Automatic Implantable Cardioverter Defibrillator is an electronic device that is located in the chest of the patient suffering from arrhythmia. Arrhythmia is a condition which causes abnormal rhythm of heartbeat in the patients. It is a life-threatening condition. The device is located in the chest to correct the rhythm of a heartbeat.

AICD device works in two ways:

Firstly, it tries to correct the abnormal heartbeat rhythm and release high- speed heartbeat pace. This is called cardioversion. Patients with AICD generally do not feel the process.

However, if the effect of cardioversion is null then the device will give a mild electric shock to the patient's heart to correct arrhythmia and reset the rhythm.

This second method is called defibrillation. The patient can feel the defibrillation.

The modern-day AICD device is programmed to store the data about the patient s heart rhythm. Doctors use the programmed device which contains your condition and provides medically correct therapy.

Preparation for AICD Implantation

The patient is required to fast six hours before undergoing the surgery. On admission, prescribed medicine is given to the patient and the latest heart condition is measured by an ECG test. If the patient is on blood-thinning medication, then it will be stopped 24 hours before the surgery.

The procedure will be carried out by a cardiologist. The patient will remain under observation in the hospital for at least two days.

Procedure

The entire process of setting up the device in the chest of the patient takes about 2 hours. The patient is sedated, and the area below the collarbone is numbed for the operation. A small incision is made in the chest area. With the help of imaging techniques, cardiologist sets up the device in the chest. The device is then connected to the veins and the heart. After the surgery, the patient is kept under observation. Heart rate, blood pressure, and overall health condition are observed by the doctors to determine successful implantation of Automatic Implantable Cardioverter Defibrillator (AICD). Post Procedure After the successful recovery of the patient, doctors usually discharge the patient with AICD attached. The doctors give complete care instructions of the device along with health. Doctors also guide the patient through the list of activities that one can and cannot perform. AICD is a life-saving device. Hence, proper care and regular check-ups are recommended by the doctors. The regular check-up of the device is also essential since the device runs on a battery. The doctors also train the patient about the workings of the device. They will also explain about the mild shocks of the device one may receive to correct the arrhythmia. Before leaving, make sure the site of the surgery is dry and healing, and you do not have a fever for the past 24 hours.

AICD Implantation - Know Procedure Of It!

During breathing activity, chest wall moves out & in, lungs expand & relax. For the smooth movement of the lungs inside the chest cavity, they are lined by pleura.

Pleura includes two thin linings, the layer lining lungs is called visceral pleura and the one lining chest wall is called parietal pleura. The cavity formed between these two layers is called Pleural cavity. It contains a small amount of lubricant called Pleural fluid which helps smooth sliding of two pleural surfaces. Any condition which results in inflammation of the pleural surfaces or accumulation of excessive fluid in the pleural cavity gives rise to symptoms attributable to pleural involvement or disease.

Pleural effusion is nothing but the collection of excess fluid in the pleural cavity. Excess fluid in the pleural space is not normal and can occur due to a variety of reasons. Depending on the chemical composition it is broadly divided into two categories, transudate and exudate. 


What Causes Pleural Effusion?

1. Transudate pleural effusions 

Transudate pleural effusion is formed when fluid leaks from blood vessels into the pleural space. Chemically, transudates contain less protein and LDH than exudates. It is generally seen in the following conditions.

Congestive heart failure

Liver failure or cirrhosis

Kidney failure or nephrotic syndrome

Peritoneal dialysis

2. Exudate pleural effusions 

Exudate pleural effusion is caused by inflammation of the pleura itself and are often due to diseases involving the lung. Following are some common illnesses giving rise to exudate pleural effusion.

Tuberculosis
Pneumonia
Lung or breast cancer
Lymphoma
Pulmonary embolism
Post chest wall trauma or surgery
Asbestosis and mesothelioma
Secondary to intra-abdominal pathology 
Pancreatic pseudocyst, etc
Symptoms of Pleural Effusion -

Chest Pain: Chest pain is mainly due to irritation of the pleural lining. The pain is sharp, localized and worsens with a deep breath, yawning, coughing which is usually described as pleuritic. If the effusion causes inflammation of the diaphragm the pain may be referred to the shoulder or the upper abdomen. As the pleural effusion increases in size, the pain may increase or disappear altogether due to the separation of inflamed pleural surfaces.

