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CARDIAC

Cardiology is a branch of medicine dealing with disorders of the heart as well as parts of the circulatory system. This field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology.

Physicians who specialize in this field of medicine are called cardiologists, a specialty of internal medicine. Physicians who specialize in cardiac surgery are called cardiothoracic surgeons or cardiac surgeons, a specialty of Cardiac surgery.

At B.P. Poddar Hospital & Medical Research Ltd., we specialise in the treatment of heart disorders and ailments, making sure that all your cardiological needs are taken care of with the best-in-class treatments and services available.

Cardiac Surgery at B.P. Poddar Hospital & Medical Research Ltd. specializes in all streams that include cardiac surgery. Innovative techniques and multiple specialists give patients, the advantage of superior therapies and preventive care for disorders of the heart and vascular system (blood vessels).

CONDITIONS

CORONARY ARTERY DISEASE

Coronary artery disease refers to a condition caused by the coronary arteries being blocked or constricted.

  • Causes of Coronary Artery Disease
  • Risk Factors of Coronary Artery Disease
  • Symptoms Which Should Cause Patients to Consult Their Doctor
  • Diagnosing Coronary Artery Disease
  • Guidelines for Treating Coronary Heart Disease

Causes of Coronary Artery Disease

Coronary artery disease is the result of a buildup of plaque around the interior wall of the arteries, causing the lining of the arteries to thicken and become constricted. When this happens, the heart can’t pump as much oxygenated blood as required. Over time, if a patient develops coronary artery disease, his or her blood vessels will no longer be able to supply sufficient oxygenated blood to the heart muscle, which can lead to sudden and severe chest pains or heart attack. If there is a sudden blockage of the arteries caused by deposits of plaque, a rupture or a blood clot may then develop, resulting in a potentially fatal heart attack and other serious related complications.

Risk Factors of Coronary Artery Disease

The risk factors of coronary artery disease can be divided into two main types, as outlined below:

Unavoidable risk factors :

  • Family history: If you have a close family member who has suffered from coronary artery disease, then you are more likely to develop coronary artery disease.
  • Aging: As you grow older, the quality of your blood vessels will begin to deteriorate.
  • Gender: Men are more likely to develop coronary artery disease than women. However, women who have already reached menopause are at almost equal risk of developing coronary artery disease as men.

Avoidable risk factors: In a study conducted during the year 2008-2009, researchers monitoring the risk factors of heart disease and coronary artery disease in Thailand found that the condition often develops due to poor lifestyle choices as outlined below.

  • Being overweight or obese: Gaining weight, or having a higher than normal body mass index (BMI), will increase your risk of developing heart disease and coronary artery disease. In Asian countries, healthy individuals should have a BMI of no more than 23kg/m2.

There are a number of symptoms directly caused by being overweight or obese which can significantly increase your chances of developing heart disease or coronary artery disease. Also known as metabolic syndrome or insulin resistance, the condition is usually diagnosed when a patient presents with three of the five following symptoms:

  • (1) Obesity: For women, obesity should be diagnosed when the patient's waist reaches a width of 80 centimeters, while that number is 90 centimeters for men.
  • (2) High blood pressure: If you have a blood pressure level of 130/85 mm Hg or higher.
  • (3) Diabetes and abnormal blood sugar: If you have diabetes or your blood sugar level reaches 110mg/dL or higher after not eating or drinking for eight hours.
  • (4) If your triglyceride count is 150mg or higher after not eating or drinking for 12 or more hours, or if (you are already taking weight loss drugs (also known as diet pills).)
  • (5) If your HDL cholesterol level (HDL-C, good or healthy fats) is less than 40 mg in men, or less than 50mg in women.

High blood pressure: To be diagnosed with high blood pressure, a patient must have a blood pressure of 140/90 mm Hg or higher. High blood pressure causes the lower left ventricle to thicken and become inefficient - a condition also known as hypertrophy. Hypertrophy is a key risk factor for heart disease and coronary artery disease. In terms of diet, studies have shown that eating large amounts of salty foods is another key factor which causes high blood pressure.

Stress: There are five stress-related factors which are known to increase your chances of developing heart disease and coronary artery disease. These are depression; chronic and unresolved stress; repressed emotions; loneliness and a lack of close relationships, social support and close relatives; and status anxiety.

High blood sugar level or diabetes: Chronic high blood sugar causes deterioration of the arteries, both large and small, including the coronary arteries. Over time, if you have chronic high blood sugar or diabetes, the cells along the inner walls of your arteries will no longer be able to reproduce efficiently. This causes your arteries to harden and become inefficient, which in turn causes other organs to deteriorate, as well as putting you at greater risk of coronary artery disease.

High blood lipids (fats): If you have an abnormal level of lipids (fats) in your bloodstream, then your arteries are at a greater risk of becoming clogged. Individuals who are not sick and do not suffer from other health problems related to fat should use the following readings as a guide for protecting themselves against coronary heart disease. Your overall cholesterol level should be less than 200mg/dL; your LDC cholesterol (or bad fats) should be less than 100mg/dL; your HDL cholesterol (good fats) should be more than 40mg/dL in women and more than 50mg/dL in men; and your overall triglycerides count should not exceed 150mg/dL.

Lack of exercise: Not being physically active and not getting enough exercise makes you 1.5 times more likely to develop heart disease and coronary artery disease.

Not having enough fruit and vegetables in your diet: Studies have found that most people eat too many sweet, fatty, and high-calorie foods. Not eating enough fruit and vegetables is also a factor which will increase your risk of developing coronary artery disease.

Smoking: This refers to people who smoke regularly; people who don't smoke but inhale passive smoke from others (second-hand smokers); people who consume smokeless tobacco, such as snuff other chewing tobacco; as well as people who have smoked regularly in the past but have recently quit. Studies have found that smokers are 2.4 times more likely to develop coronary heart disease than non-smokers, due to the high amount of poisonous chemicals contained in cigarettes, such as nicotine, which destroys the inner walls of the arteries; hydrogen cyanide, which causes the blood vessels to harden; and carbon monoxide, which destroys the hemoglobin required to transport oxygen via the red blood cells, causing the body to become starved of oxygen and meaning that the heart has to work harder. Additionally, cigarette smoke causes blood platelets to clump together, meaning that the blood sticks together and develops clots more easily. These different factors can lead to constricted or severely blocked blood vessels.

Symptoms Which Should Cause Patients to Consult Their Doctor

  • A crushing pain in the chest is a typical symptom of coronary heart disease: the pain is severe, and is often likened to a heavy load being placed on top of you, or being squeezed around the chest or underneath the sternum. You may also experience a pain in the neck, jaw, shoulders and arms, especially on your left side, and particularly during exercise, lasting for around 2-3 minutes. When seated, or when taking medication to dilute the blood vessels under the tongue (also known as nitrates), the symptoms should improve.
  • You may feel easily tired during physical activity or when exercising. This can take place suddenly and severely in one to two weeks, or it can be a chronic symptom lasting for three weeks or more.
  • Fatigue, shortness of breath, difficulty lying on one's side, tightness in the chest, shallow breathing and also a crushing chest pain. These symptoms may appear suddenly or periodically and may last for a long time.
  • Fainting, as well as tightness of the chest, which is caused by sudden or severe low blood pressure.
  • Unconsciousness or cardiac arrest.

Diagnosing Coronary Artery Disease

B.P.Poddar Hospital Together with a physical examination, a review of the patient history should include the history of heart disease in the family, smoking history, diet, exercise, chronic illness, etc. This will help the doctor to know whether the patient is at risk of developing coronary artery disease.

B.P.Poddar Hospital Lab investigation and special examination, such as:

  • Electrocardiogram
  • Chest X-ray
  • Cardiac enzyme test
  • Exercise stress test
  • Echocardiogram
  • Computed tomographic angiography
  • Cardiac catheterization or coronary angiogram

Guidelines for Treating Coronary Heart Disease

  • The doctor will offer recommendations of lifestyle and behavior changes that will help you to protect against risk factors, for example, quitting smoking, eating healthily, taking regular exercise, and reducing stress.
  • Treatment using medication, such as antiplatelet and anticoagulant medicines, vasodilator medicines, antiarrhythmic medicines and beta blockers, weight loss pills.
  • Treating coronary artery disease with angioplasty and stents is a way to expand the coronary artery by using a balloon combined with implant stents to prop up the artery wall.
  • Coronary artery bypass surgery / coronary artery bypass grafting

Protecting Against Coronary Artery Disease

The best way to protect against coronary artery disease is to change your lifestyle and behavior patterns which constitute risk factors, such as:

  • Changing your diet: Every individual should eat only enough to meet the physical demands of each day, in order to maintain one's energy balance.

