Being asked to write a book review is largely a royal pain. Authors hope you will be kind, while you hope the book at best might tell you something that every other book for heart patients hasn’t already told you. I frequently write here about books I like reading, but I won’t write about books I don’t – a waste of the very limited hours I have left on this earth, preferring instead to simply ignore them. As my late friend and co-author Jill Stewart Bowen used to say of our first book project together:
“The mediocre they can find for themselves.”
Perhaps that’s why a review copy of the book called Your Personal Guide: Angioplasty* sat on my coffee table for weeks (looking quite smart nestled on top of a pile of other heart books next to the candle centrepiece, I thought). One day, I finally got tired of looking at this latest addition to my living room decor and decided to give it a go. And within a very few pages, I learned some fascinating things I didn’t know before.
1. It’s possible to have significant coronary artery disease (CAD) with multiple blockages greater than 70% yet have no symptoms of angina on exertion. This is called a silent heart attack, and in many cases can happen to people who are very sedentary (because they don’t exert themselves enough to challenge their heart muscle).
2. Heart attacks are usually triggered by unstable coronary artery blockages of less than 70% which don’t cause any symptoms. In fact, only 20-30% of heart attacks occur at the site of an artery that’s more than 70% blocked. If you have one blocked artery causing you chest pain and other cardiac symptoms, it is virtually certain that this is merely the tip of the iceberg.
3. When you have a blockage in a coronary artery, Emergency Department staff may administer clot-busting drugs, especially if your hospital isn’t equipped to perform emergency angioplasty procedures to help re-open that artery. Clot busters, however, have only a 50-60% success rate.
4. The word “stent” comes from its creator, Charles Stent (1807-1885), an English dentist who invented a compound to produce dentures and other things like skin grafts and hollow tubes (essentially what a metal coronary stent is). His real claim to fame occurred when he suggested using his material to coat underwater trans-Atlantic cable, which had broken several times as a result of corrosion by seawater.
5. Most coronary stents start out as a solid, hollow tube. The openings (a lattice-like chicken wire effect) are then created with laser cuts, although some newer stents are braided from individual thin metal wires. It’s a design intended to keep the stent flexible enough to navigate the twists and turns of our coronary arteries.
6. The air pressure in your fully inflated car tires is about 2 atmospheres. By comparison, the high pressure used to inflate a balloon inside a coronary artery during angioplasty is between 10-20 atmospheres.
7. Angioplasty is not generally recommended for blockages below 70%. There is no proven benefit in implanting a stent in a blockage that does not impair blood flow to the heart muscle. These blockages require only medications and lifestyle changes to treat successfully.
8. There is no cure for the chronic condition called coronary artery disease (CAD). Once plaque has built up in your arteries, it is very difficult to eliminate. Embracing a healthy lifestyle can help control CAD, but remember that the word “control” here means “stopping the progression of the disease”.
9. If you have a significant coronary artery blockage (more than 70% blocked) , it’s a red flag that more blockages can happen at any time in the future. In fact, once a critical blockage like this is identified, it means you already have plaque buildup and minor blockages in many, many arteries of your heart that can significantly increase your chances of having a heart attack.
10. Up to 30% of those who have had stents implanted or open heart bypass surgery still experience angina afterwards.
This book is co-written by Dr. Allen Jeremias, a cardiologist with impressive career credentials. The format is loosely based on the varied experiences and 36 questions of five fictional but true-to-life heart patients: Brian, Michael, Diane, Rosa and Reginald. It’s a clever idea, but does mean that useful information may not be as accessible as it would be in a more topically-organized format. You virtually have to read the entire book cover to cover to make sure you catch all references to each important area. I know that many patients, however, often use heart books (or Dr. Google) to look up the answer to one key question they may have at one particular moment. The good news: the book is an easy read, so jam-packed with factual and useful information that you’ll have no trouble reading the entire book straight through. I did it in virtually one sitting.
Responses to each of the questions posed by the five fictional patients are generally those typical of patients facing angioplasty (although do so many of them have to be smokers?) Answers to the questions are divided into two sections:
- The Bottom Line (basic important information)
- The Nitty Gritty (additional info in more detail)
While the book’s 248 pages go into impressive detail for any patients who have already undergone (or are scheduled for) angioplasty procedures, there remain at least a couple of areas of unfortunate omission.
First, I was surprised to discover that despite the fact that one of the book’s co-authors (Dr. Susan Bartell) is a psychologist, the psychosocial impact of being diagnosed with heart disease is virtually ignored here.
In fact, I could find only one reference to this debilitating fallout common among so many heart patients, and that one reference is buried in a single paragraph in the “What About Sex?” section about halfway through the book:
“Aside from receiving medical clearance to engage in sexual activity, it is important to note that many individuals with coronary artery disease experience anxiety or depression as a result of the diagnosis. These feelings often come from being confronted with a life-or-death situation (especially after a heart attack). These strong emotional responses (especially depression) can contribute to decreased sexual desire or a reduced ability to perform sexually.”
But narrowly limiting this too-brief overview to the sex chapter unfortunately dismisses critically important issues that can be so damaging to overall health recovery following a cardiac event. (Mayo Clinic cardiologists, for example, estimate that up to 65% of newly diagnosed heart patients experience depression, yet fewer than 10% of these cases are appropriately identified).
I’m not a psychologist, but I’ve written more about heart disease and mental health issues on this one little blog than this book from two experts even begins to cover.
This is a serious gap in a book that includes, for instance, page after page of very sound exercise recommendations for those diagnosed with coronary artery disease. We know that one of the inevitable consequences experienced by heart patients who are suffering from depression is a severely impaired ability to follow the very exercise and lifestyle improvements recommended here. Readers keen to learn more about coping with these psychosocial issues known to be associated with a diagnosis of heart disease would do well to instead seek out Dr. Wayne Sotile‘s very useful book called Thriving With Heart Disease.
Secondly, I may have missed this, but I could find no mention here of implanting stents in patients who survive heart attacks caused by Spontaneous Coronary Artery Dissection (SCAD). No longer considered a rare disease, this often deadly diagnosis usually strikes young, healthy females with few if any cardiac risk factors. It’s now more correctly thought to be an under-diagnosed disease – not rare – and thus needs to be included in any book that covers angioplasty. Mayo Clinic, for example, has undertaken two important SCAD research trials on this deadly condition.
I’d love to see these omissions addressed in future editions of an otherwise excellent basic resource for heart patients and those who care about them.
This user-friendly book does a solid job of clearly describing cardiac diagnostic tests, angioplasty and other invasive cardiac procedure options, risk factors and heart disease symptoms – all helpfully illustrated throughout with easy-to-understand drawings. It would be especially useful to worried patients who are scheduled for angioplasty at some point in the near future, and want a comprehensive overview to help them prepare.
For these reasons, it deserves a permanent spot in my bookshelf of heart books.
Please note: information on this website or in the book being reviewed here is not intended to replace medical advice. Consult your physician for questions about your own personal health.
* Your Personal Guide: Angioplasty by Allen Jeremias, M.D. and Susan S. Bartell, Psy.D. – MPP Publishing 2012.
- The new country called Heart Disease
- Women’s heart pain is both physical and emotional
- The chest pain of angina comes in four flavours
- ‘Time equals muscle’ during women’s heart attacks
- Squishing, burning and implanting your heart troubles away
- “I’m not depressed!” – and other ways we deny the stigma of mental illness after a heart attack
- Depressing news about depression and women’s heart disease
- 10 non-drug ways to treat depression in heart patients
Q: Do you have a favourite heart book? Tell us about it.