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!

Every woman wishes for great legs they can flaunt in tiny shorts and skirts whenever they feel like it. The greatest impediment to this freedom, however, is unattractive spider and varicose veins that make legs lose their aesthetic value and limit women from enjoying experimenting with short outfits. Not only do these veins look unattractive on legs, but they are quite painful as well. The good news is that modern medicine has enabled doctors to use the body's own healing mechanisms to amend the problem. Doctors can now employ the use of laser treatments and injections to provide quick relief to patients. What's more, these treatments can be addressed easily in a doctor's office and require short visits, and you can walk comfortably out of the doctor's office on your own.

How it works
Minimally invasive laser treatments and injections are used to collapse and then shrink the affected veins. Thereafter, the veins are then absorbed into the tissue that underlay this, and will bring a clear effect such that all the visible traces will be gone. The surrounding healthy veins will then take control and restore the normal circulation of the body. While there might be some little bruising noticed, it will only last temporarily.

Options available
Today the treatments for these veins are improved and what's more, the process is much more comfortable. This is unlike the past where thick, uncomfortable, elastic compression socks were used to relieve pain and the procedures involved a surgery where veins are stripped out of the leg and patients are put under anesthetics. The options that are available today include endovenous laser ablation where a map around the abnormal vein is created with ultrasound, a catheter inserted into the vein and a laser carefully passed through the catheter generating a controlled amount of heat that will seal the vein and redirect blood to the healthy vessels. There is injection sclerotherapy where a pharmaceutical liquid is injected into the vein that will cause the vessels walls to adhere and then seal shut and the blood instantly gets directed to healthier veins while the treated vein disappears. Laser sclerotherapy is reserved for tiny superficial veins and may not get injected.

While there is no cure for varicose veins, a doctor can prescribe post treatment instructions that will minimize the chances of a patient getting the veins again. Things like managing diet, exercise and good lifestyle choices are among them. Also routine monitoring is the key to preventing future reoccurrences.

Want Beautiful Legs? You Can Opt for Vein Removal Therapy

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

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!

Coronary artery disease is characterized by accumulation of plaque in the coronary artery that chokes blood supply to the heart. This plaque buildup usually starts with cholesterol accumulation and gradually other particles such as calcium and lipoproteins get deposited as well. Over time, the plaque accumulates, making the blood vessels narrow and choking the supply of blood. In some cases, if the plaque ruptures, it may lead to formation of blood clots resulting in stroke.

The symptoms of coronary artery disease are:

1. Breathing difficulties: This disorder may lead to shortness of breath as the blood pumping mechanism of the heart is impaired; this usually results in fatigue and exertion. It is advised to avoid advanced cardio exercises such as the high intensity interval training.

2. Chest pain: Stress related activities may cause intense pressure or tightness in your chest, resulting in pain in the middle or left portion of your chest. If you discontinue the activity, the pain would usually subside. In some cases, you may feel the pain in the arm and the neck.

3. Heart attack: If the level of plaque accumulation is excessive, then it may result in a heart attack. It is characterized by breathing difficulties, pain, tightness in the chest and sweating. You may also experience pain in the neck and the jaw.

The causes of coronary artery disease are:
1. Smoking and alcohol consumption
2. Leading a sedentary lifestyle ups the risk of coronary artery disease
3. Hypertension
4. High cholesterol levels in the body
5. Blood sugar problems

Treatment
1. Get your blood pressure under control: If you suffer from high blood pressure, then it is recommended to get it under control to prevent coronary artery disease.
2. Quit smoking: If you are a habitual smoker, then it is time to nip the habit in the bud. Smoking is known to constrict blood vessels as it is a vasoconstrictor.
3. Eat healthy: Eat a well balanced diet consisting of vegetables and fruits so that your body receives the essential nutrients to function well.
4. Beat stress: You need to control your stress levels through exercise or meditation. Take time off work and do activities that make you happy.

Coronary Artery Disease: Causes and Treatment

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?

Don't wait any longer, manage your Vascular Surgery online with a Lybrate doctor today

Consult for Vascular Surgery - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES