Dialysis is a very important and life-saving procedure. It is performed to replace kidney function in case of renal failure. Wastes and extra fluids in the blood are filtered out during this process. To be able to perform Dialysis, the connection between the patient s bloodstream and the equipment for performing Dialysis (dialyzer) outside the body is established. This connection is created through Dialysis Access Surgery. It is a type of Vascular Surgery which forms the vascular opening for access during Dialysis. Thus, Dialysis Access Surgery is the lifeline for the survival of the patient.

Types of Vascular Access for Dialysis- 
There are three types of Vascular Access for Dialysis: Arteriovenous (AV) Fistula, Arteriovenous (AV) Graft, and Venous Catheter.

  Arteriovenous (AV) fistula is a surgical connection of an artery to a vein. An AV fistula is usually placed in the upper arm or in the forearm. It causes extra blood to flow into vein making it grow large. A larger vein hence provides easy access to blood vessels. An AV fistula is preferred over other methods as it lasts longer than other methods of access and provides a good flow of blood. Moreover, it is less prone to infection and blood clots than other methods. Before an AV Surgery, a Vessel Mapping Test is sometimes performed for assessing the blood vessels most suitable for Dialysis. An AV fistula is performed under local anaesthesia and requires two to three months for maturation before hemodialysis. If it fails to mature, the procedure is repeated.

  Arteriovenous (AV) graft is performed when AV fistula fails to mature. It is hence the second most preferred choice for long-lasting access to vascular tissues for Dialysis. An AV graft is a looped plastic tube which establishes a connection between an artery and a vein. Like AV fistula, AV graft is also performed under local anaesthesia. It is slightly more difficult to maintain than an AV fistula.

  A venous catheter is used for short- term hemodialysis. It is a tube which is inserted into chest, neck, leg, or near groin for vascular access. After exiting the body, the tube splits into two halves. In the case where a renal disease has made quick progression leaving little or no time for the AV fistula or AV graft to mature, a venous catheter is used to establish the required vascular connection. This procedure is also performed under local anaesthesia. It is a tool for emergencies but is not suited for long- term use. It can cause narrow vein due to an infection,
scarring, or blood clot. If long- term venous catheter is used, it is tunnelled under the skin which has fewer problems associated with it and is more comfortable. 

How to Care for a Vascular Access?
  Get checked for infections and other problems before each hemodialysis session;
  Use the operated site for access only for the intended use;
  Always keep the access clean;
  Prevent cutting or bumping the access;
  Check for thrill/ vibration in the access and inform the doctor if any;
  Do not put pressure on the access site;
  Do not put blood pressure cuff around the access arm;
  Do not wear jewellery or tight-fitting garments over the site;
  Do not lift a weight.

Take Away-
Vascular Surgery for Dialysis is performed to provide vascular access for the procedure. AV fistula is the most preferred type followed by an AV graft. A venous catheter is recommended to be used only in case of an emergency when there is not much time left for the other two options to mature.

Vascular Surgery - Can It Help For Dialysis?

The coronary arteries supply the heart with oxygen-enriched blood and nutrients. If these arteries become damaged or diseased; they could cause Coronary artery disease or CAD. Plaque deposits on the walls of the arteries are the most common cause of this disease. This plaque is usually the result of high cholesterol levels. As the plaque builds up, the passage of blood flow is reduced. This reduces the amount of blood that reaches the heart. In cases of a complete blockage, CAD can even cause a heart attack. Because of its slow progression, this disease is often not diagnosed until it reaches a dangerous stage. However, it can be prevented and treated if diagnosed in time.

In the early stages of CAD, symptoms are not very noticeable. Symptoms become visible only when blood flow to the heart reduces and the heart has to pump harder than normal. The most common symptoms experienced include:

Chest Pain: This is also referred to as angina. It may feel like a tightening of the chest or pressure on the chest as though someone is pressing against it. This type of chest pain may be triggered by emotional or physical stress. It is usually relieved within a few minutes of stopping the activity. Women may experience this pain as a sharp, fleeting pain in the back, arm or neck.
Breathlessness: When the heart does not receive enough blood, it has to work harder to pump blood through the body. This may be translated to breathlessness of shortness of breath when performing any type of physical activity. It can also cause extreme fatigue.
Heart Attack: A heart attack is the most severe symptom of coronary artery disease. This is caused by the complete blockage of a coronary artery. A heart attack can occur without any symptoms or be preceded by slight symptoms. The signs of an impending heart attack include pain in the chest and shoulder, shortness of breath and extreme sweating. The chest pain may also travel to the lower jaw. These symptoms are more pronounced in men as compared to women. Women have a higher tendency of experiencing atypical signs such as extreme fatigue.
Other symptoms that might indicate coronary artery disease are dizziness, nausea and an irregular heartbeat. The good news is that this disease can be prevented. Staying physically active, maintaining a healthy weight, reducing stress and eating a low fat and low salt diet can help reduce the risk of CAD.

