Heart attack (myocardial infarction) interventions and treatment | NCLEX-RN | Khan Academy

Summary

This script delves into post-heart attack treatments, emphasizing the importance of both medication and procedures like coronary angiograms to assess blockages. It explains minimally invasive PCI, involving angioplasty and stent placement, and contrasts it with the extensive open-heart CABG surgery, which reroutes blood flow around severe blockages using vessels from the patient's body. The summary highlights the complexity and skill involved in these life-saving interventions.

Takeaways

• 💊 Medications are an integral part of post-heart attack treatment, but procedures may also be necessary for optimal recovery.
• ⚕️ Interventional procedures and open heart surgeries are typically reserved for patients with more severe heart conditions, such as STEMIs.
• 🔍 Coronary angiograms are the initial diagnostic tool used to assess the extent and location of blockages in the coronary arteries.
• 📷 An angiogram involves injecting a dye to make the heart's blood vessels visible under an X-ray, providing a clear picture of the arterial blockages.
• 🚑 Depending on the severity of the blockages, cardiologists recommend the next course of action, which could range from medication to surgery.
• 🌌 The script provides a visual representation of a coronary angiogram, showing a dynamic picture of the heart's blood vessels before and after treatment.
• 🩺 Percutaneous Coronary Intervention (PCI) involves inserting a catheter with a balloon to open blockages or placing a stent to keep the artery open.
• 🛠️ Angioplasty is a PCI technique that uses a balloon to clear blockages, while stenting involves leaving a mesh-like cylinder to maintain artery patency.
• 💡 Coronary Artery Bypass Grafting (CABG) is a more invasive open-heart surgery performed for severe coronary artery disease, often in cases of triple vessel disease.
• 🔄 CABG reroutes blood flow around blockages by using blood vessels from other parts of the body to bypass the affected areas.
• 🔑 Common sources for blood vessels in CABG include the internal mammary artery, radial artery, and the great saphenous vein.
• 🧐 The script emphasizes the complexity and skill required for CABG, highlighting the low complication rate due to the surgeons' expertise.

Q & A

What are the types of procedures a patient might undergo after a heart attack as part of their treatment?

Patients might undergo a range of procedures from smaller interventional procedures to major open-heart surgeries. These are generally reserved for patients with STEMIs, but can also be performed for NSTEMIs if medication alone is not effective or if the patient has significant risk factors for coronary artery disease.

What is a coronary angiogram and why is it performed?

A coronary angiogram is a specialized type of X-ray that allows an interventional cardiologist to visualize the heart's blood vessels by injecting a special dye into the patient's circulation. It is performed to assess the extent and location of blockages or narrowing in the coronary arteries.

How does a cardiologist determine the severity of blockages in the coronary arteries during a coronary angiogram?

The cardiologist uses the coronary angiogram to see the blood vessels clearly with the help of a dye. The severity of blockages is determined by observing the narrowing or clogging within the coronary arteries in real-time.

What is the purpose of a Percutaneous Coronary Intervention (PCI)?

PCI is performed to open a blocked or narrowed coronary artery. It involves inserting a catheter with a balloon at its end to inflate and open the blockage, and sometimes placing a stent to keep the artery open.

What is a stent and why is it used in PCI?

A stent is a tough, mesh-like cylinder made of metal that is inserted into a coronary vessel during PCI. It is used to prop the vessel open and prevent it from narrowing again after an angioplasty, ensuring continued blood flow.

What is the difference between an angioplasty and the insertion of a stent during PCI?

Angioplasty involves inflating a balloon on a catheter to open a blocked artery. The insertion of a stent is an additional step in PCI where the stent is left in the artery to maintain its openness, preventing future blockages.

When is Coronary Artery Bypass Grafting (CABG) considered as a treatment option?

CABG is considered for patients with severe coronary artery disease, particularly those with triple vessel disease, where significant plaques have built up in at least three coronary vessels, causing a large area of the heart to be deprived of oxygen.

How does the process of Coronary Artery Bypass Grafting (CABG) work?

CABG involves taking blood vessels from other parts of the body and using them to bypass the atherosclerotic plaques in the coronary arteries. This re-routes blood flow around the blockages to restore oxygen supply to the heart muscle.

What are the common sources of blood vessels used in Coronary Artery Bypass Grafting?

The common sources for blood vessels in CABG include the internal mammary artery from the inside of the rib cage, the radial artery from the forearm, and the great saphenous vein from the inner leg and thigh.

