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Health & Fit Heart disease patients with chest pain may not need a stent

19:15  17 november  2019
19:15  17 november  2019 Source:   nbcnews.com

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Heart patients who get chest pain during exercise may not need a stent , finds new research presented at the American Heart Association's annual meeting. But they do need to do some work, new research finds, including sticking to medication and changing behaviors.

Sometimes patients get stents when they have no pain at all, just blockages. Heart disease is still the leading killer of Americans Neither the patients nor the researchers assessing them afterward knew who had received a stent . He explained to Mr. Stevens and his wife that he did not need a stent .

For people with heart disease, it’s been thought that inserting a stent was the best way to treat sudden chest pain during exercise. But a landmark study suggests that this invasive procedure might not be necessary, and instead, medication and lifestyle changes are enough.

a close up of a hand: A small stent for coronary arteries.© marvinh A small stent for coronary arteries.

The findings, presented Saturday at the American Heart Association's annual meeting in Philadelphia, could help guide millions of conversations between patients and their doctors when deciding which treatments are best.

For more on this story, watch NBC Nightly News with Lester Holt tonight at 6:30 p.m. ET/5:30 p.m. CT.

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After heart attack stenting, coming back to open other narrowed arteries pays off: Study A new study offers some advice for doctors poking around the heart to reopen a clogged artery that has caused one type of heart attack: Come back again to finish the job. © gorodenkoff/Getty Images The study found that when doctors also open other arteries that are dangerously narrow -- either while the patient is still hospitalized or after a month or so -- those patients are half as likely to die from heart problems, have a heart attack or need repeat surgery due to chest pain than patients given conventional medical therapy.

Heart Disease Community. 20.1k Members. chest pain after stent . You just need to give it time to heal. I suggest light exercise for a while if it causes chest pain . I think that you may be experiencing "referred pain " from either your left main or aorta. I told him of the pain I had experienced in the chest post procedure and he told me there is a minority of patients who have this pain after stenting.

If a patient has chest pain despite taking recommended medications, a stent or bypass might help improve quality of life. But getting a stent does not obviate the need for medical therapy, Dr. Boden noted. Since patients with stents need an additional anti-clotting drug, they actually wind up taking

"Probably the majority of patients, if you offered them a choice of just taking medicine or having a procedure, many will likely opt to just take medicines," said Dr. Glenn Levine, a professor of medicine at Baylor College of Medicine and the director of the cardiac care unit at the Michael E. DeBakey Medical Center in Houston. He was not involved in the new research.

The study focused on patients with what's called ischemic heart disease. That usually means that plaque has built up in the coronary arteries, which supply blood to the heart muscle, narrowing them and making it more difficult to pump blood.

That translates into chest pain or tightness — called angina — when those patients exercise or experience emotional stress, because their body is trying to pump more blood, but can’t do so effectively through such a restricted space.

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The American Heart Association explains angina is the medical term for chest pain or discomfort due to coronary heart disease . Angina is chest pain or discomfort caused when your heart muscle doesn't get enough oxygen-rich blood.

A heart attack may require bypass surgery or placement of a stent in one or more of your blocked coronary arteries. 3. Myocarditis. Chest pain associated with aortic aneurysm: may not cause noticeable symptoms, or your chest may feel tender to the touch. The aorta is the largest artery in

When patients rest, though, the pain goes away. Doctors call that “stable angina.” It’s not a medical emergency, but does require an appointment with a doctor. According to the American Heart Association, stable angina accounts for 2.3 million such office visits in the United States every year.

During those exams, patients hop onto a treadmill or stationary bike so physicians can see what’s going on in those narrowed arteries. Medications, such as aspirin and drugs to lower cholesterol, are almost always ordered.

But very often, doctors also refer patients for an invasive procedure to widen the artery. That could mean either inserting a tiny balloon to inflate the artery, followed by placement of a metal tube called a stent to keep the artery propped open, or bypass surgery, when surgeons redirect the flow of blood around the blocked artery.

"It's common practice, if you have a very abnormal stress test, to go to the cardiac catheterization lab pretty promptly, because [doctors] are afraid that the patient is going to have a heart attack or die," said study leader Dr. Judith Hochman, the senior associate dean for clinical sciences at New York University School of Medicine.

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Chest pain following successful balloon angioplasty or stent is a common problem. Although the development of chest pain after coronary interventions may be not a problem, it is disturbing to patients , relatives and hospital staff. Possible Causes of Pain : acute coronary artery closure

“I had a patient who came in with chest pain and he was worried he was having a heart attack,” she says. “After taking his history If you do receive a coronary artery disease diagnosis, your doctor may want to start you on statins, insert a stent into one of the arteries, or schedule you for bypass surgery.

"This study is saying, let's rethink this," she told NBC News.

Hochman and her team of investigators looked at 5,179 patients in 37 countries. All of the patients were put on an intensive drug regimen that included aspirin and medications to lower levels of unhealthy LDL cholesterol, along with blood pressure drugs such as ACE inhibitors and beta blockers.

They were also encouraged to lose weight if necessary, by exercising and cutting down on saturated fat in their diet, and to quit smoking.

Half stuck with this “conservative” approach — medications and lifestyle changes only — as long as their condition didn’t worsen.

The other half got the medications and lifestyle advice, too, but were also referred for either a stent or bypass surgery.

The study found that after four years, the rates of heart attack, cardiovascular death and other bad outcomes were nearly identical in both groups: 13.3 percent in the half that received invasive procedures, versus 15.5 percent in the conservative group.

“It was surprising to find that with modern medical therapy and lifestyle changes, there was no added benefit of an invasive strategy to open those blockages,” Hochman said.

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  This is the stent procedure Bernie Sanders' doctors just performed The procedure he underwent is one of the most routine performed by cardiologists. “It’s an in-and-out procedure and can take as little as 30 minutes,” said Allen Taylor, chair of cardiology at MedStar Heart & Vascular Institute. “Many patients go home the same day. And the outlook is often very good." Coronary arteries — arteries that feed blood to the heart muscle — can become blocked over time with the buildup of fatty deposits or plaque. As the artery narrows, it reduces blood flow and can cause chest pains. Heart attacks happen when that blood flow to a part of the heart becomes completely blocked.

Heart disease is the leading killer of Americans, and the use of stents is part of treatment in practically every hospital. More than 500,000 heart patients worldwide have stents inserted each year to relieve chest It started with 200 patients , with 105 patients receiving a stent and 95 in the placebo group.

Chest pain may also be caused by problems in your lungs, esophagus, muscles, ribs, or nerves, for example. Some of these conditions are serious Hypertrophic cardiomyopathy. This genetic disease causes the heart muscle to grow abnormally thick. Sometimes this leads to problems with blood flow

There was one noteworthy difference: Patients who had a surgical intervention reported more chest pain relief than those in the conservative group.

That’s an important consideration for some patients, experts said. Take, for example, an active 60-year-old woman with ischemic heart disease, whose exercise-induced chest pain has forced her to cut back on the tennis she loves. She may opt for immediate relief of her angina with a procedure, in addition to medication.

“We can now sit down with patients armed with the information from this trial and customize a program based upon their wishes,” said Dr. Elliott Antman, a senior physician of cardiovascular medicine at Brigham and Women’s Hospital in Boston. Antman was not involved with the new research, but is a past president of the American Heart Association.

On the other hand, this trial also shows ischemic heart disease patients can do well if they stick to their medications and make aggressive lifestyle changes that push their cholesterol and blood pressure down significantly.

“This is cutting-edge medical therapy that's disease-modifying,” Antman said. “Lowering cholesterol will lead to a less lipid-rich plaque.”

It’s important to note that not all chest pain is equal. If you've never experienced it before, or if it doesn't go away within a few minutes, call 911 immediately.

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Heart stent surgery is now more common than heart bypass surgery for coronary heart disease . Learn about safety issues and success rates for the procedure. If you have a sudden onset of severe chest pain caused by a heart attack, an emergency angioplasty with heart stent surgery may save your life.

Although chest pain is often associated with heart disease , many people with heart disease say In general, chest discomfort related to a heart attack or another heart problem may be described by or Chest pain has many possible causes, all of which need medical attention. Heart -related causes.

“Patients who have severe chest pains or who have pain at rest need to clearly understand that this study did not include patients like them,” Levine said.

In those patients, invasive procedures are “often, if not usually, better than just medical therapy alone,” he added.

"If you’re having a heart attack, stents save lives," Hochman said.

Do Women Really Have Different Heart Attack Symptoms Than Men? .
A new study looking at patient-reported symptoms yields some surprising results.In the study, researchers assessed the symptoms of 1,941 patients (of which 39 percent were women) admitted into the emergency department of the Royal Infirmary of Edinburgh in Scotland for acute coronary syndrome—an “umbrella term for situations where the blood supplied to the heart muscle is suddenly blocked,” according to the American Heart Association (AHA).

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