Coronary Artery Disease (CAD) - What Are The Symptoms?

High blood pressure is a condition which occurs when the pressure of the blood flow through the arteries increases, resulting in intense pressure. Hypertension occurs when the systolic pressure (pressure at which the heart pumps blood) and the diastolic pressure (pressure at which the heart relaxes) is more than 140 and 90 respectively.

Symptoms of high blood pressure are: 

1. Shortness of breath

If you have high blood pressure, then you may experience regular shortness of breath.

2. Headaches

You may experience headaches on a regular basis.

3. Weakness of the heart muscles

Hypertension results in a weak heart which may not be able to pump blood properly.

4. Narrowing of blood vessels

Narrowing of blood vessels may lead to other complications such as failure of the kidneys, heart, and brain.

5. Vision problems

It may lead to vision problems as blood vessels in the eye may be affected.

The various causes of blood pressure are: 

1. Tobacco
If you smoke on a regular basis, you put yourself at an increased risk of getting affected by blood pressure.

2. Lifestyle
Not exercising regularly, eating a sodium-rich diet are all factors which can increase the chances of hypertension.

3. Age
The chances of getting affected by hypertension increase as you age.

4. Weight
Being excessively obese also increases your risk of getting affected by hypertension.

5. Diabetes
Being diabetic makes you more prone to getting affected by diabetes.

6. Hyperthyroidism
If you have an overactive thyroid gland, then it may result in hypertension.

Hypertension may result in various health complications in the body such as:

1. Aneurysm

This is a disorder of the blood vessels which causes the blood vessels to bulge and weaken.

2. Heart attack

High blood pressure causes the arteries to harden and thicken which may lead to a heart attack.

3. Metabolic syndrome

This syndrome refers to a group of complications such as high bad cholesterol levels and insulin levels in the body.

4. Impaired brain functioning
It may also impair your ability to learn and impact your cognitive skills.

Hypertension and High Blood Pressure

Things to do in case of chest pain or angina pain

Unlike yesteryears chest pain or heart related problems aren’t just age related anymore. Many young people under 30 are experiencing chest pain. It seems to be directly proportional to the increasing stress levels.The medical term for mild chest pain is angina pectoris and it happens when your heart is not getting its usual requirement for blood. Such a situation occurs when one or more arteries are blocked. Angina Pectoris is experienced usually while doing physical activities or experiencing strong emotions. At such times, the heart doesn't get as much blood as it requires for normal functioning.

Broadly speaking, discomfort in the upper part of the body is the symptom of angina, the symptoms typically include:

1.  It may feel like you are suffering from indigestion or gas or fullness and pressure.

2.  It may also feel like chest pain spreading to the neck, back, arms, shoulder or jaw.

3. You feel better after a little rest or some medication.

4. It doesn't last for too long, at the most five minutes.

5. Shortness of breath, anxiety, dizziness, sweating, fatigue and nausea and also symptoms of angina.

Physical conditions and habits which put you at the high risk zone for angina are:
1. When you don't get enough exercise.
2. If you are a smoker
3. If you are overweight
4.  If you have a history of heart diseases
5. If you are diabetic
6. If you suffer from blood pressure of high cholesterol

Steps You Must Do To Manage the Pain and Resultant Effects

1. Calm Down - The first thing to do to counter angina pains is to rest and calm down. If you are doing physical activity, stop doing it. And if you are under emotional turbulence, you need to find ways to calm down immediately. Meditate, if needed.

2. Get Professional Help - Do not delay in consulting the doctor and ensure that you take the prescribed medication diligently. In situations where the damage is much more and medications cannot clear the problem, surgery is resorted to.

3. Change Of Lifestyle - In the long run, lifestyle change is a good idea. Staying fit, a clean medical report and keeping a healthy lifestyle will keep enough blood pumping into your heart.

If you would like to consult with me privately, please click on 'Consult'.

From Lybrate: If you found this tip useful, please thank the doctor by clicking on the heart icon below. Also, spread good health by sharing this tip with your loved ones over WhatsApp, Facebook and other media.