  • Age group Energy required per day (kilocalories)
    Children aged 6-13 1,600
    Working women aged 25-60 1,600
    Elderly persons aged 60 and above 1,600
    Young men and women aged 14-25 2,000
    Working men aged 25-60 2,000
    Working men and women in strenuous occupations, such as farmers, labourers, athletes, etc. 2,400

You should eat foods that are low in fat and low in salt. Avoid animal fats, saturated fats, and trans fats. Cut down on sugary drinks and try to eat more and a greater variety of fruits and vegetables. The World Health Organization (WHO) recommends that each person should eat at least 600 grams of fruits and vegetables per day. Avoid salty foods (you should consume no more than 2.4 grams of salt per day, which is no more than a teaspoon of salt, or no more than 1½-2 tablespoons of fish sauce or soy sauce). You should also avoid junk food, fast food, and preserved food.

B.P.Poddar Hospital Perform regular exercise and be more physically active: Physical activity or exercise can be moderate or slightly more strenuous at your discretion. Your aim is to burn enough energy to increase breathing and raise your heart rate above its normal level. Try exercising continuously for ten minutes or more per session. This could even just mean taking a walk around the office at work, doing some house work, cooking, carrying light objects, performing work-related activities, walking as part of your daily routine, or other activities during your spare time.

B.P.Poddar Hospital Quit smoking: Studies have shown that when you stop smoking for 20 minutes, your blood pressure falls to a normal level. After quitting smoking for at least 10 years, a former smoker will have a similar risk of developing heart disease and coronary artery disease as non-smokers. And after quitting smoking for more than 15 years, a former smoker will be only as likely as a non-smoker to develop heart disease and coronary artery disease.

B.P.Poddar Hospital Reduce stress: The best way to manage stress is by doing things you enjoy, such as exercise, yoga, or meditation. You should also strive to have healthy relations with your family members and others in your workplace or community.

HEART DISEASE

The heart is a hollow muscular organ the size of a fist. It lies in the center of the chest, slightly to the left and under the sternum or breastbone.

The heart’s function is to pump blood containing oxygen and nutrients to all parts of the body. The heart is divided into four chambers (two atriums and two ventricles). The right side of the heart receives "used" blood from the body and pumps it to the lungs, where it picks up oxygen. The oxygen-rich blood then returns to the left side of the heart and is pumped through the aorta to all parts of the body.

There are four valves in the heart. These are located between the upper and lower chambers of the heart and in the major blood vessels of the heart. The valves keep blood pumping in one direction.

At rest, a heart beats an average of 60–100 times a minute. Each beat or contraction is caused by an electrical stimulus triggered by specialized cells called the SA node. The electrical impulse from the SA node travels through a series of fibers located throughout the heart chamber and causes a contraction of the heart muscle.

Coronary Arteries

The heart, like the other organs in the body, needs oxygen to function effectively. The coronary arteries provide oxygen-rich blood to the heart muscle.
The coronary arteries branch off the aorta. They lie on the surface of the heart and have many branches to feed all of the heart muscle.

Coronary Artery Disease

The lining inside a healthy coronary artery is normally smooth. Damage to the inner lining of the artery contributes to gradual build up of material (fatty layers and other deposits - called atherosclerosis). This build-up blocks the flow of blood and may eventually lead to serious problems such as angina or heart attack.
The build up is much like what happens in an old rusty pipe. Only a trickle of blood can get through which creates an imbalance between the demand of the heart muscle for oxygen and the ability of the narrowed coronary artery to meet that demand.

What is angina?

When the heart does not receive enough oxygen-rich blood some discomfort called angina may be experienced. Angina is also caused by a spasm in the coronary artery. Angina is the heart's way of warning that it needs more oxygen.
Each person may experience any of the many different symptoms associated with angina.

  • Pain, aching or discomfort
  • Indigestion
  • Squeezing or cramping
  • Numbness or tingling
  • Shortness of breath Tightness
  • Pressure
  • Fullness or heaviness
  • Burning
  • Sweating or dizziness

Symptoms may be felt in the chest, shoulders, upper back, arms, neck, throat or jaw. Angina can be triggered in times of stress, during vigorous physical activity, or after heavy meals. Never ignore angina. Rest and medication are both effective ways to relieve angina.

What is a Heart Attack or Myocardial Infarction?

A heart attack occurs as a result of a blocked coronary artery. Since the coronary arteries are like pipelines running through the heart, a clot, blockage or spasm will restrict blood flow. The area of the heart that does not receive oxygen may become permanently damaged. Damage to the heart muscle occurs when the cells of the heart are starved of oxygen. These cells die because of the blockage. Eventually scar tissue is formed in the damaged area.

How your heart muscle heals?

After a heart attack, the heart muscle is damaged. The damaged area will heal and scar tissue will form. Small blood vessels can enlarge to nourish the area that surrounds the scar or damaged site. A partial scar is formed in three to four weeks. A firm scar develops anywhere from six weeks to three months after the initial injury.

New circulation surrounding the damage area is called collateral circulation. Aerobic exercise helps to form this new circulation that nourishes the heart. Rest and gradual increase in activity is the key to success. Aerobic exercise will strengthen the heart muscle and help it become a more efficient pump.

Congestive Heart failure

Congestive heart failure (CHF) occurs when the heart is unable to pump forcefully enough to circulate blood to all parts of the body. If the heart is weakened or damaged, it may be a less effective pump. When this happens, blood begins to back up in the chambers of your heart, lungs or other parts of the body.

Symptoms of CHF include:

  • Shortness of breath - may be all time, with exertion, or only at night
  • Sudden weight gain from fluid not fat
  • Swelling (edema) of hands, feet or abdomen
  • Extreme fatigue
  • Dry, hacking, frequent cough
  • Difficulty sleeping

Most of the time these symptoms can be controlled with rest, diet and medications. You can help control these symptoms by:

Contacting your doctor when any of the above symptoms concern you. Take your medications as prescribed. They will help prevent water retention and increase effective heart contraction. Weigh yourself each day, recording your weight and call your doctor with any rapid weight gain. Follow a low sodium diet as recommended by your doctor. Rest when you feel tired. This will help to reduce the workload on your heart.

Arrhythmia

Damage to the heart can affect the electrical impulse in the heart and change the rhythm. Disturbance in the rhythm of the heartbeat is called an arrhythmia. It has various causes. Arrhythmiascan be too slow, too fast, irregular or all of these.

Some are serious. They can be treated by medications and sometimes surgery. Some arrhythmias may need a pacemaker. Life -threatening arrhythmias may need emergency shock treatment (defibrillation) to restore the heart's rhythm.

Find more information about arrhythmia treaments

What causes heart disease?

There are many unanswered questions when it comes to heart disease but there are certain risk factors that have been identified as contributing to its development and progression.

Coronary risk factors are habits or personality characteristics that may increase a person's risk of developing heart disease. Risk factors are divided into two groups: the controllable risk factors that can be altered, and the uncontrollable risk factors that cannot be altered.

It's important to note that while you can’t change your age, gender or family history, you can modify or delay their effects by working on controllable risk factors that can be changed. You can prevent future cardiac problems.

Uncontrollable risk factors

  • Family history: Your chance of having a heart attack is greater if you have parents, grandparents or siblings with heart disease. Familiar lifestyles as well as genetic tendencies may contribute to this fact.
  • Age 55 or over: Coronary artery disease is associated with the aging process. The older a person becomes the more likely he or she is to develop atherosclerosis.
  • Gender: Current research shows that coronary artery disease is more prevalent in men than in women. This may be due to hormonal factors. Women after menopause have increased risk of cardiac events.

Controllable Risk Factors

  • Cigarette smoking: Smoking contributes to lung cancer, bronchitis and emphysema. Smokers have more than twice the risk of heart attack and are two to four times more likely to die of sudden cardiac death than non-smokers. Smoking is also detrimental to family members. The nicotine in cigarettes causes the heart to work harder, increasing the heart rate and blood pressure. The carbon monoxide in cigarette smoke clings to the hemoglobin in your blood more readily than oxygen does, thus your heart may not get the oxygen it needs. These chemicals may also contribute to injury in the artery walls. Do not smoke!
  • High Blood Pressure: High blood pressure can speed the process of atherosclerosis and put an added strain on your heart. The pumping force needed to supply blood for your body is greater with elevated blood pressure.
  • Hypertension increases your risk of heart attack, heart failure or stroke. You can control hypertension by modifying your diet, exercising regularly, taking medications your doctor has prescribed as directed and learning relaxation and stress management techniques.
  • High Cholesterol: Cholesterol is a fatty substance made by your body and found in some foods. Cholesterol is the main ingredient of the fatty deposits that are found in the coronary arteries when coronary artery disease develops. The higher the cholesterol levels in your blood, the greater the chance this disease will develop and progress quickly. To keep blood cholesterol at a healthy level, it is important to follow a low-fat, low cholesterol eating plan.
  • Diabetes: Diabetes Mellitus is a disorder characterized by raised blood sugar levels. This is caused by the failure of the body to produce insulin (a hormone that helps to move sugar from the blood to the body’s cells), or the body resisting the insulin that is present. Prolonged high levels of blood sugar damage the inside lining of blood vessels and encourage plaque deposits to accumulate (atherosclerosis). Keeping your diabetes well controlled reduces the risk.
  • Sedentary lifestyle: Inactivity has been shown to increase the risk of developing coronary artery disease. Regular exercise has numerous benefits. It can strengthen your heart muscle and help it work more efficiently. It can also help lower your cholesterol level, maintain an ideal body weight and aid your coping with stress. If you do not exercise regularly (at least three to five times per week) and your job does not involve regular physical activity, you have a sedentary lifestyle. Beginning a safe exercise program after a heart attack or bypass surgery can help you to recover more rapidly and help prevent further cardiac problems. It is important to start slowly, increase your level of exercise gradually and have fun. Most people find it helpful to participate in a cardiac rehabilitation program designed to help you begin a safe exercise program which is individualized to meet your needs.

Other factors to consider:

  • Diet: A low fat and low cholesterol diet can help to prevent atherosclerosis (the deposit and build up of fatty substances in your arteries). Foods to avoid are foods that contain large amounts of saturated fats such as meats, fast foods, butter, and full fat dairy products.
  • Stress: Negative stress has been linked to many physical ailments ranging from heart attacks to tension headache. Learning to recognize your stress response and anticipating situations that trigger it may help avoid some stressful situations.
  • Obesity: If you are obese or overweight, your heart has to work harder to supply your tissues with blood, oxygen and nutrients. An overweight person's heart also works harder to do activities than a person at his or her ideal body weight. Reducing your weight with exercise and sensible diet can help you modify other controllable risk factors.
  • Excessive use of alcohol: Prolonged use of excessive amounts of alcohol can contribute to elevated fat (triglyceride) levels in the blood. It may also damage your heart muscle, thus interfering with your heart's ability to pump blood to the rest of your body.

How do you know if you have heart disease?

There are often no signs that a person has heart disease. A doctor can use a number of tests to determine if there is a problem.

History and physical examination

A complete physical examination can help determine if you have or may develop heart disease. Your medical history is also important. Questions about smoking history, alcohol intake and exercise habits, will be asked. Information about your health history as well as a history of your family's health will also be important.

Electrocardiogram (EKG or ECG)

ECG is short for Electrocardiogram, which measures the heart's electrical beating pattern. Electrodes are placed on the chest wall to pick up the electrical impulses, which are then printed on a graphed paper. A similar pattern is seen in normal functioning hearts. A change in this pattern may indicate that an area of the heart is injured or damaged. This is a very simple procedure and can be easily performed in any doctor’s office.

Exercise Stress Test

A stress test is similar to a resting ECG test in that a series of leads are attached to your chest. However, the recording is made while exercising, such as walking on a treadmill or riding a stationary bicycle. This exercise intensifies the demands on your heart by increasing your heart rate and blood pressure. This test is used to evaluate the heart's response to physical stress, including: electrical abnormalities, the amount of blood flowing to the heart muscle, and the heart muscle's response to exercise.

Blood enzyme tests

Cardiac enzymes are substances normally stored in heart muscle cells. When the heart is damaged, enzymes are released into the bloodstream. These blood tests show an increase in the level of enzymes when you have had a heart attack.

Echocardiogram

An echocardiogram uses high frequency sound waves to take moving pictures of your heart. Your doctor studies the pictures to measure and determine the function and structure of your heart.

Radionuclide Scan

A radionuclide scan is a test in which a radio-active substance (Radionuclide) is injected into your blood stream and travels to your heart. A special camera projects a picture of your heart on screen, showing any malfunction of your heart.

Heart Catheterization (angiogram)

A heart catheterization is an X-ray test performed by a doctor. A thin, flexible tube is passed through the blood vessel in your groin and follows the artery to your heart. A special dye is injected through the tube. The location of any narrowing or blockages can be seen on an X- Ray screen.

Treating Heart Problems

There are several different ways to treat heart disease. The doctor takes many factors into consideration when deciding how to treat a blocked artery. These factors are:

  • The number of blockages
  • The location of blockages
  • Your medical history
  • Your individual needs

Medication

There are many medications that can be used to treat heart disease, and they all work in different ways. Some decrease the stress on your heart and others may increase its ability to pump blood.

Coronary Angioplasty and Stent Placement

Coronary angioplasty (PTCA) and stent insertion is a method used to open a blockage in a coronary artery from inside the artery. Like an angiogram, a long tube or catheter is threaded through to the heart from the artery in the groin or arm. The catheter used has a special balloon at the tip. The balloon catheter is threaded down the coronary artery containing the blockage. The balloon is inflated at the blockage and compresses the plaque of cholesterol, thereby opening a new channel for blood flow. Where possible, an expandable metal tube (stent) is implanted in the blockage, using the balloon catheter. The stent acts like a scaffold in the blockage and provides a better opening in the artery.

Open Heart Surgery

Open Heart Surgery is done when normal circulation is changed by coronary artery disease, heart valve disease, or other heart problems. Common heart surgeries are:

  • Coronary artery bypass graft
  • Repair or replacement of Valves
  • Atria septal defect repair
  • Aneurysm of the heart muscle
  • Aneurysm of the aorta

Coronary artery surgery

Coronary artery surgery is done to bypass each narrowed artery with a healthy vein or artery from your body. A leg vein (usually the saphenous vein) or an artery from your chest (internal mammary artery) and from your arm (radial artery) or Gastroepiploic artery can be used for the bypass graft. Your doctor will decide on what type of graft to use depending on the number and location of your blockages. The bypass increases blood flow to the heart muscle to relieve angina and improve heart function.

Heart valve surgery

The valves can be abnormal or damaged by birth defects, infection (rheumatic fever or scarlet fever) and degeneration from aging. When scarring or thickening occurs, this makes the valves harder to open (stenosis) or unable to close completely (insufficiency). A damaged heart valve may be repaired but more often it must be replaced with a mechanical or tissue valve.

Atrial septal defect

The atrial septum is the wall that divides the upper chambers (atria) of the heart. An atrial septal defect (ASD) is an opening in this wall "hole in the heart" that fails to close during fetal development. The surgery is designed to repair this hole so that blood will follow the normal pathway through the heart chambers.

You can read more articles about the heart disease treatment and condition in detail at Heart (Cardiology) Center and Arrhythmia Center.

CONGENITAL HEART DEFECTS

Congenital heart defects (congenital heart disease) , refers to certain abnormalities in the structure of the heart or in the blood vessels around the heart. The heart of an infant in the womb normally begins to develop in the 5th week of pregnancy, and will be fully formed by around the 12th week. Genetic material known as genes is responsible for the construction of the infant's heart. Genes direct the action, order, and structure of the heart, and act as a blueprint for the rest of the body. A huge number of genes are required for the development of an infant's heart during pregnancy, and each of these genes must fit together correctly. If there is a defect in any one gene, or in any number of genes, then it may cause structural abnormalities to develop in the heart of an unborn child. At present, only a few defects in a small number of genes have been scientifically proven to cause congenital heart defects, and for the majority of patients, the doctor will be unable to identify the exact cause of the condition. The doctor will be aware, however, of certain factors which increase the risk of congenital heart defects in unborn children, by monitoring for such factors during pregnancy as the infant's heart develops.

