The heart is an extraordinary muscular pump that ensures bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood circulation throughout the entire body. It is the engine of life.
The coronary arteries
This vital muscle functions thanks to the supply of oxygen delivered by a network of bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood vessels called coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that. These arteries surround and penetrate the heart, delivering the oxygen it needs to function properly. Their diameter ranges from 2 to 4 mm.
Any reduction in the size of these arteries, even slight, can impair the oxygen supply to the heart muscle, compromising its function. If the reduction becomes significant enough, it can lead to irreversible damage to the heart.
Three Main Types of Blockage
There are three acute alterations that can obstruct bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow in the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that, all originating from the muscular layer called the media:
1-Artery spasm:
This phenomenon can occur spontaneously or be triggered by substances such as cocaine. It involves a contraction of the media layer, narrowing the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood vessel.
The severity of the spasm, whether partial or complete, along with its duration, determines its impact. This temporary blockage can have serious consequences if the oxygen supply to the heart is obstructed for too long.
2-Spontaneous dissection:
This is a tear in the media, the cause of which is still poorly understood. This rupture may be linked to a weakness or abnormality in the artery wall.
As with a spasm, the effects depend on the extent of the tear, ranging from a partial obstruction to a total blockage of the vessel.
3-Rupture of an atheroma plaque (cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >> plaque):
By far the most common cause of coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that obstruction, these cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >> plaques build up in the media of the arteries and can rupture spontaneously, leading to the formation of a clot that reduces or completely blocks bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow to the heart muscle.
Let’s take a closer look at the last case.
Cholesterol Plaque
The rupture of an atheroma plaque is the most common cause of acute coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that obstruction.
These plaques, mainly composed of cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >>, gradually accumulate in the media of the arteries.
At some point, the plaque may rupture, triggering the formation of a clot that disrupts bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow.
A Plaque Ruptures
When an atheroma plaque ruptures, the body responds by triggering a repair mechanism to seal the breach.
This process begins with the activation of bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood plateletsPlatelets, also known as thrombocytes, are small cell fragments produced by the bone marrow. They play a crucial role in blood clotting by forming aggregates and clots to stop bleeding when blood vessels are damaged. >>, which play a critical role in bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood clotting.
It's "911" for Platelets
PlateletsPlatelets, also known as thrombocytes, are small cell fragments produced by the bone marrow. They play a crucial role in blood clotting by forming aggregates and clots to stop bleeding when blood vessels are damaged. >> are tiny particles circulating in the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood, originating from large cell fragments found in the bone marrow. Their primary function is to assist in bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood coagulation, a process that stops bleeding by sealing breaks in bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood vessels.
Understanding Blood Clotting "101"
When someone gets a cut, bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flows out due to a breach in the bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood vessels.
To stop the bleeding, the body sends out a distress signal, like an emergency call. Blood clotting is the natural process that steps in to seal the wound.
Formation of the Blood Clot
Platelets are the first responders to this emergency call. When they come into contact with the inner layers of the vessel, called the intima, they change shape, develop tentacle-like structures, and begin clumping together. These clumping forms the foundation of the clot.
Simultaneously, the plateletsPlatelets, also known as thrombocytes, are small cell fragments produced by the bone marrow. They play a crucial role in blood clotting by forming aggregates and clots to stop bleeding when blood vessels are damaged. >> release substances that attract more plateletsPlatelets, also known as thrombocytes, are small cell fragments produced by the bone marrow. They play a crucial role in blood clotting by forming aggregates and clots to stop bleeding when blood vessels are damaged. >> and trigger the transformation of certain bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood proteinsProteins are fundamental components manufactured by the cells of our body. They play an essential role in many biological functions, acting as hormones, antibodies, and even cholesterol transporters, among others. >> into filaments.
These filaments form a mesh around the plateletsPlatelets, also known as thrombocytes, are small cell fragments produced by the bone marrow. They play a crucial role in blood clotting by forming aggregates and clots to stop bleeding when blood vessels are damaged. >> and red bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood cells, reinforcing the structure of the clot and making it more secure to seal the breach effectively.
It's the Same Process in the Coronary Artery
When a cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >> plaque ruptures in a coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that, the same coagulation process is triggered to seal the breach. PlateletsPlatelets, also known as thrombocytes, are small cell fragments produced by the bone marrow. They play a crucial role in blood clotting by forming aggregates and clots to stop bleeding when blood vessels are damaged. >> gather and form a clot to repair the damage, just as they would in the case of a cut.
