The Cardiology Department of STAR Hospitals offers a full range of services in every subspecialty of cardiovascular diseases, including interventional catheterization, non invasive imaging including stress test, echo cardiograms, CT imaging, heart failure and transplantation, arrhythmia, vascular disease and heart disease prevention. STAR’s Cardiology Team headed by Dr. Ramesh Gudapati has vast experience in the following:
Atrial Fibrillation is the most common arrhythmia. Over two million Americans are living with atrial fibrillation. Although it is not life-threatening, it can cause uncomfortable symptoms. It can also cause other problems such as congestive heart failure and stroke. To fully understand atrial fibrillation, you need to know how the normal heart works.
There are four chambers in the heart, two atria, which are the upper chambers of the heart, and two ventricles, which are the lower chambers of the heart. There is a right and left atrium and a right and left ventricle. An electrical impulse stimulates the heart muscle to contract. The normal electrical conduction starts in the sino-atrial (SA) node sending an impulse through the atria to the atrio-ventricular (AV) node, which is the relay station of the heart. It sends the electrical impulses to the ventricles. They are the major pumping structures of the heart.
With atrial fibrillation, there is an abnormal focus of electrical impulses that cause the atria to fibrillate or quiver rather than contract in a regular pattern. The storm of impulses is sent to the AV node, which conducts some of the impulses through to the ventricle. If the impulses are rapidly conducted the ventricular rate can be very fast. Some people experience atrial fibrillation on and off, terminating without treatment and is classified as paroxysmal. Some people experience atrial fibrillation that needs to be terminated with some type of treatment to revert to normal sinus rhythm and that is classified as persistent. Some people are always in atrial fibrillation and even with treatment they stay in atrial fibrillation and that is classified as permanent.
Since the atria are not emptying properly when in fibrillation, blood clots can develop and travel (or embolize) to small vessels in the head and cause a stroke. It is important for people experiencing atrial fibrillation to be treated with an anticoagulant (drug that reduces the blood’s ability to clot) such as Warfarin (Coumadin) or aspirin.
Most people with atrial fibrillation have heart disease. Many Conditions lead to atrial fibrillation. The most common causes are:
Less common causes of atrial fibrillation include:
Many patients with atrial fibrillation have no symptoms, so it’s important to get regular checkups. Some people experience:
In atrial fibrillation, the electrical signals in the atria (upper chambers of the heart) are chaotic and the electrical impulses reach the ventricles (lower heart chambers) often at irregular intervals, causing a fast and irregular heartbeat. A comprehensive diagnosis Ourhelps to determine the severity of the atrial fibrillation and its potential to cause more serious conditions, such as stroke.
To diagnose atrial fibrillation, the patient may be asked about or tested for conditions that may trigger the fibrillation, such as heart disease or a thyroid gland problem. Several tests may be given to better understand the cause of the arrhythmia.
In this test, electrodes (sensor patches with wires attached) are placed on the patient’s skin to measure the electrical impulses given off by the heart. The ECG measures the timing and duration of each electrical phase in the heartbeat.
Echocardiogram (Doppler Echocardiogram):
This test uses sound waves to produce detailed images of the patient’s heart. Through a handheld device (transducer) on the patient’s chest, sound waves bounce off the heart and are reflected to produce video images of the heart’s size, structure and motion. The echocardiogram can also be used to measure the heart’s blood volume and the speed and direction of blood flow through the heart.
These may help rule out thyroid problems or other blood chemistry abnormalities that may lead to atrial fibrillation. In addition, the heart may be monitored during regular activity.
A Holter monitor is a portable ECG device that the patient wears for a day or more to record the heart’s electrical activity during the patient’s daily routine.
Atrial fibrillation can be controlled and in some cases can be cured! Treatment helps patients regain normal heart rhythms, control their heart rate, prevent blood clots and reduce their chances for stroke. Atrial fibrillation is a complex condition affecting a wide variety of patients. Your physician may recommend one of the following treatments, depending on your symptoms and heart health.
Medication is often the first treatment for atrial fibrillation. Types of medication include:
You can make some or all of these changes to improve your heart health:
When medications do not correct or control atrial fibrillation, a procedure may be necessary.
Coronary artery disease (CAD) or coronary heart disease is characterized by the accumulation of fatty deposits along the innermost layer of the coronary arteries. The fatty deposits may develop in childhood and continue to thicken and enlarge throughout the lifespan. This thickening, called atherosclerosis, narrows the arteries and can decrease or block the flow of blood to the heart. CAD is the most common type of heart disease.
Coronary arteries supply blood to the heart muscle. Like all other tissues in the body, the heart muscle needs oxygen-rich blood to function, and oxygen-depleted blood must be carried away. Coronary arteries are the major blood vessels that supply your heart with blood, oxygen and nutrients. These arteries become damaged or diseased — usually due to a build-up of fatty deposits called plaques, which can slowly narrow your coronary arteries, causing your heart to receive less blood. Eventually, diminished blood flow may cause chest pain (angina), shortness of breath or other symptoms. A complete blockage, caused either by accumulated plaques or a ruptured plaque, can cause a heart attack.