  • Factors
  • Symptoms
  • Diagnosis
  • Treatments

Factors Which Increase the Risk of Congenital Heart Defects

1. Certain Types of Hereditary Conditions

  • Down syndrome develops when an infant has more than two copies of chromosome 21, which in turn causes delayed motor and cognitive development and lower than average IQ. Around 40 percent of children who have Down syndrome will also have heart defects.
  • Turner syndrome develops when an infant girl is born with only one X chromosome, leading to a shortness of height and absence of menstruation (infertility). Around 30 percent of girls who have Turner syndrome will also develop heart valve defects and constricted blood vessels around the heart.

2. Risk Factors for Mothers During Pregnancy

  • Chronic conditions, such as diabetes. Women with diabetes who manage their blood sugar level poorly during pregnancy will increase the risk of their child developing congenital heart defects. Common congenital heart defects caused by diabetes during pregnancy include Transposition of the Great Arteries (TGA), and a thickened heart muscle.
  • Illness during pregnancy, especially during the first trimester, can have an impact on the development of an infant's heart. If a pregnant mother is sick with German measles, for example, it may cause congenital heart defects in her child as well as defects in other organs such as the brain and eyes. If a pregnant mother is sick with influenza during pregnancy, this will double the risk of her child developing congenital heart defects. Therefore, during pregnancy the mother should make sure to look after her own health; and before pregnancy, the mother should get vaccinated for German measles and influenza (if she does not already have immunity). In addition, if the mother has a high fever during pregnancy, this can also cause congenital heart defects in her child. The mother should therefore take medication to reduce fever symptoms during pregnancy. Paracetamol is a safe medication to use for fever during pregnancy. However, a pregnant mother should not use other medications such as aspirin to reduce fever, as aspirin can cause heart defects in unborn children. Pregnant mothers should exercise caution, use as little medication as possible, and consult a doctor before taking any kind of medication during pregnancy.

Using medication or other drugs during pregnancy

1. Use of alcohol or drugs during pregnancy may cause heart and other organ defects in the child in the womb, including brain defects. The severity of such defects will depend on the amount of drugs or alcohol the mother consumes during pregnancy. The best way to protect against such defects is for the mother to abstain from drinking alcohol and using narcotic drugs for the entire duration of her pregnancy.

2. The mother should avoid using other drugs such as anticonvulsants, ibuprofen, and medication to treat spots or acne caused by vitamin A (retinol) deficiency, including both creams and tablets.

3. The mother should also avoid coming into contact with certain types of chemicals, especially organic solvents used in paints, oil varnish, and nail polish.

Symptoms of Congenital Heart Defects

The symptoms of congenital heart defects will depend on the type and severity of the heart defects present. In patients who have only mild congenital heart defects, there will usually be few symptoms or no symptoms at all. For patients who have more severe defects, however, the following symptoms may be observed:

  • Bluish tint of the skin, lips, fingernails, and inner lining of the mouth (cyanosis)
  • Rapid heartbeat
  • Rapid breathing / difficulty breathing
  • Becoming tired easily; decreased breast milk intake due to becoming tired easily
  • Not growing or gaining weight properly
  • Excessive sweating
  • Fatigue

Diagnosis

By monitoring the child's development using ultrasound scans, some types of congenital heart defects can be diagnosed while the child is still in the womb. However, some defects may only be identified once the child is born, and often congenital heart defects may only be identified once the child has grown older or into an adult. If the doctor suspects that a child may have congenital heart defects, the doctor will conduct a physical examination of the child and may need to conduct further tests, such as those described below:

  • An echocardiogram, which uses ultrasound waves to examine the interior structure of the heart, the heart valves, and the function of the heart.
  • An electrocardiogram, which measures the electrical activity of the heart. It measures the amount of electricity and the time it takes for the electricity to pass through the heart so that doctor may be able to find out if parts of the heart are too large or are overworked.
  • A chest X-ray, which examines the size and the position of the heart, as well as the condition of the blood vessels which supply blood to the lungs.
  • Cardiac catheterization, which refers to the insertion of a small plastic tube (known as a catheter) into a large blood vessel, usually in the groin or the side of the neck. The catheter is then guided towards and enters the chambers of the heart, where it can measure the pressure and the level of oxygenated blood, in order to examine the functioning of the heart. Additionally, the doctor may also inject a special dye (known as contrast medium) into the heart in order to examine the functioning of the heart utilizing X-ray movies.
  • An MRI scan, which examines the structure of the heart and creates 3-D images of the heart using a magnetic field and pulses of radio wave energy.
  • A CT scan, which examines the structure of the heart using an X-ray computer.

Treating Congenital Heart Defects

Congenital heart defect patients with only mild heart defects who have no symptoms and follow a normal growth pattern will normally not require treatment. However, patients who experience severe symptoms, such as a heart failure, shortness of breath, or becoming easily tired, will likely need to take medication to manage their symptoms. However, if the symptoms do not improve with treatment, then catheter intervention or heart surgery to correct the defects will be required. Certain types of defects, such as a hole in the heart wall can be treated using a heart catheterization so that an open heart surgery can be avoided. During the heart catheterization, a specially designed device can be mounted on the tip of a small plastic tube. This plastic tube can be inserted into a large blood vessel, usually from the groin, and sneaked into the heart to the site of the defect. Then, the device will be deployed to close off the defect.

Looking After Children with Congenital Heart Defects

  • Growth and development: Some factors related to congenital heart defects may interfere with a baby’s growth. These include rapid heartbeat, increased respiratory rate, poor appetite, and decreased food intake due to rapid breathing and fatigue. The most common reason for poor growth is that the baby does not take in enough calories and nutrients. But even if your baby seems to drink enough milk, he or she may still gain weight very slowly due to the increased caloric needs. A 250-450 gram gain in a month may be an acceptable weight gain for a baby with a heart defect.
  • Most children with congenital heart defects can attend school and fully participate. However, some children may have delays in development or learning difficulties. A child’s primary physician can make recommendations for testing and work with parents to find the right solution for the child.
  • Heart defects could lead to an increased risk of heart tissue infection (endocarditis). The mouth is a major source of germs that cause infection. Therefore, good oral hygiene is very important in preventing infection of the heart. Some children with congenital heart defects may need to take antibiotics before surgery or undergo dental procedures to prevent heart infection.
  • Some children with congenital heart defects require multiple procedures and surgeries throughout life. Even after corrective surgery, these children require ongoing care for the rest of their life.
ARRHYTHMIA

Arrhythmia is an irregular heartbeat - the heart may beat too fast or too slowly. The condition is caused by changes in the heart’s electrical system or a short circuit in the heart. This causes the heart to pump blood inefficiently resulting in poor blood circulation in the body. This can lead to an increased risk of heart failure and stroke.

  • Types of Arrhythmia
  • Causes of Arrhythmia
  • Symptoms of Arrhythmia
  • Diagnosis of Arrhythmia
  • Arrhythmia Treatment Options
  • Prevention of Arrhythmia

Types of Arrhythmia

There are two major types of arrhythmia as follows:

  • Tachycardias (the heartbeat is too fast)
  • Bradycardia (the heartbeat is too slow)

Causes of Arrhythmia

The causes of arrhythmia vary in each patient. Whether the heartbeat becomes faster or slower depends on the individual’s lifestyle, health history and environment. Common causes of arrhythmia include:

  • Congenital defects or heart defects, such as congenital heart disease, valvular heart disease, hypertrophy (swelling of the heart), and ischemic heart disease (coronary artery disease).
  • Physical abnormalities which affect the ability of the heart to function well, such as high blood pressure, high blood cholesterol, diabetes, thyrotoxicosis, and electrolyte imbalance.
  • Certain medications and substances (such as medications containing amphetamine) and caffeine in tea, coffee or carbonated drinks.
  • Stress and anxiety

Symptoms of Arrhythmia

Most patients with arrhythmia do not know that they have this problem. Arrhythmia is mostly discovered during a medical check-up or the treatment of other diseases. Sometimes, patients might have a family history of sudden cardiac arrest. However, some patients experience the following symptoms:

  • Dizziness
  • Blackouts
  • Lightheadedness
  • Palpitations
  • Shortness of breath
  • Chest pain
  • Fainting and collapsing

Diagnosis of Arrhythmia

  • Patient information is collected, including caffeine consumption (such as in tea, coffee or carbonated drinks) and underlying diseases (such as coronary thrombosis, high blood pressure, diabetes, and thyroid diseases)
  • Electrocardiogram (ECG or EKG) is performed when symptoms are observed at hospital or could performed at home as:
    • Holter monitoring test (a test of the heart’s rate and rhythm) is performed for 24 or 48 hours if the patient experiences symptoms often but not constantly.
    • Event recorder is only used when you have symptoms. The device can be a wrist band with an activation button or a pager-sized device that you press onto your chest if had dizziness and palpitation.
    • Looping monitor may be a wrist band, finger attachment, chest plate or surgically placed under your skin. This device records several minutes at a time, then starts over. The patient will push a button during or after an event to save the recording if rarely had fainting and collapsing.
  • Exercise Stress Test (EST)
  • Echocardiogram
  • Cardiac electrophysiology study

