CARDIOLOGY

TREATMENTS

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1. CORONARY ANGIOGRAPHY

WHAT IS ANGIOGRAPHY ?
  • Angiography is an X-ray technique for assessing blood vessels. This examination enables the doctor to determine whether there are any artery-related problems, such as a blockage.
  • To examine the arteries, a special dye is injected into the blood, as a normal x-ray does not show blood vessels clearly. The dye increases contrast, allowing the doctor to see any associated problems.
  • The X-ray images created during an angiography are known as angiograms.
WHY IS IT NECESSARY ?

Angiography is used to examine your blood vessels’ condition and the way that blood flows through them.

 

Angiography can help to investigate or diagnose several issues involving blood vessels such as

  • Atherosclerosis in which narrowing of the arteries increases the risk of a heart attack or stroke.
  • Decreased blood flow to the leg muscles due to peripheral artery disease
  • Chest pain called Angina brought on by inadequate blood supply to the heart muscles.
  • Brain aneurysm that causes a protrusion in a blood artery in the brain.
  • Pulmonary embolism, which is a blockage in the artery supplying lungs, or blood clots
  • A blood vessel obstruction in your kidneys
WHAT HAPPENS DURING ANGIOGRAPHY ?
  • For the test, a small cut (incision) is to be made over one of your arteries, typically near your groin or wrist.
  • For this, local anaesthetic is applied to numb the area where the cut is to be made.
  • In order to investigate the arteries, a very thin, flexible tube called a catheter is placed into the artery.
  • A contrast medium (dye) is injected into the catheter, and as the dye travels through your blood vessels, a series of X-rays are taken.
  • These X-rays will be assessed by the doctor & an angioplasty may be advised if the situation is critical.
  • You will typically be awake for the procedure, but you may be given a sedative to help you relax.
SAFETY & RISK FACTORS
  • Angiography is often a painless and safe technique.
  • However, it’s typical to experience the following for a few days or weeks afterward: bruising, discomfort, and a very little lump or collection of blood close to the cut.
  • Though a very small chance of more severe side effects, like an allergic reaction to the dye, a stroke, or a heart attack, is also present.

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2. CORONARY ANGIOPLASTY

WHAT IS ANGIOPLASTY ?

Coronary arteries are the main blood vessels supplying blood to the heart. An angioplasty procedure is done to open up clogged or clogged coronary arteries. A general angioplasty procedure involves use of a balloon with or without a mesh-like tube called as a stent. The balloon is removed after the procedure while the stent remains in the place permanently to ensure the artery does not narrow down again.

Percutaneous transluminal coronary angioplasty is another name for coronary angioplasty (PTCA). Percutaneous coronary intervention is the common name for the procedure that combines coronary angioplasty with stenting (PCI).

WHY IS IT NECESSARY ?

The heart requires a steady flow of blood, much like every other organ in the body. The coronary arteries provide the necessary oxygenated blood to the heart.

These arteries may narrow and stiffen over time as people age, which can result in coronary heart disease. Angioplasty can help in many situations such as

  • Angina, a type of chest pain caused by a restriction in the blood supply to the heart, is typically brought on by workout or stress. While medication is frequently useful in treating angina, in severe cases where medication is ineffective, a coronary angioplasty may be necessary to restore the blood supply to the heart.
  • Emergency treatment after a heart attack.

After an angioplasty, the blood flow through the coronary arteries often improves. Many people discover their symptoms dramatically improve after the operation, and they are able to perform more than they could before.

An angioplasty can improve your chances of surviving a heart attack more than only the medication.

WHAT HAPPENS DURING ANGIOPLASTY ?
  • For the procedure, a small cut (incision) is made over one of your arteries, typically near your groin or wrist.
  • A local anaesthetic is applied to numb the area where the cut is to be made.
  • In order to investigate the affected artery, a very thin, flexible tube called a catheter is placed into the artery.
  • Once the catheter is in position, a thin wire is used to deliver a small balloon to the afflicted coronary artery by being directed along the length of the artery. The artery is then made wider by inflating this, which pushes fatty deposits up against the arterial wall and allows blood to flow through the artery more freely after the balloon is deflated.
  • If a stent is utilized, it will be positioned around the balloon before to insertion. When the balloon is inflated, the stent will expand and will stay in place when the balloon is deflated and taken out.
  • The entire procedure lasts for about 30 mins to 2 hours. You will mostly be awake during the procedure but a sedative will keep you relaxed.
  • For at least a week, you must refrain from heavy lifting, physical activity, and driving.
  • You might have to stay in the hospital for a few days after the angioplasty operation if you had a heart attack and were admitted.
SAFETY & RISK FACTORS
  • The operation is typically performed safely in most people because it doesn’t require large incisions in the body. This type of therapy is referred to as minimally invasive by doctors.
  • A coronary angioplasty generally carries a low risk of major consequences, however it also depends on other factors such as your general health, if you had a heart attack earlier & your age. Generally, angioplasty being the most common treatment for cardiac issues doesn’t have many risk factors. But there is a very small chance that a patient might face excessive bleeding, a heart attack or stroke.

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3. PACEMAKER IMPLANTATION

WHAT IS PACEMAKER ?
  • A pacemaker is a tiny, 20–50g, mechanical device. This device is used to monitor and maintain your heart beats if they are abnormal.
  • It consists of one or more wires known as pacing leads that attach to your heart andlong with a pulse generator with a battery and a small computer circuit.
  • Your heart receives electrical impulses from the pulse generator via the connections. The pacing rate refers to the frequency at which electrical impulses are transmitted.
  • The pacemaker transmits signals steadily if it detects that your heart has skipped a beat or is beating too slowly.
  • It doesn’t send any messages if it notices that your heart is beating regularly on its own.
  • A unique sensor found in most pacemakers may detect body movement or your breathing rate.
  • By doing this, pacemaker might increase the discharge rate while you are active.
WHY IS IT NECESSARY ?

The heart is essentially a muscular pump that responds to electrical signals.

Several factors can cause these signals to be interrupted, which can result in a variety of potentially severe heart diseases, including:

  • excessively slow heartbeat (bradycardia)
  • a very rapid heartbeat (tachycardia)
  • Heart block
  • Cardiac arrest

If you struggle with a slow heart beat, a pacemaker can greatly enhance your quality of life. For certain people, the device may even save their lives.

WHAT HAPPENS DURING PACEMAKER IMPLANTATION ?
  • Implanting a pacemaker is a fairly simple procedure.
  • Since it’s typically done under local anaesthesia, you’ll be conscious throughout the entire procedure.
  • First a small incision will be made.
  • On the left side of the chest, the generator of the pacemaker is often positioned under the skin close to the collarbone.
  • The generator is then connected to a wire that travels to the heart through a blood artery.
  • The pacemaker will be programmed to match the requirements of the patient. The pacemaker will continue to monitor & maintain the heart beats.
  • The pacemaker also collects related data to help doctors for further diagnosis.
SAFETY & RISK FACTORS
  • The risk of complications is often quite low while having a pacemaker implanted.
  • The primary issue one could be facing is that the pacemaker will no longer be able to regulate the heartbeat due to a malfunction or a wire that has moved out of place.
  • Wireless signals can occasionally be used to reprogram the pacemaker to correct a problem.
  • But if the pacemaker shifts out of place, additional surgery might be required.
  • A pacemaker can be affected by anything that generates a strong electromagnetic field, such as an induction cooktop.
  • However, as long as you use the majority of standard household electrical appliances—like hairdryers and microwaves—more than 15 cm (6 inches) away from your pacemaker, there shouldn’t be any issues.
  • Keep your pacemaker at least 60 cm (2 feet) away from your electric stove if you have one.
  • Simply move away from an electrical appliance if you experience lightheadedness or a quicker heartbeat while using it to allow your heartbeat to return to normal.

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4. DEVICE CLOSURE

WHAT IS DEVICE CLOSURE ?

Device Closure is a surgical procedure that involves inserting a metal device to close a hole in the heart and keep it functioning normally. This ensures that the hole in the heart does not affect heart’s performance and the patient’s body continues getting oxygenated blood supply.

WHY IS IT NECESSARY ?
  • Four chambers make up the heart. Atria refers to the upper two chambers. The Atrial Septum, a wall that divides the atria, is present. Ventricles-Right and Left are the names of the bottom chambers. The Left Atrium receives oxygenated blood from the pulmonary veins. To circulate oxygenated blood throughout the body, the left atrium delivers this oxygenated blood to the left ventricle via the mitral valve.
  • The heart’s well-separated walls support a healthy circulatory system. However, in some congenital heart defect circumstances, any holes on the heart, whether in the atrial wall or the ventricle wall; can cause disrupted blood circulation and heart failure. If the holes are quite small, they may be surgically filled with some metal components. This technique is called device closure.
WHAT HAPPENS DURING DEVICE CLOSURE ?
  • After cleaning the area around the person’s groyne and arm, a catheter will be put through it. A small incision will be made for this. The patient will be awake and conscious throughout the surgery while receiving sedatives for relaxation and local anaesthetic.
  • In order to visualise the heart chambers and the size of the hole, a contrast dye would be injected into the arteries. O nce the hole’s size has been established, a special catheter that carries a tiny metallic mesh-like closure device is inserted into the arteries. Then, the catheter releases the device after it has been inserted into the hole.
  • After the catheter is removed, the closure device eventually grows heart tissue and becomes an integral part of the heart.
SAFETY & RISK FACTORS

Although closure is typically secure and efficient, there are some risks involved, such as:

 

    • allergies to the surgical supplies utilised.
    • irregular heartbeat
    • bleeding that might call for a blood transfusion
    • damage to or puncture of the heart’s veins or tissue, which calls for surgical repair.
    • infection surrounding the closure device or in the incision.
    • renal failure
    • Transient ischemic attack or stroke (mini-stroke).

