Coronary artery disease or CAD is the name given to the heart condition in which the major blood vessels that supply your heart with blood, oxygen and nutrients, also called coronary arteries, get blocked, damaged or diseased.

Blockages usually happen when cholesterol-containing deposits called plaque deposit in your arteries. Plaque narrows the lumen of your coronary artery which means your heart gets lesser and lesser oxygen and nutrients to function properly.
Inflammation is also to blame for coronary artery disease.
Common symptoms of CAD include

Angina or pain in the chest
Shortness of breath
If the blockage is complete, you can get a heart attack.
Common Diagnostic tests
When you go to a heart specialist, she will ask questions about your medical history and follow it up with a physical exam and order routine blood and diagnostic tests to confirm CAD like:

Electrocardiogram (ECG): An ECG records electrical signals as they travel through your heart revealing evidence of a previous heart attack or one that s happening. Holter monitoring is a type of ECG where you wear a portable monitor for 24 hours as you go about your normal daily activities. Abnormalities in the results suggest reduced blood flow to the heart signaling CAD.
Echocardiogram: This test uses sound waves to produce images of your heart. It helps your doctor determine whether all parts of your heart wall are contributing to your heart's pumping activity. If certain parts are moving weakly it can mean damage to muscle due to a heart attack or because of receiving too little oxygen- again signaling CAD.
Exercise Stress test: This test is done by making you do exercises like walking on a treadmill or riding a stationary bike during an ECG. Sometimes, medication to stimulate your heart may be used instead of exercise.
This again detects areas in your heart that receive less blood flow.

Cardiac catheterization or angiogram. A special dye is injected into your coronary arteries to observe blood flow through your heart in a test known as an angiogram.
The dye is sometimes also injected into the arteries through a long, thin, flexible tube called catheter that is threaded through an artery in your leg to the arteries in your heart. This procedure is called cardiac catheterization. This test is very good in diagnosing CAD as the dye outlines narrow spots and blockages on the X-ray images of your heart.
Heart scans. Computerized tomography or CT can help your doctor actually see calcium deposits in your arteries that can be narrowing your arteries. If a substantial amount of calcium deposits are found, coronary artery disease could be the reason.
MRI scans are also done to diagnose CAD.

Common Tests For Coronary Artery Disease!

Your heart is the most important and vital organ of all and regulates the flow of heart to all parts of the body. Thus, the valves and the arteries which take the blood to your heart are also an important component in ensuring that the circulation is constant. Thus, any hindrance to this process will put a lot of pressure on your heart and lead to more serious problems in the long run. Coronary artery disease is one such problem and can seriously put the health of your heart at risk.

What is coronary heart disease?
Coronary arteries are very important blood vessels, which carry nutrients, blood and oxygen to your heart. If the level of bad cholesterol is high in your blood, it will start leaving deposits on the walls of the arteries which are commonly known as plaque. This plaque will start building up over time causing blockage of the arteries and disrupting proper blood flow. Excessive build up of the plaque may then rupture the lining of the plaque. This will then induce blood clotting and further prevent the normal flow of blood.

Symptoms
Primary symptoms may include

Shortness of breath: This may occur while you are exercising or performing activities which are mildly exerting.
Heart beats very hard and fast: Your heart may beat very hard and fast, especially when doing everyday activities such as climbing stairs or walking for a prolonged distance.
Angina or chest pain: You may experience pain in your chest as if someone was pressing against it with a lot of force. Angina is also triggered due to stressful activities or even emotional stress. It usually occurs on the left or the middle of the chest and may even be felt in the back, arms, and neck.
Heart attack: Heart attacks are the most common and the most serious complications of coronary heart disease. You would feel extreme pain, akin to crushing on your chest, shoulder, or arm. It may even be accompanied by jaw pain, and sweatiness.
Treatment
Non invasive forms of treatment are always preferable rather than invasive surgeries or procedures to treat coronary heart disease, especially where the risk of serious complications such as heart attack are still on the lower side. Some of the treatments used for coronary heart disease are as follows:

Making lifestyle changes: Quit smoking, reduce alcohol consumption along with consumption of regulated diet will automatically start cleaning plaque that has built up within the arteries. Losing weight also tends to help.
Medications: Special medications can take care of cases wherein the deposits are still lesser and the plaque buildup can be removed without the requirement of extensive surgery. Anti-cholesterol medications are one example of this.
Surgical procedures: These are usually employed when the blockage is severe and cannot be corrected by the conventional methods mentioned above. Some of the procedures are angioplasty, stent replacement, as well as coronary artery bypass surgery.

Coronary Artery Disease -  Know the Primary Signs!

What is Deep Vein Thrombosis?

Blood clots can arise anywhere in your body. They develop when blood thickens and clumps together. When a clot forms in a vein deep in the body, it's called Deep Vein Thrombosis (DVT). Deep vein blood clots typically occur in the lower leg or thigh. But if your symptoms stem from a blood clot deep in your leg, it can be dangerous. Blood clots can happen to anyone, anytime. But some people are at increased risk. Therefore, they should immediately consult with vein specialist to avoid blood clot forming in the veins which can help avoid potentially serious problems.

DVT Symptoms:

"Deep vein thrombosis has classic symptoms - for example, swelling, pain, warmth, and redness on the leg," says Dr. Rajendra Bansal, a DVT treatment expert in Jaipur.  But about 30 40% of cases go unnoticed since they don't have typical symptoms.  In fact, some people don't realize they have a deep vein clot until it causes a more serious condition.

Deep Vein Clots:

DVT symptoms include deep vein clots - especially those in the thigh - can break off and travel through the bloodstream. If a clot lodges in an artery in the lungs, it can block blood flow and lead to a sometimes-deadly condition called pulmonary embolism. This disorder can damage the lungs and reduce blood oxygen levels, which can harm other organs as well.

Some people are more at risk for deep vein thrombosis than others. "Usually people who develop deep vein thrombosis have some level of thrombophilia, which means their blood clots more rapidly or easily," Dr. Bansal says, a DVT specialist in Jaipur. Getting a blood clot is usually the first sign of this condition because it s hard to notice otherwise. In these cases, lifestyle can contribute to a blood clot forming if you don t move enough, for example. Your risk is higher if you ve recently had surgery or broken a bone if you re ill and in bed for a long time, or if you're traveling for a long time (such as during long car or airplane rides).

Other Symptoms:

Having other diseases or conditions can also raise your chances of a blood clot. These include a stroke, paralysis (an inability to move), chronic heart disease, high blood pressure, surgical procedure, or having been recently treated for cancer. Women who take hormone therapy pills or birth control pills are pregnant, or within the first 6 weeks after giving birth are also at higher risk. So are those who smoke or who are older than 60. But deep vein thrombosis can happen at any age.

Chronic vs Acute DVT:

Chronic DVT refers to long-standing venous thrombosis present for more than 28 days.  It can either permanently block the vein or it can adhere to the wall of the vein.  Chronic DVT that doesn t block the vein can still cause long-term problems known as Post Thrombotic syndrome which occurs due to pooling of blood in legs by gravity as the protective valves are damaged or destroyed. Patient symptoms are:

Leg swelling after standing for long periods
Aching pain
Varicose veins
Skin ulcers in severe cases.
Acute DVT refers to venous thrombosis for which symptoms have been present for 14 days or less. The symptoms of acute DVT are sudden limb swelling and pain. During this period the clot is soft and easily treated with clot-dissolving drugs. The period between 14-28 days is called Sub-acute DVT.

Clues of a Clot:

Seek DVT treatment if you have these symptoms. They may signal a deep vein clot or pulmonary embolism:

Swelling of the leg or along a vein in the leg
Pain or tenderness in the leg, which you may feel only when standing or walking
Increase in warmth in the area of the leg that s swollen or painful
Red or discolored skin on the leg
Unexplained shortness of breath
Pain with deep breathing
Coughing up blood
A prompt diagnosis and a proper DVT treatment can help prevent the complications of blood clots. See your doctor immediately if you have any signs or symptoms of deep vein thrombosis or pulmonary embolism. A physical exam and other tests can help doctors determine whether you ve got a blood clot.

Your doctor will diagnose deep vein thrombosis (DVT) based on your medical history, a physical exam, and the color Doppler ultrasound or sometime may require CT or MRI. He or she will identify your risk factors and rule out other causes of your symptoms. After analyzing the risk factors, the doctor will tell you whether you need an immediate DVT treatment or not.

