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Category Archives: Heart Care

Obesity and Sedentary lifestyle are Principal cause behind early Arthritis & Knee Damage

By Vinod Kumar

Experts warn vicious cycle of inactivity and unbalanced diet flare the overweight kids up for arthritis as adult. According to experts  the effects of obesity put children at risk of long-term foot, leg and back problems.

While Childhood Arthritis (juvenile arthritis) is considered a rare disorder, the incidence is rising and doctors of the city blame obesity to be one of the major contributors. City doctors are shocked to discover that the school going children are also suffering from bone disorders like arthritis and osteoporosis. While there are many reasons for the kids to be obese, including hormonal issues, but being overweight is strongly connected to diet and inactivity inform the experts.

“Our hips and knees bear five to seven times our body weight. These little frames aren’t supposed to be carrying 50 to 60 kg of body weight. The heavier the child, the bigger the pressure on the joints and cartilage, and that can be painful. It sets up their soft tissue for inflammation.” Informed Dr. (Prof.) Raju Vaishya, Founder President of Arthritis Care Foundation (ACF) and senior consultant, orthopaedic & joint replacement surgeon at  Indraprastha Apollo Hospitals. Obesity causes an increased mechanical stress caused by extra weight on the joints as well as inflammatory effects of elevated cytokines and adipokines that affect cartilage degradation, said Dr. Vaishya.

According to senior dietitian & nutritionist Dr pallavi Vaishya, “if your child complains of joint pain, swelling or stiffness in one or more joints for a period of six weeks or longer, seek medical attention as early diagnosis and treatment is necessary to prevent permanent joint damage. The inactivity related to watching TV and playing video games have a significant impact on childhood obesity. Poor eating habits also lead to diets deficient in calcium and vitamin D – important nutrients for growing bones,”

“The diagnosis of knee osteoarthritis is occurring much earlier. Obesity and knee injuries may be helping to drive the increase in knee Osteoarthritis among younger people. Injuries to the knee have been linked with an increased risk of knee arthritis.   “More knee replacements are being performed in younger population than before due to obesity, sedentary lifestyles & other forms of arthritis,” said Dr. Raju Vaishya.

According to Dr. Vaishya, Over the last few years, the volume of joint replacement procedures has increased dramatically—and the percentage of joint replacement in patients who are younger than 65 years have seen marked increase.

Dr. Raju Vaishya said that it is a common misconception that autoimmune diseases (AIs) affecting joints, such as rheumatoid arthritis (RA), only affect the elderly. Statistics show that both the young and active can also suffer from these debilitating conditions.

“Patients must not lose hope. Treatment has improved significantly and newer therapies and methodologies including the very exciting biologic disease modifying drugs and procedures like arthroscopy and joint replacements have made a tremendous impact on our ability to treat the various Arthritis. With the help of these therapies, patients are now able to live a fuller, healthier and more active life no matter what their age. They can still reach for the stars and realize their dreams.” said Dr (Prof) Rohini Handa, senior consultant, rheumatology, Indraprastha Apollo Hospitals.

“As the number of younger patients with arthritic knees increases, the emphasis should be given to prevention, and improvements in surgical techniques and implants will lead to better long-term outcomes when joint replacement is performed,” said Dr. Handa.

According to Dr, Raju Vaishya now a day’s arthritis of the knee and other joints is striking at younger ages but shedding a few pounds if you’re overweight may reduce your risk. As people become more aware of the facts around joint pain they are more inclined to seek help.

“Many people believe that only the elderly suffer from arthritis but I treat patients of all ages in my practice. Often they are misdiagnosed because some doctor’s rule out the possibility of a patient having some form of arthritis as they are too young, and the elderly don’t seek treatment as they believe there is nothing that can be done,” explains Dr. Handa.

According to Dr. Pallavi Vaishya, “ a program of exercise & taking precautions has reduced pain and improved mobility by as much as 50 percent in those with knee arthritis. A good physical activity programme is possible for people of all abilities, sizes, ages and attitudes.  An effective self-management plan should include a plan to stay active, as well as medication, balance between rest and recreation, a healthy diet, and joint protection techniques.”