What is the main goal of performing a CABG surgery?

The main goal of CABG surgery is to re-establish blood flow to areas of the heart muscle that are deprived of oxygen due to blocked coronary arteries by using grafts to bypass the blockages.

Why is the skill and knowledge of the interventional cardiologist important during PCI and CABG procedures?

The skill and knowledge of the interventional cardiologist are crucial during PCI and CABG to navigate the catheter and perform precise maneuvers within the coronary arteries, as well as to execute the complex open-heart surgery of CABG with minimal complications.

Outlines

00:00

🏥 Post-Heart Attack Treatments and Procedures

Following a heart attack, patients may undergo a range of treatments, from medication to surgical interventions. The script discusses the use of smaller procedures and major surgeries, particularly for patients with STEMIs or NSTEMIs who do not respond to medication or have significant risk factors. The initial step is a coronary angiogram, a specialized x-ray that uses dye to visualize the heart's blood vessels, identifying blockages. Depending on the severity, a recommendation for further procedures is made. The script also explains Percutaneous Coronary Intervention (PCI), which can involve angioplasty to clear blockages or the insertion of a stent to keep the artery open. This is contrasted with Coronary Artery Bypass Grafts (CABG), a more invasive open-heart surgery for severe coronary artery disease, where blood vessels from other parts of the body are used to bypass the blocked arteries.

05:02

🔍 Understanding Coronary Artery Bypass Grafting

In cases of severe coronary artery disease, where significant blockages prevent oxygen from reaching the heart muscle, Coronary Artery Bypass Grafting (CABG) is performed. This procedure involves taking blood vessels from other parts of the body to create a detour around the blockages, restoring blood flow to the affected areas. The script illustrates the concept by showing how new vessels are attached before and after the plaque, effectively bypassing it. Common sources for these vessels include the internal mammary artery from the rib cage, the radial artery from the forearm, and the great saphenous vein from the leg and thigh. CABG is a complex surgery requiring high skill and composure from the surgical team, but it has a low complication rate due to the surgeons' extensive training.

Keywords

💡Heart Attack

A heart attack, also known as myocardial infarction, is a serious medical condition where blood flow to a part of the heart is blocked, leading to damage or death of heart muscle cells. In the script, it is mentioned as the initial condition that may lead to various treatments and procedures, emphasizing its importance as the central theme of the video.

💡STEMI

STEMI stands for ST-Elevation Myocardial Infarction, which is a type of heart attack characterized by a complete blockage of a coronary artery. The script mentions that procedures are generally reserved for patients with STEMIs, indicating the severity of this condition and its priority in treatment.

💡NSTEMI

NSTEMI, or Non-ST-Elevation Myocardial Infarction, is another type of heart attack where there is a partial blockage in the coronary artery. The script explains that procedures can also be performed for NSTEMI patients if they are not responding to medication or have significant risk factors.

💡Coronary Angiogram

A coronary angiogram is a diagnostic procedure used to visualize the blood vessels of the heart. The script describes how a cardiologist uses this procedure to inject dye into the patient's circulation to clearly see the blood vessels and determine the extent of blockages in the coronary arteries.

💡Interventional Cardiologist

An interventional cardiologist is a specialized heart doctor who performs procedures to treat heart diseases. In the script, the interventional cardiologist is the one who performs the coronary angiogram and subsequent procedures based on the findings.

💡Angioplasty

Angioplasty is a minimally invasive procedure used to treat narrowed or blocked arteries. The script explains that during PCI, a balloon is inflated at the end of a catheter to open up a blockage, allowing blood to flow more freely.

💡Stent

A stent is a small, mesh-like tube that is inserted into a narrowed artery to keep it open. The script describes how a stent is used in conjunction with angioplasty to prop open a coronary vessel and prevent re-narrowing.

💡Percutaneous Coronary Intervention (PCI)

PCI is a non-surgical procedure used to treat narrowed coronary arteries. The script details how PCI can involve angioplasty and stent placement to improve blood flow in the heart.

💡Coronary Artery Bypass Grafting (CABG)

CABG is an open-heart surgery used to treat severe coronary artery disease by using blood vessels from other parts of the body to bypass blocked arteries. The script illustrates CABG as a more invasive procedure for patients with triple vessel disease.

