Introduction
In 1977, percutaneous transluminal coronary angioplasty (PTCA) was introduced to dilate narrow coronary arteries. Over the years, the development of the procedure knocked down major anatomical obstacles. Typically the procedure involves a small incision into the leg, a catheter is inserted through the groin vein and is then steered to the blocked coronary vessel via a guide wire. On the tip of the catheter is a deflated balloon. Once at the congested region of the artery the balloon is inflated, causing plaque to compress against the artery wall, dilating the artery and restoring blood to flow [1]. The initial success was demoted by the occurrence of elastic recoil. Nevertheless, scientist over came these drawbacks (well so they thought), by mounting a bare-metal stent (BMS) on the balloon of the catheter [2]. Jacques Puel and Ulrich Sigwart inserted the first stent into a human coronary artery in 1986. The inflation of the balloon caused the minute expandable metal to implant into the vessel, causing the vessel to expand and remain expanded. The hindrance of elastic recoil was believed to be defeated, therefore in 1994 the U.S Food and Drug Administration approved the use of the first Palmaz-Schatz stent [3]. The insertion of BMS did initially improve results, mainly by reducing the risk of abrupt closure and improving long-term results. However, a new barrier was exposed in the form of In-Stent Restenosis (ISR). The new problem included negative remodelling and neointimal formation. One way to combat ISR was the concept of “coating” the metallic stent with an anti-proliferative pharmacological agent. The drug coated stents, referred to as drug eluting stents (DES), delivered the drug locally from the surface of the...
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...st generation SES. The second generation EES showed superior clinical and safety over PES in the SPIRT trails. Highly significant data in TLF, MACE, stent thrombosis and target lesion revascularization was demonstrated in favour of EES. However, second generation DES may not be the “be all” of what they are made out to be. A number of clinical trail’s report negative information for ZES. ENDEAVOR I and III trails and Kandazri et al. observed significantly higher rates of in-stent late lumen loss ZES verses SES. Furthermore, SORT-OUT III trails also observed negative results for ZES, reporting considerable increases in stent thrombosis, myocardial infarction and target lesion revascularisation. On comparing both of the second generation DES together, mixed results were obtained. ESTROFA-2 reported low rates of thrombosis in both ZES and ESS. Explain difference....
(14) Chieffo A. Transcatheter Aortic Valve Implantation with the Edwards Sapien Versus the Medtronic Corevalve Revalving System Devices: A Multicenter Collaborative Study: The Pragmatic Plus Initiative. 2013;61(8).
28- Aspirin Versus Aspirin þ Clopidogrel Following Transcatheter Aortic Valve Implantation: the ARTE trial. 2012. Available at: http://clinicaltrials.gov/ct2/show/nct01559298?term¼nct01559298&rank¼1.Accessed May 30, 2012.
An artery is an elastic blood vessel that transports blood away from the heart. There are two main types of arteries: pulmonary arteries and systemic arteries.
...lood Vessel Stents.” 1-3). Bypass surgery is another option; a blood vessel from somewhere in the body is used to go around the blocked artery. This completely bypasses the blocked artery, so it no longer becomes an issue. Thrombolytic therapy is a method that involves injecting a medication into the artery that will dissolve the clot and allow blood to pass freely through the artery (“Peripheral Artery Disease.” 3).
The next stage in myocardial infarction is the formation of thrombus. Exposure of the subendothelial matrix of the plaque to blood due to superficial abrasion generates platelet activation and aggregation. Clotting factors on the platelet membrane carry out reaction which release prothrombin activator, this activator then converts prothrombin to enzyme thrombin. The transformation of fibrinogen to fibrin is then catalysed by thrombin. During proteolysis (the breaks down of protein), fibrinogen is converted to fibrin strands which stabilize the final blood clot. Complete occlusion of coronary artery by thrombus disrupts blood flow and causes ischemia due to atherosclerotic coronary artery steno...
Coronary artery disease (CAD) is the most common type of multifactorial chronic heart disease. It is a consequence of plaque buildup in coronary arteries. The arterial blood vessels, which begin out smooth and elastic become narrow and rigid, curtailing blood flow resulting in deprived of oxygen and nutrients to the heart [1].
...(CBC), Activated Partial Thrombo Plastin Time (APTT) Test, Prothombin Time (PT) Test, and Fibrinogen Test”.
