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CT Scan

Cardiac CT Scan- Cardiac Computed Tomography

Diagnosis,

A cardiac CT is a non – invasive and painless imaging test that uses x – rays to capture images of the heart. It helps to diagnose coronary artery disease and evaluate cardiac function. The CT scan can also assess scarring of the heart muscle, plaque buildup in the arteries, and fluid accumulation in the pericardial sac.

How is Cardiac CT Scan performed?

The CT scanner is a large tunnel-like machine with a sliding table attached to it. The patient is asked to lie down on this table, and electrodes will be attached to his chest to monitor his electrocardiogram (ECG). This ECG is connected to the computer that is attached to the scanner. It helps to monitor the heart rate during the scan. A contrast dye is then injected intravenously into the arm of the patient if needed. It is done to highlight the heart and the blood vessels to get a clearer picture. Once the dye is injected, the table will slide into the scanner.

Inside the scanner, the patient can hear a whirring or buzzing sound while the pictures are taken. Throughout the test, the patient can communicate to the technician via a two–way intercom. The technician may ask the patient to hold his breath for a few seconds to capture good quality images. Generally, the contrast media is injected at a high flow rate (4 – 5 mL/sec) for a cardiac CT scan compared to other CT scans. Apart from this, the patient is also administered with a beta-blocker and sublingual nitrate before the test. These medications are given to lower the heart rate, avoid arrhythmia, and dilate the coronary arteries. This scan is not recommended for pregnant, breastfeeding patients or anyone diagnosed with acute myocardial infarction.

Are there any risks involved in it? :

Due to exposure to a small dose of x – rays, cardiac CT has a slight risk of causing cancer, especially in patients below 40 years of age. The minor complication associated with cardiac CT scan is allergic reactions to the contrast dye.

FAQs:

What are preparations required from the patient? 

If contrast dye is to be used, then the patient must not eat for 4 to 6 hours or have caffeinated drinks for 12 hours before the test. Otherwise, he must refrain from eating for 2 hours before the test. Patients with kidney failure and those with metallic objects in the chest (pacemaker, surgical clips) should notify the doctor beforehand. 

How long does it take?

 The cardiac CT scanning takes about 10 to 15 minutes. 

Who performs it?

 A radiologist or radiology technologist generally does the cardiac CT scanning.

How much does it cost?

 The average cost of a cardiac CT scan lies around Rs. 6K to 12K.

When can I go home after the procedure?

The patient can usually go home and resume his normal activities immediately after the procedure.

References:

Cardiology Posts-Part 1

Pharma Company

About the Author: Snehal Shinde

Snehal is currently pursuing Bachelors’s in Pharmacy from Pune University. Her areas of expertise are- Clinical Research / Pharmacovigilance/Data Management.

Cardiologists in India

External Resources

FAQs

Check Cardiac Diagnostic Tests

Check Cardiac Disorders

Cardiologists at Reliance Hospital – Navi Mumbai

Heart Specialist,

Reliance Hospital Navi Mumbai is a super-specialty hospital that offers patient-centric, affordable, accessible healthcare services. It is a 300 + bed facility center with 38 specialty departments. The hospital offers 24X7 accident and emergency services. The accreditation include-NABH accreditation, ISQua, International Society for Quality in Healthcare. Know about Cardiologists at Reliance Hospital and the details of the cardiac treatments offered.

Contact details:

  • Address- Thane – Belapur Road, Opp. Kopar Khairane Station, next to Dhirubhai Ambani Knowledge City, Navi Mumbai, Maharashtra 400710
  • Board Number+91(22)7197 9797 | +91(22)3966 6666
  • Emergency+91(22)7198 1111 | +91(22)3922 2222
  • Appointments+91(22)7198 1100 | +91(22)3969 3969
  • Executive Health Checkups+91(22)7198 1010 | +91(22)3969 6969

Cardiac Treatments offered

  • Electrocardiogram (ECG or EKG)
  • Holter Monitor:  moveable ECG t
  • Stress Test
  • Echocardiogram or Echo
  • Computed Tomography (CT)
  • Coronary Angiography
  • Coronary Angioplasty

Cardiologists at Reliance Hospital

Dr. Lalit Chaudhari

Name of the doctorDr. Lalit Chaudhari
SpecializationCardiovascular and Thoracic surgeon
Specialty deals withCardiac Sciences
Book an appointmentdr-Lalit-Chaudhari
QualificationMBBS, MS, M.Ch. (Cardiothoracic Surgery)
Experience14 years
ExpertiseCardiothoracic surgery
Doctor’s availability8:00 AM to 8:00 PM (Monday – Saturday)

Dr. Nilesh Maru

Name of the doctorDr. Nilesh Maru
SpecializationCardiovascular and Thoracic surgeon
Specialty deals withCardiac Sciences
Book an appointmentdr-Nilesh-maru
QualificationMBBS, MS, MCh (CVTS)
Experience17 years
ExpertiseCardio-Thoracic and Vascular surgeon
Doctor’s availability8:00 AM to 9:00 AM (Monday and Friday)

Dr. Sujit Jana

Name of the doctorDr. Sujit Jana
SpecializationCardiovascular and Thoracic surgeon
Specialty deals withCardiac Sciences/Adult Cardiac Surgery
Book an appointmentdr-Sujit-Jana
QualificationMBBS, MS, MCh (CVTS)
Experience18 years
ExpertiseCardiac Surgery, CABG, Valve Replacements
Brief profileHe was an Advanced Clinical Fellow(Cardiac Surgery) at Mayo Clinic, Rochester, MN, USA (Aug 2005-Aug 2006).
Doctor’s availability4:00 PM to 6:00 PM (Monday – Friday)