Why You Must Not Dismiss Chest Pain as a Minor Affair!

Why Do You Get Palpitations? How to Get Immediate Relief?

Palpitations is the feeling that you experience when your heart beats abnormally. Heart palpitations can be felt in the form of rapid, fluttering or pounding heartbeats. They can be frightening as when you palpate, you heart beats so hard that it even skips a beat and the sensations are so strong that they can be felt all through your chest, neck, and throat.

Palpitations are also common especially in young people because of abnormal electrical circuits in heart from birth. However, they may have normal hearts on Echo. Such palpitations are curable by a nonsurgical methods called Radiofrequency Ablation.

Palpitations can be triggered as a result of a number of reasons like stress, certain medications, exercise etc.

Here are a few prominent causes of heart palpitations.

Causes unrelated to the Heart -

- Anxiety, fear, and stress
- Consumption of alcohol and drugs like caffeine, nicotine etc.
- Consumption of street drugs likes cocaine, amphetamines etc.
- Certain medical conditions such as thyroid, anemia, dehydration, low blood pressure and low sugar levels etc.
- Hormonal changes that occur as a result of menstruation, pregnancy, menopause etc.
- Certain nutritional and herbal supplements
- Certain medications like asthma inhalers, diet pills etc.
- Abnormal levels of electrolyte
- Sensitivity to certain food items like some carbohydrates

Causes related to the Heart -

- Coronary artery disease
- Prior instances of heart attack
- Congestive heart failure (a condition wherein your heart's chambers get affected)
- Problems associated with the heart valves or the heart muscles

Immediate Relief Mechanisms-

It is crucial to go to the most easily available doctor to get an ECG done during palpitations as ECG will give an exact diagnosis, which helps in identifying the clear line of treatment.

Here are a few techniques that can help you in getting immediate relief from heart palpitations until you are able to visit a doctor in case of a serious condition.

- Cough it out
- Splash cold water on your face or take a cold shower
- Practice slow, deep breathing exercises



Why Do You Get Palpitations? How to Get Immediate Relief?

The heart pumps pure blood to all parts of the body through a network of arteries. These are thicker in the beginning and become finer and thinner as they reach the various organs. These arteries are lined by a layer of epithelial tissues and as blood flows through them, the heavier cholesterol / fat molecules settle down along the walls. 


This attracts more and more fat molecules to settle down.  This is known as atherosclerosis (hardening of the arteries). Over a period of time, the vessels circumference reduces and the blood supply to the target organ reduces. This impacts proper functioning of these organs and when this happens to the major organs like the heart, kidney or the brain, conditions like stroke or thrombosis or heart attack can occur.


This condition, known as coronary artery disease, is becoming a major cause of deaths.  While that is the bad news, the good news is that it is largely lifestyle dependent, and if steps are taken, it can be prevented, and in the early stages, the damage completely reversed.


Preventive measures: 
1. Diet: A low-fat, high-fiber, heart-healthy diet consisting of Omega-3 fatty acids is recommended by doctors, especially to people who are prone to develop heart disease.  This also requires reduced salt, increased unsaturated fats, reduced triglycerides and reduced sugar.  Include loads of fresh fruits and vegetables, whole grains, nuts and seeds and fish oils. Include multivitamins or other supplements after checking with your doctor.


2. Exercise:  Regular exercise in any form increases the efficiency of the circulatory system, keeps the cholesterol levels in check and helps in blood pressure management.  Exercise in any form is advisable, based on individual preference. A moderate physical activity of 30 to 45 minutes per day is advisable.


3. Smoking: This is one of the major risk factors for smoking, and quitting or controlling smoking is one of the best methods to prevent coronary artery disease.


4. Alcohol consumption:  While moderate alcohol consumption is believed to be healthy for the heart, excessive alcohol consumption is a strict no-no.  Binge drinking especially is shown to cause heart attacks.


5. Weight management: Check with your doctor on what is ideal BMI for you and work out a plan to keep your weight under check.


6. Regular medications: If you are on blood pressure or diabetes medications, ensure you do not miss them.  Keep a constant check to ensure your readings are managed well. 


7. Watch out:  Ask your doctor if there are specific symptoms that you need to watch out and seek medical support if you see any of them.


Coronary disease is not treatable fully, but can be prevented and managed effectively to improve the overall quality of life.

Coronary Artery Disease - 7 Ways You Can Prevent it 

Don't wait any longer, manage your Cardiac Anesthesiologist online with a Lybrate doctor today

Consult for Cardiac Anesthesiologist - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES