The fact that coronary stenting does not require the opening of the sternum and the introduction of anesthesia does not equate it with aesthetic procedures. This is a serious intervention in the work of the heart vessels, despite the fact that the patient at the same time feels quite comfortable and can monitor the course of the operation on a par with the doctor.
Yes, the recovery period after stenting of the coronary arteries is less and proceeds more easily than in the case of a cavitary operation. But this does not mean that the patient does not need to follow the doctor's recommendations afterwards. After all, post-operative appointments and lifestyle requirements are not accidental. They are dictated by the fact that the operation is only an opportunity to alleviate the condition of the patient, but it does not solve the very problem that caused the narrowing of the vessels of the heart.
Recovery after surgery can last several days, weeks and even months. Within 1-3 days, while the patient is in the hospital, his condition is monitored by the medical staff, after discharge from the hospital this will have to be done by the patient himself. And given that complications can occur not only while in the hospital, but also after discharge, you need to seek help from a doctor in the following cases:
- if a new bruise has appeared on the site of the catheter placement, blood oozes or a strong swelling of the tissues is observed,
- if in the puncture area the pain does not weaken, but on the contrary increases,
- if there is an increase in body temperature, and the skin around the wound is red and swollen, which most likely speaks of infection of the wound,
- with tenderness of the limb, a decrease in its sensitivity, the appearance of an unpleasant display and a feeling of running shivers,
- if there is a change in the temperature and color of the limb, near which the artery was punctured (bluish skin tone and cold to touch body indicates a serious violation of peripheral circulation),
- if there were heart symptoms: chest pain, shortness of breath, increased heart rate, cough,
- when appearing on the body incomprehensible rashes, joint pain, increased fatigue and sweating,
- with symptoms such as nausea and vomiting that can not be stopped with drugs, even if they are observed for 2 or more days after the operation.
Any serious deterioration in health after discharge from the hospital is a reason for calling for emergency care.
Avoid many complications and deterioration of the condition can be, if you follow the operation after a certain caution. In the first days of home stay, the patient is recommended to rest. A person can serve himself, but it is still dangerous to do physical work that requires considerable effort, since in this case the risk of bleeding from the wound and complications in the work of the heart increases, but the stent is an alien body and it takes time for the organism to go to it used to.
Avoiding bleeding will help and refusal to take a hot shower or bath. This moment associated with hygiene procedures, it is necessary to discuss with a doctor who will tell you when it will be possible to wet the wound and take a bath. The doctor can make such conclusions after examining the site of the catheter installation and assessing the patient's condition.
When the patient's condition is stabilized, small walks will be useful, because physical inactivity will not contribute to a quick recovery. In the first couple of weeks, preference is given to walking on level ground, and then the volume of physical activity gradually increases.
First time can not be overworked. But dangerous can be a nervous overexertion, which is observed, for example, while driving a car. In the first days after the operation, it is worth noting such an occupation. And those whose work is related to transportation, it is better for 5-6 weeks to change occupation or take a vacation.
Recommendations of doctors
Some patients mistakenly believe that coronary stenting can solve all their problems associated with the work of the cardiovascular system. In fact, this is not so, because this effective operation is only one of the variants of symptomatic therapy. If the cause of vessel stenosis is atherosclerosis, then stenting will help restore the permeability of the vessel, but it will not relieve it of cholesterol deposits, which can become a barrier to blood flow in any other place.
The patient's life after the stenting of the coronary arteries can not remain the same, otherwise there would be no sense in such a sufficiently serious operation. It is necessary to understand that after the operation it is still too early for a patient to think about a full recovery. This is the beginning of a long journey. Restoration of blood flow in the arteries of the heart only facilitates its work and relieves painful attacks of angina, while the patient's diagnosis remains the same. After all, the cause of pathology is not eliminated, which means that the disease can continue to progress, suggesting a threat to human life.
The patient who underwent the operation should realize the need for subsequent treatment, which includes both medical therapy and lifestyle changes. Only strictly following the recommendations of a doctor can stop the development of the disease and give yourself a few years of life.
Vessel treatment does not end with the introduction of a stent alone, especially when it comes to old designs that are not capable of preventing thrombus formation and proliferative processes in the coronary arteries. Patients are required to appoint:
- Antiplatelet agents. For example, "Aspirin" can be prescribed to patients on a regular basis daily in a daily dosage not exceeding 325 mg, and "Clopidogrel" will have to be taken during the year (75 g once a day).