DVT Treatment

There are many ways in Deep Vein Thrombosis treatment. DVT treatment process includes medicines, certain devices, and therapies. The main goals of DVT treatment include:

Stopping the blood clot from getting bigger
To dissolve the already formed clot
Preventing the blood clot from breaking off and moving to your lungs
Reducing your chance of having another blood clot
To prevent long-term complication known as Post Thrombotic Syndrome.
Anticoagulants (Blood Thinners):

These are the most common medicines in DVT treatment. These medicines decrease your blood s ability to clot. They also stop existing blood clots from getting bigger. However, blood thinners can t break up blood clots that have already formed. (The body dissolves most blood clots with time.)

Blood thinners are taken either as a pill, an injection under the skin, or through a needle or tube inserts into a vein (called intravenous or IV injection). There are different types of  Blood thinner. The choice of anticoagulant depends upon multiple factors, including the preference of the patient and the healthcare provider, the patient s medical history and other conditions, and cost considerations.

Initial anticoagulation is continued for 5 to 10 days. After that, long-term anticoagulation is continued for 3 to 12 months depending upon the patient profile, length of vessel involvement and risk of recurrence. In some patient where permanent risk factor like a congenital cause or cancer lifelong anticoagulation may require.

Other available treatments, which are for specific situations, include thrombolytic therapy or placing a filter in a major blood vessel (the inferior vena cava).

Thrombolysis (Clot-Busting DVT Treatment):

Minimally invasive procedures in DVT treatment are performed by an interventional radiologist under X-ray Guidance, if a patient has severe pain, difficulty in walking, significant swelling while on blood thinners, or if there is clot blocking the pelvic veins (iliac veins).  When performed early, thrombolysis is highly effective at dissolving a clot and preserving the valves in the veins.

It is designed to rapidly break up the clot, restore blood flow within the vein, and potentially preserve valve function to minimize the risk of post-thrombotic syndrome. The interventional radiologist inserts a tiny tube called catheter into the vein behind the knee or other leg vein and threads it into the vein containing the clot using x-ray guidance. The catheter tip is placed into the clot and a  clot-busting  drug is infused directly to the thrombus (clot) followed by clot removal by special devices. The fresher the clot, the faster it dissolves   one to two days. Clinical resolution of pain and swelling and restoration of blood flow in the vein is greater than 85 percent with these invasive techniques.  In patients in whom thrombolysis or blood thinners are not medically appropriate, an interventional radiologist can insert a vena cava filter, a small device that functions as an umbrella to capture blood clots that would float to the lung, but allows normal liquid blood to pass.

DEEP VEIN THROMBOSIS PREVENTION:

You can take simple steps to lower your chances for a blood clot:

Exercise your lower leg muscles if you re sitting for a long time while traveling.
Get out of bed and move around as soon as you re able after having surgery or being ill.
The more active you are, the better your chance of avoiding a blood clot.
Take any medicines your doctor prescribes to prevent clots after some types of surgery.
Wear compression stocking to prevent complication or recurrence as per instruction.
Keep regular follow-up with your doctor to avoid or prevent post DVT complication.
SPECIAL PRECAUTIONS FOR PEOPLE WITH DEEP VEIN THROMBOSIS:

Patients being treated for venous thrombosis are at an increased risk for developing another blood clot. The patient should watch for new onset leg pain or swelling. If these symptoms occur, the patient should speak to his/her health care provider or seek medical attention as soon as possible.
Risk of bleeding is high with anticoagulant so dose should not change unless the provider or clinic directs the patient to do so.
Patients may bleed easily from anywhere while taking anticoagulants. In some cases, bleeding can develop inside the body and can t notice immediately. Bleeding inside the body can cause a person to feel faint, or have pain in the back or abdomen. A healthcare provider should be notified immediately if there is any sign of this problem.

What is Deep Vein Thrombosis (DVT) - Symptoms,Treatment & Prevention

Varicose Veins is a condition in which an individual s veins become swollen and warped or twisted, which is visible on the skin. This condition most often is prevalent in the legs but can occur in any part of the body. Varicose Veins is a common medical condition with a few symptoms and signs. It affects the skin tone and texture for which some people undergo a treatment.  

These symptoms might not affect the person seriously, but they can get severe depending upon different conditions. Usually, Varicose Veins does not require medical treatment, but if it gets severe, then one needs to see the doctor or undergo surgery, which happens rarely. This condition can be easily diagnosed through physical examinations, but one might need to undergo some medical tests depending upon the severity of the condition.