💡Triple Vessel Disease

Triple vessel disease refers to a condition where significant plaques are built up in at least three of the coronary vessels. The script uses this term to describe patients who are candidates for CABG due to the severity of their coronary artery disease.

💡Internal Mammary Artery

The internal mammary artery is a blood vessel that can be used as a graft in CABG surgery. The script mentions it as one of the main sources of blood vessels for bypass grafting, highlighting its importance in the procedure.

Highlights

After a heart attack, in addition to medication, patients may undergo procedures ranging from smaller interventions to open heart surgeries, primarily for STEMIs but also for NSTEMIs if medication alone is insufficient or if there are many risk factors for severe coronary disease.

The first interventional step is a coronary angiogram, a specialized x-ray using dye to clearly visualize the heart's blood vessels and assess blockages.

Coronary angiograms provide real-time, dynamic images of coronary artery health, showing blockages and their severity.

Depending on the severity of blockages, cardiologists recommend subsequent procedures to address the underlying heart issues.

Percutaneous Coronary Intervention (PCI) involves inserting a catheter with a balloon to open blockages or placing a stent to keep the artery open long-term.

Angioplasty is a PCI technique where a balloon on a catheter is inflated to push atherosclerotic plaque aside, restoring blood flow.

Stents are metal mesh cylinders used in PCI to prop open arteries post-angioplasty, remaining in the vessel indefinitely.

Coronary Artery Bypass Grafts (CABG) are open heart surgeries performed for severe coronary artery disease, often involving triple vessel disease.

CABG aims to re-route blood flow around blockages using blood vessels from other parts of the body to restore oxygen supply to the heart muscle.

Blood vessels for CABG are typically harvested from the internal mammary artery, radial artery in the forearm, or the great saphenous vein in the leg.

CABG is a complex procedure requiring high skill levels from surgeons, with a low rate of complications due to their extensive training.

The skill and composure of surgeons performing CABG are remarkable, as they navigate the intricacies of this open heart surgery.

PCI and CABG are critical procedures for treating severe heart conditions, with PCI being less invasive and CABG addressing more extensive blockages.

The decision between PCI and CABG depends on the extent of coronary artery blockages and the patient's overall health and risk factors.

Both PCI and CABG are essential in the arsenal of treatments for heart attacks, offering different approaches to restoring blood flow and improving heart health.

The use of dye in angiograms and the deployment of stents in PCI are innovative methods that enhance the visualization and treatment of coronary artery blockages.

CABG's effectiveness in treating triple vessel disease highlights the procedure's importance in managing severe and complex coronary artery conditions.

Transcripts

- In addition to treatment with medications

after a heart attack,

as part of your overall treatment,

you might also have some procedures done.

And these range from smaller interventional procedures

to big open heart surgeries.

Generally these are reserved

for patients with STEMIs,

ST-Elevation Myocardial Infarcts

The more serious type of Infarct.

But they can be done for patients with NSTEMIs,

Non ST-Elevation Myocardial Infarcts, as well,

if they're not responding

to treatment with medication alone,

or if they have a lot of risk factors

for bad coronary vessel disease.

So, once you've been given some medications

to deal with your myocardial infarct,

the first thing that happens,

from a interventional point of view,

is you'll get a coronary angiogram done.

Which is where an interventional cardiologist,

a specialized heart doctor,

will take a sort of unique type of x-ray

of your heart's blood vessels.

And normally on a normal x-ray

you can't really see people's blood vessels,

so in an angiogram, the cardiologist will inject

a special type of dye into the patient's circulation.

And that dye will help the cardiologist

to really see the blood vessels of the heart

really clearly.

So, coronary angiograms are to check

how badly, and also where your coronary arteries

are blocked or narrowed.

And depending on how the bad the clogging is

inside the coronary arteries,

the cardiologists will then make a recommendation

for what procedure that you need to go on to next

to fix the underlying problem with your heart.

So, this is what a coronary angiogram looks like.

You can see, it's really a cool, sort of, dynamic picture.

You can get a real-time look

at how healthy the person's coronary arteries are.

So, yes, these are blood vessels

and this is actually the outline of the heart here.

In this coronary artery here,

there's a pretty severe blockage,

a pretty severe narrowing of this coronary artery.

And over here on the right, it's resolved,

it's opened up.

And that's after treatment.

So depending on how bad the clogging is

inside a given person's coronary arteries,

the cardiologist will then go on

to make a recommendation

for what procedure to move on to next

to fix the underlying problem with someone's heart.