Dr. Kamlesh Jain

Name of the doctorDr. Kamlesh Jain
SpecializationConsultant, Cardiovascular and Thoracic surgery
Specialty deals withCardiac Sciences
Book an appointmenthttps://www.reliancehospitals.com/doctors-profile/dr-kamlesh-jain/#appointment-form-sec
QualificationMBBS, MS, MCH
ExpertiseCardiac surgeries, Vascular surgeries, Minimally Invasive Cardiac Surgeries
Brief profileHe is the first Cardiac surgeon to perform successful TAVI in Maharashtra
Doctor’s availability9:00 AM to 4:00 PM (Thursday and Saturday)

Dr. Kumar Rajeev

Name of the doctorDr. Kumar Rajeev
SpecializationConsultant, Interventional Cardiology
Specialty deals withCardiac Sciences
Book an appointmentdr-rajeev-kumar
QualificationMBBS, MD, DNB (Cardiology)
Experience9 years
Brief profileHe has been awarded a fellowship at the European Society of Cardiology (FESC). He is a lifetime member of the Cardiological Society of India. He actively participated as a delegate in the annual conference of Cardiology Society of India, Mumbai, in December 2011 and as a delegate in the annual conference of CAD Asia Intervention summit, Pune, 2011 & 2012
Doctor’s availability9:00 AM to 11:00 AM (Monday – Saturday)

Dr. Mahesh Ghogare

Name of the doctorDr. Mahesh Ghogare
SpecializationConsultant, Interventional Cardiology
Specialty deals withCardiac Sciences
Book an appointmentdr-mahesh-s-ghogare
QualificationMBBS, MD (Internal Medicine), DM (Cardiology)
Experience10+ years
ExpertiseCoronary Angiography, Coronary Angioplasty, Peripheral Vascular Interventions including PTRA, Carotid stenting, Cardiac Catheterisation in Congenital Heart diseases, Interventions in Valvular Heart Diseases, Permanent Pacemakers
Doctor’s availability6:00 PM to 8:00 PM (Monday – Saturday)

Dr. Nikhil Jadhav

Name of the doctorDr. Nikhil Jadhav
SpecializationCardiologists at Reliance Hospital, Interventional Cardiology
Specialty deals withCardiac Sciences
Book an appointmentdr-Nikhil-Jadhav
QualificationMBBS, MD (Medicine), DM (Cardiology), Interventional Cardiology
Experience4 years
ExpertiseCardiology (Adult Invasive & Non-invasive)
Doctor’s availability8:00 AM to 8:00 PM (Monday – Saturday)

Dr. Ratan Rathod

Name of the doctorDr. Ratan Rathod
SpecializationConsultant (Cardiologists at Reliance Hospital), Interventional Cardiology
Specialty deals withCardiac Sciences
Book an appointmentdr-ratan-Rathod
QualificationMBBS, DM (Cardiology)
Experience17 years
ExpertiseCardiology (invasive and non-invasive)
Doctor’s availability8:00 AM to 8:00 PM (Monday – Saturday)

Dr. Niket Arora

Name of the doctorDr. Niket Arora
SpecializationConsultant, Cardiothoracic surgery
Specialty deals withCardiac Sciences
Book an appointmentdr-niket-arora
QualificationMBBS, DNB, PGD (Healthcare Management)
ExpertiseCABG (on and off-pump; total arterial), Valve replacements(Aortic, Mitral & Double valve), ASD patch closure, PDA ligation, Exposure to minimally invasive cardiac surgery, Emergency re-sternotomy and reexploration, Pericardial drainage(subxiphoid/thoracotomy)
Doctor’s availability8:00 AM to 8:00 PM (Monday – Saturday)

Dr. Vijay Kumar Verma

Name of the doctorDr. Vijay Kumar Verma
SpecializationConsultant (Cardiologists at Reliance Hospital), Interventional Cardiology
Specialty deals withCardiac Sciences
Book an appointmentdr-Vijay-Verma
QualificationMBBS, MD (General Medicine), DM (Cardiology)
Experience31 years
ExpertiseManagement of cardiac cases-Myocardial Infarctions, Emergency cases, Temporary pacings, IABP, Pericardiocentesis, Central line insertions and routine OPD cases, Management of high-risk Medical & surgical cases
Doctor’s availability8:00 AM to 8:00 PM (Monday – Saturday)

Coronary Artery Disease

Heart Diseases,

Coronary Artery Disease or CAD is a common heart disease involving a reduced supply of oxygen–rich blood to the heart muscles. This condition occurs due to the accumulation of plaque (waxy–like substance) in the larger coronary arteries of the heart. 

Types:

  • Obstructive coronary artery disease – Gradual narrowing and blockage of the arteries supply oxygenated blood to the heart.
  • Non – Obstructive coronary heart disease – Endothelial dysfunction or inappropriate vasoconstriction without narrowing of the arteries.
  • Coronary Microvascular disease – Obstruction of blood flow occurs due to damage to the inner walls of the tiny coronary arteries.
  • Spontaneous coronary artery dissection – Artery splits to form a false channel that reduces the blood supply to the heart.

