All posts by admin

How Cardiac MRI help to diagnose heart problems

Diagnosis,

Cardiac MRI is a scan that uses magnetic fields to create a detailed picture of the heart. It allows the doctor to assess the function and structure of the heart non – invasively. Based on this, the doctor decides on the best treatment plan to address the patient’s heart condition. An MRA or magnetic resonance angiography is usually done to diagnose and detect blood vessel diseases. It is also non-invasive and follows the same procedure as MRI. Read about the heart problems that need early diagnosis and treatment.

How is Cardiac MRI performed? :

The test is done in a medical imaging facility or a hospital in an MRI or MRA machine. The equipment has a table that slides in and out of a donut-shaped machine. The patient is asked to lie on the table, and a contrast dye may be injected into the vein in the arm. It is done to highlight the heart and the blood vessels. The table then slides along with the patient into the machine. 

Inside the MRA machine, the patient is surrounded by a magnetic field. This field reacts with the hydrogen atoms in the body as these atoms are magnetic. Finally, a faint radio signal gets created, and the computer reads this. This signal gets converted to an image that is seen on the computer’s monitor. Claustrophobic patients are either given a calming medication before the test or recommended an open MRI or MRA. During the test, the patient can communicate with the technician to follow his instructions and voice his discomfort. MRI cannot be done if the patient has a pacemaker or other metallic devices like valves, clips, etc., in his body.

Are there any risks involved in it? :

 Cardiac MRI and MRA are harmless and painless procedures. Few patients might find it uncomfortable to remain still or be bothered by the scanner’s noise during the test. The body might also feel slightly warm while the images the being taken.

Apart from Cardiac MRI, there are other diagnostic tests that are performed to detect heart problems.

Cardiac MRI : FAQs

What are preparations required from the patient? 

The patient will be asked to remove all metallic or magnetic items and jewelry before the test. He/She must inform the doctor about his history of claustrophobia and the presence of metallic implants in the body. Women must notify the doctor if they are pregnant or breastfeeding before scheduling the MRI.  

How long does it take?

An MRI scan lasts for approximately 60 to 90 minutes, while an MRA takes over 30 to 90 minutes.

Who performs it?

A radiologist or a radiology technologist usually does the MRI and MRA.

How much does Cardiac MRI cost?

The average cost of an MRI is around Rs. 1500 to 25K, and that of MRA is around Rs. 2500 to 10K.

When can I go home after the procedure?

The patient is allowed to go home and resume regular activity immediately after the test.

Cardiology

FAQs

What is cardiology?

Cardiology is a sub-branch of medicine that deals with the study of function and diseases of the human heart.

Who is a cardiologist?

A medical physician who has obtained a specialized degree in the treatment and management of cardiovascular issues is a cardiologist. Cardiologists additionally look to create awareness and education in the patients about the health of the heart.

What are the super specializations in cardiology?

The field of cardiology is a vast field, including care, management, diagnosis, and treatment of many heart conditions. A doctor typically does a 5-year MBBS course, followed by a post-graduate course for Doctor of Medicine (M.D.) in general medicine. To be a cardiologist, they further have to do a 3-year super specialty course of D.M. in Cardiology to be a cardiologist. Some of the other courses offered are – Diploma in Cardiovascular Technology, P.G. Diploma in Clinical Cardiology Course (PGDCC), M.S. in Cardiological nursing, M.Ch. In Cardiology, M.Ch. Cardiovascular and Thoracic Surgery, P.G. Diploma in Community Cardiology, DNB Cardio-Thoracic Surgery, Doctor of Medicine in Cardiology, and B.Sc. in Cardiac Care Technology.

What is the scope of cardiology? What are the different types of diseases in cardiology?

The epidemiology of heart disease is one of the leading causes of death globally. There have been increasing demands of cardiologists all around the world. With advancements in health & technology, newer fields have emerged in cardiology. It is not only limited to patient treatment & management, but the role has been extended for medical devices and biomedical engineering. 

There exist a diverse pool of diseases and disorders that cardiologists manage. Some of the common conditions encountered upon clinical examination include – 

  1. Disorders of heart rate, rhythm, and conduction
  2. Atherosclerosis
  3. Vascular disease
  4. Coronary artery disease
  5. Congenital heart disease
  6. Heart valve diseases
  7. Diseases of myocardium
  8. Diseases of the pericardium

The common signs and symptoms include – 

  1. Chest pain
  2. Breathlessness (dyspnea)
  3. Acute circulatory failure (cardiogenic shock)
  4. Heart failure
  5. Palpitations 
  6. Syncope & Presyncope
  7. Cardiac arrest and sudden cardiac death
  8. Abnormal heart sounds and murmurs

A patient should take any of these persisting problems seriously.

What are the comorbidities, complications, organs affected, signs, and symptoms of cardiovascular problems?

Patients with cardiovascular abnormalities are found to have chronic comorbidities associated with them. Some of the most common comorbidities include – 

  1. Depression & Anxiety 
  2. Diabetes 
  3. Metabolic syndrome 
  4. Chronic obstructive pulmonary diseases 
  5. Obesity
  6. Hypertension 

Any persistent cardiac problems can have a deteriorating effect on the overall health of an individual. The heart is a vital organ that transports blood loaded with oxygen to various body organs. Upon cardiovascular abnormalities, the blood flow to different organs becomes impaired. Other organs get affected due to the insufficient supply of oxygen. The most common organs affected are the highly perfused organs such as – brain, kidney, and liver. In addition to the direct impact on the functioning of major organs, there are several issues with the peripheral blood vessels, leading to peripheral edema and swelling of legs, ankles, and other distant organs.

What are the different diagnostic tests?

Cardiovascular conditions are complex and require specific investigations. Thus, the diagnosis of cardiac disease becomes essential for treatment and management.

Some of the standard tests for cardiovascular diseases include – electrocardiography, chest X-ray, and echocardiography.

Other techniques are more sophisticated that require highly skilled personnel.

  1. Electrocardiogram – used to assess cardiac conduction and rhythm. There are different ECG – exercise (stress) ECG, ambulatory ECG, and 12-lead ECG.
  2. Laboratory tests – uses plasma/serum to measure cardiac biomarkers (chemicals that hint towards heart problems). Some of the commonly tested biomarkers include – cardiac troponins, brain natriuretic peptides, and CPK.
  3. Other techniques – 
    1. Chest X-ray 
    2. Echocardiography (echo) – is used to image heart structures in real-time. It is also known as cardiac ultrasound. There are different types of echo, like – two-dimensional (2D) echocardiography, doppler echocardiography, transesophageal echocardiography, stress echocardiography.
    3. Computed tomographic imaging (C.T.), magnetic resonance imaging (MRI)
    4. Cardiac catheterization is a complex process that involves the insertion of a pre-shaped catheter into the heart with X-ray guidance. It is used to measure the pressure and oxygen saturation in the cardiac chamber and prominent blood vessels. 
    5. Electrophysiology study – it is used to diagnose a suspected arrhythmia. It is done by placing a percutaneous electrode catheter into the heart through femoral and neck veins. 
    6. Radionuclide imaging – imaging heart using gamma-emitting radionuclides non-invasively. It is used less commonly. Two techniques under radionuclide imaging include – blood-pool imaging and myocardial perfusion imaging.

What is the consultation cost for a cardiologist?

The average cost for consulting an oncologist in India ranges between INR 500-1000.

The cost of consultation in major cities of India are as follows –

  • New Delhi – INR 500-2000
  • Mumbai – INR 800-3000
  • Chennai – INR 500-1000
  • Bengaluru – INR 600-1000
  • Hyderabad – INR 500-1000

Growing concerns of Sudden Cardiac Arrest in India

Heart Diseases,

A sudden cardiac arrest (SCA) or sudden cardiac death is a condition in which the heart suddenly stops beating. In turn, it prevents the flow of oxygen-rich blood to the brain and other organs. If SCA is not treated immediately, then the patient dies within minutes.

About 10% of the deaths in India is due to sudden cardiac arrest which is also the most common factor of death in the world.

Economic Times

Causes:

SCA occurs due to:

Risk factors:

  • Age – The risk of SCA increases with age due to the presence of other health conditions.
  • Gender – Men are more likely to be affected as compared to women. The risk of SCA in children is high if they have any inherited heart disease.
  • Ethnicity – African Americans and Blacks are at a higher risk, especially if they have other underlying conditions like hypertension, diabetes, and chronic kidney disease.
  • Ischemic heart disease – People with ischemic heart disease are at a higher risk.
  • Other heart conditions – Patients diagnosed with heart attack, heart failure, cardiac arrhythmias, coronary artery disease, and scarring or damage to the heart tissue have increased incidence of SCA.
  • Physical stress – Intense physical activity or exercise raises the risk in people who already have heart problems.
  • Unhealthy lifestyle habits – Obesity, smoking, sedentary lifestyle, and alcohol abuse elevate the risk of getting SCA.
  • Family history – People born with heart defects like coronary artery anomaly or those with a family history of arrhythmias are at a higher risk.
  • Drug abuse – Illicit drug use of cocaine and other addiction-forming drugs elevates the risk.
  • Medications – Certain drug overdose and medicine used to treat heart disease increases the risk.