Arrhythmia Treatment Options

The doctor will choose a treatment based on the causes, symptoms, location and severity of the disease. Some types of arrhythmia may not require treatment. However, medical treatment is needed for certain types of arrhythmia as follows:

  • Heart Rate Control Medications: Although the medications do not cure the problem, they can reduce episodes of arrhythmia and the severity of the symptoms. Some rhythm disorders respond well to medication.
  • Pacemaker: In order to maintain the heart rate at a regular beat, a small device called a pacemaker is placed under the skin near the collarbone with a wire extending from the device to the heart. The pacemaker helps regulate and optimize heart-rate-related functions.
  • Cardioversion: Cardioversion is used to slow down a rapid heartbeat. This is done externally in a monitored setting. A small electrical shock is delivered to the chest wall that synchronizes the heart rate in order to bring the heart back to a normal rhythm.
  • Ablation Therapy: This procedure is used to eliminate the source of the irregular heartbeat and can permanently cure certain heart arrhythmias. Ablation therapy is usually combined with electrophysiology study. A catheter is threaded through to the area of the heart that is believed to be the source of the arrhythmia. High-frequency electrical energy is then delivered to eliminate the small area of tissue inside the heart that causes the abnormal heart rhythm.
  • An MRI scan, which examines the structure of the heart and creates 3-D images of the heart using a magnetic field and pulses of radio wave energy.
  • Implantable cardioverter defibrillator: This is a similar procedure to implanting a pacemaker. This device is recommended if the patient is at risk of developing a dangerously irregular heartbeat in the lower half of the heart (ventricular fibrillation). If the device detects a rhythm that is too slow, it will stimulate the heartbeat. In contrast, when the heart beats too fast, a series of small electrical impulses will be delivered to the heart muscle to slow it down and restore a normal heart rate.

Prevention of Arrhythmia

There is no guaranteed method for preventing arrhythmia, but you can reduce the risk in the following ways:

  • Don’t smoke, reduce stress, and drink coffee and alcohol in moderation, or not at all.
  • Eat a healthy diet and exercise regularly.
  • See your doctor for regular medical check-ups.
HEART FAILURE

Heart failure refers to a wide range of symptoms caused by abnormalities in the functioning of the heart. It may develop due to abnormalities in either the structure or functioning of a patient's heart, which, as a result, causes the heart to become inefficient in pumping blood to the rest of the body or in retrieving blood from the rest of the body.

  • Types of Heart Failure
  • Symptoms of Heart Failure
  • Factors Which May Exacerbate Heart Failure Symptoms
  • Diagnosing Heart Failure
  • Guidelines for Treating Heart Failure
  • Self-Care for Heart Failure Patients

Types of Heart Failure

Heart failure is divided into many different types, but when classified according to the duration of symptoms, heart failure falls into one of two categories:

  • Acute heart failure – Acute heart failure refers to cases in which new heart failure symptoms develop rapidly and in a short period of time. Acute heart failure may also refer to cases in which symptoms of previous heart failure have stabilized, but have later returned and become more severe in a short period of time.
  • Chronic heart failure – When the doctor physical examination for chronic heart failure, they are looking to find out whether the patient's symptoms and/or abnormalities in heart function have been present for an extended period of time.

Symptoms of Heart Failure

Heart failure produces symptoms and other complications when the amount of blood being pumped from the heart is insufficient in meeting the demands of the rest of the body. Symptoms may also arise due to excess salt and fluid retention.

Common symptoms of heart failure include:

  • Shortness of breath (which is a key symptom of heart failure). Patients may also experience exhaustion during physical activity, fatigue, difficulty breathing or coughing when lying down, and may wake during the night due to shortness of breath.
  • Patients may develop fatigue and muscle cramps when there is a reduced amount of blood reaching the muscles, making it difficult to carry out daily routines.
  • Swelling may develop due to fluid and salt retention, which usually occurs around the legs and ankles. Additionally, heart failure patients may also develop fluid retention in the lungs, liver, or large intestine. Fluid retention can also occur in the abdominal cavity, causing discomfort, pain, and bloating of the abdomen.

Factors Which May Exacerbate Heart Failure Symptoms

  • Heart conditions, such as rapid heart rate (tachycardia), slow heart rate (bradycardia), the heart muscle not receiving sufficient blood (myocardial ischemia), cardiomyopathy, or heart valve disease, etc.
  • Excessive salt, fluid, or medication intake
  • Use of medications that cause fluid or salt retention, impair heart muscle function, or are toxic on the heart.
  • Not taking medications regularly.
  • Excessive alcohol consumption
  • Various conditions, such as kidney damage or failure, blood clots in the lungs, high blood pressure, thyroid disorders, anemia, and infections, etc.

Diagnosing Heart Failure

  • he patient’s history should be examined in detail in order to identify risk factors and other conditions which may result in heart failure – this also includes reviewing the history of previous heart failures in both the patient and their relatives.
  • Comprehensive physical examination.
  • Assessment of fluid and electrolyte balance.
  • Laboratory tests to assist in diagnosis and treatment:
    • Blood test, red blood cell count, kidney function test, liver function test, thyroid gland function test, or cardiac enzyme test.
    • Chest X-ray.
    • Electrocardiogram.
    • Heart test using an echocardiogram or ultrasound scan.

Guidelines for Treating Heart Failure

Many factors must be considered before a patient may begin heart failure treatment. The cause of the patient's heart failure, for example, must first be established, as well as the severity and duration of symptoms, and other co-existing conditions. After assessing such factors, the doctor will decide on the best treatment option for the patient. Heart failure treatment aims to reduce the severity of the patient's symptoms and increase life expectancy by focusing on suppressing or decelerating the development of changes in the structure or functioning of the heart, and also by protecting against other complications which may arise as the condition progresses.

Treatment options include:

  • Medication, such as diuretic drugs, drugs to reduce blood pressure, drugs to increase heart function, hormone therapy, drugs to treat coronary artery disease, antiplatelet drugs, drugs to treat irregular heart rate, etc.
  • Use of an automated implantable cardioverter-defibrillator (AICD) or a permanent pacemaker implantation to help the lower left and right heart chambers contract together. These two treatments may also be combined simultaneously.
  • Coronary bypass surgery (CABG) or angioplasty to help improve blood flow to the heart muscle.
  • Heart transplant surgery or heart valve surgery.

Self-Care for Heart Failure Patients

  • Become familiar with the different symptoms caused by fluid and salt retention, such as weight gain, swelling, fatigue, discomfort when lying down, or having to wake during the night to sit up and catch your breath. If any of these symptoms are experienced, immediately inform the doctor or nurse.
  • Measure your weight and record it every morning – or at least for two mornings per week – immediately after going using the toilet after you wake up. Write down your weight reading before eating breakfast, as any weight gain of more than one kilogram in 1-2 days (or 2 kilograms in 3 days) indicates fluid and salt retention
  • Limit salt intake to 2-3 grams per day, and avoid eating salty food in general, including canned foods, pickled foods, and soy sauce. Also, limit intake of drinking water according to the treatment plan.
  • Overweight patients should aim to lose weight if possible, as weight gain means the heart must work harder to pump blood to the rest of the body. In cases where the patient experiences loss of appetite, sickness, vomiting, stomach cramps, weight loss of more than 5 kilograms in 6 months, or where the patient's BMI is less than 22 kg/m2, the patient should eat small portions of easily digestible food at regular intervals in order to prevent malnutrition.
  • Avoid smoking tobacco and drinking alcohol (or have no more than 2 drinks per day), as alcohol adversely affects the heart.
  • Keep to a suitable exercise regime. Start off with walks on a flat surface, starting with short sessions of 2-5 minutes per day, and then increasing the sessions to 5-10 minutes per day. Joining an exercise-based cardiac rehabilitation program is also an option. However, if fatigue, exhaustion, or feelings of discomfort occur during exercise, stop immediately.
  • Only engage in sexual activity if you are able to walk up one flight of stairs (of 8-10 steps) without gasping for breath or stopping to rest. This is recommended as symptoms of heart failure may be increased with sex.
  • Take any medications as instructed. However, if any unusual symptoms occur – which could be side effects of medication – consult your doctor (prior to stopping your medication). If purchasing any additional medication from the pharmacy, consult your doctor regarding the side effects of the medications on your heart and kidneys, as well as interactions with other medications which you are currently taking.
  • Try to lower stress levels with relaxing activities such as a light exercise or meditation.
  • Avoid walking long distances, especially if needing to sit for long periods along the way. Heart failure patients should not go out for walks alone; they should be accompanied by a friend or relative. Additionally, avoid flying if your symptoms worsen.
  • Get vaccinated for the flu yearly, if possible.
  • Have regular health check-ups and meet with the doctor as scheduled.
ATRIAL FILLIBRATION

Atrial fibrillation (also called AF or A-Fib) is the most common type of irregular heartbeat, occurring in 1-2% of the general population. However, it is a problem that increases with age, with approximately 5-15% of people between 80-90 years of age affected. There is also an increased risk of atrial fibrillation among people with heart conditions, including irritation of the membrane surrounding the heart (pericarditis), heart muscle disease (cardiomyopathy), abnormal heart valves or congenital heart defects.

