Inside the heart: ultrasound now breaks down plaque that hardens arteries – 6/21/2022

When the board is in the bloodstream to prevent its passage, people usually say that it is made of oil, almost simplifying life.

But among us, the sign is made up of many things. Fat, yes, of course. But also, for example, fiber and calcium. Oh, yes, he can have these many minerals, which accumulate there for many years, slowly, without a quick taste.

“Because of these delays and people living longer, we get a heart rate calculated daily and a rapid increase”, observes cardiologist Pedro Lemos, referring to the vascular network that supplies the heart. And how he relies on them!

“The heart is a muscle that if you can take a small piece and look under a microscope you will see that it looks very similar to the thigh”, compares the doctor who is the coordinator of the Cardiovascular Center at the Hospital. Israelta Albert Einstein, in São Paulo. Paul, and the owner of the rare ability to talk about Medicine as if he were telling a good story.

Where the paradigm ends: the heart muscle beats 80 times per minute. “If I asked anyone to lift his thigh 80 times in the same minute, it wouldn’t last long,” he says.

In fact, being the athlete placed in our chest, the heart needs constant energy, requiring a good supply of oxygen at all times. This supply service is done correctly by patients. Therefore, it does not take more than a few seconds for them to feel resentful if they are blocked by such signs.

“If you join a tissue for one of them, this blockage is sudden. We have a heart attack”, says a cardiologist. “Now, if it happens slowly, making the blood vessels narrower and narrower because of excess plaque, a person feels angina pain.”

In one way or another, in these times something must be done – otherwise the heart will not take a deep breath. That’s the time, with balloons and stenti, Pedro Lemos and his colleagues enter the scene through vessels to the problem area, performing popular angioplasty. But no one thinks twice about the problem that calcification could mean that day.

“Well, all the fat is soft, spongy”, explains the cardiologist. “But calcium is an ingredient we find in bones and teeth.”

It is easy to determine where this story goes: when minerals accumulate on the walls of vessels, they become more and more difficult. “And it’s okay if it’s complicated, that is, as long as there is blood at a reasonable level,” comments Pedro Lemos. “The problem is when that stops happening.”

Until last week, for a doctor, cases like these were equally problematic. “To open the heart, I need to expand it, that’s for sure,” he says, citing a basic principle. “But how can I expand a tool that is difficult? stent Do not do that. It is only the help that clarifies the heart disease that I have expanded. So, I repeat, what would I do if this vein did not widen? “

Yes, there was an alternative. But the best answer to this question came only last week, when Pedro Lemos and his colleagues at Einstein (in the picture), in a procedure unprecedented in the country, they used ultrasound and, with it, simply broke all that calcium into the heart artery, which was as hard as stone.

how it was before

In addition to failing to properly expand the blocked area to restore blood flow, taking a balloon with the help of a catheter to fill it properly at the time, doctors had the following challenge: to reach this area itself, if lucky. they found several other places numbered along the way.

“It was like walking on slippery skirts on a rocky road,” recalls Pedro Lemos. In fact, a blood vessel without many plaques can be seen as a paved road, which a cardiologist could circulate through a catheter as smoothly as possible. However, calcifications create indentations that often prevent the device from moving.

“It may be that I did not even reach the wound,” the doctor reveals. Therefore, he had to deal with illiterate and dilated arteries. By the way, to complete: no matter how much they ask for tests before the procedure, cardiologists only feel the patient’s vascular stiffness when touching them, for now.

“If they are very difficult, it is not always a matter of stopping what was being done in the middle. But, if we continue, the results of the release are not good,” notes the doctor.

Alternatives that were not perfect

There are high pressure balloons that, let’s say, expand the calculated artery heart. “To give you an idea, a normal blood pressure, which is 120 to 80 mmHg, or a millimeter of mercury, would be equal to 1/6 or 1/5 of the 1 atmosphere, which is another unit of pressure measurement”, teaches Pedro we . read. “And we have balloons reaching the atmosphere 24, 25. Even under the sea there is no such pressure.” Walls made of concrete from a calculated cardiovascular system can be very resistant? Not always. There are dangers.

Interventional cardiologists can also use microscopic slides, making similar small incisions in calcium-filled plaques. So you can visualize the effect of this: “It’s like a watermelon where you just have to stab it with a knife and it opens.”

Finally, another strategy is blood transfusion, which works as a specialist in interfering with heart disease, say, hard plaque. “It is very safe and has been used for many years”, says the doctor. “But devices need to touch plaques, and usually can only do so on the inner surface of the coronary artery, while some calcifications, perhaps more, are deep because they penetrate into the artery wall.”

The result: a person even improves, but we can’t say leave with completely blocked heart arteries. He still has a certain level of problem that took him to the hospital. “But it was the offensive line we had until then,” says Pedro Lemos.

Ultrasound into the chest

The new technology that lands Einstein in the same week as in Japan – implemented four years in Europe and one year ago in the United States – solves a good part of all these shortcomings.

Doctors call it lithotripsy, a name that means a lot because it means something like “breaking stones”. Urologists have been saying it for a long time. It is not today that they use this very high-energy sound wave, with the highest speed of what we can hear, to make the kidney stones tremble to the point of rupture. “It’s like when a very loud noise breaks a glass,” Pedro Lemos compares the other.

In this case, however, kidney stones turn into sand and fulfill their destiny of urinary excretion. “Heart calcium does not go anywhere,” explains a cardiologist. “Only, that large plate breaks into a thousand pieces, forming a mosaic, and the wall of the vase becomes simpler.” Then, with peace of mind, an angioplasty balloon can do its job.

Benefits of novelty

As soon as he arrived, an ultrasound scan had already entered the São Paulo hospital system. This is because, according to various clinical tests performed, it provides rare compounds in newly launched devices.

“It is normal for a new procedure in medicine to be more effective than the previous one, but to pay the price: that of being more invasive or less secure”, notes Dr. Pedro Lemos.

The opposite can also happen: new treatments will bring more security, but they will not be as effective as those previously available. “But, in the case of cardiovascular lithotripsy, it provides the conditions of clearance to be better and, at the same time, safer for the patient”, confirms the cardiologist.

According to him, angioplasty takes about an hour and a half when no such plaques are calcified. However, the duration of the procedure is unpredictable when calcifications are very high. “Sometimes, when we travel with a catheter through vessels, we take a long time through a small passage”, says the doctor.

To give you an idea, with an ultrasound dropping the plate into pieces – including the method of demolition, when necessary – the procedure takes about an hour and a half longer. Quickly, the coronary arteries lose their stiffness and angioplasty progresses as normal. One day later, the man is at home, with open veins. And, I risk, be more flexible, provide full support for 80 beats per minute that fill us with life.

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