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!

A VNUS closure procedure is a medical minimal invasive treatment that offers an efficient and non- surgical alternative for treating varicose veins. Varicose vein is a medical condition where the veins become large and swollen and begin to appear on the skin especially on the legs. The condition arises when the valves do not function properly and the blood begins to flow in the opposite direction. This often results in pooling of the blood in a certain area which makes the vein enlarge. As a result, they begin to appear on the skin as blue or dark purple and the most commonly affected areas are the legs. Apart from treating them with medicines, there are two distinct methods to treat them- invasive and non- surgical methods. VNUS closure is one non-surgical procedure that can treat and cure varicose veins.

The twisted and bulging chords in case of varicose veins can burst and give rise to ulcers. Before conditions get worse, one must get it treated and as proven, non-surgical methods are best to treat them. The VNUS procedure uses radioactive frequency to heat and close the vein from within. These heat waves contract the collagen found inside the vein walls and causes them to collapse and shut down.

There are several reasons why this is the best process to treat varicose veins. Some of which are:

This is not an open surgery and is minimally invasive.
The treatment does not require a very big setting such as other surgeries. It can be performed on the patient under local anesthesia and patients are often allowed to walk out of the clinic after a few hours of the procedure.
The patients can resume normal activities within two days of the procedure being performed.
The treatment is effective and provides long-lasting relief for the problem.
There is nothing scary about this treatment and it is a very simple procedure.
Before the procedure begins, the doctor using an ultrasound marks the position at the end of the groin. After the patient has been sedated using a local anesthesia, a special catheter is then inserted into the vein through a small 2-3mm cut just below the knee. Once that has been done, radiofrequency energy is used to seal the faulty veins. At the end of the procedure, a small dressing is applied, along with a special compression stocking which the patient needs to wear for the next 7 to 10 days. The process provides instant relief from the symptoms.

However, one must consult a doctor who can advise the patient on the best procedure for varicose veins after an examination to determine the intensity of the problem. 

VNUS Closure - Why Is It Performed?

Congestive heart failure is a chronic progressive condition that affects the pumping power of your heart muscles. Simply referred to as heart failure, congestive heart failure can be life-threatening. It does not mean that the heart has stopped working. Rather, it means that the heart pumping power is weaker than normal. As a result, the heart cannot pump enough oxygen and nutrients to meet the body s needs. Over a period of time, the reduced ability of the heart causes the organs to receive less amount of oxygenated blood.

Signs and symptoms of congestive heart failure: In the early stages of congestive heart failure, you most likely won t notice any changes in your health. If your condition progresses, you will experience gradual changes in your body. The hallmark and the most common symptom of congestive heart failure is shortness of breath and it may occur while you are at rest, doing any activity that exerts your body, when you are lying flat or while getting up from sleep. Some of the other most common symptoms of congestive heart failure include a persistent and unexplained cough, swelling in the legs, ankles, abdomen, or hands, tiredness, changes in thinking and memory, nausea, rapid heart rate, and dizziness or light-headedness.

Causes of congestive heart failure: Congestive heart failure is most likely to occur in people who have other conditions that weaken the heart. The risk also increases by several lifestyle factors that are bad for the heart. Risk factors for congestive heart failure include congenital heart defects, high blood pressure or cholesterol, obesity, asthma, chronic pulmonary disease, coronary heart disease, heart infection, reduced kidney function, a history of heart attack, irregular heart rhythms, abuse of alcohol and drugs, smoking, and old age. Though there are over a hundred other less common causes of heart failure, the exact cause of congestive heart failure is often idiopathic or unknown. Congestive heart failure might also exacerbate by unhealthy lifestyle habits. Specific habits such as smoking, excessive use of alcohol, obesity, lack of exercise, high salt intake, noncompliance with medications, and other therapies may increase the risk of congestive heart failure.

Diagnosis of congestive heart failure: A doctor or cardiologist will perform a physical exam. This may involve listening to the heart for abnormal heart rhythm. Some common tests that are done to help with the diagnosis of congestive heart failure include an electrocardiogram, chest X-ray, series of blood tests, echocardiography, stress test, magnetic resonance imaging (MRI) and cardiac catheterization.

Treatment of congestive heart failure: The goal of treatment for congestive heart failure is to have the heart beat more efficiently so that it can meet the energy needs of the body. Specific treatment depends upon the underlying cause of heart failure. You and your doctor may consider different treatment, depending on your overall health and how far your condition has progressed. There are several medications that can be used to treat congestive heart failure. ACE inhibitors open up narrowed blood vessels to improve blood flow. Vasodilators are another option if you cannot tolerate ACE inhibitors. Beta blockers can reduce blood pressure and slow a rapid heart rhythm. Diuretics reduce your body s fluid content. A surgery such as angioplasty is recommended if medications are not effective on their own.

Congestive Heart Failure - Signs & Symptoms You Must Not Ignore!

How many of us have heard about Extracorporeal Membrane Oxygenation (ECMO) before Tamil Nadu, Chief Minister late J Jayalalithaa was put on it for recovery? Hardly a handful. Patients who are placed on the device have 50-50 chance of survival and while it could not help the late Chief Minister, her condition put a spotlight on ECMO.

What is ECMO?
ECMO is a life support device that is put in place when a patient's heart and lungs stop functioning completely post a cardiac arrest. When the patient does not respond to Cardio Pulmonary Resuscitation (CPR), the patient is put on ECMO.

Function of ECMO
The core function of the device is to separate carbon dioxide from the blood and add oxygen into it. It takes the load off from heart and lungs, providing critical time to the body organs for its treatment and recovery.
Patients are only put on ECMO, if there is a chance that the condition can be reversed.