What are the Signs and symptoms of Sudden Cardiac Arrest?

  • Dizziness or lightheadedness just before the patient faints
  • Loss of consciousness (fainting)
  • Unexplained shortness of breath
  • Racing heart
  • Chest pain
  • Seizures
  • Fatigue
  • Vomiting
  • Lack of palpable pulse
  • Nausea
  • Unable to breathe normally and make gasping noises

Complications:

Emergency treatment helps to prevent death due to SCA. After resuscitation, the following complications are associated with SCA:

  • Postcardiac arrest shock 
  • reduced heart function
  • Organ damage

Diagnosis: how is Sudden Cardiac Arrest diagnosed?

  • SCA happens without any warning and is rarely diagnosed as it is happening. Most often, it is diagnosed after it happens.
  • Diagnostic tests –
    • Electrocardiogram (ECG) – Detects the heart’s electrical activity and signs of heart damage due to ischemic heart disease.
    • Echocardiography (echo) – Helps identify areas of poor blood flow, previous injury to the heart muscle, and regions of the heart muscle that are not contracting properly.
    • Gated blood pool scan or MUGA (Multiple gated acquisition) tests – A radioactive substance is injected into the vein to show how well the heart pumps blood.
    • Cardiac Magnetic Resonance Imaging (MRI) 
    • Cardiac catheterization – To detect narrowed or blocked coronary arteries.
    • Electrophysiology study – To record how the heart’s electrical system responds to electrical stimuli and certain medicines.
    • Blood tests – The levels of potassium, magnesium, and other chemicals involved in the heart’s electrical signaling are detected.

Treatment: how is Sudden Cardiac Arrest treated?

  • Emergency treatment is done to restore the heart’s normal rhythm. Cardiopulmonary resuscitation (CPR) is immediately performed to keep blood and oxygen circulating to the brain and throughout the body.
  • Emergency treatment – Defibrillation is usually done to restore the vitals as well as consciousness immediately. CPR is performed till defibrillation can be done. 
    • Automated External Defibrillators (AEDs) – Untrained individuals can use a particular defibrillator to give electric shocks if a dangerous arrhythmia is detected.
    • Cardiopulmonary resuscitation (CPR) – The center of the chest is pushed down by at least 2 inches at the rate of 100 to 120 pushes per minute. The chest is allowed to come back to the normal position before the next push.
  • Surgical procedures – Long–term treatment in the hospital and other surgical procedures are done to treat the underlying condition responsible for the SCA. These include:
    • Coronary artery bypass grafting or coronary angioplasty – These restore blood flow via the narrowed or blocked arteries to treat the ischemic heart disease and prevent another SCA in the future.
    • Implantable cardioverter-defibrillator (ICD) – It is surgically placed in the skin in the chest to send electric shocks to control dangerous arrhythmias.
  • Medications to prevent sudden cardiac death –
    • Antiarrhythmic drugs – Lidocaine, amiodarone, etc. for acute and chronic therapy to prevent ventricular arrhythmias and sudden cardiac death.
    • Other drugs – Statins and drugs, acting on the renin-angiotensin-aldosterone system to treat the underlying heart conditions.

Prevention:

Living with SCA – 

  • Cardiac rehabilitation
  • Dietary intake rich in soluble fiber and low in saturated and trans fat
  • Managing a healthy weight
  • Managing stress
  • Quitting smoking

Preventing SCA –

  • Exercising regularly
  • Regularly taking the prescribed medicines to treat the underlying conditions
  • Controlling diabetes, high blood pressure, and high cholesterol
  • Limiting alcohol intake

When to see a doctor? :

Consult immediately with a cardiologist or cardiac electrophysiologist if chest pain or shortness of breath is experienced for prolonged periods. It is critical to call the emergency helpline number immediately if someone collapses or seems lifeless. The average cost of an AED for use at – home ranges from Rs. 65K to 2 lakhs. The price of a standard ICD surgery lies around Rs. 3.5 to 4.5 lakhs.

Heart Failure: a Chronic and Life-threatening Condition

Heart Diseases,

Heart failure (HF) is a chronic and life-threatening condition in which the heart cannot pump blood sufficiently to meet the body’s demands. It is also known as congestive heart failure and requires medical care.

Types:

  • Left-sided heart failure – Left ventricle of the heart cannot pump enough blood around the body leading to the accumulation of blood in the pulmonary veins.
    • Heart failure with reduced ejection fraction (HFrEF) or systolic failure – Left ventricle loses its ability to contract normally.
    • Heart failure with preserved ejection fraction (HFpEF) or diastolic failure – Left ventricle loses its ability to relax normally.
  • Right-sided heart failure – Right ventricle cannot pump sufficient blood to the lungs leading to the accumulation of blood in the veins.
  • Biventricular heart failure – Both sides of the heart are affected, and a build-up of fluid is seen.
  • Congestive heart failure (CHF) – Congestion in the body tissues occurs as the blood flow from the heart slows down and the blood returning to the heart via the veins backs up.

What Causes Heart Failure:

The main etiological factors are:

  •  Medical conditions that damage or overwork the heart, such as coronary artery disease or heart attack.
  •  Infection or injury that damages the heart.
  •  Blood clot in the lung.
  •  Faulty heart valves.
  •  Congenital heart disease.
  •  Arrhythmia.
  •  High blood pressure.
  •  Cardiac amyloidosis.
  •  Cardiomyopathy.
  •  Conditions that stiffen the heart chambers, such as obesity and diabetes.
  • Conditions that damage the lungs such as chronic obstructive pulmonary disease.

Risk factors:

  •  Age – Older adults and those above 65 years of age are at a higher risk due to aging–related changes of the heart muscle and the presence of other health conditions.
  • Genetics – Risk of HF is higher if there is a family history of heart failure. Gene mutations also raise the risk.
  •  Unhealthy lifestyle habits – Unhealthy diet, smoking, drug abuse, heavy alcohol consumption, and physical inactivity increases the risk.
  •  Medical conditions – Obesity, high blood pressure, diabetes, sleep apnea, atrial fibrillation, and serious lung disease also raise the risk.
  •  Medications – Diltiazem, verapamil, tricyclic antidepressants, antipsychotics, chemotherapy, and radiation therapy further elevate the risk.
  •  Ethnicity – African Americans are more likely to suffer from heart failure as compared to other races.
  •  Gender – Women are more susceptible to developing HFpEF while men are more likely to develop HFrEF. Men are more prone to heart failure at a younger age as compared to women.

What are the Signs and symptoms of Heart Failure?

  • Shortness of breath when active and resting
  • Swelling (edema) of feet, ankles, stomach, and lower back
  • Unusual tiredness
  • Water retention
  • Palpitations
  • Fatigue
  • Decreased stamina
  • Loss of appetite
  • Nausea
  • Chronic coughing

Complications:

The serious complications arising due to heart failure are:

  • Kidney or liver damage
  • Fluid buildup in or around the lungs
  • Malnutrition
  • Leaking heart valves
  • Sudden cardiac arrest
  • Cardiac arrhythmias
  • Pulmonary hypertension

Diagnosis: How is it diagnosed?

  • Medical history – The physician assesses symptoms, family history, and other risk factors.
  • Physical examination – Heart rate, blood pressure, heart sounds, and edema in the body are examined by the physician.
  • Diagnostic tests –
    • Blood tests – Electrolyte levels, kidney and liver function tests, complete blood count, C – reactive protein levels, and brain natriuretic peptide (BNP) are monitored.
    • Chest x-ray
    • Magnetic resonance imaging (MRI)
    • Breathing tests – To ascertain if the lung problem is responsible for breathlessness.
    • Radionuclide ventriculography – Radioactive substances are injected to see how well the heart chambers are functioning.
    • Cardiac catheterization with coronary angiography – Blockages in the coronary arteries and the parts of the heart that has weakened or damaged are identified.
    •  Holter or event monitor – Electrical activity of the heart is monitored for 24 to 48 hours while doing the normal daily activities.

Treatment: how is How is Heart Failure treated?

  • Improving the symptoms and preventing the aggravation of the disease are the main objectives of treatment.
  • Assessing the reversible risk factors is the other goal of treatment.
  • Implantable devices –
    • Implantable cardioverter-defibrillator (ICD) – To deliver an electric counter-shock to the heart when a life-threatening abnormal rhythm is detected.
    • Left – ventricular assist device (LVAD) – Implanted in end-stage heart failure patients when heart transplantation cannot be done.
    • Cardiac Resynchronization Therapy (CRT) – A pacemaker to make the ventricles contract in synchrony and improve heart function.
  • Surgical procedures –
    • Heart transplantation – Replacement of the damaged heart in severe, progressive heart failure patients with a healthy heart.
    • Percutaneous coronary intervention (PCI) or angioplasty – An inflated balloon pushes open the artery, and a stent is kept in place to reopen the blocked blood vessels.
    • Coronary artery bypass – Rerouting the blood supply around the blocked section of the artery to restore blood flow to the heart.
    • Valve replacement – Replacement of the defective or diseased valve with a good valve.
  • Medications –
    • Angiotensin – Receptor Neprilysin inhibitors – Sacubitril/valsartan reduces the risk of hospitalization for heart failure.
    • If channel blocker – Ivabradine to reduce heart rate.
    • Beta-blockers – Bisoprolol, metoprolol, etc., to lower heart rate.
    • Aldosterone antagonists – Spironolactone, eplerenone, etc., to remove extra sodium and fluid from the body.
    • Diuretics – Furosemide, bumetanide, etc. to treat edema.
    • Digoxin – To make the heartbeat stronger and pump more blood.
    • Other medications – Anticoagulants and statins.