However, in the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that, the formation of this clot can have serious consequences. It can result in either a partial or complete obstruction of the vessel.
In both cases, this disrupts the oxygen supply to the heart muscle, potentially leading to major complications, such as unstable angina or, in more severe cases, a myocardial infarction (heart attack).
Obstruction Partielle de l’Artère Coronaire – Angine Instable
When a blood clot partially obstructs a coronary artery or one of its branches, the heart muscle supplied by this artery continues to receive oxygen, but in insufficient amounts. This precarious condition is known as unstable angina, now referred to in medical terms as Non-STEMI (Non-ST Elevation Myocardial Infarction).
The formation of a clot in the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that is a dynamic process. Just as the body has a clotting system to seal breaches in bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood vessels, it also has a clot-dissolving mechanism.
These two systems work in balance: clotting forms clots to seal damaged vessels, while the dissolving process limits the size of the clot to prevent excessive obstruction. This constant interaction, akin to yin and yang, regulates the size of the clot.
In some cases, fragments of this clot may break off and travel further down the smaller branches of the artery, causing distal obstructions that can impact other areas of the heart muscle, making the situation even more complex and dangerous.
An Unstable Situation
The fluctuating size of the clot in the coronary artery leads to symptoms that vary over time. Typically, chest discomfort or pain occurs in episodes, with changing duration and intensity, and can appear both during exertion and at rest.
This unstable condition presents a serious risk, as the artery could become completely blocked at any moment, leading to a heart attack or STEMI (ST-Elevation Myocardial Infarction), a cardiac emergency that requires immediate medical attention.
Seek Immediate Medical Attention
When experiencing such symptoms, it is crucial to consult a healthcare professional as quickly as possible.
It is recommended to go directly to the emergency room, as swift intervention can prevent irreversible damage to the heart and save lives.
Treatment of Unstable Angina
The treatment of unstable angina primarily focuses on “thinning” the blood to slow down the formation of the clot in the coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that.
The doctor will prescribe oral medication that works by inhibiting the action of plateletsPlatelets, also known as thrombocytes, are small cell fragments produced by the bone marrow. They play a crucial role in blood clotting by forming aggregates and clots to stop bleeding when blood vessels are damaged. >>, preventing them from clumping together. In parallel, another medication is administered intravenously to slow down the clotting process, thereby reducing the likelihood of clot formation.
In the next step, the doctor will usually perform a coronary angiography, an examination that allows for direct visualization of the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that to identify the blockage causing the symptoms. If a significant obstruction is found, the artery is often unblocked with the use of a coronary stent to keep it open and restore normal bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood flow.
What Does a Coronary Angiography Involve?
A coronary angiography is performed under local anesthesia, although a sedative may be administered to improve patient comfort during the procedure. The patient lies on an examination table while a camera-equipped device is positioned above to capture images from various angles.
The procedure begins with the doctor making a small puncture in the artery of the wrist (or, less commonly, in the thigh). This puncture serves as the entry point for the insertion of catheters—thin plastic tubes. These catheters are then carefully guided up to the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that, providing direct access to the vessels that supply bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood to the heart.
Once in place, an iodine-based contrast agent is injected into the coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that. This liquid enables the visualization of the arteries via X-rays, allowing the physician to identify the specific artery causing the obstruction. The entire procedure is typically painless, aside from the initial puncture.
Repairing the Artery with a Balloon and Metal Stent
When coronary angioplasty is possible, the doctor proceeds immediately to repair the damaged coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that, keeping the patient informed throughout the process.
Angioplasty involves using catheters to repair the blocked artery. The catheter is placed at the entrance of the affected coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that and is used to transport the necessary tools for the procedure.
The Guidewire: A "Railway Track"
A very thin metal guidewire is inserted into the coronary artery to pass through the lesion. This guidewire acts as a “railway track,” guiding the instruments to the precise location of the obstruction.
The Balloon Catheter
A balloon catheter is then advanced to the center of the blockage. Once positioned, the balloon is inflated to widen the obstruction, compressing the plaque and bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood clot against the artery wall, creating a wider passage for bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood to flow through.
After the dilation, the balloon is deflated and removed.
