Recovery and life after coronary artery stenting

The fact that coronary stenting does not require opening the sternum and administering anesthesia does not make it an aesthetic procedure. This is a serious intervention in the functioning of the heart vessels, despite the fact that the patient feels quite comfortable and can control the course of the operation equally with the doctor.

Yes, the recovery period after coronary artery stenting is shorter and easier than in the case of abdominal surgery. But this does not mean that the patient does not have to follow the doctor's recommendations afterwards. After all, postoperative prescriptions and lifestyle requirements are not accidental. They are dictated by the fact that the operation is only an opportunity to alleviate the patient's condition, but it does not solve the problem itself that caused the narrowing of the heart vessels.

Recovery after surgery can last several days, weeks and even months. For 1-3 days, while the patient is in the hospital, his condition is monitored by medical staff, after discharge from the hospital, the patient himself will have to do this. And given that complications can arise not only during the hospital stay, but also after discharge, it is necessary to seek help from a doctor in the following cases:

• if new bruises appear at the site of catheter insertion, blood oozes, or severe tissue swelling is observed,
• if the pain in the puncture area does not subside, but rather intensifies,
• if there is an increase in body temperature and the skin around the wound is red and swollen, which most likely indicates that the wound is infected,
• in case of pain in the limb, decreased sensitivity, the appearance of an unpleasant tingling sensation and a crawling sensation,
• if there is a change in the temperature and color of the limb near which the artery was punctured (a bluish tint to the skin and a body that is cold to the touch indicate a serious disruption of peripheral circulation),
• if cardiac symptoms appear: chest pain, shortness of breath, increased heart rate, cough,
• if you experience any unexplained rashes, joint pain, increased fatigue and sweating on your body,
• for symptoms such as nausea and vomiting that cannot be relieved with medication and that persist for 2 or more days after surgery.

Any serious deterioration in health after discharge from the hospital is a reason to call an emergency room.

Many complications and deterioration of the condition can be avoided if certain caution is observed after the operation. In the first days of staying at home, the patient is recommended to rest. A person can take care of himself, but doing physical work that requires noticeable effort is still dangerous during this period, because in this case the risk of bleeding from the wound and complications in the work of the heart increases, after all, the stent is a foreign body and it takes time for the body to get used to it.

Avoiding hot showers or baths will also help to avoid bleeding. This point, related to hygiene procedures, should be discussed with a doctor, who will definitely tell you when you can wet the wound and take a bath. The doctor can make such conclusions after examining the site of catheter installation and assessing the patient's condition.

When the patient's condition stabilizes, short walks will be useful, because hypodynamia 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.

At first, you should not overwork yourself. But nervous overstrain, which is observed, for example, while driving a car, can also be dangerous. In the first days after the operation, you should give up such activities. And those whose work is related to transportation, it is better to change their type of activity for 5-6 weeks or take a vacation.

Doctors' recommendations

Some patients mistakenly believe that coronary stenting can solve all their problems related to the cardiovascular system. In fact, this is not true, because this effective operation is only one of the options for symptomatic therapy. If the cause of vascular stenosis is atherosclerosis, then stenting will help restore the patency of the vessel, but will not rid it of cholesterol deposits, which can become an obstacle to blood flow in any other place.

The patient's life after coronary artery stenting cannot remain the same, otherwise there would be no point in such a serious operation. It is important to understand that after the operation it is too early for the patient to think about a full recovery. This is the beginning of a long journey. Restoring blood flow in the heart arteries only makes its work easier and relieves painful attacks of angina, while the patient's diagnosis remains the same. After all, the cause of the pathology has not been eliminated, which means the disease can continue to progress, posing a threat to human life.

A patient who has undergone surgery must understand the need for subsequent treatment, which includes both drug therapy and lifestyle changes. Only by strictly following the doctor's recommendations can you stop the progression of the disease and give yourself a few years of life.