No drop of Heart Attacks and Cancer even after Smoking banned in Public Places

By Vinod Kumar

While the ban of smoking in public places in the western countries has resulted to lesser heart attacks with the average drop being 20 %, leading  health experts in India feel that the ban has not resulted of any positive development in terms of the incidence of heart attacks, cancer and other diseases.

Dr. Purushottam Lal, Chairman of Metro Hospitals and Heart Institute said that the government should bring out stringent laws to stop the usage of all tobacco products among the masses. Apart from the policies undertaken by the government, it’s the will power of the smokers along with counseling and clinical intervention and more awareness that can bring the desired results. For a smoker the chance of dying from a heart attack is 2 to 3 times greater than that of a person who does not smoke. About 1 out of 4 heart attacks is believed to be directly related to smoking.

Quitting smoking is probably the most important step to be taken to decrease the chances of coronary artery disease (CAD) and a heart attack. Although all types of tobacco smoking increase the risk of developing CAD, smoking cigarettes increases this risk more than pipe smoking or cigar smoking. Up to 30% of all deaths related to CAD are attributed to cigarette smoking.

Dr. Lal said, “Smoking causes the platelets in the blood to clump together easily by making your blood cells more “sticky” and more likely to form clots. It can also cause spasms in the coronary arteries, which reduces the blood flow to the heart in a way similar to that of atherosclerosis.”

Apart from the above, smoking also triggers irregular heartbeats or (arrhythmias). It lowers “good” cholesterol (high-density lipoprotein, or HDL). It reduces the amount of oxygen that can be carried by red blood cells in the bloodstream.

World Health Organization (WHO) estimates that smoking-related deaths worldwide will surpass 9 million annually by 2020—with 7 million of those deaths occurring in developing nations. At present Around 5.4 million deaths a year are caused by tobacco, which means every 6.5 seconds a current or former smoker dies. Twenty-five years ago, nearly 70 percent of the lung cancer deaths worldwide occurred in high-income nations. Today, 50 percent of lung cancer deaths occur in low-income nations, and by 2030 that number is expected to increase to 70 percent. With around 9 lakh deaths occurring annually, cancer has become a major public health concern in India.

“There is a universal fear of cancer,” he said. “But, with the right frame of mind, and by taking appropriate action, some cancers can be averted or cured, ” said Dr. Lal.

According to Dr. Lal, apart from smoking, air pollution – mainly from vehicles, industry, and power plants – raises the chances of lung cancer and heart disease in people exposed to it long term. There’s an excess risk of both lung cancer and cardiopulmonary disease associated with increased exposure to fine particles [in air pollution],” said Dr. Lal.

More than 30 percent of all cancers can be prevented through simple measures such as avoiding smoking, eating a healthy diet and taking exercise, limiting alcohol consumption and protection against cancer-causing infections.

“Some cancers can be detected early, treated and cured. Certain cancers like those of the mouth, breast and cervix can be cured if detected early. One should be aware of its early signs and consult a health professional at the earliest.Easy accessibility of medical care and technology has made the disease curable, ,” said Dr. Lal.

What are the risks involved in Angioplasty & Complications ?

Dr. Subrat Akhoury

Although Angioplasty is a less invasive way to open clogged arteries than bypass surgery and hence in relative to bypass surgery, angioplasty carries lower risk in carefully selected patients but there are unique & potential dangerous risks & complications. Just like many other types of invasive procedures, patients may have an allergic reaction to the anesthetic, the dye, or some of the materials used in the angioplasty. Some common risks associated with coronary angioplasty include:

  • Re-narrowing of your artery (restenosis).With angioplasty alone – without stent placement – restenosis happens in about 30 percent of cases. Stents were developed to reduce restenosis. Bare-metal stents reduce the chance of restenosis to about 15 percent, and the use of drug-eluting stents reduces the risk to less than 10 percent.
  • Blood clots.Blood clots can form within stents even after the procedure. These clots can close the artery, causing a heart attack. It’s important to take aspirin, clopidogrel (Plavix), prasugrel (Effient) or another medication that helps reduce the risk of blood clots exactly as prescribed to decrease the chance of clots forming in your stent.