Causes:

The common causes of CAD are:

  • Accumulation of plaque in the coronary arteries resulting in over 50 % blockage of the heart.
  • The buildup of small plaques in the tiny coronary artery blood vessels.
  • Narrowing of the arteries due to damage to the wall lining.
  • Injury to the artery walls due to chronic inflammation, high blood pressure, or diabetes.
  • Normal ageing–related changes in the coronary blood vessels.

Risk factors:

  • Age – Risk of developing CAD increases with age, significantly above 45 years of age.
  • Gender – Women have a lower risk when compared to men before menopause but this increases in women above 55.
  • Occupational factors – Sedentary work, working for more than 55 hours a week, and work involving exposure to toxins, radiation, and other hazards increase the risk.
  • Environment – Air pollution increases the risk in older adults, women, and people with diabetes or obesity.
  • Genetics – The likelihood of developing CAD is high if the male relative was diagnosed before age 55, or the female relative was diagnosed before age 65.
  • Unhealthy lifestyle habits – Physical inactivity, lack of quality sleep, unhealthy eating habits, and stress are other risk factors.
  • Smoking – Long – term smokers and exposure to secondhand smoke for extended periods elevate the chances of developing CAD.
  • Other medical conditions – The presence of congenital coronary artery defects, chronic kidney disease, Crohn’s disease, and certain other diseases also raises the risk.
  • Ethnicity – African Americans, Hispanics, and people of South Asian ancestry are at a higher risk.

Signs and symptoms:

  • Chest pain or discomfort during physical activity
  • Chest tightness, numbness, or heaviness
  • Shortness of breath
  • Extreme fatigue
  • Indigestion
  • Anxiety
  • Sleep disturbances
  • Neck pain

Complications:

CAD causes some severe complications if left untreated. This includes:

Diagnosis:

  • The doctor assesses medical history – Diet, physical activity, and other risk factors for CAD.
  • Diagnostic tests – Commonly performed tests are:
    • Blood tests – To check the levels of cholesterol, triglycerides, sugar, lipoproteins, or C – reactive proteins.
    • Coronary calcium scan – This is a cardiac CT scan used to measure the buildup of calcium in the walls of the coronary arteries.
    • Cardiac MRI – To detect tissue damage or obstruction to blood flow in the heart.
    • Cardiac PET scanning – It is a nuclear heart scan used to diagnose coronary microvascular disease.
    • Coronary angiography – Helps to visualize the insides of the coronary arteries.
    • Coronary computed tomographic angiography – Non – invasive coronary angiography.
    • Exercise ECG – Stress test – To assess the working of the heart while walking on a treadmill.
    • Electrocardiogram (ECG) – Electrical activity, rate, and regularity of the heartbeat.
    • Echocardiography (stress echocardiography) – Ultrasound is used to visualize the heart.

Treatment:

Lowering the risk for heart attack and preventing the aggravation of CAD are the main goals of treatment. Depending on the health status and goals, CAD is treated as follows:

  • Surgery – Damage to the arteries can be repaired by:
    • Coronary angioplasty
    • Atherectomy
    • Coronary artery bypass surgery
  • Minimally invasive procedures – Hybrid coronary revascularization is done if the patient has several blockages. This involves stenting some blockages and bypassing some, depending on the medical needs of the patient.
  • Medications – Drugs that are frequently used for the treatment and management of CAD are:
    • Statins – Atorvastatin, lovastatin, etc. These lower cholesterol levels and reduce the risk of CAD.
    • Calcium channel blockers – Amlodipine, bepridil, etc. These increase the blood supply to the heart and reduce cardiac workload.
    • Beta-blockers – Bisoprolol, metoprolol, etc. lower blood pressure, cardiac workload, and prevent angina.
    • Antiplatelet drugs – Aspirin, ticlopidine, etc. are used to prevent ischemic events in CAD.
    • Vasodilators – Nitroglycerin is used to widen coronary arteries and increase blood flow to the heart.

Prevention:

  • Living with CAD –
    • the patient must perform routine medical checkups.
    • Do not skip any dose of the prescribed medication.
    • Quit smoking.
    • Consuming low sodium and a low-fat diet.
    • Increasing physical activity.
    • Maintaining a healthy weight and stress.
    • Cardiac rehabilitation is advised post-surgery. 
  • Preventing CAD –
    • Decreasing obesity and cholesterol levels.
    • Treating high blood pressure.
    • Stopping smoking.
    • Increasing the levels of physical activity.
    • Decreasing psychosocial stress.
    • Avoiding consumption of trans fat and weight control.

When to see a doctor?

Prolonged or severe chest pain not relieved by nitroglycerin, or shortness of breath, or upper body discomfort along with lightheadedness are some of the alarming signs of CAD. When any of these are experienced by the patient, it is advisable to consult with a cardiologist immediately. The average cost of angioplasty with stenting ranges from Rs. 4 to 6 lakhs.

References:

Cardiomyopathy: diseases affecting the Heart Muscles

Heart Diseases, , , , ,

Cardiomyopathy is a group of diseases affecting the heart muscle. It is characterized by minimal to no symptoms in the initial stages. The heart muscle becomes enlarged, thick, or rigid, and weaker as the disease progresses.