  • What is atrial fibrillation?
  • Causes of Atrial Fibrillation
  • Types of Atrial Fibrillation
  • Symptoms of Atrial Fibrillation
  • Tests and Diagnosis of Atrial Fibrillation
  • Treatment Options of Atrial Fibrillation

What is atrial fibrillation?

Atrial fibrillation occurs when electrical signals in the heart’s upper chambers (atrium) cause the atrium to beat quickly and erratically, causing an irregular fast heart rhythm. As a result, the heart may not be able to pump enough blood around the body or out of the atrium completely with each heartbeat. If not correctly treated, atrial fibrillation can lead to heart failure. People with atrial fibrillation also have a 5 times higher risk of a potentially fatal stroke as the condition can cause blood clotting that blocks the artery supplying blood to the brain.

Causes of Atrial Fibrillation

  • Heart diseases including heart attack from blockage of heart vessels (coronary artery disease or acute myocardial infarction), abnormal heart valves, heart muscle disease (cardiomyopathy and myocarditis), high blood pressure (hypertension), and irritation of the membrane surrounding the heart (pericarditis)
  • Other conditions, including over function of thyroid gland (hyperthyroidism) and lung diseases such as emphysema, sepsis, postoperative complications, cerebral haemorrhage and stroke
  • Unknown causes

Types of Atrial Fibrillation

  • First diagnosed atrial fibrillation: When the atrial fibrillation is first identified, it is classified as first diagnosed atrial fibrillation. If it is restricted to only one episode, it is called acute atrial fibrillation, which is a common arrhythmic problem after heart surgery. If it occurs more than once, it is classified as paroxysmal atrial fibrillation and requires treatment.
  • Paroxysmal atrial fibrillation: In this case, the atrial fibrillation begins suddenly and then stops on its own. In most cases of paroxysmal AF, the episodes will stop within 24 hours, although they can last up to 7 days.
  • Persistent atrial fibrillation: When the atrial fibrillation lasts for more than 7 days or cannot stop on its own, it is classed as persistent AF.
  • Long standing persistent atrial fibrillation: If the atrial fibrillation lasts for more than 1 year, and the doctor and patient decide to treat the condition and return the heartbeat to normal, it is classed as long standing AF.
  • Permanent atrial fibrillation: If the atrial fibrillation lasts for more than 1 year, and the doctor and patient decide not to treat the condition, it is permanent AF.

Symptoms of Atrial Fibrillation

More than half of patients with atrial fibrillation have no visible symptoms (asymptomatic). The condition is usually detected when a patient sees the doctor about a related complication, particularly paralysis of one part of the body. Those who do have symptoms may experience the following:

  • Palpitations, irregular heartbeat
  • Shortness of breath, weakness
  • Becoming tired easily during exercise
  • Decrease in ability to exercise
  • Chest pain
  • Lightheadedness
  • Difficulty breathing
  • Fainting

Tests and Diagnosis of Atrial Fibrillation

  • Check of heart rate and rhythm
  • Electrocardiogram
  • Other laboratory tests, including:
    • Anemia or kidney function test
    • Thyroid function test
    • Chest x-ray
    • Echocardiography

Treatment Options of Atrial Fibrillation

The goals of atrial fibrillation treatment include reducing the symptoms and complications, with the aim of minimizing mortality rates and hospitalization. The type of treatment depends on the age of the patient, medical history, symptoms, other medical conditions, and type of atrial fibrillation.Treatment options include the following:

  • Medications can be administered to:
    • slow the heart rate (rate control)
    • control the rhythm (rhythm control)
    • reduce the risk of blood clots that form and cause blockage of vessel supply to any part of the body but especially the brain
  • Electrical cardioversion is used to restore a normal rhythm to the heart immediately and is only used in urgent conditions. This procedure cannot prevent a recurrence of atrial fibrillation. A regular rhythm has to be maintained through either long-term medication or ablation.
  • Radiofrequency ablation or cryoablation is used to eliminate the abnormal signals that cause atrial fibrillation. This procedure restores the normal heart rhythm immediately and prevents any recurrence of atrial fibrillation in the future.

PROCEDURES

ANTICOAGULATION TREATMENT

Because of the danger of abnormal coagulation (the development of a hard mass of blood within the body commonly known as abnormal blood clotting), Bumrungrad International puts a strong emphasis on prevention, ensuring effective treatment, and care for patients at risk.

Blood clots can cause symptoms as mild as pain and as severe as stroke, heart attack and pulmonary embolism. They are usually treated through the careful use of medication called anticoagulants.

  • What Is An Anticoagulant?
  • Indications For Use Of Anticoagulants
  • Bumrungrad Services

What Is An Anticoagulant?

Anticoagulants are drugs that slow down the blood clotting process. The objective is to prevent blood clotting within the circulation system. One of the most commonly used anticoagulants is warfarin.

Patients taking this kind of medicine need regular checks of the appropriate level of inhibition of blood clotting. They are given special instructions which must be followed while taking this medicine. Patients must also be aware of side effects, foods that may have interaction with warfarin, and other cautions for optimal benefit and reduction of risk.

To ensure proper treatment, Bumrungrad has a coordinated, multidisciplinary team of:

  • Physicians
  • Pharmacists
  • Cardiac Clinical Nurse Coordinators

working together to determine the proper medication dosage.


Indications For Use Of Anticoagulants

  • Atrial fibrillation
  • Deep vein thrombosis and/or pulmonary embolism
  • Certain types of stroke
  • Certain artificial heart valves
  • Some vascular devices
BALLOON ANGIOPLASTY

What is a Balloon Angioplasty?

Balloon Angioplasty is a medical procedure in which a balloon is used to open narrowed or blocked blood vessels of the heart.

  • What is a Balloon Angioplasty?
  • How is it done?
  • Why is it done?
  • Risks & complications
  • Alternatives
  • Candidate eligibility

How is it done?

Balloon Angioplasty generally takes 1 to 2 hours. The patient is awake for the procedure but local anesthesia is used and pain medication can be given as needed. During the procedure the surgeon will insert a small balloon catheter into an artery in the groin or arm and advance it toward the narrowing in the coronary artery. The balloon is then inflated to enlarge the narrowing in the artery. In some cases, a stent of wire mesh inflates with the balloon and is left behind to support the artery walls.

Why is it done?

When successful, Balloon Angioplasty can relieve chest pain of angina, improve the prognosis of patients with unstable angina, and minimize or stop a heart attack without having the patient undergo open heart surgery.

Risks & complications

As with any surgery, there are risks, including the possibility of:

  • Complications associated with anesthesia, including respiratory or cardiac malfunction
  • Infection
  • Bleeding in the groin (or other catheter access site)
  • Complete obstruction of blood flow to an area of the heart (a small risk, less than 1%)
  • Damage to a valve or blood vessel
  • Stroke
  • Arrhythmia
  • Kidney failure
  • Allergic reaction to X-ray dye

Balloon Angioplasty treats the condition, but does not cure the cause of narrowed arteries. Recurrent narrowing can be expected in up to a quarter of cases over a 6 month period. This recurrent narrowing may or may not require a repeat procedure.
Risks can be reduced by following the physician's instructions before and after surgery.