Talk to your doctor about how long you’ll need to take these medications. Never discontinue these medications without discussing it with your doctor.

  • You may have bleeding in your leg or arm where a catheter was inserted. Usually this simply results in a bruise, but sometimes serious bleeding occurs and may require a blood transfusion or surgical procedures.

Other rare risks of angioplasty include:

  • Heart attack.Though rare, you may have a heart attack during the procedure.
  • Coronary artery damage.Your coronary artery may be torn or ruptured (dissected) during the procedure. These complications may require emergency bypass surgery.
  • Kidney problems.The dye used during angioplasty and stent placement can cause kidney damage, especially in people who already have kidney problems. If you’re at increased risk, your doctor may take steps to try to protect your kidneys, such as limiting the amount of contrast dye and making sure that you’re well-hydrated during the procedure.
  • During angioplasty, a stroke can occur if plaques break loose when the catheters are being threaded through the aorta. Blood clots also can form in catheters and travel to the brain if they break loose. A stroke is an extremely rare complication of coronary angioplasty, and blood thinners are used during the procedure to reduce the risk.
  • Abnormal heart rhythms.During the procedure, the heart may beat too quickly or too slowly. These heart rhythm problems are usually short-lived, but sometimes medications or a temporary pacemaker is needed.

Angioplasty isn’t a cure for blocked arteries. In some cases, arteries can become narrow again. This is called restenosis. The risk of restenosis is higher when your doctor doesn’t use a stent.

Associate Director, Cath Lab & Interventional Cardiologist, Asian Institute of Medical Sciences (AIMS), Faridabad

Effects of long-term Diabetes & newer Therapies for Diabetes Control

Dr Tejal Lathia

India is home to over 50 million adults with Diabetes and this number is likely to increase to over 120 million by 2040. Diabetes Mellitus is characterized by high blood sugar levels. Exposure to high blood sugar leads to weakness, weight loss, increased thirst and frequent urination. The long term complications include damage to eyes, Heart, Kidneys and Nerves resulting in loss of vision, Heart failure, Kidney failure and often, amputation.

There are two main types of Diabetes Mellitus – Type 1 and Type 2. Type 1 Diabetes Mellitus predominantly occurs in children and adolescents, and is characterized by complete deficiency of Insulin (a hormone required to keep blood sugar levels normal) in the body. Such patients are completely dependent on Insulin injections for their survival.

Type 2 Diabetes Mellitus results primarily from an imbalance in the demand and supply of Insulin. Though insulin is present in the body, it is not sufficient to control the blood sugars. However, newer research has caused a paradigm shift in the way we look at Diabetes. Not only insulin but other hormones like Glucagon, GLP-1 play a part in Diabetes. The way the Kidneys handle blood sugar is also of importance. These myriad defects have resulted in the coinage of the term – ‘Ominous Octet’.  Identifying these novel defects has been helpful in the sense that we now have medicines to tackle these individual defects opening up a new era in the treatment of diabetes.

Case study:

A 56 year old gentleman, presented to our hospital for a routine health check-up. He has been diagnosed with Diabetes Mellitus 5yrs ago, for which he has been on medications. Recently, he was also diagnosed with Hypertension. His fasting blood sugar was 150 mg/dl and post-meal blood sugar was 200 mg/dl, which is satisfactory to the patient.

However, on evaluating for complications, it was found that there are changes in his eyes because of Diabetes, which threatens his vision, though he has no symptoms. The nerves of his feet are damaged with reduced perception of pain and temperature. His Serum Creatinine (measure of his Kidney function) is abnormally elevated; this leaves the patient shocked.