So, let's actually have a look

at a few of these procedures.

Percutaneous Coronary Intervention, or PCI,

is where a doctor will insert a catheter.

So, here I'm drawing a catheter now,

this purple thing.

So this is actually a wire-like tube

that a doctor will thread into your femoral artery,

or actually sometimes some other arteries,

but usually the femoral artery.

So, he'll thread it into your artery,

sort of put it into your artery,

and thread it up to your heart

and into your coronary vessels.

Which, as it probably sounds like,

it takes a lot of skill and knowledge to do this.

And depending on what they find in your coronary vessels,

depending on how bad the blockage in your vessels is,

they'll either just do something called an angioplasty,

which is where they blow a balloon up,

that's on the end of the catheter.

So, there's a balloon on the end of the catheter

and when they blow it up,

it sort of opens up the blockage,

pushes all that atherosclerotic plaque aside,

and allows blood through again.

Or they'll do an angioplasty,

so what we saw here,

and insert a stent,

which is a tough, mesh-like cylinder

made out of metal,

that gets left behind in your coronary vessel

to prop it open.

So that's PCI, that's Percutaneous Coronary Intervention.

Either just angioplasty,

so opening up a clogged artery with a balloon

by using a catheter with a balloon on the end,

or by doing angioplasty, so the ballooning technique,

plus inserting a stent and leaving it

in there long-term.

So, i.e., forever, right, indefinitely.

So, that's PCI.

Now, the next sort of grade up,

in terms of interventions,

is Coronary Bypass Grafts.

So, this one is really a whole different ball game.

This is an open heart surgery.

So, let me clear off some space here.

Let me clear off some room here.

Because now this is the big time.

So, here I'll draw in some more coronary arteries here.

And the reason I'm drawing more on,

is because I just want to show you that

Coronary Artery Bypass Grafts,

or cabbage, as the acronym sort of

allows us to pronounce it, cabbage,

is really only done in patients

who have really severe coronary artery disease.

And so by severe coronary artery disease I mean

if they have pretty significant plaques built up

in at least three of their coronary vessels.

And we call this condition triple vessel disease.

And so you can just kind of imagine that

if somebody has triple vessel disease

it's really not going to be easy for them

to get oxygen, say, from their coronary artery up here,

right, down to this part of the heart down here

because there's this huge blockage in the way.

And that's the same sort of thing goes

for this plaque and this plaque right here.

So, in the situation like this,

you've got huge areas of heart,

so basically all of this area of heart

that this vessel supplies,

actually it supplies more than that

but I won't bother drawing it in,

and, you know, all of this area of heart

and all of this area of heart,

that's essentially being deprived of oxygen.

So, we have to do something about that.

That's really, really serious.

So, what happens?

What happens in Coronary Artery Bypass Grafting?

Well, just as the name suggests, bypassing,

we take blood vessels from elsewhere in the body

and use them to bypass the atherosclerotic plaque.

So, I'll draw some on here

to show you exactly what I mean.

And I'll actually use pink to draw

on the new blood vessels.

So a blood vessel might be sort of attached on here

before the plaque,

and then sort of used to re-route blood

around the plaque,

so it'd be obviously attached again

on the other side, after the plaque.

And by doing this, you can restore blood flow

to that affected area that I sort of highlighted before,

that wasn't getting much oxygen at all.

And so the same sort of procedure will happen

with the rest of your blocked vessels.

And, let me just say, that I'm not drawing it

exactly how it's done in theater, in the operating theater,

but this is really the general idea of what happens.

So, just for interest's sake, blood vessels are

usually taken from three main places.

So, on the inside of your rib cage.

So, what I'm drawing now is on the inside,

not on the outside, on the inside of your rib cage,

there's one that's really popular

for use in bypass graft.

That's called your internal mammary artery

and there's one on each side.

In the forearm, you've got a good one.

So, in the forearm you've got a radial artery.

And on your inner leg and thigh,

you've got another one,

a vein, called the great saphenous vein.

And, again, just to reiterate,

the purpose of Coronary Artery Bypass Grafting

is to re-route blood around plaques.

So, the blood can get to the heat muscle

where it's needed.

So this is a really cool surgery.

I mean it sounds super complex and difficult

and it really is.

But I remember the first time I scrubbed

into one of these procedures,

and the whole time I was really just amazed

at the skill and the composure of the surgeons

who were doing it.

They're really well trained.

So the rate of complications is low.