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Heart is an important organ in the body which is responsible for pumping blood in our circulatory system thereby helping provide our body with oxygen and nutrients.
Our heart has four chambers: Left atrium, right atrium, left ventricle and right ventricle. The right atrium receives impure blood from the body which is passed on to the right ventricle. The presence of Mitral Valve between the right atrium and right ventricle prevents the back flow of the blood. The right ventricle pumps blood into our lungs which turn impure blood into pure. The pure blood comes back to the left atrium and is passed on to the left ventricle. The left ventricle, which is the strongest heart chamber, then pumps the pure oxygenated blood to our body.
Cardiovascular diseases are the most common cause of death world over. Amongst all the cardiovascular disease, most common are the Coronary Artery Disease (CAD) and Stroke.
Coronary Artery Disease is the most common heart disease. It is the leading cause of death around the world. The coronary artery disease occurs when the arteries supplying to the heart become hard and narrow because of collection of plaques inside the vessels. These plaques are formed of cholesterol and other material and this is called atherosclerosis. Coronary Artery Disease can lead to angina (chest pain), heart attack, heart failure and arrhythmia (irregular heart rhythm).
Chest pain: This pain feels like pressure or tightness in the chest. The chest pain starts from middle or left side of the chest and may radiate to the left arm. Emotional or physical stress precipitates onset of this pain. This often subsides in a few minutes after stopping the stressful activity.
Shortness of breath: Since, the blood supply to the heart is partially or completely cut off, the pumping potential of the heart gets compromised. As a result of this, not enough oxygen is delivered to our body leading to shortness of breath:
Sweating or “cold sweat”
Fullness, indigestion, or choking feeling (may feel like “heartburn”)
Nausea or vomiting
Light-headedness and dizziness
Rapid or irregular heart beats
Stroke occurs when blood flow to the brain cuts off either because of a blood clot (ischaemic stroke) or when a blood vessel supplying to the brain breaks off and bleeds within brain (hemorrhagic stroke).
Heart has four important valves that prevent backflow of blood: tricuspid valve (between right atrium and right ventricle), Mitral valve (between left atrium and left ventricle), Pulmonary valve and Aortic valve. Heart valve diseases can occur if valves are not opening properly (valvular stenosis) or if the valves are not closing properly leading to regurgitation of blood (valvular insufficiency)
Echocardiography,Transesophageal echocardiography and Cardiac catheterization (also called an angiogram) are the mainstay investigations for diagnosing Heart valve diseases.
Angioplasty (Percutaneous Coronary Intervention - PCI)
It is an endovascular procedure in which a deflated balloon catheter is passed upto coronary artery or carotid artery where the obstruction is present because of the plaque. The balloon on reaching the spot is inflated to relieve the obstructed artery and hence the blood flow. A stent may be inserted to ensure that there is no future obstruction of the artery. The patients, if have no complications, are discharged the following day. The patients are advised to rest and not exercise for about two weeks after which they can resume low level exercises.
Coronory Artery Bypass surgery (CABG)
CABG is a surgical procedure to restore the blood flow in the coronary arteries. It is usually done when arteries are 50% to 99% obstructed. The graft is usually taken from the great saphenous vein and is attached to obstructed artery to immediately restore the blood flow to the heart. The surgery can be done on a non-beating heart (on-pump) or beating heart (off-pump). There is limited and inconclusive research on whether off-pump is superior to the on-pump procedure. On-pump has been the gold standard CABG for decades. Recently, trend has been observed of more and more surgeons preferring to off pump procedure which although is more difficult to master.
Outcomes of CABG
Survival depends on variety of factors including presence of other complicating diseases. Usual grafts last for 8 to 15 years. Over the years, grafts can become rough and atherosclerosed. It also depends on where the graft was taken from, as there are only few coronary artery bypass surgery hospitals in India. The great saphenous vein grafts hold better than the arterial grafts but have lesser patency rates.
Comparison of Percutaneous Coronary Intervention Angioplasty and Coronary Artery By-pass Grafting (PCI vs CABG) Angioplasty is a non-invasive procedure while CABG is a major surgery. The choice of procedure depends on multiple factors like the location of obstruction in the coronary artery, the branch involved, the amount of obstruction, the number of obstructions, the presence of other complicating diseases like diabetes, low left ventricular function, etc. CABG is preferred for larger obstructions and multivessel coronary artery disease. CABG is also preferred if the patient profile is such that he/she has other diseases like diabetes, etc.
In heart transplant, the ailing heart is removed and replaced by a donor’s healthy heart. This procedure is recommended when the heart muscle becomes too weak and inadequate (End stage heart failure) to pump enough blood to the body and when all other treatment options have been exhausted.
Causes of end stage heart failure range from previous heart attacks to viral infections and valve diseases. Patient’s body’s immune system plays an important role in success of a heart transplant as it may reject the donated heart. Like in other transplants, patients often need immunosuppressive injections to improve acceptability of the donated heart.
Mitral Valve Repair
It is the most common surgery for a regurgitating Mitral Valve. Against mitral valve replacement, mitral valve repair provides long term survival, lesser complications and may not require a long term use of anticoagulants.
Most commonly annuloplasty rings are used to bring the leaflets of the mitral valve closer to each other to block abnormal regurgitation. Though repair offers many advantages over replacement, not all valves are reparable. Degenerated, calcified and rheumatic valves are not ideal for repair and usually require a replacement. Too large a heart may also be a contraindication to the valve repair procedure.
Mitral valve repair is a very skilled procedure and many surgeons may not prefer it to relatively easier replacement surgery.
MedMonks provides heart surgery in India, and helps patients choose amongst the best and most experienced cardiologist and cardiac surgery specialist with the most cost effective treatment and surgery packages. We also help you choose from a comprehensive list of latest treatment options like Angiograohy, Angioplasty, Valve Replacement, Minimal Invasive Cardiac Surgery, Robot assisted Cardiac Surgery, Cardiac Bypass Surgery (CABG), Heart Transplant etc. that you can choose from depending upon your heart ailment and clinical requirement. We ensure that you are always safe and comfortable.
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