Types:

  • Hypertrophic cardiomyopathy – Ventricles, septum, and heart muscle thicken without any apparent cause.
  • Dilated cardiomyopathy – Ventricles enlarge and weakens, and over time, become unable to pump blood effectively.
  • Restrictive cardiomyopathy – Ventricles become stiff, rigid, and become unable to pump blood. Still, the walls of the heart do not thicken.
  • Arrhythmogenic Right Ventricular Dysplasia – muscle tissue of the right ventricle is replaced with fatty or fibrous tissue and causes arrhythmias.
    • Unclassified cardiomyopathy –Left ventricular non – compaction – Rare congenital cardiomyopathy characterized by the projections of muscle inside the ventricles.
    • Takotsubo cardiomyopathy (broken heart syndrome) – Sudden temporary weakening of the muscular portion of the heart due to extreme stress.

What Causes Cardiomyopathy?

  • It can be acquired or inherited, but the etiology is often unknown.
  • The common etiological reasons are:
    • Inherited genetic mutation
    • High blood pressure
    • Thyroid disease
    • Aging-related changes 
    • Excessive alcohol consumption
    • Drug abuse
    • Viral infections affecting the heart
    • Amyloidosis, connective tissue disorders
    • Cardiac diseases
    • Chemotherapy and radiation therapy.

Risk factors:

  • Age – Teenagers and young adults are at a higher risk of developing arrhythmogenic right ventricular dysplasia than older adults.
  • Gender – The incidence of dilated cardiomyopathy is higher in men as compared to women.
  • Genetics – Patients with a family history of cardiomyopathy, heart failure, or sudden cardiac arrest show a higher rate of cardiomyopathy.
  • Medical conditions – Ischemic heart disease, heart attack, or a viral infection causing inflammation of the heart muscle elevates the risk.
  • Cardiac diseases – Diseases that damage the heart muscle like hemochromatosis, sarcoidosis, or amyloidosis also increase cardiomyopathy risk.
  • Unhealthy lifestyle habits – Long–term alcoholism, severe obesity, and other metabolic diseases are other risk factors.
  • Ethnicity – African Americans are more susceptible to developing dilated cardiomyopathy as compared to Whites.

Signs and symptoms:

  • Fatigue
  • Swelling of the lower extremities
  • Shortness of breath after exertion
  • Palpitations
  • Fainting or briefly passing out
  • Chest pain after physical exertion or heavy meals
  • Arrhythmias
  • Heart murmurs

Complications:

Cardiomyopathy can lead to additional complications like:

  • Heart failure
  • Heart valve regurgitation
  • Heart rhythm problems
  • Sudden cardiac arrest
  • Blood clots (emboli)
  • Heart block

Diagnosis: How is Cardiomyopathy diagnosed?

  • Medical history – Family history of cardiac disease and signs and symptoms experienced by the patient is assessed by the physician.
  • Physical examination – Heart sounds, the timing of heart murmurs, swelling of the ankles and legs, and other physical signs are examined.
  • Diagnostic tests – 
    • Blood tests – The levels of B – type natriuretic peptide (BNP) in the blood are evaluated to rule out the other conditions.
    • Chest x-ray
    • Electrocardiogram (ECG)
    • Holter and event monitors – Records the heart’s electrical activity for 24 to 48 hours while performing normal daily activities.
    • Echocardiography (echo)
    • Stress test – Tests like nuclear heart scanning, echo, and positron emission tomography (PET) scan of the heart are done. At the same time, the patient is asked to exercise to assess the heart’s efficiency.
  • Additional tests –
    • Cardiac catheterization – Blood pressure, blood flow in the heart’s chambers, and the insides of the arteries are evaluated for blockages.
    • Coronary angiography 
    • Myocardial biopsy – Changes in the cardiac cells are viewed under a microscope and used for diagnosing different types of cardiomyopathy.
    • Cardiac magnetic resonance imaging (MRI)
    • Radionuclide ventriculography – Radioactive tracer is injected into the patient’s blood. The radioactivity is measured to determine the blood flow in the large vessels and heart chambers.
  • Genetic testing – Genetic mutations that can cause cardiomyopathy are detected using patients’ blood with a family history of the disease.

Treatment: How is Cardiomyopathy treated?

  • The primary rationale behind cardiomyopathy treatment involves controlling the signs and symptoms and reducing the risk factors. 
  • It is also aimed at managing the conditions that trigger or exacerbate the disease and reducing the complications caused by it. The other major goal is to prevent the aggravation of the disease.
  • Surgery – 
    • Septal Myectomy – An open–heart surgery for removing a part of the thickened septum that bulges into the ventricle.
    • Heart transplant – Replacement of the diseased heart with a healthy heart in people with end-stage heart failure.
  • Surgically implanted devices –
    • Pacemaker 
    • Left ventricular assist device (LVAD) – helps the heart to pump blood before heart transplantation or for long–term therapy.
    • Cardiac resynchronization therapy (CRT) device – Coordinates the contractions between the heart’s left and right ventricles.
    • Implantable cardioverter-defibrillator (ICD) – Controls life-threatening arrhythmias.
  • Non – surgical procedures – Alcohol septal ablation is done to shrink the hypertrophic cells to normal size by using ethanol.
  • Medications – Drugs prescribed for different purposes are given below:
    • To lower blood pressure – Angiotensin-converting enzyme (ACE) inhibitors (captopril, enalapril, etc.), angiotensin II receptor blockers (losartan, telmisartan, etc.), beta-blockers ( bisoprolol, carvedilol, etc.), and calcium channel blockers (amlodipine, bepridil, etc.).
    • To lower heart rate – Beta-blockers, calcium channel blockers, and digoxin.
    • To prevent arrhythmia – Anti-arrhythmic drugs (adenosine, verapamil, etc.)
    • Balance electrolyte levels – Aldosterone blockers (spironolactone, eplerenone, etc.)
    • Remove excess fluid and sodium – Diuretics (furosemide, bumetanide, etc.)
    • Prevent blood clots – Anticoagulants (rivaroxaban, dabigatran, etc.) and blood thinners (aspirin, clopidogrel, etc.)
    • Reduce inflammation – Corticosteroids