Problems Related to Varicose Veins:

Some of the most common problems related to Varicose Veins are:

Telangiectasias: In this condition, blood vessels form a cluster, mostly on the upper body and face. They appear red and can be caused by many reasons such as genetic disarray, liver problems, pregnancy, or viral diseases. Although this is not something to worry about, one should consult the doctor if other symptoms accompany it too.

Spider Veins: This condition of Spider Veins is concerned with the smallest blood vessels called Capillaries. They are called spider veins because they develop mostly on legs and face and appear like a spider web. They are a moderate form of telangiectasias and hence does not really need medical treatment.

Varicoceles: Varicoceles appears in the scrotum region of the male body or over the testicle skin. This condition might result in infertility in males. A doctor should be immediately consulted if such a condition is seen.

Symptoms:

The Varicose Veins is not a serious medical problem unless the patient is going through severe pain and significantly manifested symptoms. There are many symptoms to identify the condition.

A visible cluster of blue or purple looking veins.

Frequent leg cramps.

Shrinking of skin of the ankle as a result of Lipodermatosclerosis (hardening of fat under the ankle skin).

Veins become tumefy or swollen and warped or twisted.

Ankles become swollen.

Throbbing legs.

Blood clots.

An unusual amount of bleeding in the affected part with a small injury.

Restless leg syndrome.

Scars like white, irregular patches on the ankle (Atrophie Blanche).

Redness, itchiness, and dryness on the affected area (stasis dermatitis or venous eczema).

Skin Discoloration.

Skin ulcers.

Precautions:

There are some precautions that one can take to relieve the pain caused by Varicose Veins.

Avoid standing for a longer period of time.

Maintain a healthy and balanced weight.

Sitting with legs straight and uncrossed.

Exercising.

Avoid wearing tight-fitting clothes.

Elevating legs while relaxing.

Take away:

Varicose Veins is a condition in which blood vessels get clustered in a part of the body under the skin. The veins appear blue or purple and become swollen and twisted. This condition is often not a serious medical problem, but in some cases, it might need surgery to avoid any serious issue. This can be treated by precautions and medications, but one can undergo surgery to get rid of the texture and view of the clustered veins. The recovery of Varicose Veins is quicker.

Varicose Veins - What You Must Be Aware About?

Varicose veins are superficial, swollen, enlarged and twisting veins, often appearing dark purple or blue on the feet and legs. The condition occurs when blood through the veins flow in the wrong direction and starts accumulating.

Although varicose veins is not a serious condition, you should seek treatment if it causes symptoms like swelling and pain in the extremities. In severe cases, where a varicose vein ruptures or develops to form skin ulcers, your doctor may recommend laser treatment.

Can laser treatment cure varicose veins?

Laser surgery can effectively treat varicose veins. The procedure involves using a high-intensity beam of light to reduce enlarged, bulging veins that are observed usually on the calves or thighs.

How does the procedure work?

The heat emitted from the laser damages a vein, which causes scar tissues to form. This scar tissue shrinks and closes the vein. A closed vein gradually loses its source of blood and dies. After some time, usually in a year or two, the vein disappears on its own.

Two types of laser surgery are performed, namely  

  Simple Laser Treatment   This is done on the outer layers of your skin. It can cure small varicose veins and spider veins under the skin surface. Normally, more than one session, scheduled every 6-12 weeks is needed.
  Endovenous Laser Treatment   This particular procedure is used to cure large varicose veins that appear on the legs.
The steps of the procedure are as follows  
  Your healthcare provider will administer local anaesthesia to numb the area. You may be provided with an eyeglass to protect your eyes
  The surgeon will make a small incision on the skin and pass a laser fibre through a catheter into the veins while closely monitoring the vein on a screen
  As he/she pulls out the catheter, the length of the vein will heat up and shrink, and eventually close

This outpatient procedure is less painful than stripping and litigation. It has a shorter recovery period and can be performed under local anaesthesia or mild sedatives.

What to Expect

After the laser treatment, you can walk around without much complication. The recovery period is typically brief. You can expect to return to your daily activities following simple laser surgery. However, you might need to wear a compression stocking for a week or so after the endovenous laser procedure.
You may notice redness, bruising or burns on the skin after the treatment. That is only normal, so you need not worry. Do follow up with your doctor to see if the vein has closed.


Laser Treatment For Varicose Veins!

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?

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