– Thickening of the walls of the arteries feeding the heart muscle
– Accumulation of fatty plaques within the coronary arteries
– Sudden spasm of a coronary artery
– Narrowing of the coronary arteries
– Inflammation within the coronary arteries
– Development of a blood clot within the coronary arteries that blocks blood flow
– Major risk factors include:
– Male Gender: The risk of heart attack is greater in men than in women, and men have heart attacks earlier in life than women. However, at age 70 and beyond, men and women are equally at risk.
– Advanced age: Coronary artery disease is more likely to occur as you get older, especially after age 65
– Heredity: strong family history of heart disease
– Obesity and being overweight
– High blood pressure
– Sedentary lifestyle—poor fitness can also increase your risk of CAD and premature death.
– High blood cholesterol (specifically, high LDL cholesterol, and low HDL cholesterol)
– A diet that is high in saturated fat, trans fat, cholesterol, and/or calories—drinking sugary beverages on a regular basis may increase your risk of CAD.
The most common symptom of coronary artery disease is angina (also called angina pectoris). Angina is often referred to as chest pain. It is also described as chest discomfort, heaviness, tightness, pressure, aching, burning, numbness, fullness, or squeezing. It can be mistaken for indigestion or heartburn. Angina is usually felt in the chest, but may also be felt in the left shoulder, arms, neck, back or jaw.
Other symptoms that may occur with coronary artery disease include:
– Shortness of breath
– Palpitations (irregular heartbeats, skipped beats or a “flip-flop” feeling in your chest)
– A faster heartbeat
– Extreme weakness
– If you experience any of these symptoms, it is important to call your doctor, especially if these are new symptoms or if they have become more frequent or severe.
– Symptoms in women: Women often have different symptoms of coronary artery disease than men. For example, symptoms of a heart attack in women include:
– Pain or discomfort in the chest, left arm or back
– Unusually rapid heartbeat
– Shortness of breath
– Nausea or fatigue
– Proper diagnosis begins with a physical exam that includes questions about the patient’s family and medical history, including risk factors for coronary artery disease (CAD).
– No single test can diagnose CAD. Various tests are used to diagnose CAD and rule out other possible causes of symptoms and signs. Testing may include:
– Diagnostic tests help your doctor evaluate the extent of your coronary heart disease, its effect on the function of your heart, and the best form of treatment for you. They may include:
– Electrocardiograph tests, such as an electrocardiogram (ECG or EKG) or exercise stress tests, use the electrocardiogram to evaluate the electrical activity generated by the heart at rest and with activity.
– Laboratory Tests: include a number of blood tests used to diagnose and monitor treatment for heart disease.
– Invasive Testing, such as cardiac catheterization, involve inserting catheters into the blood vessels of the heart in order to get a closer look at the coronary arteries.
Other diagnostic tests may include:
– Nuclear Imaging produces images by detecting radiation from different parts of the body after the administration of a radioactive tracer material.
– Ultrasound Tests, such as echocardiogram use ultrasound, or high frequency sound wave, to create graphic images of the heart’s structures, pumping action, and direction of blood flow.
– Radiographic Tests use x-ray machines or very high tech machines (CT, MRI) to create pictures of the internal structures of the chest.
– Specific treatment will be determined by your physician based on:
– Your age, overall health, and medical history
– Extent of the disease
– Your tolerance for specific medications, procedures, or therapies
– Expectations for the course of the disease
– Your opinion or preference
Medications can help prevent the progression of coronary artery disease. If the disease is present, prescription drugs can improve blood flow to the heart. Some of the more common medications include:
– Cholesterol-lowering medications. By decreasing the amount of cholesterol in the blood, especially LDL (the “bad” form of cholesterol), these drugs decrease the primary material that deposits on the coronary arteries. Examples include statins, niacin, fibrates and bile acid sequestrants.
– Aspirin. This common over-the-counter medication may be recommended as an anti-platelet, which thins the blood, and as an anti-coagulant, which reduces the tendency for blood to clot and block a coronary artery, causing a heart attack. Other anti-platelet drugs or anti-coagulants may be prescribed as well.
– Beta-blockers. These drugs help make the heart’s job of pumping blood easier by relaxing the heart, slowing its rhythm, decreasing blood pressure and lowering the heart’s demand for oxygen. They include metoprolol, atenolol and propranolol.
– Nitroglycerin. This drug, as a tablet, spray or skin patch, helps relieve chest pain (angina) by opening narrowed blood vessels and improving blood flow to the heart muscle. The patient may also receive nitrates, a longer-lasting form of nitroglycerin.
– Calcium channel blockers. These medications help to open coronary arteries to increase blood flow to the heart muscle. They can also help reduce high blood pressure.
– ACE inhibitors (angiotensin converting enzyme inhibitors). Similar to beta-blockers, these help lower blood pressure and make the heart’s job of pumping blood easier. In addition, ACE inhibitors have shown significant benefits for patients in recovering from a heart attack. They include ramipril, lisinopril, enalapril and captopril.
– Vitamins. Folic acid, B-6 and B-12 are vitamins that help to decrease homocysteine in the blood. Homocystiene has been associated with accelerated clogging of the arteries (atherosclerosis). In specific situations, some patients may be prescribed L-arginine or Omega-3 fatty acids.
Surgical and Other Invasive Procedures
– When medications and lifestyle adjustments cannot relieve the chest pain symptomatic of coronary artery disease, surgery may be necessary to restore adequate function to the heart. Patients may benefit from one or more of these surgical treatment options:
– Catheter-assisted procedures. A thin, flexible tube (catheter) is inserted into the patient’s artery, usually in the leg, and then is threaded through the arteries to the heart. Read more about heart catheterization.
– Coronary angioplasty and stents. Angioplasty opens blocked coronary arteries to allow blood to flow more freely to the heart. When the catheter tip reaches a blocked artery, a small balloon expands in the artery to push open the blood vessel. To help prevent the artery from closing again, the heart surgeon will typically insert a small wire tube (stent) in the coronary artery to help keep it open. The stent may be plain, drug-coated or a drug time-release stent (eluting stent.)
– Radiation brachytherapy. In cases where coronary artery blockage reoccurs, the patient may benefit from brachytherapy. In this procedure, the coronary artery segment is reopened during angioplasty and exposed to radiation. The procedure is performed in the catheterization laboratory in collaboration with radiation oncologists and radiation physicists.
– Atherectomy. A catheter is inserted into the blocked artery and one of several types of small devices remove plaque build-up.
– Coronary artery bypass surgery. Bypass surgery, also called coronary artery bypass grafting (CABG), creates a detour around a blocked coronary artery with a new blood vessel, or graft. A short piece of blood vessel (graft) is taken from another location in the body and surgically placed onto the heart muscle, around the blocked coronary artery. Blood flows through the new graft to the heart. If more than one artery is blocked, each can be bypassed.
Adopting a healthy lifestyle is one of the best treatments for coronary artery disease. Either by itself or in combination with medical treatments, a healthy lifestyle can prevent or slow coronary artery disease. All patients with coronary artery disease can benefit from healthy lifestyles. The patients are advised to build habits for regular exercise, including those recovering from heart attacks and those who have low physical strength for exercise. Counselors at STAR advise patients and their families on healthy diets and nutrition to reduce the risk of another heart attack. Cigarette smoking and other uses of tobacco are a leading cause of coronary heart disease and patients are advised on how they can quit smoking.
Cardiomyopathy is any disease of the heart muscle in which the heart loses its ability to pump blood effectively. It causes the wall of the heart muscle to thicken. When the walls get too thick, the heart muscle functions inefficiently, causing some patients to have obstruction to blood flow from the heart. There may be multiple causes of cardiomyopathy, including viral infections. Often, the exact cause of the muscle disease is never found.
There are two major categories of cardiomyopathy: ischemic and non-ischemic cardiomyopathy. Ischemic cardiomyopathy occurs when the heart muscle is damaged from heart attacks due to coronary artery disease. Non-ischemic cardiomyopathy, the less common category, includes types of cardiomyopathy that are not related to coronary artery disease.
There are three main types of non-ischemic cardiomyopathy:
– Dilated—Damaged heart muscles lead to an enlarged, floppy heart. The heart stretches as it tries to compensate for weakened pumping ability.
– Hypertrophic—Heart muscle fibers enlarge abnormally. The heart wall thickens, leaving less space for blood in the chambers. Since the heart does not relax correctly between beats, less blood fills the chamber and is pumped from the heart.
– Restrictive—Portions of the heart wall become rigid and lose their flexibility. Thickening often occurs due to abnormal tissue invading the heart muscle.
Viral infections that infect the heart are a major cause of cardiomyopathy. In some instances, cardiomyopathy is a result of another disease or its treatment, such as complex congenital (present at birth) heart disease, nutritional deficiencies, uncontrollable, fast heart rhythms, or certain types of chemotherapy for cancer. Cardiomyopathy can be acquired or inherited. “Acquired” means you aren’t born with the disease, but you develop it due to another disease, condition, or factor.
“Inherited” means your parents passed the gene for the disease on to you. Researchers continue to look for the genetic links to cardiomyopathy. They also continue to explore how these links cause or contribute to the various types of cardiomyopathy.
Many times, the cause of cardiomyopathy isn’t known. This is often the case when the disease occurs in children.
In more than half of the cases of dilated cardiomyopathy, the cause isn’t known. As many as one-third of the people who have dilated cardiomyopathy inherit it from their parents.
Certain diseases, conditions, and substances also can cause the disease, such as:
– Coronary artery disease, heart attack, diabetes, thyroid disease, viral hepatitis, and HIV
– Infections, especially viral infections that inflame the heart muscle
– Alcohol, especially if you also have a poor diet
– Complications during the last month of pregnancy or within 5 months of birth
– Certain toxins, such as cobalt
– Certain drugs (such as cocaine and amphetamines) and two medicines used to treat cancer (doxorubicin and daunorubicin)
Most cases of hypertrophic cardiomyopathy are inherited. It also can develop over time because of high blood pressure or aging.
Sometimes, other diseases, such as diabetes or thyroid disease, can cause hypertrophic cardiomyopathy. Sometimes the cause of hypertrophic cardiomyopathy isn’t known.
– Hemochromatosis. This is a disease in which too much iron builds up in your body. The extra iron is toxic to the body and can damage the organs, including the heart.