Prevention:

  • Living with cardiomyopathy –
    • Heart-healthy eating
    • Managing a healthy weight
    • Physical activity
    • Quitting smoking
    • Not skipping any dose of medicine.
  • Preventing cardiomyopathy –
    • Regular checkups
    • Avoiding alcohol
    • Getting adequate sleep
    • Managing stress

When to see a doctor? :

Consult immediately with a cardiologist if there is trouble breathing when lying flat, shortness of breath unrelated to exercise, or sudden weight gain of 5 or more pounds in a week. The cost of open-heart surgery lies around Rs. 3 lakhs while that of pacemaker implantation ranges between Rs. 2.5 to 3.5 lakhs.

References:

Atrial Fibrillation: Irregular and Fast Heartbeats

Heart Diseases,

Atrial fibrillation (AF or A – fib) Brief description:

Atrial fibrillation is a type of cardiac arrhythmia that is characterized by irregular and abnormally fast heartbeats. The heart rate in AF is generally between 100 to 175 beats per minute. It starts as a brief period of arrhythmia but gradually becomes longer with time.

Types:

  • Paroxysmal atrial fibrillation – Rapid, erratic heart rate that begins suddenly and lest for less than 24 hours but may last up to a week.
  • Persistent atrial fibrillation – Abnormal heartbeats that resolve with medical intervention only and last for more than seven days.
  • Long–term persistent atrial fibrillation – Continuous incidences of atrial fibrillation that last for greater than 12 months.
  • Permanent atrial fibrillation – Abnormal heart rhythm is permanent, and medications are needed to keep heart rate in check.

Causes of Atrial Fibrillation

AF occurs due to one or more of the following reasons:

  • Abnormality in the heart’s anatomy or heart rate adjustment leading to variations in the electrical signaling.
  • Premature or extra heartbeats. 
  • Presence of patches of faster or slower tissues in the heart.
  • Repeated stimulation of certain tissue patches in the heart.
  • Development of an atypical loop set off by a trigger heartbeat.
  • Changes in heart tissue due to aging, infection, heart disease, or genetics.
  • Fibrosis, inflammation, thickening, or thinning of the heart walls.
  • Abnormal buildup of proteins, minerals, or cells in the heart tissue.

Risk factors:

  • Age – Risk increases with age and is often higher in individuals above 65 years of age.
  • Genetics – Family history of AF increases the risk by 40 %. Mutations in the genes of ion channels also increase the rate of AF.
  • Alcohol – Binge drinking increases the risk at a higher rate than low – to – moderate alcohol consumption.
  • Unhealthy lifestyle habits – Sedentary lifestyle, lack of physical activity, and drug abuse can trigger or aggravate AF.
  • Stress – Panic disorders and other types of emotional stress are associated with the development of AF.
  • Medical conditions – Obesity, high blood pressure, congenital heart defects, sleep apnea, and diabetes are some of the health conditions that raise the risk of AF.
  • Ethnicity – People of European ancestry and Whites are more susceptible to developing AF than African Americans.
  • Cardiac surgery – Previous heart surgery and surgery to correct congenital heart defects raise the risk of AF.
  • Medications – Dobutamine, chemotherapeutic agents like cisplatin, NSAIDs, adenosine, and corticosteroids increase the risk of developing AF.

Signs and symptoms:

  • Heart palpitations
  • Exercise intolerance
  • Fatigue
  • Shortness of breath
  • Lightheadedness
  • Difficulty breathing
  • Chest pain or discomfort

Complications:

Serious complications that arise due to untreated AF are:

  • Venous thromboembolism
  • Alzheimer’s disease
  • Vascular dementia
  • Heart attack
  • Heart failure
  • Stroke
  • Sudden cardiac arrest

Diagnosing Atrial Fibrillation

  • The physician assesses medical history – Diet, physical activity habits, family history, and other risk factors.
  • Physical examination – Heart rhythm, blood pressure, pulse rate, and other physical abnormalities are checked by the physician.
  • Diagnostic tests – 
    • Blood tests – Complete blood count, levels of potassium, and other electrolytes are determined.
    • Thyroid-stimulating hormone (TSH) test – Low levels of serum TSH indicate an increased risk of AF.
    • Echocardiography – This test identifies regions of poor blood flow in the heart, previous injury to the heart muscle, and harmful blood clots.
    • Electrophysiology study (EPS) – The heart’s electrical system is evaluated and checked for abnormal heart rhythms.
    • Holter and event monitors – Records the heart’s electrical activity while doing normal daily activities for long periods.
    • Loop recorder – Devices implanted in the chest area to monitor the heart’s electrical activity for months.
    • Sleep study – To ascertain if sleep apnea is responsible for AF.
    • Exercise stress test – Helps to identify the changes in the heart’s activity during and after exercise.
    • Transesophageal echocardiography – To detect blood clots in the atria, especially in the left atria.
    • Walking test – Helps to measure the heart activity while walking for 6 minutes to determine how the heart behaves under normal circumstances.
    • Electrocardiogram (ECG)
    • Chest x-ray

Treatment of Atrial Fibrillation

AF is treated to manage the symptoms and reduce the risk factors that aggravate the condition. It also helps to prevent blood clots and reduce the risk of stroke.