Drug therapy

Treatment of vessels does not end with the introduction of a stent, especially when it comes to old-style designs that are unable to prevent thrombus formation and proliferative processes in the coronary arteries. Patients are required to receive:

• Antiplatelet drugs. For example, "Aspirin" can be prescribed to patients on a permanent basis every day in a daily dosage not exceeding 325 mg, and "Clopidogrel" will have to be taken for a year (75 g once a day).

Sometimes patients are prescribed the drug "Plavix", which prevents platelets from sticking together and forming blood clots at the site of the stent. It is recommended to take it for two years in the dosage prescribed by the doctor, which is strictly individual.

Antiplatelet drugs after coronary stenting are prescribed to prevent restenosis and vascular thrombosis. But at the same time, their use can provoke bleeding in the brain, stomach, intestines, so it is necessary to strictly adhere to the dosage and report all suspicious symptoms to the doctor.

• Statins and other drugs that reduce the level of harmful cholesterol in the blood. These are drugs for the treatment and prevention of vascular atherosclerosis, which cannot be cured by stenting. In addition, they reduce the risk of possible complications. The dosage of statins is individual and can be increased until the cholesterol level in the blood is stabilized at 4.6 mmol. The drugs are taken with the last meal. At the same time, at least once every six months, the patient is required to have tests for the content of cholesterol, lipoproteins, triglycerides, etc.
• Other medications that your doctor may prescribe in connection with your primary and concomitant diseases.

Coronary stenting may reduce the amount of drug therapy, but it is not a serious reason to refuse medication. This is only possible temporarily if the stent used in the operation has a drug coating with prolonged action.

Physical activity and exercise therapy during coronary artery stenting

Rehabilitation of patients after stenting lasts on average from 2 to 4 weeks, after which the work of the heart and blood vessels is fully restored. If in the first week the patient's actions and movements are limited, then in the future hypodynamia can only cause harm. In this regard, doctors have developed a set of therapeutic physical training (LFK) exercises that helps restore organ functions during the rehabilitation period.

Ideally, exercise therapy sessions should be part of rehabilitation programs that include work with a psychologist, consultations with a nutritionist, physiotherapy sessions, and sessions with an exercise therapy doctor. Thus, during rehabilitation, the patient will be constantly under the supervision of medical specialists.

There is no single universal set of exercises for therapeutic physical training. Each patient requires an individual approach that takes into account his condition and regulates physical activity.

The classes are held in 4 stages. If the patient's condition is stable, the first stage can be started the next day, but the exercises will mainly include movements of the hands and feet, tension of the muscles of the arms and legs, changing the body position from horizontal to vertical. The complex also includes some breathing exercises.

Then the volume of exercises increases, as does the pace of their implementation. Walking, squats, torso bends, leg swings, arm rotations, etc. are added to the exercises described above. At the same time, the medical staff constantly monitors the patient's condition, conducts heart function tests (ECG with and without stress), measures blood pressure and pulse.

Physical therapy classes begin while the patient is still in the hospital and do not stop after discharge. The doctor decides when the patient can be transferred to the next stage of physical therapy with increased physical activity. After the patient has completed all 4 stages of the first stage of rehabilitation, they move on to the second, which includes exercises to restore the patient's ability to work: training walking, basic exercises for the arms, legs, abs, back, which are performed at a fairly fast pace, close to moderate loads for a healthy person.

Despite the fact that coronary stenting is performed on the heart vessels and physical activity should be significantly limited in the first days, a sedentary lifestyle will not contribute to a quick recovery and return to work. On the contrary, doctors recommend swimming, running (dosed light running, not for speed), working on a stationary bike or riding a bicycle, skiing, participating in sports games, i.e. leading a full active life a month after the operation.

Physical exercise in the form of morning gymnastics, afternoon classes or evening jogging is now mandatory. Moreover, moderate and intense classes should be included in the daily routine at least 3-4 times a week. The duration of classes is at least half an hour, ideally a person should exercise for 1 hour 5-6 times a week with one or two days off. Additional loads, such as the road to and from work, climbing stairs, working in the country, 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 the rehabilitation period, but also throughout his entire life.