Shortness of breath: As the effusion grows larger with more fluid, the harder it is for the lung to expand and the more difficult it is for the patient to breathe resulting in shortness of breath.

Other Symptoms: Other symptoms are generally attributable to the underlying disease process.

Diagnosis of Pleural Effusion -

Patient s Detailed History and Clinical Examination are the mainstays of diagnosing pleural effusion and it s the underlying cause. Following investigative modalities are generally opted for working out the final diagnosis before instituting appropriate therapy.

Chest X-ray: X-ray will help indicate the presence of fluid. 
Chest Ultrasound(USG): will help in confirming the presence of the fluid and it s localization which in turn can guide the physician about its quantity and its capability.
CT Scan: CT scan of the chest may at times be required to ascertain the underlying cause or to know about any other co-morbid conditions.
Thoracentesis: Thoracentesis is a procedure used to sample the fluid from the pleural effusion. Using a long thin needle, fluid can be removed and sent for testing to confirm the diagnosis.
This can be just for diagnostic purposes or can even be used as a therapeutic procedure.
Chemical analysis of the fluid will help determine the type of pleural effusion.
Treatment of Pleural Effusion -

Treatment of underlying Disease: The treatment of a pleural effusion usually requires that the underlying illness or disease is treated and controlled to prevent the accumulation of the pleural fluid. Like anti-TB therapy for Tubercular etiology or treatment of Cancer in malignant pleural effusion, etc.

Thoracentesis: As discussed earlier Thoracentesis can be used as a therapeutic procedure to remove excess fluid and help lung expand and function properly.

Tube thoracostomy: Thoracostomy or chest tube insertion may be done to drain and treat fluids which cannot be removed by needle aspirations, e.g. empyemas (pus collections).

Pleurodesis: Some pleural effusions reoccur multiple times; sclerosing agents that induce scarring such as talc or tetracycline was used to prevent a recurrence.

Decortication: If sclerosing agents fail, surgery may be required, called Decortication.

Pleural Effusion - What Is It?

If you thought that chest pain occurred only due to a heart-related issue like a heart attack, you are wrong. Chest pain is one of the most common reasons that people visit the emergency services and it can be caused due to problems with your heart, lungs and digestive system. 

Chest pain can be due to either of these two main reasons:

Heart- related Issues

1. Heart attacks called myocardial infarctions are very common reasons for chest pains. During a heart attack, the blood supply that serves the heart with oxygen is cut off due to plaque build-up in heart arteries causing the death of heart muscles. 

Other reasons for heart attacks are blood clots or torn blood vessels. 
Not all people having a heart attack have symptoms. Usually, people report symptoms like chest pain, upper body pain, nausea, sweating, fatigue, and trouble breathing.
A heart attack is a serious medical emergency for which immediate care is needed.
2. Angina pectoris is a type of chest pain that results from reduced blood flow to the heart. Low blood flow means your heart doesn t get enough oxygen. The angina pain is often triggered by physical activity or emotional stress and feels like a vice squeezing your chest or a heavy weight on your chest. It can also spread from your chest to your neck, arms, and shoulders. Other symptoms are fatigue, dizziness and nausea and these normally last up to 15 minutes only.

3. Unstable angina which causes crushing chest pains suddenly and even when you are not doing anything strenuous is a medical emergency as it can lead to a heart attack. This usually shows that your heart, arteries are narrowing alarmingly.

4. Other heat-related reasons for chest pains are-

Mitral valve narrowing or stenosis
Heart arrhythmias
Coronary Artery disease
Inflammation of heart muscles or pericardium and weakening of the heart muscles. 
All of these are emergencies and need immediate medical attention to prevent a fatality.

Not Heart- related:

1. Lung conditions like Pneumonia, Bronchitis, Pulmonary embolism. 

Pneumonia is an infection in one or both lungs caused by fungi, bacteria, or viruses. It causes inflammation in your lung s air sacs and makes them full of pus which makes it difficult to breathe and causes chest pains, amongst other debilitating symptoms.
Bronchitis is an inflammation of your bronchial tubes. It can be chronic or acute and it can cause a cough with mucus and chest pains. 
Pulmonary embolism is a blood clot that occurs in the lungs. It can go on to damage parts of your lung due to limited blood flow. Apart from this, it can also decrease oxygen levels in the blood and affect other organs. 
It can be life-threatening due to permanent lung damage. The most common symptom of a pulmonary embolism is gradual or sudden shortness of breath. 