Alternatives

If the arteries are not sufficiently widened by angioplasty or the blockages are too severe to be treated by angioplasty, open heart surgery may be recommended.

Candidate eligibility

The physician will make the final determination of each patient’s eligibility for the procedure after an examination and consultation with the patient.

CORONARY ANGIOGRAM

What is Coronary Angiogram?

Coronary Angiogram is a diagnostic procedure of which the status of coronary arteries (arteries that give blood supply to the heart) is defined.

  • What is Coronary Angiogram?
  • How is it done?
  • Why is it done?
  • Risks & complications
  • Alternatives
  • Candidate eligibility

How is it done?

The procedure is performed either through the groin or the wrist or the front part of the elbow. The right side is preferable. It is done using local anesthesia. During the procedure, a small catheter is introduced to the root of the aorta (great artery). Contrast agent is injected directly into the coronary arteries. Pictures are taken during the contrast injection. There is no pain during the procedure.

Why is it done?

The procedure is done to see if one has any blockage in the coronary arteries. It also provides information of how severe the blockage is.

Risks & complications

There are very infrequent potential risks or complications:

  • Stroke (0.2%)
  • Death (0.1%) usually occurs in the patients who are very unstable.
  • Bleeding at puncture site (less than 2%), usually easily managed.

Alternatives

Computerized tomographic angiogram using multislice technique may be an alternative.

Candidate eligibility

If the arteries are not sufficiently widened by angioplasty or the blockages are too severe to be treated by angioplasty, open heart surgery may be recommended.

Patients with:

  • Acute coronary syndrome (new onset of angina, unstable angina, heart attack etc.)
  • Severe valvular heart disease
  • Known disease of the heart muscle needing to rule out coronary artery disease
  • Sudden death who survive
CORONARY ARTERY BYPASS GRAFT (CABG - HEART SURGERY)

What is Coronary Artery Bypass Grafting (CABG) Surgery?

CABG is a heart surgery procedure in which one or more blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart. These grafts usually come from the patient’s own arteries and veins located in the chest (thoracic), leg (saphenous) or arm (radial). The graft goes around the blocked artery (or arteries) to create new pathways for oxygen-rich blood to flow to the heart.

  • What is Coronary Artery Bypass Grafting (CABG) Surgery?
  • How is it done?
  • Why is it done?
  • Risks & complications
  • Alternatives
  • Candidate eligibility

How is it done?

To bypass the blockage, the surgeon makes a small opening just below the blockage in the diseased coronary artery. If a saphenous (leg) vein or radial (arm) artery is used, one end is connected to the coronary artery and the other to the aorta. If a mammary artery is used, one end is connected to the coronary artery while the other remains attached to its origin at left subclavian artery. The graft is sewn into the opening, redirecting the blood flow around this blockage.
The procedure is repeated until all affected coronary arteries are treated. It is common for three or four coronary arteries to be bypassed during surgery.
Before the patient leaves the hospital, the doctor or nurse will explain the specific bypass procedure that was performed.

  • Heart-Lung Machine : During surgery, the heart-lung bypass machine (called “on-pump” surgery) is used to take over for the heart and lungs, allowing the circulation of blood throughout the rest of the body. The heart’s beating is stopped so the surgeon can perform the bypass procedure on a “still” heart.
  • Off-pump or beating heart bypass surgery : Off-pump or beating heart bypass surgery allows surgeons to perform surgery on the heart while it is still beating. The heart-lung machine is not used. The surgeon uses advanced operating equipment to stabilize (hold) portions of the heart and bypass the blocked artery in a highly controlled operative environment. Meanwhile, the rest of the heart keeps pumping and circulating blood to the body

Why is it done?

The goals of the procedure are to relieve symptoms of coronary artery disease (including angina), enable the patient to resume a normal lifestyle and to lower the risk of a heart attack or other heart problems.

Risks & complications

As with any surgery, there are risks, including the possibility of:

  • Complication associated with anesthesia, including respiratory or cardiac malfunction
  • Infection
  • Bleeding
  • Stroke
  • Arrhythmia
  • Kidney failure
  • Low cardiac output
  • Perioperative myocardial infarction
  • Death

Alternatives

Medical management, balloon angioplasty, or transmyocardial laser revascularization may be alternatives for some patients.

Candidate eligibility

The decision to prescribe medical treatment, invasive procedures or cardiac bypass surgery depends on several factors including the extent of cardiovascular disease, the severity of symptoms, your age and other medical conditions. The cardiologist (heart specialist) and surgeon will determine the best method of therapy for each patient.

LEFT ATRIAL APPENDAGE CLOSURE USING WATCHMAN

Left Atrial Appendage Closure Using WATCHMAN

The left atrial appendage (LAA) is a small sac located in the muscle wall of the left atrium, which is located in the top left chamber of the heart. Normally, when the heart contracts with each heartbeat, the blood in the left atrium and the LAA is squeezed out of the left atrium and into the left ventricle, which is located in the bottom left chamber of the heart.

  • What Is Atrial Fibrillation?
  • Are There Any Treatments?
  • What is the Alternative?
  • What is the WATCHMAN?
  • Adverse Events

What Is Atrial Fibrillation?

In the case of Atrial Fibrillation, the electrical impulses that control the heartbeat do not travel the way they’re supposed to, in an orderly fashion. Instead, many impulses happen all at once and spread through the atria in a chaotic manner. When this happens, the atria does not have enough time to contract and effectively squeeze blood into the ventricles, and because the LAA is a small sac, blood can collect there and form into clots in the LAA and the atria. Blood clots can cause a stroke, which is why people with the condition of Atrial Fibrillation are 5 to 7 times more likely to have a stroke than those without this condition.

Are There Any Treatments?

The common treatment for patients with Atrial Fibrillation has been taking blood thinners, the most common on being Warfarin. However, many patients have concerns about taking the drug as it requires frequent monitoring and can interact with other drugs and even food to cause an adverse reaction. These side-effects require several adjustments of the drug, and can become a hassle for many patients. There are other, newer medications such as Dabigatran, Rivaroxaban, and Apixaban available on the market, but they are suited for patients who do not have heart valve disease. However, like Warfarin, some patients have concerns and problems with these medications, including the potential high cost and maybe side effects.

What is the Alternative?

The procedure of Left Atrial Appendage Closure can be a welcome alternative to patients, as it can eliminate the need for long-term anticoagulation medication while helping to prevent the risk of stroke. Weperforms this procedure using the WATCHMAN device, making it possible for patients to experience the benefits of this treatment right away.

What is the WATCHMAN?

The WATCHMAN device has been approved by the FDA: To reduce the risk of thromboembolism from the LAA in patients with nonvalvular atrial fibrillation who are at increased risk of stroke or systemic embolism but are not candidate from long term anticoagulation as well as who have an appropriate reason to want treatment with non – medication alternative to warfarin.

The WATCHMAN Device is a parachute-shaped, self-expanding device that closes the LAA. It was tested in several studies that showed the device was a good alternative treatment for patients who cannot tolerate treatment with medication.

The WATCHMAN device is implanted percutaneously (through the skin) in the electrophysiology (EP) lab. The implant procedure does not require surgery; however, general anesthesia may be used during the procedure. A catheter sheath is inserted into a vein near the groin and guided across the septum, which is a muscular wall that divides the right and left sides of the heart to the opening of the LAA. The device is placed in the opening of the LAA. This seals off the LAA and keeps it from releasing clots.

Adverse Events

Please be aware of the potential adverse events including, but not limited to: airway trauma, congestive heart failure, arrhythmias, deep vein thrombosis, excessive bleeding, fever, hypotension, Ischemic stroke, hemorrhagic stroke, respiratory insufficiency, or even death. There may also be other potential adverse events that are unforeseen at this time.

PACEMAKER IMPLANTATION

Pacemaker Implantation

A pacemaker is a device that is placed in the chest or abdomen to help control an arrhythmia. It uses electrical pulses to prompt the heart to beat at a normal rate.

  • Methods of Pacemaker Implantation
  • Pacemaker Components
  • How a Pacemaker Works
  • Preparation Before a Pacemaker Implantation Procedure
  • Steps for Pacemaker Implantation Procedure (takes approximately 1-2 hours)
  • Possible Risks and Complications
  • Notify the Doctor If These Symptoms Occur

Methods of Pacemaker Implantation

When choosing the most appropriate method, the doctor must consider the age, overall health, and lifestyle of the patient. There are two primary methods of pacemaker implantation.