– Sarcoidosis. This is a disease that causes inflammation (swelling). It can affect various organs in the body. The swelling is due to an abnormal immune response. This abnormal response causes tiny lumps of cells to form in the body’s organs, including the heart.
– Amyloidosis. This is a disease in which abnormal proteins build up in the body’s organs, including the heart.
– Connective tissue disorders.
Diagnosis of hypertrophic cardiomyopathy (HCM) requires a thorough cardiology and genetics evaluation. A complete medical history including a family medical history will be taken. Then a physical examination will be done. This includes listening to the heart and lungs with a stethoscope to check for any abnormal heart sounds or murmurs. The pulse in both your arms and neck will be checked and the doctor may feel for an abnormal heart beat in the chest.
Your doctor will want to learn about your medical history. He or she will want to know what symptoms you have and how long you’ve had them. Your doctor also will want to know whether anyone in your family has had cardiomyopathy, heart failure, or sudden cardiac arrest.
Your doctor will use a stethoscope to listen to your heart and lungs for sounds that may suggest cardiomyopathy. These sounds may even suggest a certain type of the disease. For example, the loudness, timing, and location of a heart murmur may suggest hypertrophic obstructive cardiomyopathy. A “crackling” sound in the lungs may be a sign of heart failure. (This condition often develops in the later stages of cardiomyopathy.)
Physical signs also help your doctor diagnose cardiomyopathy. Swelling of the ankles, feet, legs, or abdomen suggests fluid buildup, a sign of heart failure. Signs or symptoms of cardiomyopathy may be found during a routine exam. For example, your doctor may hear a heart murmur or you may have abnormal test results.
You may have one or more of the following tests to diagnose cardiomyopathy.
– Blood tests: During a blood test, a small amount of blood is taken from your body. It’s usually drawn from a vein in your arm using a thin needle. The procedure usually is quick and easy, although it may cause some short-term discomfort.
Blood tests give your doctor information about your heart and help rule out other conditions.
Chest x ray: A chest x ray takes pictures of the organs and structures inside your chest, including your heart, lungs, and blood vessels. This test can show whether your heart is enlarged. A chest x ray also can show whether fluid is building up in your lungs.
– EKG (electrocardiogram): An EKG is a simple test that records the heart’s electrical activity. This test shows how fast your heart is beating and whether the rhythm of your heartbeat is steady or irregular. An EKG also records the strength and timing of electrical signals as they pass through each part of your heart. This test is used to detect and study many heart problems, such as heart attack, arrhythmia, and heart failure. EKG results also can suggest other disorders that affect heart function.
– Echocardiography: A noninvasive test that uses sound waves to produce a study of the motion of the heart’s chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart.
– Stress test: Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise (or are given medicine) to make your heart work hard and beat fast while heart tests are done.
These tests may include nuclear heart scanning, echocardiography, magnetic resonance imaging (MRI), and positron emission tomography (PET) scanning of the heart.
You may have one or more medical procedures to confirm a diagnosis or if surgery is planned. These procedures may include cardiac catheterization, coronary angiography, or myocardial biopsy.
Cardiac Catheterization: This procedure checks the pressure and blood flow in your heart’s chambers. The procedure also allows your doctor to collect blood samples and look at your heart’s arteries using x-ray imaging.
– During Cardiac catheterization, a long, thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck and threaded to your heart. This allows your doctor to study the inside of your arteries to look for blockages.
– Coronary Angiography: This procedure often is done with cardiac catheterization. During the procedure, dye that can be seen on an x ray is injected into your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels.
– Dye also may be injected into your heart chambers. This allows your doctor to study the pumping function of your heart.
– Myocardial biopsy: For this procedure, your doctor removes a piece of your heart muscle. This can be done during cardiac catheterization. The heart muscle is studied under a microscope to see whether changes in cells have occurred that may suggest cardiomyopathy.
– The biopsy is useful for diagnosing some types of cardiomyopathy.
– Genetic testing: Some types of cardiomyopathy run in families. Thus, your doctor may suggest genetic testing to look for the disease in your parents, brothers and sisters, or other family members. Genetic testing also may be useful if your doctor thinks you may have cardiomyopathy, but you don’t yet have signs or symptoms. Your doctor can then start treatment early, when it may be more effective.
Not everyone who has cardiomyopathy needs treatment. People who have no signs or symptoms may not need treatment. In some cases, dilated cardiomyopathy that comes on suddenly may even go away on its own.
For other people who have cardiomyopathy, treatment is needed. Treatment depends on the type of cardiomyopathy you have, how severe the symptoms and complications are, and your age and overall health.
The main goals of treating cardiomyopathy are to:
– Manage any conditions that cause or contribute to the disease
– Control signs and symptoms so that you can live as normally as possible
– Stop the disease from getting worse
– Reduce complications and the chance of sudden cardiac arrest (SCA)
Treatments may include lifestyle changes, medicines, surgery, implanted devices to correct arrhythmias, and a nonsurgical procedure.
Your doctor may suggest lifestyle changes to manage a condition that’s causing your cardiomyopathy. These changes can help reduce symptoms.
In heart failure, the heart is unable to pump the right amount of blood throughout the body. This causes blood to back up in the veins. Depending on which part of the heart is affected most; this can lead to a build up of excess fluid in the lungs, feet, and elsewhere. Heart failure can worsen with time, which may lead to the use of many treatments. Because of this, doctors are aggressive in treating heart failure to try to prevent it from worsening.
