Coronary angioplasty with stenting is a fairly standard and commonplace procedure in the management of blocked coronary arteries, with many skilled cardiologists performing the procedure all over the world. However, an understanding and appreciation of the importance of post-procedure practices, on part of the patient, is still lacking.
This list of advice which can best be labeled as a ‘rule of five’ or a ‘hand rule’ following the stenting procedure is essential for ideal long term outcomes.
Rule No 1: Take your medicines regularly: It is quite common for patients to be irregular or non-compliant with medications – particularly as the time from the procedure elapses. There is an erroneous belief that once the procedure has been accomplished successfully, medication can be discontinued. Contrary to this belief, medications (at least blood thinners and cholesterol-reducing statins) are mandatory following stent implantation – since they prevent an important life-threatening complication I.e stent thrombosis.
Rule No 2: Do not ignore or hide symptoms: If a post-angioplasty patient develops any unusual discomfort in the form of chest pain, dyspepsia or breathing difficulty, it is always advisable to get an ECG and consult a cardiologist. No symptom – even if it occurs at an awkward time or location – should be ignored – as any complication in this group of patients can be life-threatening.
Rule No 3: Moderation in Diet: There is a general belief that some types of diet need to be discontinued following angioplasty. In a social context, it is extremely difficult for an individual to suddenly stop a dietary pattern that he has been brought up with. It is much more rational to advise moderation in the existing diet – I.e tries and reduces the overall dietary intake by about 20-30 percent with a replacement of undesirable food items with more desirable ones. It should be remembered that the stricter a dietary advice, the less likely that a patient will follow it!
Rule No 4: Moderate exercise after stenting procedure: No patient needs bed rest following stent implantation. It is advisable for patients to commence moderate exercise such as walking on the plain ground soon after angioplasty and gradually increase the intensity of exercise. One can expect to reach the pre-disease exercise status within one month of a stenting procedure. Heavy exercise such as lifting weights or walking up steep slopes should be avoided for about 4-6 weeks.
Rule No 5: Go for regular follow-ups: Follow-ups following angioplasty/stenting are aimed at optimization of treatment, screening for adverse effects or complications as well as control of risk factors. The frequency of follow up might vary depending on the clinical situation and the risk profile of a patient. They are generally once a month – and these must be adhered to as advised by the treating cardiologist.
To conclude, while a technically successful procedure is the essence of angioplasty/stenting, post procedure adherence to advise and recommendations hold the key to good long term outcomes. As a society, it must be appreciated that even small errors in the implementation of follow up advise can result in undesirable consequences.
The writer, Prof. (Dr.) Hemant Madan is Senior Consultant & Director Cardiology at, Narayana Superspeciality Hospital in Gurugram