Diabetes Mellitus unfortunately is a silent killer. There are no symptoms of the damage it is doing to the body, before it is too late. And once the damage is done, it is irreparable. A common misconception is that if the blood sugar level is below 200 mg/dl, you are safe. A normal person’s fasting blood sugar is below 100 mg/dl and after-meal sugar is less than 140 mg/dl. Any increase in the blood sugar values above this leads to damage of vital organs.

Medications like DPPIV inhibitors, SGLT2 inhibitors, GLP-1 agonists as well as newer insulin co-formulations are the key to the future of Diabetes management. Newer rapid acting and ultra-long acting insulins have further strengthened our armamentarium against Diabetes.

There is no substitute for lifestyle modifications though – regular aerobic exercise like walking, cycling, swimming (at least 150 mins per week) and a diet which eschews refined carbohydrates and excess oil is mandatory. These lifestyle changes need to be followed throughout life. Early diagnosis and aggressive treatment of the disease with medications, is imperative to avoid complications and improve quality of life of a Diabetic.

Is a Consultant Endocrinologist, Hiranandani Hospital, Vashi

 

Why are Youth these-Days More Susceptible to Heart Disease

Dr Zakia Khan

Deaths caused due to heart disease are usually attributed to the adult population. What is less known is that young adults are not spared of this main cause of death worldwide. The Coronary Artery Risk Development in Young Adults (CARDIA) conducted a study to find the reasons for youth being susceptible to heart diseases and what are the reasons that put them to this risk. Around 5,000 young adults from the age of 18-30Yrs were a part of this study and were monitored for up to 15 years to learn about what resulted into them acquiring heart diseases. Every man in the 3rd and 4th decade is affected by this disease. It is noted that the youth who smoke up to 10 cigarettes a day are likely to develop heart diseases by 50%. A rise in cholesterol levels can irk heart rates and the risk increases by 50%; rise in blood pressure levels increase the risk rate to up to 30%.

The increase in heart disease in younger adults are caused due to habits of smoking, stress(work and non-work related), unhealthy diet, lack of sufficient physical activity and excess consumption of salt and packaged food in some cases. To curb these issues, we need to first understand how to minimise these triggers. Parents should help their child to maintain healthy diet and motivate them to excise on a regular basis, so that they can control high blood pressure issues, since it is quiet common among who are overweight. They also need to help them maintain their salt intake. Warn them about the dangers about smoking and the effects nicotine has on the blood vessels, causing the blood vessels to narrow down and make it harder for the blood to flow through the vessels. If after many efforts of controlling the diet and increasing the child’s physical activity it still doesn’t lower their blood pressure, a physician should be consulted to seek immediate intervention.

The numbers are not going to decrease unless drastic steps are taken. The problem is that we are leading a very sedentary lifestyle that doesn’t allow us much physical activity. Today’s youth is stressed out mentally as well as physically. A major solution to this is drastic lifestyle modification that will help prevent premature heart attacks. Thrive on healthy food instead of relying on junk food, this is simple to adopt and very effective. Despite having a busy schedule, try and make time to organise, prioritise and balance your lifestyle. Take up either yoga or dance or any other form of exercise that is therapeutic and helps in keeping you physically and mentally healthy.

Is a Interventional Cardiologist, Fortis Hospital, Kalyan

Caring For Yourself After A Heart Surgery

Heart surgery recovery takes a lot of care.The first phase of heart surgery recovery can last from 6 to 8 weeks. When you’re released from the hospital, you will have to follow a set of instructions for post-surgery care. These will help you heal physically and feel better.

Care of the incision after heart surgery

Depending on your surgery, your chest incision may extend through layers of skin, muscle and bone. Your skin should be healed by the time of discharge, your breastbone should take six to eight weeks, and your scar should fade in approximately six months to one year. Tingling, itching, and numbness are normal sensations associated with surgical wounds and will eventually disappear. During the first six months after surgery, protect your incisions from the sun by wearing a shirt or sun block. For women, wearing a soft bra to support your breasts will minimize incisional discomfort.