Heart failure also affects the body by interfering with the kidney’s normal function of eliminating excess sodium and waste from the body. In congestive heart failure, the body retains more fluid – resulting in swelling of the ankles and legs. Fluid also collects in the lungs – resulting in shortness of breath.
Heart failure may result from any/all of the following:
– Heart valve disease – caused by past rheumatic fever or other infections
– High blood pressure (hypertension)
– Infections of the heart valves and/or heart muscle (i.e., endocarditis)
– Previous heart attack(s) (myocardial infarction) – scar tissue from previous attacks may interfere with the heart muscle’s ability to work normally
– Coronary artery disease – narrowed arteries that supply blood to the heart muscle
– Cardiomyopathy – or another primary disease of the heart muscle
– Congenital heart disease/defects (present at birth)
– Cardiac arrhythmias (irregular heartbeats)
– Chronic lung disease and pulmonary embolism
– Drug-induced heart failure
– Excessive sodium intake
– Hemorrhage and anemia
– Shortness of breath—at first only with activity, then progressing to shortness of breath at rest
– Unexplained weight gain
– Fatigue, weakness
– Loss of appetite, nausea, and abdominal pain
– Swelling of feet, ankles, or legs
Persistent Cough —may be dry and hacking or wet sounding, may have a pink, frothy sputum
– Reduced urination
– The symptoms of heart failure resemble those of other medical conditions. Always consult your physician for a diagnosis.
In addition to a complete medical history and physical examination, diagnostic procedures for heart failure may include any, or a combination of, the following:
– Chest x-ray – a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
– Echocardiogram (Also called echo.) – a noninvasive test that uses sound waves to produce a study of the motion of the heart’s chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart.
– Electrocardiogram (ECG or EKG) – a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
– BNP testing – B-type natriuretic peptide (BNP) is a hormone released from the ventricles in response to increased wall tension (stress) that occurs with heart failure. BNP levels rise as wall stress increases. BNP levels are useful in the rapid evaluation of heart failure. The higher the BNP levels, the worse the heart failure.
Your physician based on will determine specific treatment for heart failure:
– Age, overall health, and medical history
– Disease progression
– Tolerance for specific medications, procedures, or therapies
– Expectations for the course of the disease
– Opinion or preference
If heart failure is caused by valvular heart disease, surgery is usually performed to repair or replace the valve. If a disease such as anemia causes heart failure, then the disease is treated.
Congestive heart failure treatments can significantly improve symptoms and help a weakened heart work as efficiently as possible. Medication, surgery and change in lifestyles are the treatment options available.
Treatment of heart failure may include:
Angiotensin converting enzyme (ACE) inhibitors to decrease the pressure inside the blood vessels, or angiotensin II receptor blockers if ACE inhibitors are not tolerated
– Diuretics to reduce the amount of fluid in the body
– Vasodilators to dilate the blood vessels and reduce workload on the heart
– Digitalis to increase heart strength and control rhythm problems
– Inotropes to increase the pumping action of the heart
– Antiarrhythmia medications to keep the heart’s rhythm regular and prevent sudden cardiac death
– Beta-blockers to reduce the heart’s tendency to beat faster by blocking specific receptors on the cells that make up the heart
– Aldosterone blockers to block the effects of aldosterone, which causes sodium and water retention
Heart valve repair or replacement
In some cases, doctors recommend surgery to treat the underlying problem that led to congestive heart failure. For example, a damaged heart valve may be repaired or, if necessary, replaced with an artificial one.
Coronary Bypass Surgery
Sometimes doctors recommend coronary bypass surgery to treat congestive heart failure if the disease is related to severely narrowed coronary arteries.
– Heart Transplant
Some people have such severe congestive heart failure that medications or surgery don’t provide adequate help. They may need to have their diseased heart replaced with a healthy donor heart.
About 2,000 Americans each year undergo a heart transplant. The procedure has dramatically improved the survival and quality of life of people with severe congestive heart failure. However, candidates for transplantation often have to wait years before a suitable donor heart is found. Some transplant candidates improve during this waiting period through drug treatment and other therapy and can be removed from the transplant waiting list.
– Heart Pumps
When a weakened heart needs help pumping blood, a ventricular assist device (VAD) can be implanted into the abdomen and attached to the heart. These mechanical heart pumps can be used either as a “bridge” to cardiac transplantation or permanent therapy for patients who aren’t eligible for heart transplant. This new therapy offers hope to many patients who previously had no options for improving quality and quantity of life.
– Biventricular Cardiac Pacemaker
Biventricular cardiac heart pacemakers send specifically timed electrical impulses to the heart’s lower chambers to treat moderate to severe congestive heart failure. Approximately 30 percent to 50 percent of people with congestive heart failure have abnormalities in their heart’s electrical system, which cause their already weakened heart muscle to beat in an uncoordinated fashion. This inefficient muscle contraction wastes the heart’s energy and may cause heart failure to worsen.
A biventricular cardiac pacemaker consists of a pulse generator that’s implanted in the chest and connected to the heart by three wires (leads) that deliver electrical impulses. One wire is placed in the upper-right chamber (right atrium), one wire in the lower-right ventricle, and the third is used to stimulate the lower-left ventricle.
Patients with heart failure are at high risk of fast rhythms which are life threatening. Some patients need internal cardiac defibrillators (ICD) and medicines to prevent sudden death.
Myectomy is the surgical removal of part of the overgrown heart muscle in hypertrophic cardiomyopathy to decrease the obstruction to blood flow. It is used when medication has become ineffective at relieving symptoms.
Lifestyle changes can often help relieve symptoms of congestive heart failure and prevent the disease from worsening. Among the most important and beneficial changes are:
– Quit smoking
– If overweight, lose weight
– Avoid or limit alcohol consumption to one drink two or three times a week
– Avoid or limit caffeine
-Eat a low-fat, low-sodium diet
– Exercise individually or in a structured rehabilitation program (under a physician’s guidance)
– Reduce stress
Heart Attack – Damage to the heart caused by a blockage in one of the arteries that supplies the heart muscle. Blockage of one of these arteries “coronary arteries” reduces the blood flow to the heart muscle and can cause chest pain or “angina”
A heart attack, or myocardial infarction, is caused when one or more regions of the heart muscle experience a severe or prolonged lack of oxygen caused by blocked blood flow to the heart muscle. The blockage is often a result of atherosclerosis – a buildup of plaque composed of fat deposits, cholesterol, and other substances. Plaque ruptures and eventually a blood clot forms. The actual cause of a heart attack is a blood clot that forms within the plaque-obstructed area. This plaque and clot completely obstruct the flow of blood to the heart muscle the coronary artery supplies.
If the blood and oxygen supply is cut off severely or for a long period of time, muscle cells of the heart suffer damage and die. The result is dysfunction of the muscle of the heart in the area affected by the lack of oxygen.
The following are the most common symptoms of a heart attack. However, each individual may experience symptoms differently. Symptoms may include:
– Severe pressure, fullness, squeezing, pain and/or discomfort in the center of the chest that lasts for more than a few minutes
– Pain or discomfort that spreads to the shoulders, neck, arms, or jaw
– Chest pain that increases in intensity
– Sweating, cool, clammy skin, and/or paleness
– Shortness of breath
– Nausea or vomiting
– Dizziness or fainting
– Unexplained weakness or fatigue
– Rapid or irregular heart beat
– Fullness, indigestion, or choking feeling (may feel like “heartburn”)
Although chest pain is the key warning sign of a heart attack, it may be confused with indigestion, pleurisy, pneumonia, or other disorders. The symptoms of a heart attack may resemble other medical conditions or problems. Always consult your physician for a diagnosis.
If you have any of these symptoms of a heart attack, call emergency services immediately. Since most of the damage to the heart muscle during a heart attack occurs in the first 6 hours, emergency treatment may prevent damage to the heart muscle and death. Some people, especially those who are elderly or have diabetes, may not have typical chest pain but may have many of the other symptoms of a heart attack..
Women often have different symptoms of a heart attack than men and may report symptoms before having a heart attack, although the symptoms are not typical “heart” symptoms. Women’s symptoms may include:
– Upper back or shoulder pain
– Jaw pain or pain spreading to the jaw
– Pressure or pain in the center of the chest
– Pain that spreads to the arm
– Unusual fatigue for several days
In a multi-center study of 515 women who had an acute myocardial infarction (MI), the most frequently reported symptoms were unusual fatigue, sleep disturbances, shortness of breath, indigestion and anxiety. The majority of women (78%) reported at least one symptom for more than one month before their heart attack. Only 30% reported chest discomfort, which was described as an aching, tightness, pressure, sharpness, burning, fullness or tingling.
Women can protect themselves by learning to identify the common symptoms of heart disease in women, getting a physical exam that includes screening for heart disease, and seeking a second opinion if symptoms persist.
Although symptoms vary with every heart attack, several common signs signal that a heart attack is occurring. Based on symptoms, a few questions and vital sign checks, paramedics or emergency room personnel can usually diagnose a heart attack. After immediate treatment to open the blockage, several diagnostic tests can examine the aftereffects of an attack.
The diagnosis of the heart attack is based on your symptoms, ECG and the results of your blood studies. The tests screen your heart and help the doctor determine what treatment and lifestyle changes will keep your heart healthy and prevent serious future medical events.
– Electrocardiogram (Also known as ECG or EKG or Electrocardio-graphy)
It records the electrical activity of the heart including the timing and duration of each electrical phase in your heartbeat. This helps in determining that a heart attack has occurred, predict if a heart attack is developing and also monitors changes in heart rhythm.
– Ambulatory Electrocardiography (Also known as Holter Monitoring or Ambulatory ECG or Ambulatory EKG)
Records the electrical activity of the heart during daily activities. Documents and describes abnormal electrical activity in the heart during daily activities to help doctors determine the condition of the heart. Helps determine the best possible treatments.
– Chest X-Ray
Takes a picture of the heart, lungs and bones of the chest. Determines whether the heart is enlarged or if fluid is accumulating in the lungs as a result of the heart attack.
– Echocardiography (Also known as echocardiogram)
A hand-held device placed on the chest that uses high-frequency sound waves (ultrasound) to produce images of your heart’s size, structure and motion. Provides valuable information about the health of your heart. Helps gather information about abnormal rhythms (arrhythmias) in the heart.
– Computer Imaging (Also known as Tomography)
This includes CT, CAT scan, EBCT, PET, DCA, DSA, MRI and SPECT. Computer imaging (tomography) refers to several diagnostic-imaging tests that use computer-aided techniques to gather images of the heart. Evaluates aortic disease (such as aortic dissection), cardiac masses and pericardial disease.
Exercise Stress Test (Also known as Treadmill Test, Exercise Test, Exercise Cardiac Stress Test and ECST)
A monitor with electrodes that are attached to the skin on the chest area to record your heart function while you walk in place on a treadmill. Many aspects of your heart function can be checked including heart rate, breathing, blood pressure, ECG (EKG) and how tired you become when exercising. Helps diagnose coronary artery disease (CAD). Helps diagnose the possible cause of symptoms such as chest pain (angina). Helps determine your safe level of exercise. Helps predict dangerous heart-related conditions such as heart attack.
– Blood Test
Measures cardiac enzymes (including troponin and creatine kinase), C-reactive protein (CRP), fibrinogen, homocysteine, lipoproteins, triglycerides, brain natriuretic peptide (BNP) and prothrombin. Used to confirm that a heart attack has occurred and determines the extent of damage. Helps in determining the degree of risk for future heart-related problems and best treatment course. These tests also help in determining the degree of coronary artery disease (CAD).
– Cardiac Catheterization
A general group of procedures. The most common is Coronary Angiogram (also known as Angiography or Arteriography). Examines the inside of your heart’s blood vessels using special X-rays called angiograms. Dye visible by X-ray is injected into blood vessels using a thin hollow tube called a catheter. It takes 2-3 hours. It is one of the most useful and accurate tools in diagnosing cardiovascular problems. It can detect where arteries are narrowed or blocked. It measures blood pressure within the heart and oxygen in the blood. It also evaluates heart muscle function annd helps in determining the best course of treatment.
– Transesophageal Echocardiography (Also known as TEE)
Uses high-frequency sound waves (ultrasound) to produce images of the heart. Involves passing a tube through the throat into the esophagus. It takes 10-30 minutes. Evaluates the function and small detailed structures of the heart and associated vessels. Helps find abnormalities in the heart. Also gathers information about abnormal rhythms (arrhythmias) in the heart.
– Electrophysiologic Tests
“Maps” the spread of electrical impulses through the heart with catheters tipped with electrodes that are threaded through blood vessels to different locations in the heart. Can stimulate the heart to beat rapidly. Gives a more detailed analysis than simple ECG (EKG). Helps determine if abnormal rhythms (arrhythmias) develop in the heart and in which part of the heart they are located.
– Thallium Stress Test (Also known as Myocardial Perfusion Imaging (MPI), Multigated Acquisition (MUGA) Scan, Radionuclide Stress Test and Nuclear Stress Test)
This test is similar to a routine exercise stress test but with images. Uses radioactive substance called thallium injected into the bloodstream when patient is at maximum level of exercise to take pictures with a special (gamma) camera of the heart’s muscle cells.
Thallium Stress test helps in measuring the blood flow of your heart muscle at rest and during stress. It helps in determining the extent of a coronary artery blockage, extent of damage from heart attack, cause of chest pain (angina), and the level of safe exercise for patients.
The goal of treatment for a heart attack is to relieve pain, preserve the heart muscle function, and prevent death. When a heart attack occurs, a fast and accurate medical response is crucial. Each minute that the heart is deprived of oxygen increases the chances of damaging or destroying part of the heart muscle.
The goals of medication therapy are to break up or prevent blood clots, prevent platelets from gathering and sticking to the plaque, stabilize the plaque, and prevent further ischemia. These medications must be given as soon as possible (within 30 minutes from the start of heart attack symptoms) to decrease the amount of damage to the heart muscle. The longer the delay in starting these drugs, the more damage that occurs and the less benefit they can provide.
Emergency treatment may include:
– Intravenous therapy – nitroglycerin, morphine
– Cardiac medication – such as beta-blockers or calcium channel blockers to promote blood flow to the heart, improve the blood supply, prevent arrhythmias, and decrease heart rate and blood pressure
– Continuous monitoring of the heart and vital signs
– Oxygen therapy – to improve oxygenation to the damaged heart muscle
– Pain medication – by decreasing pain, the workload of the heart decreases, thus, the oxygen demand of the heart decreases
– fibrinolytic therapy – intravenous infusion of a medication which dissolves the blood clot, thus, restoring blood flow
– antithrombin/antiplatelet therapy – used to prevent further blood clotting
Once the condition has been diagnosed and the patient stabilized, additional procedures to restore coronary blood flow may be utilized. Those procedures include
Coronary angioplasty – with this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow. Although angioplasty is performed in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. PCI is also called percutaneous transluminal coronary angioplasty (PTCA). There are several types of PTCA procedures, including:
– Balloon angioplasty – a small balloon is inflated inside the blocked artery to open the blocked area.
– Atherectomy – the blocked area inside the artery is cut away by a tiny device on the end of a catheter.