  • Endocardial lead placement
  • Epicardial lead placement

Pacemaker Components

  • Battery
  • Pulse generator (produces the electrical signals that cause the heart to beat)
  • Wires (also called leads) carrying the electrical signals from the pulse generator to the heart

How a Pacemaker Works

A pacemaker works by sending electrical impulses from the pulse generator to stimulate the heart to contract and produce a heartbeat, thus restoring the heart’s natural rhythm. The wires carry the pulses between the generator and the chambers of the heart.

Preparation Before a Pacemaker Implantation Procedure

  • Do not consume food or drinks 8 hours prior to the procedure.
  • Consult with your doctor regarding medications from which you may need to refrain.

Steps for Pacemaker Implantation Procedure (takes approximately 1-2 hours)

  • Endocardial lead placement: The doctor inserts the lead(s) (thin insulated wires) and guides it through a vein to the patient’s heart. Once the lead(s) have reached the heart, the surgeon will then attach the lead tip to the heart muscle, guided to the correct position with the aid of x-ray images. After this, the doctor will connect the lead(s) to the pacemaker generator and insert the device under the skin through the small incision either on the right or left side of the patient’s upper chest (just below the collarbone). The patient may feel slight pressure while the lead(s) and pulse generator are inserted under the skin. Once the implantation has been completed, the doctor will then check the x-ray images and test the pacemaker to ensure it is in the correct position and that it is working properly to meet the patient’s medical needs.
  • Epicardial lead placement: An incision is then made in the chest, after which the lead(s) are attached directly to the surface of the heart. The pulse generator is then placed under the skin in the upper abdomen, or may be placed in the upper chest area, although this method is less common.

Possible Risks and Complications

  • Bleeding or blood clots due to internal bleeding or hemorrhaging under the skin
  • Infection at the site of the pacemaker implantation
  • Allergic reaction to medications used during the procedure
  • Damaged blood vessels
  • Pacemaker leads dislodged or pulled out of their original position
  • Lung or heart leaks
  • Thrombosis, causing the cerebral blood flow to be constricted, myocardial infarction or death of heart muscle tissue, as well as other related conditions – all of which are rare
  • Death (life-threatening complications of pacemaker implantation are extremely rare)

What to Expect After Pacemaker Implantation Surgery

  • Rest in the recovery room for close observation and monitoring of vital signs.
  • Expect to stay in the hospital for 1-2 days following surgery so that the doctor can ensure the pacemaker is working properly and that the heart is beating at its correct natural rhythm.
  • Avoid lifting with or reaching the affected arm above shoulder level on the side the pacemaker was inserted.
  • Refrain from lifting any heavy objects for at least 1 month following surgery.
  • Meet with the doctor for regularly scheduled appointments in order to monitor progress, during which the doctor will check to ensure the pacemaker is functioning properly. On average, a pacemaker battery lasts for about 10 years.

Notify the Doctor If These Symptoms Occur

Notify the doctor if any of the following symptoms occur after pacemaker implantation surgery:

  • Increased bleeding, swelling or pain at the site of the implantation
  • Fever
  • Chest pain
  • Breathing difficulties
EXERCISE STRESS TEST

Exercise Stress Test

An exercise stress test is a type of test that can help diagnose the risk of heart disease or acute myocardial infarction while exercising. It allows physicians to detect any abnormal responses to physical activity, such as difficulty breathing, chest pain, abnormal heart rhythms, or changes in the heart’s electrical activity. These abnormal responses indicate an inadequate blood supply to the heart muscles during exercise.

  • Methods of Pacemaker Implantation
  • Pacemaker Components
  • How a Pacemaker Works
  • Preparation Before a Pacemaker Implantation Procedure
  • Steps for Pacemaker Implantation Procedure (takes approximately 1-2 hours)
  • Possible Risks and Complications
  • Notify the Doctor If These Symptoms Occur

What to Expect During the Exercise Stress Test

  • The test will take approximately 1 hour to complete.
  • A member of the healthcare team will briefly check the patient’s medical history, focusing on current symptoms and a family history of heart disease
  • A nurse will place electrode patches on the patient’s chest to measure the patient’s heart rhythm and heartrate via wires attached to an electrocardiograph monitor. During the test, the healthcare team will monitor the patient’s blood pressure and ECG at all times.
  • • The patient will be asked to start out by walking slowly on a treadmill. The degree of difficulty and incline on the machine will gradually increase approximately every 3 minutes. Once the patient has reached the target heart rate, or if they are exhausted and cannot continue, a healthcare team member will stop the treadmill.

How to Prepare for the Exercise Stress Test

  • Do not consume any food or drinks 2 hours prior to the test – especially greasy foods, tea, coffee and alcoholic beverages.
  • Consult the doctor in advance regarding any medications planned to be taken before the test, as certain medications can interfere with the results of the test.
  • Bring your list of medications, along with the specified dosages.
  • Wear comfortable shoes and loose clothing suitable for exercise.

What to Be Careful Of During the Test

Patients must inform the medical personnel immediately if they require the treadmill to be slowed or stopped, or experience the following:

  • Chest pain, burning sensation or tightness in the chest
  • Nausea or dizziness
  • Exhaustion

Possible Risks and Complications

  • Irregular heartbeat
  • Syncope (fainting) – which can cause injury if the patient collapses
  • Acute myocardial infarction (heart attack)

After an Exercise Stress Test

Once the test is complete, medical personnel will continue to monitor the patient’s blood pressure and heart rate until the levels return to normal. If the doctor suspects any abnormalities, they may conduct further testing or propose alternative testing methods in order to acquire more definitive results.
After the test, the patient may eat, take their medication, and go about their activities as usual – unless instructed not to do so by a doctor.

STRESS ECHOCARDIOGRAM

Stress Echocardiogram

A stress echocardiogram is a type of heart examination used by doctors to help diagnose coronary heart disease. Patients are tested while exercising in order to assess the performance of the heart muscle under stress, and to see whether the heart is receiving sufficient oxygen from the blood vessels. Patients are also monitored for other abnormal symptoms that may arise during exercise, such as shortness of breath, chest pain, irregular heartbeat, and changes in heart rhythm. The use of an echocardiogram will help to discern whether or not the heart muscle is pumping sufficient blood to the rest of the body – and also allows doctors to monitor the patient’s heart rhythm and performance of the heart valves, and measure the capacity of the heart chambers. In turn, this allows the doctors to see whether the patient is suffering from coronary heart disease.
By using an echocardiogram, doctors can increase the accuracy and precision of their diagnosis, allowing for a more accurate reading than if the patient was observed while walking on a normal treadmill.

Stages of Examination (Total Duration: 60 minutes)

  • A nurse will attach a set of electrodes to the patient's chest in order to monitor the heart muscle and observe the examinee's blood pressure and heart rhythm.
  • The patient will lie flat on a bed to allow the nurse to conduct a heart recording and collect images of the heart using the echocardiogram before the examination.
  • The patient will then come down from the bed and begin on the treadmill with a slow walk.
  • The nurse will alter the speed and incline of the treadmill every 3 minutes, to simulate the patient walking up a steep hill.
  • When the patient's heart rate reaches its peak and they are unable to continue, the nurse will stop the treadmill.
  • The patient must then lie back down on the bed immediately, on their left-hand side, so that the nurse can conduct a heart recording and take an echocardiogram after exercise.
  • When the examination is complete, the doctor will then read and explain the results to the patient, comparing the echocardiogram results from before and after exercise.

Preparations Prior to Examination

  • Do not consume food or drinks 4 hours prior to the examination.
  • Do not take any medications on the morning of the examination, unless advised to do so by the doctor.
  • Provide documents showing all of the medication recently used for the doctor to review, as well as the doses prescribed.
  • Wear loose-fitting, comfortable clothing and appropriate footwear for exercise.
  • If suffering from diabetes and using insulin, use only half of the regular insulin dose, and do not eat breakfast unless advised to do so by the doctor. If using any other medications for diabetes, do not take any medication on the morning of the examination.

Precautions During Examination

Patients must inform the medical personnel immediately if they require the treadmill to be slowed or stopped, or experience the following:

  • Chest pain, burning sensation or tightness in the chest
  • Nausea or dizziness
  • Exhaustion

Potential Risks and Complications During Examination

  • Irregular heartbeat
  • Syncope (fainting) – which can cause injury if the patient collapses
  • Acute myocardial infarction (heart attack)

After the Examination

After the examination, the patient may eat, take their medication, and go about their activities as usual – unless instructed not to do so by a doctor.