Sometimes patients are prescribed a drug called "Plavix", which prevents the adhesion of platelets and the formation of thrombi at the site of stent placement. It is recommended to take it for two years in a dosage prescribed by a doctor, which is strictly individual.
Antiplatelets after coronary stenting are prescribed for the prevention of restenosis and vascular thrombosis. But at the same time, their reception can provoke bleeding in the brain, stomach, intestines, so you must strictly follow the dosage and report all the suspicious symptoms to the doctor.
- Statins and other drugs that reduce the content of harmful cholesterol in the blood. These are medicines for the treatment and prevention of arteriosclerosis of the vessels, which can not be cured by stenting. In addition, they reduce the risk of possible complications. The dosage of statins is individual and may increase until the level of cholesterol in the blood is stabilized at the level of 4.6 mmol. They take drugs with the last meal. At the same time, at least once every six months, the patient is obliged to analyze for the content of cholesterol, lipoproteins, triglycerides, etc.
- Other drugs that a doctor can prescribe in connection with the underlying and concomitant diseases.
Coronary stenting can reduce the amount of medical treatment, but it is not a serious reason for refusing to take medications. This is possible only for a while, if the stent used in the operation has a drug coating with prolonged action.
Physical activity and exercise therapy for stenting of the coronary arteries
Rehabilitation of patients after stenting on average lasts from 2 to 4 weeks, after which the work of the heart and blood vessels is completely restored. If the first week of action and movement of the patient is limited, then in the future, physical inactivity can only cause harm. In connection with this, the physicians developed a set of exercise exercises for exercise therapy (LFK), which helps restore the functions of the organs during the rehabilitation period.
Ideally, exercise therapy should be part of rehabilitation programs, including work with a psychologist, a dietitian, physiotherapy sessions, and exercise with a physician. Thus, during rehabilitation the patient will be constantly under the control of medical specialists.
There is no single universal complex of exercise of physical therapy. Each patient needs an individual approach, taking into account his condition and normalizing physical loads.
Classes are held in 4 stages. If the patient's condition is stable, the first stage can begin as early as the next day, but the exercises will mainly involve the movements of the hands and feet, the tension of the muscles of the arms and legs, the change in the position of the body from horizontal to vertical. The complex includes some exercises of respiratory gymnastics.
Further, the volume of exercises increases, however, as well as the pace of their implementation. To the exercises described above, walking, squats, torso, legs, arms rotation, etc. Are added. At the same time, the medical staff constantly monitors the patient's condition, conducts heart work (ECG with and without load), measures blood pressure and pulse.
LFK starts to be started while the patient is in the hospital and do not stop after discharge. In this case, the doctor decides when the patient can be transferred to the next stage of exercise therapy with increased physical exertion. After the patient has gone through all 4 stages of the first stage of rehabilitation, they pass to the second one, which includes exercises for restoring the patient's ability to work: training walking, elementary exercises for the hands, legs, press, backs, which are already performed at a sufficiently rapid rate, close to moderate stress for a healthy person.
Despite the fact that the operation of coronary staging is performed on the heart vessels and in the first days of physical activity should be markedly limited, in the future, a sedentary lifestyle will not contribute to a rapid recovery and return to the workforce. On the contrary, doctors recommend a month after the operation to go in for swimming, running (dosed light running, not at speed), work on an exercise bike or ride a bicycle, go skiing, participate in sports games, i.e. To lead a full-fledged active life.
Physical exercises in the form of morning exercises, day classes or evening jogging are now mandatory. Moreover, moderate and intensity training should be included in the regime of the day at least 3-4 times a week. The duration of the lessons is not less than half an hour, ideally a person should be engaged for 1 hour 5-6 times a week with one or two days off. Additional loads, such as the road to work and back, climbing the stairs, working at the cottage, etc. Will only be welcomed.
Regular dosed physical activity should become a person's lifestyle, because it is necessary for the patient not only during rehabilitation, but also during the entire life time.
Diet after coronary stenting
Drug therapy necessary to prevent thrombosis and proliferation of cholesterol deposits on the walls of the vessels, as well as physical activity, can not help the patient unless the diet of his diet is adjusted. It should be understood that the stenosis of the vessels does not arise from an empty place, it is preceded by a disease that adversely affects the condition and work of the heart and blood vessels. Alo just put a stent to improve blood flow, you need to do everything possible to repair damaged heart disease and vascular membranes.
Blood, which will now normally move along the previously narrowed artery and feed various organs, should be saturated not only with oxygen, which is promoted by active physical activities, but also by useful substances. And we can get most of them from food and water, if the diet is balanced and properly selected.
The main sources of vitamins and microelements are vegetables, fruits and berries, which should constitute the main part of the patient's diet. It is good, if they are gifts of nature with a high content of potassium, useful for the heart muscle, and antioxidant properties.
As we have already said, coronary stenting does not solve the problem of arteriosclerosis of blood vessels. To reduce the cholesterol in the body, again, you need to pay attention to the products that we use.
The benefits will go to products that contain useful organic acids and fiber (all the same fruits, berries), as well as polyunsaturated fats (vegetable oils, fish, seafood). Organic acids have a positive effect on various organs and tissues of the body, cellulose helps to bind and remove cholesterol in the intestines, preventing its entry into the blood, and polyunsaturated fatty acids reduce the content of harmful lipoproteins and triglycerides.
But the amount of saturated acids (animal fats, including butter, cream, sour cream, cheeses, eggs), which have the opposite effect, must be strictly limited. Such products as fatty pork, fat, lamb, margarine and dishes based on it should be present on the table in the minimum amount. The same goes for semi-finished products, which usually contain many fats of questionable quality. It must be remembered that fat in foods is potential cholesterol plaques on the walls of blood vessels and exacerbation of atherosclerosis and ischemic heart disease.
Diet is recommended to patients and in connection with the need to maintain a normal weight. In this regard, the danger will be presented by products with a high content of fast carbohydrates (cakes, cakes, sweets, all kinds of sweets, white flour, sweet soda). Rapid carbohydrates help increase blood sugar and fat deposits, which does not improve the health of patients. In addition, it is carbohydrates that are responsible for the increase in blood levels of harmful low-density lipoproteins and triglycerides.
Since many heart diseases are accompanied by an increase in blood pressure, you will have to adjust the amount of flavoring. This is mainly about salt, which causes fluid retention in the body and, therefore, can affect blood pressure. Patients after stenting are allowed to consume salt in an amount of no more than ½-1 tsp. In a day. In this case, you need to take into account the content of salt in the finished products (and it contains bread, and conservation, and fast food, which is generally better to exclude).
Some foods and beverages may contain components that, in large doses, cause vasospasm and create a high stress on the heart. These substances include caffeine, which we find in strong tea, coffee, cocoa, chocolate. It is not necessary to refuse these products if the pressure indicators can be kept in norm and there are no other symptoms of cardiovascular pathology. But to limit their use is still worth it.
As for alcohol, almost all alcoholic beverages are banned, except for quality natural red wine, which in small quantities is even recommended for cardiac and vascular health.
MRI after stenting of the coronary arteries
The question of whether it is possible to carry out some diagnostic studies after stenting the vessels worries many patients. The greatest number of questions arises about magnetic resonance imaging. After all, in contraindications to the MRI is indicated and the presence of metal with the stents in the vessels. True, if there is a significant caveat that dangers are implants from ferromagnetic materials that can interfere with the magnetic field of the device.
It is believed that implants from ferromagnets can change shape and shift under the influence of a magnetic field. High ferromagnetic properties are mainly of cheap simple stents made of stainless steel or cobalt, but even such products with field strength up to 3 Tesla do not create significant artifacts in the image and the kyne rarely move. Stents with a drug coating may not contain any metal parts, so the deforming effect of the magnetic field on them is excluded.
In any case, it is better to know from what material the stent is made and to report this to the doctor who will conduct the study. In addition, such studies are recommended to be conducted no earlier than six months after the installation of a vascular implant, which allows the stent to gain a foothold on the arterial wall. This precaution reduces the risk of a stent shift from the affected area of the vessel and the development of restenosis.
