NON INTERVENTIONAL CARDIOLOGY
2D Echo & Color Doppler
Very good diagnostic modality to know about heart function, its pumping efficiency, diseases related to valves inside heart, structural hearts defects since birth (congenital heart disease).
Cardiac Treadmill Test (TMT)
We stress the heart by asking patient to walk on treadmill. During the test we monitor your blood pressure and changes in the ECG. Any significant changes in the ECG, will indirectly tell about narrowing in the coronary arteries.
It is a test that uses ultrasound imaging to demonstrate how well your heart muscle is attempting to pump blood to your body. It is primarily used to distinguish a diminishing in blood stream to the heart from narrowing in the coronary arteries.You will be asked to exercise on a treadmill or be given medications to stress your heart. Any change in the pumping of the heart muscle will tell about the narrowing in the coronary arteries.
Coronary Artery Disease (CAD) is a narrowing of small blood vessels that supply blood and oxygen to the heart. By doing coronary angiography we directly visualize any narrowing of these blood vessels that will help in diagonosing CAD. This can be done by both radial (through hand) or femoral (through groin) routes. However, radial approach is being more commonly used today as it is convenient for the patient and lessens hospital stay.
After we have diagnosed the disease through angiography, the blockage site can be opened by putting the stent at the site of narrowing thereafter balloon dilatation. Results are excellent. This can be done by both radial and femoral approaches.
A) Primary Angioplasty
A life saving strategy which is done, when patient gets heart attack and if he arrives at the hospital well in time preferably in first 3 hours of heart attack, it significantly increases survival and prevents heart rate related complications. It underlines the importance of time as “Time is Muscle”.
B) Elective Angioplasty
It is done when patient presents with chest pain of longer duration and is relatively stable (Chronic Stable Angina). We can fix the problem with multiple stents in same sitting or it can be done in stages (subjective to patient’s clinical parameters).
Refers to deviation of heart rate from normal which is between 60-100 rate per minute.
Refers to our heart rate when it goes less than 60 per minute. It can cause giddiness, fatigue, breathlessness and many times patient may suddenly collapse.
Refers to our heart rate when it goes more than 100 per minute. This may be normal heart rate or abnormal heart rate. The main symptom we feel is palpitations (heart is beating fast). This may also cause giddiness and collapse.
As we do angiography to look for blood vessels supplying our heart, EP study permits us to diagnose problem related to electrical system of heart. It can diagnose causes of slow as well fast heart rate. It decides whether the patient requires pacemaker (in event of slow heart rate) or devices and ablation (in event of fast heart rate).
Ablation means removal of extra-electrical circuit in the heart electrical system that is causing fast heart rate. It is done by delivering Radio Frequency (RF) energy. It is safe and excellent method to get rid of the problem and eventually it avoids need of any medication for long term.
Pacemakers increase our heart rate and bring heart rate back in normal range.
Its an emergency procedure when heart rate is very slow and patient is symptomatic. Done till the time we are awaiting for the desirability and suitability of the patient for permanent pacing.
It is for lifetime. It is done through a small incision below the collar bone preferably on the left side. It is a minimally invasive procedure and safer treatment modality. It doesn’t require frequent follow ups. It also does not impose limitation of physical activities.
Increases survival in Heart Failure patients. Patients with poor heart function with LVEF and having significant breathlessness or other cardinal symptoms.
Implantable Cardioverter Defibrillator (ICD)
When the patient arrives in the hospital in the condition of shock, many times external shock is given to revive this patient. ICD delivers shock internally and it restores dangerous fast heart rate to normal and improves survival.
Cardiac Resynchronization Therapy (CRT)
Cardiac resynchronization therapy with and without ICD (CRT- D / CRT- P) has dramatically changed the paradigm of heart failure patients. It significantly improves symptomatic status like breathlessness, quality of life and improves survival.
Difference between Pacemaker or ICD and CRT is the difference of extra lead which is put through vein of heart (coronary sinus) to pace the left side of the heart, along with right side of the heart paced in contrast to the Pacemakers or ICD in which only leads are put in the right chambers of the heart.