– Laser angioplasty – a laser used to “vaporize” the blockage in the artery.
– Coronary artery stent – a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.
During or shortly after a heart attack, you may go to the cardiac catheterization laboratory to directly evaluate the status of your heart, arteries and the amount of heart damage. In some cases, procedures (such as angioplasty or stents) are used to open up your narrowed or blocked arteries. These procedures may be combined with thrombolytic therapy to open up the narrowed arteries, as well as to break up any clots that are blocking them.
If necessary, bypass surgery may be performed to restore the heart muscle’s supply of blood. During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest or arm may also be used to create a bypass graft.
Unstable angina results from the sudden rupture of a plaque, which causes a rapid accumulation of platelets at the rupture site and a sudden increase in obstruction to blood flow in the coronary artery. As a result, unstable angina symptoms occur suddenly, often in an unexpected or unpredictable fashion. The symptoms may be new, prolonged, more severe, or occur with little or no exertion. Unstable angina may also be less responsive to nitroglycerin medication than stable angina. Unstable angina is a medical emergency. Unchecked, the accumulation of platelets and obstruction to blood flow can result in a heart attack. This risk of heart attack remains even if the unstable angina symptoms lessen or disappear. Thus, if unstable angina occurs, seeking immediate medical attention is very important.
Unstable angina pain can last between 5 and 20 minutes. Sometimes the symptoms can ‘come and go’. The pain associated with angina can vary from person to person, and people make different comparisons to express the pain they feel. Many people describe unstable angina as:
– Pain or pressure
– A heavy, crushing feeling in the chest, neck, throat, jaw, shoulder and/or arm
– Discomfort just below the breastbone
– Burning similar to heartburn or indigestion
– Shortness of breath
-Because unstable angina occurs without warning and during rest, it can cause severe anxiety. Unstable angina sometimes brings about other symptoms such as nausea, lightheadedness, or profuse sweating. The pain from angina may subside if a person takes nitroglycerin.
– Sudden chest pain that may also be felt in the shoulder, arm, jaw, neck, back, or other area
– Pain that feels like tightness, squeezing, crushing, burning, choking, or aching
– Pain that occurs at rest and does not easily go away when using medicine
– If you have stable angina, you may be developing unstable angina if the chest pain:
– Starts to feel different
– Lasts longer than 15 – 20 minutes
– Occurs at different times
To diagnose unstable angina pectoris, a physician will take a thorough medical history (including a complete description of a patient’s symptoms), conduct a physical exam, measure blood pressure, and perform one or more of the following tests:
ECG tests monitor the electrical activity of the heart. When certain ECG findings are present, the risk of unstable angina progressing to a heart attack is significantly increased.
Cardiac blood tests:
Since unstable angina can be a precursor for a heart attack, a physician will usually order blood tests to determine if a heart attack has occurred. The test looks for evidence that heart muscle has died. Usually, several blood tests have to be checked over a period of several hours, since evidence of a heart attack can take some time to appear in the blood. Knowing the results of these tests is important in determining the next best cardiac test or treatment to have.
Cardiac catheterization and angiography:
Physicians may recommend cardiac catheterization and angiography, especially if significant resting ECG changes are present or cardiac blood tests are abnormal. During angiography, a catheter is inserted into an artery in the groin or arm and advanced into the heart. When the catheter is positioned near the arteries that supply blood to the heart, the physician injects a contrast dye. As the dye travels through the arteries, X-ray pictures are taken to see how well blood flows through the arteries, and if there are any blockages that indicate CAD.
ECG stress test:
In an ECG stress test, the patient exercises, usually by walking on a treadmill, while wearing an ECG monitor. If the heart is not receiving sufficient oxygen during the exercise, the ECG patterns reflect this and indicate the presence of CAD. If a person is unable to perform enough exercise to stress the heart adequately during a stress test, a drug designed to mimic the effects of exercise on the heart can be administered instead.
Nuclear stress test:
A nuclear stress test is similar to an ECG stress test. However, during the exercise, a radioisotope (a safe radioactive compound) is injected into a vein and travels to the arteries that supply blood to the heart. After exercise, pictures of the heart are taken with a special camera that can detect the radioisotope. These pictures can determine if blockages from CAD are present.
Echocardiographic stress testing:
An echocardiographic, or echo, stress test is similar to an ECG stress test. An echo stress test uses ultrasound waves to take pictures of the heart before and after exercise, which can show changes that indicate the presence of CAD.
Your doctor may want you to check into the hospital to get some rest and prevent complications.
Blood thinners (antiplatelet drugs) are commonly used to treat and prevent unstable angina. Such medicines include aspirin and the prescription drug clopidogrel. The two medicines are often used together. Aspirin (and sometimes clopidogrel) may reduce the chance of heart attack in certain patients.
During an unstable angina event, you may receive heparin and nitroglycerin. Other treatments may include medicines to control blood pressure, anxiety, abnormal heart rhythms, and cholesterol.
Some people may need CABG (coronary artery bypass grafting) or angioplasty with stenting. Angioplasty with stenting does not help you live longer than just taking medicine, but it can reduce angina or other symptoms of coronary artery disease. Angioplasty with stenting, however, can be a life-saving procedure if you are having a heart attack.