With some types of new stents used for coronary stenting (those that do not contain metal), doctors can appoint a dynamic MTP with contrasting one week after the operation. Such a study makes it possible to evaluate the results of the operation: whether the normal blood supply has been restored and whether there is a risk of restenosis.
Innovative stents are made of non-ferromagnetic materials with coatings that prevent rejection of the implant (the patient's body does not recognize them as foreign substances) and have a therapeutic effect (prevent the formation of thrombi and proliferation of cells of the vascular wall). The use of certain products even allows patients not to take additional medications within a year. This creates more opportunities for monitoring the condition and recovery of the patient through MRI, because the stents in this study are well visualized.
Coronary stenting is an operation that allows blood circulation in the coronary vessels to be restored with minimal risk to life and trauma. This procedure, aimed not at combating the disease causing narrowing of the lumen of blood vessels, but at correcting the consequences of pathology, i.e. Restoration of blood flow and relief from attacks of angina (pain in the heart).
It is difficult to say what the life expectancy of a patient will be after stenting. First, there is always the risk of restenosis, requiring additional surgeries by alternative methods. True, there is no alternative to coronary stenting in terms of low trauma and a relatively small risk of rasenosis. Coronary bypass surgery, which requires opening the chest and conducting open-heart surgery, is currently used primarily with insufficient stenting or the inability to perform less traumatic interventions. A balloon angioplasty, although considered a minimally invasive procedure, gives a much higher probability of restenosis.
Secondly, the prognosis of the patient's life and health largely depends on the implementation of the doctor's recommendations regarding the rehabilitation period and further existence.
As for the nearest forecast of coronary bypass surgery, in 90% of cases after the operation it is possible to restore normal blood flow in the arterial vessels of the heart. And the stent supports it for 5-15 years (all depends on the material and the size of the product).
More than half of the patients who underwent surgery noted the disappearance of symptoms of ischemia of the heart, which pushes them to the idea of full recovery. The long-term prognosis in this case will depend on whether the person intends to continue to pursue his or her health, or let things go on its own.
About 40-45% of patients after the stent installation, there is a noticeable improvement. Further, the patient's condition will depend on the life of the product, coagulograms of blood, the degree of vascular lesion with atherosclerosis.
It should be noted that the stenting of the coronary arteries markedly reduces the mortality rates associated with myocardial infarction. So the probability of a fatal outcome with stenting is more than 3%, while treatment with conservative methods gives an indicator of 10 or more percent more.
The operation to install a stent in a coronary vessel, while observing the requirements of the rehabilitation period, does not imply serious consequences. On the contrary, it improves the patient's condition and quickly returns it to normal life, so it can not be the reason for the appointment of a disability. After all, a serious condition of the patient is caused not by stenting, but by the disease, in connection with which the operation was performed.
Nevertheless, to say that after stenting the patient can not get disability is impossible. For example, stenting after a myocardial infarction in 40% of cases does not allow a person to do the previous work, if it was connected with physical labor. At the same time, mental work is not considered a great burden on the cardiovascular system and does not allow getting a disability.
But again, everything will depend on the condition of the patient and his specialty. If the patient's labor activity is associated with heavy physical labor and the impact of factors dangerous to health, a person with a disability group may well be appointed. Easy physical work and the absence of harmful conditions can put this question in doubt.
It should be understood that not the stenting itself leads to the appropriation of a disability, but a disease that weakens a person. Disability can be attributed to angina and myocardial infarction, if they greatly affect the patient's well-being and ability to work. In this case, the first group can count only those who have the disease led to severe heart failure, which reduces the possibility of self-service. And the second group is assigned to those who have a disease that limits the ability to perform work duties and movement.
In most cases, patients after shunting are able to perform their professional duties. They can be offered a translation for easier work or a change in the mode of working activity, due to the fact that the cores are forbidden to work on the night shift.
Activities associated with heavy physical labor in an unsatisfactory state of the patient gives him the right to receive a disability group. But we need to understand that as soon as a person's condition improves, MSEC can reconsider its appointment.
Coronary stenting and other methods of restoring blood flow in a stenotic vessel should be considered only as one of the stages of treatment of the underlying disease, which caused a pathological narrowing of the lumen of the heart vessels. The operation itself gives the patient time to restore his health and prevent relapse of the disease. And on how the patient will dispose of this time, the quality and duration of his life depends.