Do you sometimes feel a tightness or pain in your chest when you are a little tired, or when you climb a flight of stairs? Or do you have difficulty breathing? These can be normal fatigue, but sometimes they can be a problem with a vein that carries blood to our heart. Today we are going to talk about a condition that is a little serious, but it is very important to be aware of. That is a condition called CTO, or Chronic Total Occlusion.
Simply put, what is CTO (Chronic Total Occlusion)?
Imagine that you have a main pipe that brings water to your house. Over time, this pipe becomes clogged with rust and dirt, and eventually becomes completely blocked, preventing even a drop of water from flowing through.
The same thing happens in our heart. We have blood vessels (we call these coronary arteries) that supply clean blood to our heart. If things like oil and cholesterol are deposited inside these veins over a period of time, and the vein becomes completely (100%) blocked, meaning if this blockage persists for more than three months , we call that condition Chronic Total Occlusion (CTO) .
When an artery becomes completely blocked in this way, the part of the heart that is affected does not receive the oxygen and nutrients it needs. This can cause symptoms such as chest pain and difficulty breathing. In some cases, this can be severe, even leading to a heart attack.
Who is most at risk of developing this CTO condition?
CTO is most commonly seen in people with heart disease, especially coronary artery disease (CAD). It has been estimated that about one in three people with CAD may also have CTO.
The same risk factors that generally contribute to heart disease also contribute to CTO. Take a look to see if you have these things too.
| Risk factor | Simple explanation |
|---|---|
| Smoking | This is the main enemy. Smoking damages blood vessels and accelerates the formation of deposits inside them. |
| High blood pressure (Hypertension) | As pressure increases, the walls of the arteries become damaged and the chance of cholesterol deposits increases. |
| High cholesterol (Hyperlipidemia) | When the amount of bad cholesterol (LDL) in the blood increases, it begins to deposit directly on the walls of the arteries. |
| Diabetes | If sugar levels are not controlled, it damages blood vessels and increases the formation of these deposits. |
| Obesity | Body weight is linked to heart disease. A BMI of more than 30 is at higher risk. |
| Family history of heart disease | If your mother, father, or siblings have heart disease, you may also be at risk. |
| Lack of exercise | Not keeping your body active is like contributing to heart disease. |
| Previous heart attack or bypass surgery | If you have had a previous heart attack or bypass surgery, you are at risk of developing a CTO in another artery. |
The most important thing is that the risk of developing CTO increases with age. Therefore, as we age, we need to take more care of our heart.
What are the symptoms of a CTO?
The symptoms of CTO can vary from person to person. Some people may not have any symptoms at all. However, the most common symptoms are:
- Chest pain, tightness, or pressure: It may feel like someone is squeezing your chest.
- Dyspnea: A feeling of shortness of breath during exertion, such as walking a short distance or climbing stairs.
- Extreme fatigue: Feeling tired all the time, even without doing any work.
- Feeling dizzy.
- Irregular heartbeat.
- Nausea.
- Pain in the upper arm: especially in the left arm.
The important thing is that these symptoms are most common when you are tired. They subside when you rest. However, sometimes these symptoms can occur even when you are not tired at all.
How does a doctor find this?
If you have these symptoms, you should definitely see a doctor. He or she will examine you and, if necessary, refer you for several tests.
The main test to confirm whether you have a CTO is a coronary angiogram . In this, a very thin tube is passed through a vein in your arm or leg to the heart's veins, and a special liquid (contrast dye) is injected. Then, an X-ray is taken to see how this liquid flows through the heart's veins. If there is a blockage in a vein, this liquid will be clearly visible because it will not flow further.
In addition, the doctor may recommend other tests such as:
- ECG (Electrocardiogram): View the electrical activity of the heart.
- Echocardiogram (Echo): A scan to look at the heart's function and blood flow.
- Stress Test: See how your heart responds when you exert yourself a little (like running on a treadmill).
- Cardiac MRI: Get a clearer picture of the heart's structure and blood flow.
What are the treatments for CTO?
If you are diagnosed with a CTO, don't panic. There are now many effective treatments for this. The treatment plan will depend on the severity of your symptoms, the location of the blocked vein, and your overall health. There are two main types of treatment.
1. Percutaneous Coronary Intervention (PCI)
This is the most commonly used, non-surgical treatment. It is done in the same way as an angiogram.
- A very thin tube (catheter) is passed through a vein in the arm or leg to the heart where the blocked artery is located.
- A small balloon is passed through that tube and inflated at the site of the blockage. The layer of oil that has accumulated inside the vein is then pressed against the sides, opening the vein.
- Then, a small mesh tube called a stent is placed over the opening. The stent helps keep the artery open and prevents it from getting blocked again.
Studies have shown that this method is successful for about 86% of patients.
2. Coronary Artery Bypass Graft (CABG)
This is an open-heart surgery. It is only recommended if multiple arteries are blocked, or if the blockage is too complex to be opened with PCI.
Simply put, this involves creating a "bypass" for a blocked vein. That is, a piece of vein from another part of your body (usually from your chest or leg) is taken and a new path is created for blood to flow around the blocked part.
This surgery produces successful results for about 60% of patients.
Your cardiologist will explain to you in detail which treatment method is most suitable for you.
Questions to ask your doctor
If you are diagnosed with CTO, it is normal to have many questions in your mind. Don't be afraid or hesitant to ask these questions to your doctor.
- "Doctor, what are the early symptoms of this CTO?"
- "What tests do I need to do to confirm this?"
- "What changes do I need to make in my lifestyle to prevent this condition from occurring?"
- "What treatment options do I have? What is best for me?"
- "After treatment, what is the chance of this condition occurring again?"
Take-Home Message
- CTO (Chronic Total Occlusion) is a serious condition in which a blood vessel supplying blood to the heart is completely (100%) blocked for more than 3 months.
- The main reason for this is the deposition of substances such as cholesterol and oil on the artery walls.
- Smoking, high blood pressure, diabetes, and high cholesterol are the main risk factors. It is very important to control these.
- If you have symptoms such as chest pain, difficulty breathing, or extreme fatigue , do not ignore them and seek medical advice immediately.
- Don't worry, there are now very successful treatments such as PCI (stent placement) and CABG (bypass surgery).
- A healthy lifestyle (good diet, exercise) and taking the medication prescribed by your doctor will go a long way in managing this condition.
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