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5. MITRAL VALVE TREATMENT

WHAT IS MITRAL VALVE ?
  • A little flap in the heart called the mitral valve prevents blood from flowing in the wrong direction. Its health may have an impact on how blood circulates throughout the body.
  • The mitral valve is mostly affected by the following issues:
  • a prolapsed mitral valve where the valve gets excessively floppy
  • The valve leaks in mitral regurgitation, causing the blood to flow improperly.
  • The valve does not open as widely as it should because of mitral stenosis.
  • Although these illnesses might be quite severe, they are frequently curable.
  • Mitral valve surgery might be required in specific circumstances.
WHAT ARE PROBLEMS ASSOCIATED WITH IT ?

Mitral valve prolapse

When the mitral valve is abnormally floppy and does not seal tightly, this condition is known as mitral valve prolapse. Many persons with a mitral valve prolapse may not exhibit any symptoms, and it is possible that it is only discovered through an echocardiography, which is often performed for another reason.

 

Mitral regurgitation

Because the mitral valve does not seal properly, some blood flows in the wrong direction in the heart, a condition known as mitral regurgitation. Symptoms of mitral valve regurgitation are not always present.

 

Mitral stenosis

When the mitral valve does not open as widely as it should, it develops a condition called mitral valve stenosis, which limits the flow of blood through the heart. Symptoms of mitral stenosis are not always present.

TREATMENTS

  • If you experience symptoms linked to a mitral valve issue and if the issue is particularly serious, mitral valve surgery might be advised. The following are the most typical mitral valve procedures:

    • mitral valve repair
    • mitral valve replacement
    • balloon valvuloplasty

     

    • Mitral valve repair

    An surgery to repair the mitral valve involves moving the flaps of the mitral valve closer together. This will aid in preventing blood from entering the valve in the wrong direction.

    When mitral valve prolapse or regurgitation is a major issue and causes symptoms, it is mostly used to address those conditions.

    You are unconscious during the procedure because you are under a general anaesthetic.

     

    • Mitral valve replacement

    An procedure to replace your mitral valve with a mechanical valve or a valve made of animal tissue is known as a mitral valve replacement.

    This is often only carried out if a valve repair cannot be performed due to mitral stenosis, mitral prolapse, or regurgitation.

    You are unconscious during the procedure because you are under a general anaesthetic. Typically, your surgeon will make one cut down the middle of your chest to replace the valve.

     

    • Balloon valvuloplasty

    If you have mitral stenosis, balloon valvuloplasty is a treatment that can be used to enlarge the mitral valve. Typically, local anaesthesia is used, keeping you awake while numbing your skin.

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6. HEART FAILURE TREATMENT

WHAT IS HEART FAILURE ?
  • The heart’s inability to adequately pump blood throughout the body is known as heart failure. Usually, it occurs as a result of the heart being overly rigid or frail. Your heart has not ceased beating if you are experiencing heart failure. It signifies that it requires assistance to function more effectively.
  • Any age can experience it, but older people are more likely to have it.
  • Heart failure is a chronic illness that usually gets progressively worse with time.
  • While the symptoms can frequently be managed for many years, the condition is typically incurable.
WHAT ARE PROBLEMS ASSOCIATED WITH IT ?
  • A significant long-term condition, heart failure typically gets progressively worse over time. It frequently leads to death and can significantly reduce the activities you can engage in. However, it’s quite challenging to predict how each person’s illness would develop. While many people stay steady for many years, in rare circumstances things could abruptly worsen.
  • Heart failure frequently results from several heart conditions occurring concurrently.
  • Heart failure may result from several conditions, including :
  • Coronary heart disease : fatty molecules block the arteries that carry blood to the heart, which may result in angina or a heart attack.
  • High blood pressure
  • Cardiomyopathy
  • Heart valve problems
  • Arrhythmia
  • Congenital heart diseases
  • Heart failure can also occasionally be brought on by obesity, anaemia, excessive alcohol use, an overactive thyroid, or high blood pressure in the lungs (pulmonary hypertension).
TREATMENTS

Heart failure treatment often attempts to manage the symptoms for as long as possible and slow the condition’s severity. Depending on the causes of the heart failure the doctor will decide the course of treatment.

