Dr Nandakumar is one of the few cardiologists in Singapore who has worked as a consultant interventional cardiologist in a substantive position in the UK. Currently, he is a Senior Consultant Cardiologist at Mount Elizabeth Hospital and Mount Alvernia Hospital specialising in Interventional Cardiology.
Human Session held on 25 Jul 2018.
Dr Nandakumar answered questions from readers on:
- Best treatment for blocked heart vessels
- What happens during an angioplasty
- Risks and complications associated with stent placement
- What happens after an angioplasty
There are essentially 3 treatments for blocked heart vessels – i.e.
- Medical therapy
- Angioplasty or stents, and
- Bypass surgery
However which of these options is most suitable for yourself depends on the presence of the blockages, their severity and location.
Yes, coronary artery disease can be treated with lifestyle changes - exercise along with diet/stopping smoking/losing weight and reducing stress.
However in certain kinds of coronary disease (may need both a coronary angiogram and nuclear scan) where there is a severe blockage which is causing impairment of blood flow to a significant part of the heart muscle, it maybe advisable to proceed with heart stent or bypass surgery to prevent a heart attack with poor outcomes including mortality.
A coronary angiogram is performed whenever a patient has symptoms such as breathlessness or chest pain on exertion (not always) which usually indicate poor blood flow in the heart blood vessel due to blockages.
This could a non-invasive angiogram (ie CT coronary angiogram) or an invasive coronary angiogram (gold standard test). The modality depends on the risk and if the risk is higher an Invasive coronary angiogram maybe warranted.
When deciding between medical therapy, heart stents (angioplasty) or cardiac bypass surgery, I take into account the full picture based on factors such as:
- Clinical presentation
- Patients age
- Mental and neurologic status
- Location and severity of the blockages
- Ability to take long-term blood thinning tablets and
- Other issues such as diabetes, kidney function and heart failure along with patient expectations and