... of the need of duplicate revascularization over balloon angioplasty [75]. Both pre- and post -conditioning appears to protect cardiomyocytes at the time of reperfusion therapy. Ischemic post-conditioning is a chain of repetitive intermissions of coronary blood flow administered after a period of ischemia. Inhibition of ONOO−-induced nitro-oxidative stress might pay a critical role in postcon-mediated cardioprotection [76]. Iliodromitis et al also reported that postcon-mediated cardioprotection was in cohorts with reduced nitro-oxidative stress in vivo. The acknowledgment that iNOS activation in cardiac myocytes could be advantageous and that nitriate/NO could have both beneficial and detrimental effects, lead to the dose of 1400W iNOS inhibitor being chosen to significantly inhibit, but not restrict, increase in the level of myocardial iNOS activity after MI [77]
Coronary artery bypass graft surgery is a procedure that can be life-saving for patients with heart disease, but it also carries risks after the procedure that can impact patient outcomes negatively. Because over 395,000 Americans have CABG surgery each year, and the risk-adjusted mortality rate for patients is 2%, according to Centers for Disease Control (CDC) statistics, health care professionals must find ways of reducing risks and complications to improve the outcomes for many patients (Ferguson, 2012). Heart disease is often comorbid with other conditions, like lung disease, peripheral arterial disease, hypertension, and diabetes, which can raise the risk of complications (Ferguson, 2012; Nejati-Namin, Ataie-Jafari, Amirkalali, Hosseini, Sheik Hathollahi, & Najafi, 2013). Complications that can arise following surgery include atrial fibrillation, prolonged inflammatory reactions, a build up of fluid near the heart, accelerated atherosclerosis, and nearby vein or artery blockage (Gokalp, Ilhan, Gurbuz, Cetin, Kocaman, Erdogan, & … Satiroglu, 2013; Ferguson, 2012; Scheiber-Camoretti, Mehrotra, Ling, Raman, Beshai, & Bowman, 2013; Sicaja, Starcevic, Sebetic, Raguz, & Vuksanovic, 2013). These complications can lead to increased lengths of stay, increased readmission rates, risk of further complications, failure of the bypass graft, cognitive dysfunction and memory loss, patient suffering, and even death (Ferguson, 2012; Gokalp et al., 2013; Sicaja et al., 2013). In turn, nurses, other care providers, and institutions may face negative consequences themselves, including a risk of lawsuits, increased employee workload, higher per-patient costs, reduced or withheld private insurance, Medicaid, and Medicare reimbursements, auditing...
Coronary heart disease came in the public eye in the mid-20th century as a disease of pandemic magnitudes and it continues to be a major cause of death in the western world. The fundamental cause of coronary heart disease is Atherosclerosis. The term “atherosclerosis” is the combination of two Greek words which correctly imply the elements of the lesion. The first being “athero” the greek work for gruel which parallels to the necrotic core at the base plaque formation, and “sclerosis” from the Greek word hardening, corresponding to the fibrous cap on the outer layer of the plaque. (Vulnerable Atherosclerotic Plaque : Strategies for Diagnosis and Management, 1, 2)
There are almost 7 million Americans in the United States that suffer from Coronary Artery Disease today. The prognosis for many of these patients depends upon the major therapeutic option of medical management that they choose to receive, the most essential variables that predict the prognosis and likelihood for future events are the extent and severity of the disease at the time of diagnosis. Basically, this translates to mean that the more abnormal the scans and tests are, the higher the prognosis is going to be for future coronary events to occur and therefore the higher the prognosis is going to be for a shorter life span, the lower the progression of the disease the higher the chance is going to be for a longer life span for the patient. A higher risk patient is going to be one with extensive defects from the disease, a patient with little to no defects is going to be low risk, and those with limited defects are going to be at a more intermediate risk. Whether it is because of their familial history of the disease or because of risk factors such as smoking, high blood pressure, high cholesterol, or obesity really does not matter considerably because many of the 500,000 deaths that occur from this disease could be prevented if more of the risk factors were prevented. This disease is the number one killer of both men and women older than 65 years of age because coronary artery disease in contracted as a result from the narrowing of the coronary arteries that feed the heart, and when those arteries become clogged and cannot supply enough blood, oxygen and nutrients in the coronary arteries, people develop chest pains, also more commonly known as angina which is a secondary condition of having Coronary Artery Disease. . These t...
Atherosclerosis, the underlying causes of coronary heart disease can affect any artery in the body. Coronary heart disease is essentially the build up of plaque which sticks to the walls of the coronary arteries. The arteries in atherosclerosis is narrowed due to the excessive build up of cholesterol-rich lipids known as plaque around the artery wall (Insull, 2009). Once the plaques around the walls of the arteries become narrow, the flow of blood will be constricted, reducing the amount of blood and oxygen that are able to reach the heart. Hence the heart becomes increasingly hypoxic, as a consequence the contraction become inefficient, thus poses serious cardiovascular complications which could result in heart attack (A&P p.687)(Insull, 2009). Despite the
Coronary artery disease (CAD) is the number one killer in America, affecting more than 13 million people. CAD occurs when a fatty substance called plaque builds up in the coronary arteries. These arteries disperse oxygen-ric...
Client Profile: Lane Bronson is a 55 year old male with a history of angina, hypertension, Type 2 diabetes, COPD, and sleep apnea. He comes to the physican’s office complaining of worsening shortness of breath. His skin tone is grey, and his angina is worsening. Previously stable, he now does not get relief from rest or nitroglycerin. The physician called 911 and had Mr. Bronson directly admitted to the hospital.
Etiology Myocardial infarction occurs when the coronary arteries are blocked by a blood clot. It is commonly known as a “heart attack”. The heart needs its own constant supply of oxygen and nutrients to work properly. Two coronary arteries deliver oxygenated blood to the heart, and if one of these two arteries fails or becomes blocked, then a portion of the heart will not acquire the necessary oxygen. This clot could be because of CAD (coronary artery disease), which happens when the inner walls of the coronary arteries thicken because of buildup of cholesterol, fatty deposits, calcium among other elements that are carried in the blood (Boston Scientific, 2009).