  • Surgery – 
    • AF catheter ablation – A catheter is used to destroy the tissue inside the heart responsible for the arrhythmia.
    • Atrioventricular node ablation – The AV node is ablated to stop the irregular impulses from reaching the ventricles. The ablation is done after implanting a pacemaker.
  • Cardioversion – 
    • Electrical cardioversion – A defibrillator is used to send a low-energy electric shock to the heart. It is done if medications are not effective.
    • Pharmacological or chemical cardioversion – Anti–arrhythmic medications like amiodarone or sotalol are given intravenously or orally in the hospital to restore the normal heart rhythm.
  • Medications – The medications that are commonly prescribed are:
    • Beta-blockers – Metoprolol, carvedilol, etc., to lower the rate with which the ventricles pump blood throughout the body.
    • Blood thinners – Edoxaban, dabigatran, etc.-prevent the formation of blood clots and reduce the risk of stroke.
    • Calcium channel blockers – like Diltiazem, verapamil, etc. reduce the number of impulses that pass through the AV node to ventricles to lower the heart rate.
    • Digitalis, or digoxin – It is used with caution to increase the pumping force and reduce the heart rate.

Prevention:

  • Living with AF –
    • Regular checkup and follow-up care.
    • Eating a heart-healthy diet with low salt intake.
    • Being physically active.
    • Quitting smoking.
    • Managing a healthy weight.
    • Avoiding alcohol and substance abuse.
  • Preventing AF –
    • Managing blood pressure.
    • Avoiding large quantities of caffeine.
    • Treating other underlying conditions like diabetes, sleep apnea, etc.

When to see a doctor? :

It is best to consult with a cardiologist when the AF episode lasts for 24 to 48 hours without any break or if the symptoms aggravate over time. The cost of catheter ablation ranges from Rs. 70K to 1 lakhs.

References:

Arrhythmia: When the heart rhythm goes for a toss!

Heart Diseases, , , , , , ,

Heart Disorders

How are Heart disorders diagnosed?

Cardiac arrhythmia is a condition that affects the rate and rhythm of the heart. An adult’s heart usually beats between 60 to 100 times per minute. This gets altered in certain conditions called arrhythmia. In arrhythmia, the heartbeats are irregular and can be either too fast (> 100 beats per minute) or too slow (< 60 beats per minute).

Types of Cardiac arrhythmia

There different types of arrhythmia are:

  • Atrial fibrillation – Irregular and rapid contraction of the heart’s upper chambers (atria), causing 100 to 175 beats per minute.
  • Bradycardia – Resting heart rate is less than 60 beats per minute in adults.
  • Tachycardia – Rapid heart rhythms over 100 beats per minute. (Image credit)
  • Conduction disorders – Impairment of the electrical impulse involved in maintaining normal heart rhythm.
  • Premature ventricular contraction – Extra heartbeats or palpitations beginning from the ventricles.
  • Ventricular fibrillation – Life-threatening, abnormal heart rhythm due to erratic electrical activity of the heart.
  • Fetal arrhythmia – Abnormal heart rate beyond 160 or below 110 beats per minute in the fetus.
  • Atrial flutter – Rapid contractions of the atria followed by the ventricles resulting in abnormal heart rate.

What Causes Cardiac arrhythmia?

Cardiac arrhythmias may occur due to one or more of the following reasons:

  • Abnormality in the heart’s natural pacemaker.
  • Disruption of the normal conduction pathway anywhere between the sinoatrial node to the Purkinje fibers.
  • Disruption of the normal heart beat when another part of the heart starts acting as the pacemaker.
  • Scarring, or fibrosis of the heart tissue or reduced blood flow to the heart.
  • Release of excess stress hormones due to anxiety, strong emotional stress, anger, and pain.
  • Vomiting, cough, or other physical activity that induces the release of adrenaline.
  • Dehydration, and excess or deficiency of electrolytes such as potassium, calcium, and magnesium.
  • Thyroid hormone imbalance and low blood sugar level.
  • Medications used for treating high blood pressure, depression, and psychosis.

What are the Risk factors?

  • Age – Risk increases with age due to changes in the anatomy of the heart.
  • Environment – Particulates causing air pollution contribute to the short – term risk of cardiac arrhythmia.
  • Genetics – Family history and genes are linked with arrhythmias. Genetic mutation of the ion channels that transmit electrical impulses is a major risk factor.
  • Lifestyle habits – Smoking, drinking alcohol, and substance abuse of cocaine, amphetamine, and other such drugs increases the likelihood of getting arrhythmia.
  • Other health conditions – Heart failure, heart inflammation, obesity, high blood pressure, and rheumatoid arthritis are some of the medical conditions that increases the chances of getting arrhythmias.
  • Race – White Americans are at a higher risk as compared to African Americans.
  • Sex – Men are at a higher risk of atrial fibrillation than women. Risk factor for women rises while consuming certain medications.
  • Pregnancy – Benign heart beats and increased frequency of existing arrhythmias are more common as compared to non – pregnant women.
  • Surgery – Chances of atrial flutter are higher post-surgery of the heart, lungs, or esophagus.

