Diplomate, Board Certification of Emergency Medicine
I was asked to write about coronary bypass. Bypass surgery
used to be a lot more common, but new stents that open and
keep open clogged heart arteries make this surgery less
common. Stents are inserted into the arteries through cardiac
catheterization -- tzintor in Hebrew.
Stents are made of metal and are very small. After they are
put in, a balloon is inflated inside the stent which then
pushes the sides of the stent against the walls of the
artery. The big problem with the stents is that they can get
clogged as well, which occurs about thirty percent of the
time. Newer stents are coated with medications that prevent
this, and make clogging much less of a problem. They can now
last for years.
The key is to take chest pain seriously and not wait until a
heart attack to have these stents put in. Surgery now is
reserved for difficult places where putting stents will be
difficult or where surgery is being done anyhow, for example
to replace a bad valve.
Valves often stiffen or leak with age and these need to be
replaced occasionally. A leaky valve and a stuck one cause a
murmur, although murmurs, especially in young women, are
usually benign.
The two types of valves which are implanted are made of
either metal -- which are durable and hold up well -- or
animal valves, which do not need medications to thin the
blood like metal ones but they are less durable.
There is a strange disease called mitral valve prolapse, in
young people, which causes many strange symptoms but is
benign. The only consideration for this problem, and all
diseased valves, is that antibiotics may need to be taken
before surgical and dental procedures, since bacteria love to
wreak havoc with diseased valves. My thanks to Dr. Hillel
Steiner, cardiologist and mensch, from Shaare Zedek
Hospital.
A message from GlaxoSmithKline, sponsor of this
column. Lamactal is serious antiseizure medication. It is
a medication that can bring normal life to those who suffer
from seizures and are not controlled by the basic
medications. Once again, Glaxo brings hope.