How does ECMO work?
The device drains blood from a vein, which is attached to an oxygenator machine. The machine then removes carbon dioxide from the blood and adds oxygen to it. Depending upon the condition of the patient, the warm blood is either pumped into the body with the help of the machine or is transferred back into the body through an artery.

How long a patient can be on ECMO?
After seven days of being put on ECMO,there are chances of patient getting an infection.
In case the patient contracts an infection, it is recommended to take the patient off ECMO support.

All About ECMO - Extracorporeal Membrane Oxygenation 

High blood pressure can lead to hypertension, which is known to cause a variety of debilitating side effects or symptoms in the life of the patient. It can also lead to a number of related ailments which can affect the various organs of the body. The eyes are one of the organs that are most susceptible to this kind of spike in the body s blood pressure. Let us learn more about the connection between the two.

Retina: When high blood pressure goes untreated for a prolonged period, it can easily start to affect the blood vessels that can be found in the retina. The retina is the third or the inner most layer of the eye which is sensitive towards light and usually helps in refraction. This is where the light reaches so that one can focus clearly on an image. When the blood pressure of the patient stays high for a prolonged basis, there is significant pressure on the blood vessels in this part of the eye which can lead to an eye disease known as hypertensive retinopathy.

Symptoms: Symptoms of this eye disease include lack of clarity and focus when the eye comes to rest on an object, as well as headaches and other vision problems that typically spring from eye strain that one will go through while trying to focus even harder. It may be seen that the symptoms do not appear in the very early stages of this disease.

Diagnosis: The diagnosis of the condition is usually done by an ophthalmologist who will use an ophthalmoscope in order to project light towards the specific part of the eye so that the back of the eyeballs can be examined. The signs that the doctor will look for during the examination include narrowing of the blood vessels in this part of the eye, inflammation of the macula which is the central portion of the retina, and bleeding in the back of the eye. Also, the doctor will check for spots in the retina with the help of cotton swabs and exudates.

Treatment: The best and only way of treating this condition is by keeping one s blood pressure in control with the help of medication prescribed by the doctor.

Prevention: There are many ways of preventing the onset of this disease, including losing weight so that there is less pressure on the body. Also, one must stick to a healthy diet and exercise regularly after taking recommendations on the appropriate exercises from the doctor. Additionally, it is also important to see a doctor on a regular basis so that there is constant monitoring and regulation of the medicines and the blood pressure.

Blood Pressure - How it Affects Your Eye Sight?

What is Palpitation?
Palpitation is a feeling of awareness of your own heart beat. It is usually described as heart rate being either too fast (racing), too slow or a sensation of missing a beat.

Types of palpitations?
Normal (Benign)
- These palpitations occur as a response to physical or mental stress like exercise, fever, pain, fear, anxiety etc. 
- They are harmless and settle on their own once the precipitating factors disappear. They do not require any medical treatment.

Abnormal
- These palpitations occur due to some underlying abnormality in either the structure of heart or the beating of heart. 
- These can be dangerous and at times life threatening. They may or may not settle on their own and require some medical treatment.

Warning signs that suggest palpitations are abnormal?
Palpitations are abnormal, if they are associated with chest heaviness, chest pain, uneasiness, sweating, weakness, giddiness, feeling of black out, fainting, nausea, vomiting, seizures. Palpitations are more likely to be abnormal in people who have some existing heart disease and these patients should report to their doctor at the earliest.

What to do during palpitations?
1. Stay calm. 
2. Call for help. If u are alone avoid driving, use a taxi or auto, go to your nearest hospital/doctor and try to get an ECG during the palpitations. If you are helping someone having palpitations, if they faint, call for help, start CPR if they remain unresponsive and take them to the nearest hospital. 

Which doctor can treat palpitations?
Doctors who specialise in the treatment of palpitations are called Electrophysiologists. They specialise in heart rhythm and are capable of performing a variety of complex tests to identify and treat different types of palpitations.

Which investigations are used to diagnose palpitations?
ECG: Taken during palpitations and when the patient is normal is a very helpful tool. 
Holter: Externally applied recorder, which continuously records heart rhythm for 24 hrs. 
ELR: Extended loop recorder, is like holter, but it records rhythm for longer durations. 
ILR:  Internal loop recorder is attached within the body for recording rhythm for long duration. 
EPS: Electrophysiology study, is the most sure shot test to diagnose, identify and treat 
Palpitations.

What is EPS?
EPS stands for Electrophysiology study. By this test a trained Electrophysiologist studies the conduction and formation system of heart beat, to understand the source, cause and type of palpitation. It is a simple and safe procedure of 2 to 3 hours and can be done as a day care procedure (by admitting the patient for a few hours in hospital, with discharge on same day).

It requires fasting for 4 hrs, some standard blood investigations and is done with local anaesthesia and if required it can be combined with treatment like ablation in the same sitting.In the procedure Electrophysiologist take catheters into your heart to study and stimulate the palpitations and understand them. Once found they can use various techniques to stop the palpitations, the techniques are called Ablation.

What are the treatment options available for palpitations?
There are many options depending upon the nature of palpitations and condition of the patient: 
- Drug therapy 
- Cardioversion where either a drug or electric shock is given to stop palpitations immediately. 

Ablations using many sophisticated computer softwares 
Device Therapy like ICD (Internal cardiac defibrillator) 
Combination of all the above therapies.

Your Electrophysiologist and you as a team can make a choice about the options that will be best for you.

Palpitations - Everything You Need to Know

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