Signs and symptoms

  • Fatigue
  • Dizziness
  • Rapid heartbeat or pounding in the chest
  • Difficulty in breathing
  • Sweating, blurred vision and anxiety
  • Pain or pressure in the chest
  • Sudden cardiac arrest following collapse seen in extreme cases.

What are the Complications?

If cardiac arrhythmias are left untreated, they give rise to potentially fatal complications of the heart and brain such as:

  • Stroke
  • Heart failure
  • Sudden cardiac arrest
  • Alzheimer’s disease
  • Vascular dementia
  • Sudden infant death syndrome
  • Aggravation of existing arrhythmia

Diagnosis: How to diagnose Cardiac arrhythmia?

  • The physician assesses medical history – Diet, physical activity, and other risk factors.
  • Physical examination – Pulse rate, heart rate, rhythm, and other signs are monitored for any abnormality.
  • Diagnostic tests – The tests performed are:
    • Blood tests
    • Chest x-ray
    • Cardiac catheterization
    • Sleep study – To ascertain if sleep apnea is responsible for arrhythmia or not.
    • Holter or event monitor – Electrical activity of the heart monitored for longer periods while the patient follows his normal routine.
    • Implantable loop recorder – Helps to identify the reason for the rare palpitations experienced by the patient by continuously recording the electrical activity of the heart.
    • Tilt table testing – Heart rate, blood pressure, and ECG are monitored to identify the cause of fainting spells.
    • Ultrasound – This is done to diagnose fetal arrhythmia in the mother’s womb.

Treatment: How is Arrhythmia treated?

Restoring normal heart rhythm or controlling the heart rate to a relatively normal range is the prime goal of treatment. Improving the other causative underlying conditions and preventing the aggravation of health due to arrhythmia are the other rationale behind treatment.

  • Vagal maneuver – Physical techniques that slow down or stop the arrhythmias especially supraventricular tachycardia.
  • Other treatment approaches – Application of electricity either externally or internally to the heart using implanted electrodes can treat arrhythmia. These include :
    • Cardioversion
    • Defibrillation
    • Cardiac pacing
    • Catheter ablation
  • Medications – Antiarrhythmic drugs are commonly used for treating this condition. This includes different classes of drugs as follows:
    • Sodium channel blockers – Moricizine, oxcarbazepine, etc.
    • Potassium channel blockers – Amiodarone, bretylium, etc.
    • Adenosine, digoxin, and atropine (Slows rapid heart rate).
    • Others – Blood thinners to reduce the chances of clot formation.

Prevention: Can we prevent it?

  • Living with arrhythmia –
    • Following the prescribed treatment plan and going for regular checkups.
    • Maintaining a healthy diet.
    • Managing stress.
    • Avoiding alcohol and quitting smoking.
  • Prevention of arrhythmia –
    • Monitoring pulse and blood pressure regularly.
    • Losing excess weight.
    • Keeping cholesterol levels in check.
    • Eating a heart–healthy diet.
    • Regular exercising.

When to see a doctor? :

It is wise to consult with a cardiologist immediately if the symptoms persist for long, or if the patients feels lightheaded and difficulty breathing along with a rapid heart rate. The typical consultation fee for a cardiologist ranges from Rs. 500 to Rs. 3000 in India.

References:

Cardiac Catheterization: Procedures and Purposes

Diagnosis

Cardiac catheterization, often referred to as cardiac cath or heart cath, is a medical procedure used to examine how well the heart is functioning. It is one of the most common heart procedures. The procedure involves the insertion of a catheter (a long, thin tube) into a large blood vessel, typically through a puncture in the skin, to access the heart and its surrounding blood vessels.

The primary purposes of cardiac catheterization include:

  1. Diagnosing Heart Problems: It helps examine how well the heart functions and identify various heart issues.
  2. Coronary Angiography: This involves taking X-rays using contrast dye injected through the catheter. It helps to look for narrowed or blocked coronary arteries.
  3. Percutaneous Coronary Intervention (PCI): Procedures such as coronary angioplasty with stenting can be performed. Stenting helps to open up narrowed or blocked segments of a coronary artery.
  4. Measuring Heart Pressures: It allows for checking the pressure in the four chambers of the heart.
  5. Blood Sampling: Blood samples can be taken to measure the oxygen content in the heart’s chambers.
  6. Evaluating Heart Function: It assesses the ability of the heart’s pumping chambers to contract.
  7. Identifying Structural Defects: The procedure can help identify defects in the heart’s valves or chambers.
  8. Biopsy: A small piece of heart tissue can be removed for examination under a microscope.

How does the cardiac catheterization process work?

