Cardiac stents help reduce the risk of the artery closing after an angioplasty procedure.
Q: I am a 71-year-old woman diagnosed with coronary artery disease. My latest calcium score was 801. My right coronary artery was 80 percent blocked, and the left artery was 25 percent. My cardiologist asked me to decide if I want to do angioplasty or not. I don’t have any symptoms, only shortness of breath on exertion. I also can’t breathe, as if suffocated, when wearing a mask. I can’t decide what to do. My cardiologist seemed against getting a stent, not that he said that exactly, but he stressed the risk of getting a stent!
A: A cardiac stent is a device placed into an artery of the heart after it is reopened, usually by a balloon, in a procedure called an angioplasty. Stents help reduce the risk of the artery closing off after the procedure. In people with stable coronary artery disease, opening up a blood vessel can reduce symptoms but has not been shown, despite many studies, to reduce risk of heart attack or death.
You said you were asymptomatic, but shortness of breath is one of the major symptoms of blocked coronary arteries, which are the blood vessels that provide oxygen-rich blood to the heart muscle. It can be very difficult at times to judge whether a person’s shortness of breath is coming from blockages in the artery or not, and stress testing can help answer whether this is likely. People can have shortness of breath on exertion for many reasons, including lung problems, anemia, lack of exercise or persistent symptoms after COVID infection.
While the decision is ultimately up to you — it’s your body — it’s best if the cardiologist gives you a definite recommendation and the reasoning behind it. You can’t make an informed decision without being informed. A stent might improve your shortness of breath, but there are risks of bleeding, infection and even heart damage from a stent placement. It’s not to be undertaken lightly.
If your cardiologist doesn’t feel that the shortness of breath you have stems from your blockages, then a stent is not likely to be helpful. Revisit with your cardiologist to get a clear idea of the potential benefit and harm specific for your case, and bring a friend or family member to assist you.
Q: I read on the internet that coffee is full of antioxidants. Is this true?
A: The simple answer is that yes, coffee has lots of antioxidants. At least six different families of antioxidant compounds are found in coffee that has been roasted and brewed, the way coffee is almost always consumed in North America.
What makes the answer more complicated is whether there is evidence that the antioxidants in coffee lead to improvement in things that are meaningful, such as reducing risk of heart attack or increasing life span. Powerful antioxidants, such as folic acid, quercetin, resveratrol, vitamins E and C, and N-acetylcysteine, have shown no benefit in reducing risk, in multiple studies, used mostly individually or in small combinations. Studies on cells have shown increases in cellular damage in experimental subjects who took antioxidants, compared with those who took a placebo. The body’s systems are incredibly complex, and we don’t know enough to predict what will happen when a person takes multiple compounds, such as those within coffee, without large-scale studies.
Fortunately, we do have high-quality, long-term data, most of which confirms a benefit in reducing overall mortality risk among coffee drinkers. Benefits were seen for heart disease and stroke, as well as in multiple other causes, but not for cancer. Whether it is a specific antioxidant in coffee or the whole combination, or even whether these results will be confirmed in future trials, are not answerable at the present time. I’m not a coffee drinker, and these results aren’t enough for me to start, but coffee drinkers can rejoice that there appear to be health benefits from their daily brew.
Q: I was recently diagnosed with an NSTEMI, after a rise in troponin and EKG changes following a gastrointestinal illness. Can you please discuss causes and necessary testing?
A: “NSTEMI” stands for “non-ST elevation myocardial infarction.” This is a type of heart attack. Virtually all heart attacks are caused by blockages in the arteries that supply blood to the heart muscle. Inflammation of the heart muscle, dissection of a major artery or stress-induced cardiomyopathy is the cause.
The ST-segment is part of the electrocardiogram that, for decades, had been a major criterion in making the diagnosis of a heart attack. However, it was discovered that heart cells, when damaged, release enzymes that can now be detected in the blood in very low amounts, and this has changed the way we diagnose acute coronary syndromes. When a person has symptoms that suggest heart attack, the troponin test will show whether there is damage to the heart cells. We call the syndrome “unstable angina” when a person comes in with symptoms suggesting a heart attack but without troponin in the blood, while an NSTEMI has elevated troponin. At the time of the event, cardiologists consider whether to look for and open any blocked blood vessels with an angiogram and revascularization (like a balloon and a stent). Occasionally, there are blockages of such a type that surgery is the best option.
After the event, medical therapy (aspirin, beta blockers and a statin at a minimum, on top of lifestyle modification) can drastically reduce the risk of another acute coronary syndrome. Risk stratification, with a stress test or angiogram, will sometimes be recommended in people who have had an NSTEMI.
Q: I take Antabuse to help me quit drinking. Do I need to worry about the alcohol in hand sanitizers?
A: Antabuse is a medication that makes people feel very sick even if they drink small amounts of alcohol. It is not frequently used anymore, but it is still an effective and time-tested option for medication treatment in people with problem drinking.
Hand sanitizers are made from either ethyl alcohol, which is the alcohol in alcoholic beverages, or from isopropyl or rubbing alcohol. There have been case reports of people developing a reaction to the alcohol from practicing hand hygiene, from aftershave and even from inhaling fumes after practicing hand hygiene. According to a study during the pandemic, of 42 people on Antabuse who routinely used hand sanitizers, 20 percent had a reaction to the ethyl-alcohol-based sanitizer, and 10 percent had a reaction to isopropyl-based sanitizer. Of those, 7 percent of people had severe reactions, while the rest were mild and self-limited.
There clearly is a risk for developing symptoms from even the smallest amount of alcohol that can be absorbed through the skin or inhaled through fumes. People on Antabuse with a reaction to skin sanitizers should wash their hands rather than use sanitizers.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.
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