STEP 1: Understand the disease.

Should I do Bypass Surgery or Angioplasty if I am stable?

These two procedures are one of the most abused and risky in the medical field. They are done for heart patients under the threat of heart attack and death if not done immediately. A second opinion is necessary to understand the risk and the availability of other effective and safe alternative procedures.

Recommendations or opinions can differ from one cardiologist to another. If the recommendation is based on the substantial evidence published, it cannot change from one cardiologist to another. Many expert opinions given are possibly not based on evidence-based Medicine but rather biased false information.

How heart disease managed?

STEP 2: Cardiac Status.

Should I do Bypass Surgery or Angioplasty if I am stable?

Your current cardiac status is one of the crucial factors to determine which treatment strategy best suits you. In the cardiology community, this chest pain or Angina is classified into two categories stable Angina(Chest pain) and unstable Angina(Chest Pain).

• Stable Angina(Chest pain)

• Unstable Angina(Chest Pain)

Hospitalized for Heart attack

Not relived on nitrates

Not relieved on rest

Severe symptom

Cardiac status Syptoms
(Chest Pain, Shortness of Breath)

Mild to moderate symptoms

Relieved on rest

Relieved on nitrate

Multiple clinic visits for symptoms

1. What is a stable Angina?

Stable anginal patients usually experience discomfort or pain in the chest when they do some activi-ty, which they are not used to or while doing some routine works. The Sudden excruciating pain in the chest they experience while doing some activity will stop within minutes if that particular activi-ty is stopped. The pain sometimes may require certain drugs like nitrate to be kept under the tongue to relieve. This type of patient is called stable. So stable patients would be able to carry out the regular activity, and the pain will be of only some inconvenience, and they continue their routine activities.

2. What is an Unstable Angina?

Unstable angina patients have a completely different presentation of symptoms. The treatment ap-plicable to stable and unstable is entirely different. In unstable patients, the pain is very severe, and it will not be relieved with rest or cardiac medications. If this is not treated immediately, there is an imminent chance of getting a heart attack. Unstable angina patients need admission and should be carefully monitored to prevent further pro-gression, which can damage the cardiac muscle due to a lack of blood flow. Once the muscle is damaged, it is called a Heart attack. It may require an emergency coronary angi-ogram followed by a Bypass surgery or Angioplasty to rescue the heart muscle from further dam-age. Always remember here the surgical procedures are emergency, not elective.

STEP 3: Medical Therapy.

The first-line treatment for a stable patient is optimal medical therapy with cardiac risk factor management and lifestyle changes.

Step 4: Treatment advised.

The treatment option recommended to you will benefit you depending on the cardiac status, whether you are stable or unstable.

1. Have you chosen treatment due to fear of death?

Patients should be cautious when cardiologist uses these words : "You need Bypass Surgery or Angioplasty immediately or at the earliest." "You will get a heart attack anytime." "Without surgery, you won't live longer." You are healthy now; if you are not willing for Surgery now, later it will be Risky. Very often, these were the words used to drive you towards very high-risk Surgery. Then, as a patient, you have the right to have these words of caution written as a recommendation in writing by your cardiologist. However, every cardiologist will hesitate to provide you in writing that Bypass and Angioplasty were provided to prevent heart attack and death. If they do, please ask them to fill the form provided below.

2. Are the Stent and Surgery is for Prevention?

Cardiologists trying to argue Angioplasty and Bypass Surgery in stable patients will decrease heart attack and death are irrational. The quest to prove this theory cannot be sustained anymore after recent ISCHEMIA (2019) trial results. Also, Cardiologists should not be foolish enough to harm the patients in the name of Prevention.

3.What should patients know?

As a patient, you should understand some essential things from your doctor if the treatment sug-gested to you is highly risky. Rather than being told that the surgical procedure is beneficial, you should know how beneficial it is and in which way. In reality, you may be forced to do a risky procedure for the benefit of just a reduction of pain or an increase in walking distance a few seconds more. Here a second opinion is not a convenience but a life-saving necessity when there is a lack of clarity.

More read:-

Evidence Against Bypass surgery and Angioplasty(Stable Patients).

1) ISCHEMIA STUDY

2) ORBITA STUDY

3) COURAGE STUDY

Step 5: Quiz yourself.

Stable Angina patients should have these answers known to them clearly. If you have any more questions or do not understand, you should take a second opinion and get an explanation from the doctor.