The cardiac catheterization process involves several key steps, which are outlined below:

  1. Preparation:
    • Before the procedure, patients receive instructions regarding fasting (usually no food or drink for 6-8 hours prior).
    • An intravenous (IV) line is placed in a vein in the arm to administer sedatives and medications.
  2. Anaesthesia and Site Preparation:
    • A local anaesthetic is applied to numb the area where the catheter will be inserted, typically in the groin or wrist.
    • The skin is cleaned and sterilized to minimize the risk of infection.
  3. Insertion of Catheter:
    • The doctor makes a small puncture in the skin and inserts a needle into a large blood vessel (usually the femoral artery in the groin).
    • A thin, flexible tube called a sheath is then placed into the vessel to allow the catheter to be inserted.
    • A catheter (a long, thin tube) is guided through the sheath and into the blood vessel, using imaging technology (like fluoroscopy) to visualize its path as it is threaded toward the heart,
  4. Diagnostic and Interventional Procedures:

Once the catheter is in place, various diagnostic tests can be performed

    • Angiography: A contrast dye is injected through the catheter to visualize blood flow in the coronary arteries using X-ray imaging.
    • Pressure Measurements: The catheter can measure blood pressure in the heart’s chambers and blood vessels.
    • Biopsy: A small tissue sample may be taken for further examination.
    • Therapeutic procedures such as angioplasty (to open blocked arteries) or stenting (to keep arteries open) can be performed during the same session.

5. Completion of the Procedure:

  • The catheter and sheath are removed after the necessary tests and interventions are completed.
  • Pressure is applied to the puncture site to prevent bleeding; sometimes, a closure device is used to seal the site.

6. Recovery:

  • Patients are taken to a recovery room, where they must lie flat for a few hours to ensure proper healing at the puncture site.
  • Vital signs, including heart rate and blood pressure, are monitored during recovery.
  • Patients are advised to report any unusual symptoms, such as swelling, pain, or bleeding at the puncture site.

7. Post-Procedure Instructions:

  • Before discharge, patients receive written instructions on care at home, including medication management and follow-up appointments.

    This structured approach ensures cardiac catheterization is performed safely and effectively, providing valuable insights into heart health and enabling necessary interventions.

    What are the potential risks associated with the procedure?

    The potential risks associated with cardiac catheterization include:

    1. Bruising and Bleeding: Minor bruising at the puncture site is common, and there is a risk of bleeding that may require additional medical attention.
    2. Infection: There is a small risk of infection at the puncture site or within the bloodstream.
    3. Reaction to Contrast Dye: Some patients may have allergic reactions to the contrast dye used during the procedure.
    4. Abnormal Heart Rhythm: The procedure can sometimes lead to irregular heartbeats.
    5. Blood Clots: There is a risk of blood clots forming due to the procedure.
    6. Damage to Blood Vessels or Heart: The catheter can potentially cause damage to blood vessels or the heart itself.
    7. Heart Attack: Although rare, there is a risk of a heart attack occurring during or after the procedure.
    8. Stroke: There is a minimal risk of stroke associated with the procedure.
    9. Side Effects from Sedation: Patients may experience side effects from medications that help them relax, such as nausea or vomiting.

    While cardiac catheterization is generally considered safe, patients should be aware of the risks and discuss any concerns with their healthcare team prior to the procedure.

      References:

      Echocardiography: Diagnostic Cardiac Ultrasound Scan

      How does Intravascular Ultrasound quantify Plaque?

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      Which are the Blood Tests for diagnosing cardiac diseases?

      Diagnosis,

      A blood test involves taking a small sample of blood for testing in the laboratory. A doctor can use it to diagnose heart diseases and assess heart health. The different types of blood tests employed for this purpose are:

      • Cardiac enzyme tests and troponin tests – To diagnose a heart attack.
      • C-reactive protein test – To detect high levels of inflammation and risk of heart disease.
      • Full blood count – To detect infections and monitor heart conditions.
      • Thyroid function tests – To determine whether the irregular heart rate occurs due to hormonal imbalances.
      • Lipid profile – To measure cholesterol level.
      • Lipoprotein, homocysteine, and fibrinogen tests – To assess the risk of developing coronary artery disease.
      • Liver tests – To evaluate the functioning of the liver.
      • Clotting screen – To measure the rate of blood clotting.
      • BNP (B-type natriuretic peptides) test – To check for signs of heart failure.
      • Urea and Electrolyte test – To assess the overall functioning of the heart.  

      Read more about various cardiac disorders that require blood testing to assess risk.

      How are blood tests performed? :

      Blood is generally taken by inserting a needle in the vein inside the elbow. A pathologist can also take it from the vein on the back of the hand. The veins in these regions are used as they are closer to the surface of the skin. Before inserting the needle, a tourniquet (tight band) is wrapped tightly around the arm. It is tied just above the region where the blood is being withdrawn. This action pushes the veins to the skin’s surface, making it easier to take the blood sample. An antiseptic swab is generally used to clean this region before taking blood. The collected blood is then transferred to a vial and sent to the laboratory for analysis. After collecting the blood sample, the patient is asked to apply pressure to the area for a few minutes.

      Apart form blood tests, various diagnostic tests are also performed to find out risks associated with heart problems.

      Are there any risks involved in it? : 1

      Discomfort and bruising at the site where the needle was inserted are the common risks of blood tests. These are minor and usually go away after some time.

      FAQs:

      What preparation is required from the patient? 

      The patient may consult with the doctor to know if he/she is required to refrain from eating or drinking anything before the test. It is advised to wear a loose-fitting shirt or a short-sleeved top to make it easy to reach the arm during the test.

      How long does it take?

      The entire test is completed within a few minutes.

      Who performs it?

      The phlebotomist (pathologist) usually performs blood tests. Sometimes, the nurse or the doctor may also conduct this test.

      How much does it cost?

      The average cost of the blood test for diagnosis of heart disease ranges from Rs. 350 to Rs. 2000.

      When can I go home after the procedure?

      The patient is allowed to go home immediately after the blood tests and does not require any hospitalization.