Dealing with Discomfort

Itching, tightness or numbness along your incisions is normal when you go home after surgery.

It is also normal to have muscle or incision discomfort in your chest if you are doing an activity. But you should not have the same pain that you had before surgery; if you do, let your doctor know. Also, if your sternum (breastbone) feels like it moves, pops or cracks when you move around, call your doctor.

If you had bypass surgery and saphenous vein grafts were taken, you also may have pain or discomfort in your legs from the incisions. To help ease this discomfort, try walking or doing activities that will move and stretch your legs.

In order to take proper care of the incision after heart surgery, it is important to keep the incision clean and dry. Use Use only soap and water to cleanse the area. You should be able to take a bath or shower within a few days.

Seek medical advice if signs of infection appear. These include: Increased drainage or oozing from the incision, Opening of the incision line, Redness or warmth around the incision and Increased body temperature (greater than 100°F)

You should also seek advice if it seems the sternum (breastbone) has moved, or if it pops or cracks with movement.

Swelling in Your Legs and Feet

Removing a vein from your leg sometimes impairs the ability to return blood to the heart efficiently. The result is swelling in your feet and lower legs. If you have leg incisions, you should continue to wear your white support stockings given to you at the hospital. These should be worn as long as swelling persists during the day and removed in the evening before going to bed.To help alleviate the swelling:

  • Prop your feet up when you are sitting or lying down, so that your feet are higher than your heart level. If you are sitting on the couch, put your feet up on a higher chair or ottoman. If you are lying down, put pillows under your legs and feet.
  • Do not cross your legs.
  • Even if your legs are swollen, walk daily to help circulation.
  • Try using hospital support hose to cut down on the swelling.

If swelling persists or worsens, notify your doctor.

Diet after heart surgery

A healthy diet will help the healing process. It is common after surgery to have a poor appetite at first. If this is the case, try to eat smaller, more frequent meals. Appetite should return within the first few weeks. If it does not, seek medical advice

Activity after heart surgery

For the first six to eight weeks, the following guidelines are recommended:

  • Gradually increase activity. Household chores can be done, but standing in one place longer than 15 minutes is not recommended
  • No lifting objects that weigh more than 2.5lbs
  • No pushing or pulling heavy objects
  • Climbing up and down stairs several times a day, especially when the patient first arrives home, is not recommended. Try to arrange activities so the patient goes downstairs in the morning and upstairs when it is time for bed
  • Walk daily. Guidelines for walking will be given by the doctor upon the patient’s return home

Taking a Shower or Bath

You may shower as usual using warm, rather than hot water. It is OK to let warm water run down over your incisions; however do not take a tub bath, soak in a Jacuzzi or go in a pool for approximately four weeks. Have someone help you get in and out of the shower until you regain your strength.

Consider using a shower stool if you feel weak or unsteady. Wash your incision gently every day with warm water and mild soap then pat dry with a soft towel. Do not apply lotion, powder, or ointments until the scab has fallen off (approximately 3-4 weeks). If you have paper strips on your incisions, they should peel off as you shower daily. If they don’t, you may gently peel them off five days following discharge.

If the sutures are in your chest, shower with your back facing the water spray. If you cannot take a shower, a quick 10 minute bath is okay, but do not soak in the bathtub. Use only normal soap, not perfumed soap or body wash. Do not put the soap directly onto the incision and do not rub the incisions. Put soapy water on your hand or washcloth and gently wash your incisions. Only use a washcloth to rub when the scabs are gone and the skin is completely healed. After the shower or bath, dry yourself thoroughly. Pat your incisions dry, making sure not to rub them.

Taking Care of Your Incisions While Traveling

Doctors usually recommend no driving for about six weeks. This may be shorter for patients who have had minimally invasive surgery. Check with your doctor what is appropriate for you.