Diet after coronary stenting

Drug therapy, necessary for the prevention of thrombus formation and growth of cholesterol deposits on the walls of blood vessels, as well as physical activity will not be able to help the patient if his diet is not adjusted. It is necessary to understand that vascular stenosis does not occur out of nowhere, it is preceded by diseases that negatively affect the condition and work of the heart and blood vessels. It is not enough to simply install a stent to improve blood flow, it is necessary to do everything possible to restore the heart tissue and vascular membranes damaged by the disease.

The blood, which will now normally move along the previously narrowed artery and feed various organs, must be saturated not only with oxygen, which is facilitated by active physical exercise, but also with nutrients. And we can get most of them from food and water, if the diet is balanced and selected correctly.

The main sources of vitamins and microelements are vegetables, fruits and berries, which should make up the main part of the patient's diet. It is good if these are gifts of nature with a high content of potassium, which is useful for the heart muscle, and antioxidant properties.

As we have already said, coronary stenting does not solve the problem of atherosclerosis of the vessels. To reduce the cholesterol content in the body, again, we need to pay attention to the products we eat.

Products containing healthy organic acids and fiber (the same fruits, berries), as well as polyunsaturated fats (vegetable oils, fish, seafood) will be beneficial. Organic acids have a positive effect on various organs and tissues of the body, fiber helps to bind and remove cholesterol in the intestines, preventing it from entering 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, should be strictly limited. Products such as fatty pork, lard, lamb, margarine and dishes based on it should be present on the table in minimal quantities. The same applies to semi-finished products, which usually contain a lot of fats of dubious quality. It is necessary to remember that fat in products is a potential cholesterol plaque on the walls of blood vessels and an exacerbation of atherosclerosis and coronary heart disease.

The diet is recommended for patients in connection with the need to maintain normal weight. In this regard, the danger will be products with a high content of fast carbohydrates (cakes, pastries, candies, all kinds of sweets, baked goods made from white flour, sweet soda). Fast carbohydrates contribute to an increase in blood sugar and the formation of fat deposits, which does not improve the well-being of patients. In addition, carbohydrates are responsible for an increase in the level of harmful low-density lipidoproteins and triglycerides in the blood.

Since many heart diseases are accompanied by high blood pressure, the amount of flavorings will have to be adjusted. This mainly concerns salt, which causes fluid retention in the body and, accordingly, can affect blood pressure readings. Patients after stenting are allowed to consume salt in an amount of no more than ½-1 teaspoon per day. In this case, it is necessary to take into account the salt content in prepared foods (and it is contained in bread, canned goods, and fast food, which is generally better to exclude).

Some foods and drinks may contain components that, in large doses, provoke vascular spasms and create a high load on the heart. Such substances include caffeine, which we find in strong tea, coffee, cocoa, and chocolate. You do not need to completely give up these products if you can keep your blood pressure levels normal and there are no other symptoms of cardiovascular pathology. But you should still limit their consumption.

As for alcohol, almost all alcoholic drinks are prohibited, with the exception of high-quality natural red wine, which in small quantities is even recommended for the health of the heart and blood vessels.

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MRI after coronary artery stenting

The question of whether it is possible to conduct some diagnostic studies after vascular stenting worries many patients. The greatest number of questions arise regarding magnetic resonance imaging. After all, the contraindications to MRI also include the presence of metal stents in the vessels. However, there is a significant caveat that the danger is posed by implants made of ferromagnetic materials that can interact with the magnetic field of the device.

It is believed that ferromagnetic implants can change shape and shift under the influence of a magnetic field. High ferromagnetic properties are predominantly possessed by cheap simple stents made of stainless steel or cobalt, but even such products with a field strength of up to 3 Tesla do not create significant artifacts in the image and rarely shift from their place. Stents with a drug coating may not contain any metal parts at all, so the deforming effect of a magnetic field on them is excluded.

In any case, it is better to know what material the stent is made of and to inform the doctor who will conduct the examination about it. In addition, such examinations are recommended to be carried out no earlier than six months after the installation of the vascular implant, which gives the stent time to fix on the arterial wall. Such precautions reduce the risk of the stent shifting from the affected area of the vessel and the development of restenosis.

For some types of new stents used for coronary stenting (those that do not contain metal), doctors may prescribe dynamic MRI with contrast as early as a week after surgery. Such a study makes it possible to evaluate the results of the surgery: whether 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 implant rejection (the patient's body does not recognize them as foreign substances) and have a therapeutic effect (they prevent the formation of blood clots and the proliferation of vascular wall cells). The use of some products even allows patients to not take additional drugs for a year. At the same time, more opportunities are created for monitoring the patient's condition and recovery by conducting MRI, because stents are well visualized in this study.

Forecast

Coronary stenting is an operation that allows restoring blood circulation in the coronary vessels with minimal risk to life and trauma. This procedure is aimed not at combating the disease causing the narrowing of the lumen of the vessels, but at correcting the consequences of the pathology, i.e. restoring blood flow and getting rid of angina attacks (heart pain).

It is difficult to say what the patient's life expectancy will be after stenting. Firstly, there is always a risk of restenosis, which requires additional operations using alternative methods. However, there is no alternative to coronary stenting in terms of low trauma and a relatively low risk of restenosis. Coronary artery bypass grafting, which requires opening the chest and performing open-heart surgery, is currently used mainly when stenting is ineffective or when it is impossible to perform a less traumatic intervention. And balloon angioplasty, although considered a minimally invasive procedure, gives a much higher probability of restenosis.

Secondly, the prognosis for the patient’s life and health largely depends on his compliance with the doctor’s recommendations regarding the rehabilitation period and further existence.

As for the immediate prognosis 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 maintains it as such for 5-15 years (it all depends on the material and size of the product).

More than half of patients who have undergone surgery report that their symptoms of cardiac ischemia have disappeared, which leads them to think about a full recovery. The long-term prognosis in this case will depend on whether the person intends to continue to take care of their health or let things slide.

About 40-45% of patients experience a noticeable improvement after stent installation. The patient's condition will then depend on the service life of the product, blood coagulation profile, and the degree of vascular damage caused by atherosclerosis.

It should be said that coronary artery stenting significantly reduces mortality rates in myocardial infarction. Thus, the probability of a fatal outcome with stenting does not exceed 3%, while treatment with conservative methods gives an indicator of 10 percent or more higher.

Stenting in a coronary vessel does not imply serious consequences if the rehabilitation period requirements are met. On the contrary, it improves the patient's condition and quickly returns him to normal life, so it cannot be a reason for assigning disability. After all, the patient's serious condition is caused not by stenting, but by the disease for which the operation was performed.

However, it is impossible to say that after stenting the patient cannot get disability. For example, stenting after myocardial infarction in 40% of cases does not allow a person to do his previous job if it was related to physical labor. At the same time, mental work is not considered a big burden on the cardiovascular system and does not allow getting disability.

But again, everything will depend on the patient's condition and his specialty. If the patient's work activity is associated with heavy physical labor and exposure to factors hazardous to health, the person may well be assigned a disability group. Light physical labor and the absence of harmful conditions may call this issue into question.

It is important to understand that it is not the stenting itself that leads to disability, but the disease that weakens the person. Disability can be assigned in case of angina pectoris and myocardial infarction if they greatly affect the patient's well-being and ability to work. At the same time, only those whose disease has led to severe heart failure, which reduces the ability to take care of themselves, can count on the first group. And the second group is assigned to those whose disease limits the ability to perform work duties and move around.

In most cases, patients after bypass surgery are able to perform their professional duties. They may be offered a transfer to an easier job or a change in work schedule, due to the fact that heart patients are prohibited from working the night shift.

Activities related to heavy physical labor in the unsatisfactory condition of the patient give him the right to receive a disability group. But it is necessary to understand that as soon as the person's condition improves, the MSEK may 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 treating the underlying disease that caused the pathological narrowing of the lumen of the heart vessels. The operation itself gives the patient time to restore his health and prevent relapses of the disease. And the quality and duration of his life depends on how the patient manages this time.

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