Common treatments include :

  • Lifestyle changes : Including maintaining a healthy weight, getting regular exercise, and quitting smoking
  • Different types of medication
  • Devices : to control the rhythm of the heart
  • Surgery

Generally not all heart failure causes are curable but some cases such as damaged valves can be cured by repairing or replacing them.

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7. ARRHYTHMIA TREATMENT

WHAT IS ARRHYTHMIA ?

An inconsistent heartbeat is known as a cardiac arrhythmia. When the electrical signals that coordinate the heart’s beats aren’t functioning properly, heart rhythm issues develop. The heart beats excessively quickly (tachycardia), too slowly (bradycardia), or irregularly as a result of the poor signalling.

WHAT ARE PROBLEMS ASSOCIATED WITH IT ?

The types of arrhythmia are :

  • Atrial fibrillation : This condition causes the heart to beat abnormally faster than normal frequency.
  • Supraventricular tachycardia : This condition is characterised by irregular heartbeats that are quicker than usual while the person is at rest.
  • Bradycardia : This condition causes the heart to beat abnormally slower than normal frequency.
  • Heart block : This condition causes the heart to beat slower & make the person fall unresponsive.
  • Ventricular fibrillation : If not treated right once, ventricular fibrillation, a rare, erratic, and chaotic cardiac pattern, can quickly cause unconsciousness and sudden death.
  • All age groups can experience arrhythmias, however elderly persons are more likely to experience atrial fibrillation. Being overweight or excessively drinking alcohol both raise the risk of atrial fibrillation. Certain arrhythmias can result in abrupt cardiac death in persons with serious heart problems.
TREATMENTS

Whether you have a rapid, slow, or heart block will determine how your arrhythmia is managed. Your arrhythmia’s underlying causes, such as heart failure, must be treated as well.

  • Medicine : to halt an arrhythmia, stop it from happening, prevent it, or slow it down.
  • Electrical cardioversion : a procedure that uses electricity while you’re under anaesthesia or sedation to shock your heart back into a regular rhythm.
  • Catheter ablation : a keyhole procedure performed under local or general anaesthesia that meticulously removes the unhealthy cardiac tissue responsible for the arrhythmia.
  • Pacemaker : a tiny, self-powered device that is inserted into your chest while you are under local anaesthesia; it sends out electrical signals to replace your heart’s natural pacemaker and help it beat normally.
  • ICD : implantable cardioverter defibrillator, a pacemaker-like device that keeps track of your heartbeat and shocks it back into normal rhythm when necessary

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8. ANGINA TREATMENT

WHAT IS ANGINA ?

Chest pain from angina is brought on by inadequate blood supply to the heart’s muscles. Although it normally isn’t life threatening, it is a symptom that you may be in danger of having a heart attack or stroke.

Angina can be managed with medication and healthy lifestyle modifications, which also lowers the likelihood of developing these more severe issues.

Angina is typically brought on by a buildup of fatty substances narrowing the arteries delivering blood to the heart muscles (atherosclerosis)

Things that can increase your risk of atherosclerosis include :

  • an unhealthy diet
  • a lack of exercise
  • smoking
  • increasing age
  • a family history of heart problems
WHAT ARE PROBLEMS ASSOCIATED WITH IT ?

Angina chest discomfort typically feels tight, dull, or heavy and may radiate to your arms, neck, jaw, or back. It is brought on by physical activity or stress and subsides after a few minutes of rest. There may occasionally be other symptoms, such as feeling ill or out of breath.

The two types of angina are :

  • Stable (common) angina : attacks start with a stimulus (such as stress or exertion) and end shortly after resting.
  • Unstable (Uncommon) angina : Attacks can remain even when you’re resting and are more unpredictable (they might not have a trigger).
TREATMENTS

Treatment generally involves medication for lifetime. These medicine will be used to avoid any further attack, risk of having strokes & to treat the attacks if they happen. If the medication does not help the patient then the doctor might advice better alternatives such as an operation to treat the cause of the angina that is enhancing the blood flow through the arteries.

If the angina is well controlled with medication or after an operation, the patient can continue with most of his daily routine. But lifestyle changes are important to reduce further risk of heart attack or strokes. These changes include :

  • A balanced diet
  • Regular exercise
  • Quitting smoking
  • Quitting alcohol
  • Reducing salt, sugar & fats
  • Controlling the weight.

Since it opened its doors in 2011, Somani Cardiac & Gynaecology Centre has been offering the best medical care in Pune for conditions relating to the heart and women’s health. Instead of just concentrating on the surgeries, interventional cardiologist Dr. Abhay Somani and gynaecologist Dr. Rohini Somani choose to raise awareness about healthy lifestyles and illness prevention.

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  • 4 th Dimension, Office no 105, 1 st floor, Gulawani Maharaj Road Pandurang Colony, Erandwane Pune, Maharashtra 411004

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