Going Home by Plane

When you are making flight reservations, let the airline know that you are recovering from surgery. If you had heart surgery, the sternal wires placed during surgery may set off the airport alarms. Because the distance may be too far to walk, ask for a wheelchair to take you to and from the plane. Once in the plane, stand up in the aisle and stretch your legs for a few minutes every hour to get your circula¬tion going. If possible, also walk up and down the aisle.

Going Home by Car

When riding in a car, remember to stop every hour and walk 5 to 10 minutes to get your circulation going. You should wear your seatbelt, placing a small towel in between the seatbelt and your incision. If your car trip is longer than two hours, we recommend that you stay overnight in a hotel, get a good night’s rest, then resume the next morning.

Emotions after heart surgery

It is common for patients to feel sad. These feelings should go away after the first few weeks. If they do not, seek medical advice. It may help to:

  • Get dressed every day
  • Walk daily
  • Resume hobbies and social activities
  • Talk. Limit visits to 15 minutes at first, then increase them depending on how the patient feels.
  • Get a good night’s sleep

Pain relief after heart surgery

Some muscle or incision discomfort, itching, tightness or numbness along the incision are to be expected. However, the pain will be different from that experienced before surgery and pain medications will be prescribed.

For heart bypass surgery, there may be more pain in the legs than around the chest incision if leg veins were grafted. Walking, daily activities and time will help to lessen leg discomfort and stiffness.

Sudden Cardiac Death

Dr. Viveka Kumar

What is sudden cardiac death (SCD)?

Sudden cardiac death is the sudden, unexpected loss of heart function, breathing and conscious due to a cardiac cause occurring within 1 hour of onset of symptoms. Sudden cardiac death usually results from an electrical disturbance in the heart that interferes with its pumping action, stopping blood flow to the rest of the body.  It usually causes death if it’s not treated within minutes.

Is this similar to heart attack?

Sudden cardiac arrest is different from a heart attack. Heart attack happens when blood flow to a portion of the heart is blocked because of clot formation inside the blood vessels of heart. However, a heart attack can sometimes trigger an electrical disturbance that leads to sudden cardiac arrest. During a heart attack, some heart muscle cells die and are replaced with scar tissue. The scar tissue damages the heart’s electrical system. As a result, electrical signals may spread abnormally throughout the heart. These changes to the heart increase the risk of dangerous arrhythmias and SCD. The chances of having SCD are higher during the first 6 months after a heart attack.

What to do?

Sudden cardiac death is a medical emergency. If not treated immediately, it causes sudden cardiac death. With fast, appropriate medical care, survival is possible. Rapid treatment with a defibrillator and cardiopulmonary resuscitation — or even just compressions to the chest administration can be lifesaving. A defibrillator is a device that sends an electric shock to the heart to try to restore its normal rhythm.

Who Is at Risk for Sudden Cardiac Arrest?

The risk of sudden cardiac death increases with age. The risk also is higher if someone has underlying heart disease. Men are two to three times more likely to have SCD than women.

The major risk factor for SCD is coronary heart disease (CAD). This is especially true if somebody recently had a heart attack. However, people may not know that they have coronary artery disease until SCD occurs. Their CAD is “silent”—that is, it has no signs or symptoms. Some people can have heart attack without any signs, and they don’t even realize that they’ve had one. Other risk factors for SCD include: A personal or family history of SCD or inherited disorders that make you prone to arrhythmias, a personal history of arrhythmias, heart attack, heart failure and drug and alcohol abuse.

How Can Death Due to Sudden Cardiac Arrest Be Prevented?

Following a healthy lifestyle can help to lower the risk for CAD, SCD, and other heart problems. Other treatments for CAD, such as angioplasty or coronary artery bypass grafting, also may lower the risk for SCD.

Doctor may recommend an ICD if somebody are at high risk for SCD. An ICD is a device similar to pacemaker surgically placed under the skin in chest. The device has wires with electrodes on the ends that connect to heart’s chambers. If the ICD detects a dangerous heart rhythm, it gives an electric shock to restore the heart’s normal rhythm.

Is the Senior Director of  Cath Lab and a Senior Consultant of Interventional Cardiology & Electrophysiology at Max Super Specialty Hospital, Saket, New Delhi.

