say 95% to what we call the radial pulse or through the wrist artery.
Melanie: How does a person feel after they have had the stent put in? How soon can they return to an active lifestyle?
Dr. Ho: It generally depends on the patient, of course. Some patients, you feel like they really ought to take a few weeks off from whatever they are doing. It also depends on what they do in their normal life. Some patients want to go back to a very, very active lifestyle. Some patients’ lifestyle is not so active. I think the time varies. What I do say is, if I was to do the stent procedure through the wrist, I would tell them to take it easy on the wrist or don’t do any kind of strenuous activities for at least a week. After that, I would tell them to gauge how they do and progressively increase their level of activity beyond a week.
Melanie: What about prevention? What do you tell them about living a healthy lifestyle after stent procedure?
Dr. Ho: Once the patient has a stent placed, things change a lot about their lifestyle and what we tell them. Of course, after the stent is placed, we follow them as a patient on a much more regular and consistent basis and, also, I ask them to seek moderation in terms of their overall diet – eat less red meat, eat more vegetables. At the same time, on the other side, we also control what we can with medication. For example, if they have a history of high cholesterol before and have never been on cholesterol medication, we aggressively control their cholesterol. That’s one of the many ways we do to improve the long-term outcomes of the stent and prevent them from having to come back to the cath lab to have the stent fixed.
Melanie: In just the last few minutes, Dr. Ho, please tell the listeners what people with heart disease and might need a stent should think about when seeking care. Why should they come to Temecula Valley Hospital for their care?
Dr. Ho: I think, just like any procedures in medicine, certainly there is a wide variation between one physician to the other. I think when it comes to the question about stent placement, it’s not just the overall skill of the physician but also how a physician thinks through whether or not the patient needs a stent. I think it takes a lot of thought to place a stent. It’s not simply if the patient has a blockage, you put in a stent. It’s definitely not like that at all. You really have to look at the patient overall; not only as a heart disease patient but as a person in general. You weigh the patient’s overall physical activities, you weigh the patient’s quality of life, you weigh the disease’s outside events and, also, you balance all that with the actual risks that you have to put the patient through when attempting to put in the stent. Once you’ve taken all that into consideration, then you can decide and make a good decision on whether or not this patient needs a stent. When someone considers putting in a stent, generally, the physician that they choose, they have to feel comfortable with that physician and how that physician thinks and how that physician looks at the patient, in general. I think that Temecula Valley Hospital, certainly with me being head of cardiology there, I impart that kind of philosophy on all of the cardiologists that work at Temecula Valley Hospital. I certainly promote a lot of preparation and thought into the stent procedure just to make sure that the patients that get the stent actually get it for exactly the right reason.
Melanie: Thank you so much. It is fantastic information. Thank you so much, Dr. Ho, for being with us today. You’re listening to TVH DocTalk with Temecula Valley Hospital. For more information please visit TemeculaValleyHospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.