There is also- 

bluish skin tone 
anxiety
fainting
hest pain that extends into your arm, jaw, neck, and shoulder
lightheadedness
2. Rib cage inflammation or Costochondritis is also known as Tietze s syndrome. It is an inflammation of the cartilage in the rib cage. Patients experience chest pain in the upper and middle rib area on either side of the body due to this. The pain can also radiate to the back or the abdomen, getting worse if you move, stretch, or breathe deeply.

3. Food pipe disease or Esophagitis is any inflammation or irritation of the oesophagus, a tube that sends food from your throat down to your stomach.

Common causes of food pipe disease are acid reflux or GERD and bacterial or viral infections. 

GERD- This condition occurs when the stomach contents and acids back up into the oesophagus. This causes chest pain that can mimic a heart disease. There may also be oesophagal spasms due to GERD.

Chest Pain - Reasons and Treatment

A heart attack makes you rethink and get a double take on life. Once you survive it, you tend to realize how close your brush with death has been and how important your lifestyle choices can be. Most people go on to live a productive life after a heart attack provided they can adhere to making healthy choices. Here's what you can do if you have experienced your first attack and want to change for the better:

1. Start at the hospital: A person usually stays in the hospital for 3 days after an attack to monitor their condition. This duration increases if you have complications that involve procedures like a bypass surgery. Your first significant change will come in the form of your medication routine. Your existing dosage may be adjusted and you'll possibly be prescribed newer medicines that will treat and control your symptoms. You'll not only need to know the names of all your medicines, but when you have to take them. It's best you know exactly why you are taking each one of them, if there are other more economic alternatives since this may last a lifetime and what side effects they may have.

2. Maintaining your mental health: Once bitten, twice shy applies for heart attack victims too. Not only do they live in a constant worry about another attack, every small symptom like a harmless muscle pull can trigger the fear factor. You also get into the "heart patient" dependent mode based on how much help you need to recover. Check for support groups and other heart attack survivors in your locality to see how they are coping. Read more about your recovery and try to keep a positive frame of mind.

3. Go to a cardiac rehab: Many hospitals have a rehabilitation program that you can participate in as an outpatient or you can go to a clinic that specializes in it. Such programs help speed up your recovery. It is run by people who will hand hold you in bringing positive changes in your life to protect and strengthen your heart. You'll learn activities that positively improve heart functions and reduce your chances of developing complications or dying from heart disease. You'll also get benefit from exercises that'll be taught by a certified exercise specialist.

4. Make a change in your lifestyle: Quit smoking that is an obvious one. You'll now have to lead a more active lifestyle with daily exercise. You'll also need to actively manage your diabetes and obesity. None of these changes can happen in a day. In fact, behavioral scientists suggest that you need to practice a new activity continuously for twenty one days for it to become a habit.

How To Live After A Heart Attack

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?

Angioplasty is the procedure of opening a coronary artery blockage with the help of wire balloon and stent. This procedure is done to open the blocked coronary arteries if they are causing symptoms or acute heart attacks.

HOW IT IS DONE?

The procedure is usually done in local anaesthesia. A wrist artery (radial) or a groin artery (femoral) is used to gain access to the coronary artery as is done in angiography. A hollow tube called a catheter is passed upto heart artery and through this, a guidewire is passed across the blockage and over this wire balloon is passed and blockage dilated.

After this balloon is removed and the metallic stent is passed over this wire. The stent is then inflated and it takes its shape of the hollow tube so that the flow in the coronary artery is restored.

WHAT ARE INDICATIONS OF ANGIOPLASTY AND STENTING:

An acute Heart attack is the most definite indication of angioplasty and stenting. At the time of the heart attack, there is an urgent need to restore the blood flow of block coronary artery which is usually not possible with medicines alone. Angioplasty is the most effective and definite way of opening the artery urgently in such situation.

SHOULD ALL BLOCKAGES BE OPENED UP BY ANGIOPLASTY AND STENTING?

NO, all blockages do not warrant this procedure. There is some amount of risk involved in the angioplasty procedure itself. When the risk of blockage is considered more than the risk of opening the artery then the procedure is indicated. Patients who are doing good on medicines may be followed up without angioplasty.

All About Angioplasty!

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