Expert opinions and online advice on coronary heart disease delivered via your computer or mobile device. Second opinion is available wherever there is an internet. All you need is a PC or a smartphone.
The heart is supplied with oxygen and nutrients through the coronary arteries. If the volume of blood flow decreases because of atherosclerotic deposits in the vessels, the heart begins to "suffocate," developing a pathological condition called coronary heart disease (CHD). Its other names are coronary artery disease (CAD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease.
It is one of the most common cardiac disorders worldwide and can lead to other serious conditions, such as weak heart muscle or heart attack.
Symptoms and risk factors
The main symptom of CHD is chest pain (angina). In addition to hereditary factors and diabetes, risk factors include smoking, high blood pressure, high blood lipids and obesity.
In some cases, the description of symptoms alone is sufficient to diagnose the coronary heart disease. However, specific diagnostic procedures are usually required, which include various tests. They make it possible to evaluate the heart and coronary artery function, and may include:
- resting ECG;
- exercise ECG;
- cardiac ultrasound (echocardiography).
If necessary, additional examinations such as stress echocardiography, MRI or cardiac computed tomography may be prescribed. If indicated, cardiac catheterization is performed.
The aim of coronary heart disease therapy is to dilate the narrowed heart vessels. This should improve blood flow and its supply to the heart muscle. The key part of coronary heart disease management is drug therapy, which is aimed, on the one hand, at the treatment of disorders presenting risk factors, and, on the other, at the improvement of blood circulation. Taking anticoagulant drugs, especially aspirin, is a preventive measure to avoid a heart attack.
However, if current medications for coronary artery disease (anticoagulants, beta-blockers, cholesterol-lowering drugs, nitrates) no longer have the desired effect, the blood vessel narrowing must be treated by a special procedure.
The main method to restore the blood flow is catheter procedure, including angioplasty with stenting.
A stent (a metal implant shaped like a tube) is inserted into the coronary artery to support it from the inside and prevent it from closing again.
In particularly severe cases, bypass surgery may be needed to treat CHD. The narrowed coronary vessels are replaced by the patient's own healthy vessels, so that the heart receives sufficient amount of oxygen again.
The variety of diagnostic procedures and therapeutic options offered by modern health care for the treatment of coronary heart disease explains the benefits of additional consultations on this disorder.
What is the service about?
An independent evaluation of a coronary heart disease situation can help address a number of issues.
In terms of diagnostics, there are often conflicting recommendations regarding the use of modern radiologic techniques. Which is better, cardiac CT or MRI, or perhaps myocardial scintigraphy, is a question that can be challenging for an average cardiologist. Some doctors are simply not sufficiently aware of the nuances of the latest vascular imaging technologies; in other cases, they just have to do with what is available in their facility. As a result, patients are not referred to a study which would have been the best for them. In such cases the consultation of an independent expert in coronary heart disease will prompt the right choice.
Another diagnostic issue in which an outside opinion may be needed is the interpretation of the scan results. In this it is quite reasonable to double-check the findings with radiologists experienced in the study of cardiac structures and coronary vessels.
The presence of other cardiac conditions (e.g., valve disease) and their interrelation with decreased supply of blood to the heart muscle are important aspects determining the ischemic heart disease treatment planning. Vast experience is needed to be able to rise above the level of a particular problem and assess the situation as a whole, to understand the mutual influence of disease processes and draw the right conclusions. If your treating physician is obviously insufficiently competent, it is worth consulting a more qualified specialist.
At the point of treatment strategy planning the opinion of another expert may be needed, for example, with regard to medication prescription. The arsenal of modern medicine contains a number drug groups, not to mention names, and if the current therapy is not effective or causes complications, the right solution is to resort to the advice of a competent specialist.
An issue that is often controversial is the choice between angioplasty (stenting) and surgery (coronary artery bypass grafting). In what cases is it possible to do without surgery, and when is ACB the optimal way to restore blood supply to the heart muscle? In search of the right answer, it is advisable to listen to not one but several doctors, possibly representing "different sides", i.e., cardiologists and cardiac surgeons. This is a classic case where a second opinion is the way to understand the situation properly and make the best decision.
What will the client get?
Our expert, upon careful analysis of the available data, shall provide:
- Their own assessment of the situation, including the confirmation, refinement, or refutation of the existing diagnosis of coronary vessel disease, as well as comments on the sufficiency of the available examination findings and their interpretation.
- Answers to questions prepared in advance or arising during the online conversation.
- Recommendations for further actions, which may include continuation of the current therapy or its modification, lifestyle and/or diet correction, additional diagnostics and/or referral to specialists in concomitant diseases.
What data should be provided to get a coronary heart disease second opinion?
The amount of information required is to be specified on a case-to-case basis. The primary list shall include:
- ECG protocol;
- laboratory blood test results (heart and vessel disease risk measurements).
If available, it is also advisable to provide:
- A written opinion of your physician (general practitioner or cardiologist);
- Current medications list, including dosage and frequency of administration;
- Echocardiography and Holter monitoring protocols;
- Radiologic study findings (MRI, CT, myocardial scintigraphy) in the form of written reports and/or image files;
- Cardiac catheter (coronary angiography) findings as a written protocol and/or file with study recordings.
In which ways can coronary heart disease remote advice be delivered?
- Review of the available medical data provided in writing. The report shall contain the overall assessment of the situation, as well as conclusions and treatment recommendations. Basic size: up to 1 page.
- All services included in the written consultation. Above them, a video appointment with the doctor, where he/she shall perform a visual inspection, if necessary; clarify the symptoms, comment on the diagnostic and functional radiology tests findings, explain the proposed strategy and answer the patient's questions. Duration: up to 15 minutes.
- All services included in the written consultation. Above them, a phone talk with the doctor, where he/she shall clarify the symptoms, comment on the diagnostic and functional radiology tests findings, explain the proposed strategy and answer the patient's questions. Duration: up to 15 minutes.
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