Coronary Artery Disease (CAD) & Angioplasty Guide
A comprehensive clinical overview of coronary artery stenosis, angina pectoris, diagnostic fractional flow reserve (FFR), drug-eluting stents (DES), and minimally invasive TAVR procedures in Delhi NCR.
Chairman, Fortis Escorts Heart Institute • Fortis Escorts Heart Institute, Okhla, New Delhi
- Crushing retrosternal chest pain lasting >10 minutes unresolved by rest
- Sudden shortness of breath with cyanosis or cold clammy skin
- Radiating pain accompanied by vomiting, dizziness, or collapse
In case of severe acute onset, dial 108 immediately or proceed to the nearest 24/7 Level-1 emergency trauma center.
Strict Clinical Contraindication: In acute coronary syndromes or flow-limiting stenosis (>70%), emergency catheterization and dual antiplatelet therapy are mandatory. High-dose Ayurvedic herbal extracts (such as Guggulu, Garlic, or Arjuna) must NOT replace prescription antiplatelet or statin therapy, as uncontrolled combination with Warfarin or Ticagrelor introduces high systemic hemorrhagic risk.
Clinical Background
Coronary Artery Disease (CAD) develops when the major blood vessels that supply the myocardium with oxygen and nutrients become damaged or diseased. In South Asian populations, coronary atherosclerosis typically presents a decade earlier and with more diffuse multi-vessel involvement compared to Western cohorts, primarily driven by atherogenic dyslipidemia, elevated Lipoprotein(a), and insulin resistance.
Pathophysiology & Disease Progression
The process begins with endothelial dysfunction, allowing low-density lipoproteins (LDL) to infiltrate the arterial intima. Oxidation of these lipids triggers a chronic inflammatory cascade, forming a fibrous cap over a lipid core. Rupture or erosion of this atherosclerotic plaque exposes thrombogenic material, precipitating acute coronary thrombosis (myocardial infarction).
Recognized Symptoms
- Substernal chest pressure or squeezing (Angina Pectoris), often radiating to the left arm, neck, or jaw
- Shortness of breath on mild to moderate exertion (Dyspnea)
- Unexplained diaphoresis (cold sweats) accompanied by nausea or presyncope
- Fatigue and reduced exercise tolerance out of proportion to daily exertion
- Atypical angina symptoms (epigastric burning or back discomfort, common in women and diabetic patients)
Etiology & Risk Factors
- Elevated LDL-C (>100 mg/dL) and high triglycerides with low HDL
- Longstanding arterial hypertension (>130/80 mmHg)
- Type 2 Diabetes Mellitus and metabolic syndrome
- Tobacco consumption (smoking or chewing)
- Strong premature family history of CAD (first-degree male relative <55 or female <65)
- Sedentary lifestyle and visceral adiposity
Recommended Diagnostic Investigations
Evidence-Based Treatment Modalities
Optimal Medical Therapy (OMT)
pharmacologicalDual antiplatelet therapy (Aspirin + Ticagrelor/Clopidogrel), high-intensity statin therapy (Rosuvastatin/Atorvastatin), ACE inhibitors/ARBs, and beta-blockers for hemodynamic control.
Percutaneous Coronary Intervention (PCI / Angioplasty)
interventionalBalloon dilatation followed by deployment of second-generation drug-eluting stents (DES). In calcified lesions, rotational atherectomy (rotablation) or intravascular lithotripsy (IVL) is used to modify plaque.
Coronary Artery Bypass Grafting (CABG)
surgicalSurgical revascularization utilizing the internal mammary artery and saphenous vein grafts, indicated for complex left main disease or multi-vessel CAD with low ejection fraction.
Transcatheter Aortic Valve Replacement (TAVR)
interventionalMinimally invasive catheter-based replacement of severe calcific aortic valve stenosis in high-risk elderly patients without median sternotomy.
Frequently Asked Questions
Q:When is a Drug-Eluting Stent (DES) preferred over Coronary Bypass Surgery (CABG)?
According to Cardiological Society of India (CSI) consensus, PCI with modern Drug-Eluting Stents is preferred for single or two-vessel disease with low SYNTAX scores (<22). CABG remains the gold-standard recommendation for multi-vessel disease in patients with diabetes mellitus or left main coronary artery disease with high lesion complexity.
Q:How soon can a patient resume daily activities after an Angioplasty in Delhi?
With transradial approach (through the wrist artery), most patients are mobilized within 4 to 6 hours and discharged within 24 to 48 hours. Light sedentary work can typically resume within 5 to 7 days, accompanied by enrollment in a supervised Phase II cardiac rehabilitation program.
Q:What is Fractional Flow Reserve (FFR) and why is it necessary before stenting?
FFR is a diagnostic catheter wire test measuring pressure differences across a coronary stenosis. It accurately proves whether a narrowing is causing real myocardial ischemia (FFR <0.80), preventing unnecessary stent placement in borderline lesions.
Verified Doctors for Coronary Artery Disease (CAD) & Angioplasty Guide
Dr. Ashok Seth
Chairman, Fortis Escorts Heart Institute
Legendary interventional cardiologist with over 40+ years experience. Awarded Padma Bhushan & Padma Shri for pioneering angioplasty in India.
Dr. Naresh Trehan
Chairman & Managing Director, Medanta - The Medicity
Pioneering cardiovascular and cardiothoracic surgeon. Former Chief of Escorts, awarded Padma Bhushan for groundbreaking heart surgeries.
All India Institute of Medical Sciences (AIIMS)
Apex Public Healthcare & Research Institute of India
India's premier autonomous super-specialty hospital and medical research institution. 2,478 beds, 24/7 Level 1 Trauma Centre, and cutting-edge quaternary clinical care.
Indraprastha Apollo Hospitals
Flagship Multi-Specialty Quaternary Care Hospital
710-bed quaternary care hospital in South Delhi. First hospital in India to be internationally accredited by Joint Commission International (JCI, USA).