Prevention:

  • Living with HF–
    • Heart-healthy diet
    • Managing a healthy weight and stress.
    • Quitting smoking.
    • Medical care for other conditions.
  • Preventing HF–
    • Increasing physical activity.
    • Controlling diabetes.
    • Lowering high blood pressure.
    • Lowering cholesterol

When to see a doctor? :

Consult with a cardiologist immediately if you have a chronic cough, high heart rate, and shortness of breath while lying down. The cost of heart transplantation surgery ranges around Rs. 20 to 25 lakhs.

References:

Dr. Anupam Mehrotra- Cardiologist In Uttar Pradesh

Cardiologists at Apollo Hospitals

Find Heart Specialists

Cardiologists at Apollo Hospitals

Dr. Anupam Mehrotra is a Neurologist In Uttar Pradesh associated with Apollo hospitals In Uttar Pradesh.

  • Qualification: MBBS
  • Department: Cardiology
  • Specialty: Cardiologist
  • Locality: Uttar Pradesh
  • Consultant in: Apollomedics Super Specialty Hospitals
  • Address -KBC 31, Sector B, LDA Colony, Kanpur Road, Lucknow, Uttar Pradesh- 226012
  • Experience : 10 years
  • appointment– MON- SAT( 09:00 AM-05:00 PM )
  • Contact Number: 1860 500 1066

You can consult Dr. Anupam Mehrotra for

About Apollo Healthcare

Apollo Healthcare was established in 1983. The hospital has a presence in over 120 countries, houses 7000 + doctors, 4000+ pharmacies across places. Centers at Chennai and Hyderabad are the Joint Commission International-accredited. 

Milestones- Cardiac care

  • Apollo Hospitals, Chennai successfully performed four back-to-back MitraClip procedures in a single day.
  • India’s first advanced Aquilion One Prism 640-slice CT Scanner was introduced by Apollo Hospitals, Chennai.
  •  Apollo Hospitals, Chennai, implanted the first Artificial Pulmonary Valve (32mm) without surgery.
  • Apollo Hospitals, Indore, conducted India’s second successful Renal Denervation (RDN) Therapy for treating uncontrollable hypertension.
  • Apollo Hospitals, Chennai introduced the HIS-bundle-pacing procedure, a new technique to treat bradyarrhythmias.
  •  Apollo Hospitals, Indore implanted the first neonatal permanent pacemaker on a 2-day-old newborn baby.
  • The Guwahati center removed a cardiac tumor through Minimally Invasive Cardiac Surgery.
  • The hospital at Nellore- is the first hospital to perform TAVI in Rayalaseema & the coastal region of Andhra Pradesh on a 69-year-old patient.
  • The Indore facility- is the first hospital in Madhya Pradesh to perform Transcatheter Aortic Valve Replacement (TAVR) on a 69-year-old female patient.
  • Navi Mumbai center- successfully performed its first heart transplant on a 33-year-old male patient in 2019. The center also implanted the smallest and advanced leadless pacemaker on an 85-year-old patient.
  • Apollo Hospitals, on a 69-year-old patient, performed the first balloon-expandable TAVR in Visakhapatnam. 
  • Bhubaneswar facility was the first hospital in Odisha to perform Alcohol Septal Ablation (ASA) procedure.
  • Apollo Hospitals, Chennai, completes over 50,000 cardiac surgeries includes Bypass, Valve replacements, Pediatric cardiac procedures, Transplants, and Minimally invasive procedures.
  • Apollo Hospitals, Chennai, performed India’s first minimally invasive Robotic Hybrid Revascularisation surgery on a 63-year-old female patient in 2019
  • Apollo Hospitals Conducted over 1,52,000 cardiac surgeries – one of only ten hospitals worldwide to achieve these volumes.
  • Achieved a 99.6% success rate in cardiac bypass surgeries, over 99.6% of beating heart surgeries.
  • Apollo Hospitals, Chennai, completed 25,000 coronary bypass procedures, including 10,000 beating heart coronary bypass operations in 2009.