What To Expect Before, During And After Angioplasty?

Dr. Subrat Akhoury

Once a patient has been selected to undergo angioplasty, before the procedure, part preparation (shaving) of groin and wrist are usually done. Depending upon the need and decision by treating cardiologist other parts may also be prepared. Few necessary blood investigations are sent especially complete blood count, kidney function tests and viral biomarkers. Your treating cardiologist will review any risks of the procedure and the anesthesia if needed as well as obtain your informed consent which gives your cardiologist permission to perform the procedure. In case you are not able to give consent – one of your relative will give the consent.

During the procedure you will lie on a table in cardiac catheterization laboratory and be mildly sedated if you are too anxious but you will remain awake throughout the procedure unless indicated otherwise.

The interventional cardiologist will use a small needle to inject local anesthetic idocaine in groin or in the forearm. (This needle prick could be the only pain you will feel throughout the procedure)

Sometimes while balloon is inflated to open the blocked artery you may feel chest pain transiently.

After the procedure, you will have to follow the instructions by cardiologist like immobilization of limbs, when to eat. You should ask your doctor if you have queries.

Associate Director, Cath Lab & Interventional Cardiologist, Asian Institute of Medical Sciences (AIMS), Faridabad

What is Bypass surgery & when is it performed ?

What is heart bypass surgery?

Bypass surgery, or coronary artery bypass surgery, is used to replace damaged arteries in your heart muscle. A surgeon uses blood vessels taken from another area of your body to repair the damaged arteries. It is a surgical procedure that diverts the flow of blood around a section of a blocked or partially blocked artery in your heart. By creating a new pathway to the heart, coronary bypass surgery improves blood flow to your heart muscle.

After coronary bypass surgery, symptoms, such as chest pain and shortness of breath due to poor blood flow to the heart, generally improve. For some people, coronary bypass surgery may improve heart function and reduce the risk of dying of heart disease.

Most coronary bypass surgeries are done through a long incision in the chest while blood flow is diverted through a heart-lung machine (called on-pump coronary bypass surgery). The surgeon cuts down the center of the chest, along the breastbone. The surgeon then spreads open the rib cage to expose the heart. After the chest is opened, the heart is temporarily stopped and a heart-lung machine takes over to circulate blood to the body.

The surgeon takes a section of healthy blood vessel, often from inside the chest wall (the internal mammary artery) or from the lower leg, and attaches the ends above and below the blocked artery so that blood flow is diverted (bypassed) around the narrowed portion of the diseased artery.

What are the different types of heart bypass surgery?

  • single bypass: only one artery is blocked
  • double bypass: two arteries are blocked
  • triple bypass: three arteries are blocked
  • quadruple bypass: four arteries are blocked

When Coronary bypass surgery is done ?

When patient has severe chest pain caused by narrowing of several of the arteries that supply your heart muscle, leaving the muscle short of blood during even light exercise or at rest. Sometimes angioplasty and stenting will help, when more than one diseased coronary artery and the heart’s main pumping chamber — the left ventricle — isn’t functioning well then bypass surgery may be the best option. Your doctor may recommend heart bypass surgery if your coronary arteries become so narrowed or blocked that you run a high risk of a heart attack.

You and your doctor can consider whether coronary bypass surgery or another artery-opening procedure, such as angioplasty or stenting, is right for you.

Coronary bypass surgery is an option if:

  • Patients have severe chest pain caused by narrowing of several of the arteries that supply your heart muscle, leaving the muscle short of blood during even light exercise or at rest. Sometimes angioplasty and stenting will help, but for some types of blockages, coronary bypass surgery may be the best option.
  • Patients have more than one diseased coronary artery and the heart’s main pumping chamber — the left ventricle — isn’t functioning well.
  • Patient’s left main coronary artery is severely narrowed or blocked. This artery supplies most of the blood to the left ventricle.
  • Patients have an artery blockage for which angioplasty isn’t appropriate, you’ve had a previous angioplasty or stent placement that hasn’t been successful, or you’ve had stent placement, but the artery has narrowed again (restenosis).

Coronary bypass surgery may also be performed in emergency situations, such as a heart attack, if your doctor sees that you’re not responding to other treatments.

Some time, patient may not have any symptoms in early coronary artery disease, yet the disease will continue to progress until there’s enough artery blockage to cause symptoms and problems. If the blood supply to your heart muscle continues to decrease as a result of increasing blockage of a coronary artery, you may have a heart attack. In this condition, bypass surgery is done to restore blood flow

How Is Angioplasty Performed And What Is The Recovery Time

Dr. Purshotam Lal

An angioplasty is a common procedure that’s performed to treat people with acute coronary syndrome (ACS). An angioplasty is used to clear blockages in the arteries The angioplasty procedure is similar to that used to perform an angiogram. It is performed with the help of a catheter by an interventional cardiologist in a cath lab. In a cath lab patient lie on a table and be mildly sedated but he remain awake throughout the procedure.

The cardiologist uses a small needle to inject lidocaine, a local anesthetic, to numb an area in the groin, or upper leg, or in the arm.  This needle prick could be the only pain that patient feels throughout the procedure.

How catheter is inserted?

Catheter is a flexible tube that is smaller than the vessels. The femoral artery in the groin – near where your leg bends from the hip – is one of the vessels cardiologists most commonly use to insert a catheter and thread it through the arteries to the heart to perform the angioplasty. Instead of the femoral artery, your doctor may choose to insert the catheter in the brachial or radial artery in the inside of the elbow or wrist.

From this “access” point in leg or arm, a “guiding” catheter is threaded through the arteries to the heart. (Since there are no nerves in your arteries, patient will not feel the catheter.) An x-ray camera and images of your arteries on a TV screen help the physician guide the catheter to the blockage.

When the guiding catheter is properly positioned, the cardiologist injects a contrast dye (radiographic contrast agent) through the catheter into the heart and its arteries. Most people do not feel the dye injection. However, some feel minor discomfort, typically lasting only a few seconds, in their chest. A few feel lightheaded or nauseous.

How blockage is removed?

Next, a balloon catheter – a long, thin flexible tube with a small uninflated balloon at its tip – is threaded through the guiding catheter to where the artery is narrowed. A guide wire – a tiny, thin wire of about .014 inches’ diameter – is then passed across the narrowed segment. It serves as a guide for positioning the tiny balloon across the blockage.

Once in position, the balloon is inflated with water and x-ray dye. (It may be inflated several times.) When fully inflated, the balloon pushes the plaque against the wall of the artery. Some patients feel minor discomfort when it is inflated. If you have more than minor discomfort, medication to relieve it can be given immediately.

As the balloon inflates, plaque that extends into the wall of the artery may tear or crack. This is normal and necessary.

Once the balloon is deflated, x-ray pictures are taken ensure the blockage is gone. When the balloon catheter is removed, final x-ray pictures are made.

What is the recovery time after angioplasty?

Once your cardiologist has completed the procedure, recovery will begin. After the procedure, the artery is closed with a closure device or manual pressure is applied to stop bleeding. Patients are able to walk with assistance in four to six hours and usually stay in the hospital overnight for observation. This is far less time than is required in the case of more invasive procedures, like heart surgery.

Recovery from angioplasty and stenting is typically brief. Discharge from the hospital is usually 12 to 24 hours after the catheter is removed. Each case, of course, is different. In some cases patients were able to go home the same day of their angioplasty without a higher risk of complications. Your doctor will give you specific recovery instructions like no heavy lifting or strenuous exercise for a few weeks after the procedure.

Most people are able to return to work within 1 to 2 weeks after an angioplasty procedure. In case of a heart attack, recovery may be longer.

 Chairman  – Metro Group of Hospitals & Director Interventional Cardiology Cardiology & CTVS in Metro Hospitals & Heart Institute, Noida