The Stent
To improve long-term outcomes, a stent, or endoprosthesis, is deployed at the site of the residual blockage.
The stent is a small metal structure shaped like a spring. It is placed on a balloon catheter that carries it to the artery, where it remains crimped onto the catheter. When the balloon is inflated, the stent expands and presses against the artery wall. The balloon is then deflated and removed, leaving the stent in place permanently, keeping the artery open.
Nowadays, almost all stents are coated with medication to reduce the risk of recurrence by limiting the formation of new blockages where the stent was placed. This improves short-, medium-, and long-term outcomes for patients.
No Rejection by the Human Body
Although the stent is a foreign object, it is not rejected by the body.
However, it can stimulate platelet activity, potentially leading to the formation of a clot in the artery where it was implanted—a phenomenon known as stent thrombosis. If this occurs, the stent can become completely obstructed.
Preventing Stent Thrombosis
To prevent this complication, doctors prescribe a combination of antiplatelet medications to be taken daily.
Aspirin is prescribed for life, while a second antiplatelet drug must be taken for at least one month, often for a year or longer, depending on the patient’s specific needs.
Integration of the Stent into the Vessel Over Time
This dual antiplatelet therapy protects against clot formation on the stent.
Over time, the body’s cells will gradually cover the stent, integrating it into the vessel wall, typically within weeks or months after implantation.
Never Stop Medications Without Medical Advice
It is crucial to never stop taking antiplatelet medications without consulting a cardiologist, even for minor surgical procedures.
Stopping this medication exposes the patient to a high risk of stent thrombosis, a serious and potentially fatal complication. The leading cause of sudden stent thrombosis is the premature discontinuation of antiplatelet therapy.
Repairing Arteries via Open-Heart Surgery
In some cases, angioplasty is not sufficient to repair coronary arteriesThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that due to the number, complexity, or location of the blockages. When these obstructions are too extensive or difficult to reach, coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that bypass surgery is considered.
This procedure, commonly referred to as open-heart surgery, involves bypassing blocked arteries using vessels taken from other parts of the body to restore blood flow to the heart muscle. This approach is often used in patients with multiple or complex blockages.
Medication-Based Treatment Option
When neither angioplasty nor surgery is feasible, patients may be managed with optimized medication therapy.
This option focuses on using medications to control symptoms, slow the progression of the disease, and improve the patient’s quality of life. Treatments typically include antiplatelet drugs, beta-blockers, statins, and other medications aimed at enhancing cardiovascular health.
Two Categories of Treatment After an Acute Cardiac Event
Following an acute event, such as unstable angina, the treatment prescribed during hospitalization is divided into two categories: pharmacological and non-pharmacological.
Pharmacological Therapy
Pharmacological therapy, in addition to antiplatelet medications, includes treatments that help the heart function more efficiently, control blood pressure, and manage cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >> levels.
Aspirin, prescribed for life for these patients, is an integral part of this therapy.
Non-Pharmacological Therapy
Non-pharmacological interventions are equally, if not more, important than medication. They focus primarily on adopting new lifestyle habits to reduce the risk of future cardiac events.
Adopting Healthy Lifestyle Habits
To limit the risk of recurrence, certain lifestyle changes are necessary, such as:
- Quitting smoking.
- Monitoring diet.
- Losing weight.
- Exercising regularly.
- Keeping bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure and cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >> levels in check.
See also: Healthy Lifestyle
No One is Immune
Coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that disease can affect anyone; no one is immune. Therefore, it’s crucial to stay vigilant, both for yourself and for others, by recognizing the signs and symptoms of this condition.
It’s also important to be aware of aggravating factors such as diabetes, high bloodBlood is composed of red blood cells, white blood cells, platelets, and plasma. Red blood cells are responsible for transporting oxygen and carbon dioxide. White blood cells make up our immune defense system. Platelets contribute to blood pressure, and elevated cholesterolCholesterol is essential for the proper functioning of the human body, but it can also have harmful effects if present in excess. >> levels.
Prevention is Key
Prevention remains the best way to protect yourself and reduce the risk of developing this condition. By adopting a healthy lifestyle and monitoring these risk factors, the likelihood of coronary arteryThe two coronary arteries, the right and the left, form the blood network that supplies the heart with oxygen and nutrients. They are located directly on the surface of the heart and branch into smaller vessels that disease can be significantly reduced.
Related articles
Latest articles
