Arrhythmias (Abnormal or irregular heart rhythms)
Arrhythmias irregular beating of heart is due to different reasons like existing heart disease, blood electrolyte imbalances, cadriomyopathy or coronary artery disease.
The symptoms are dizziness, shortness of breath, palpitations, pain in chest, fatigue etc. Sometimes none of these symptoms might be there and only on evaluation arrhythmias can be detected.
There are different types of arrhythmias
- Bradycardia The heart beat is slower than the regular or normal heart i.e below 60 beats per minute.
- Tachycardia The heart beat is faster than the reglar rhythm i.e more than 100 beats per minute
- Supra ventricular Arrhythmias Arrhythmias occurring in the upper chambers of the heart are called super ventricular
- Ventricular Arrhythmias Arrhythmias occurring in the lower chambers of the heart are called ventricular Arrhythmias
- Brady Arrhythmias Arrhythmias occurring due to existing heart disease.
- ECG (Electrocardiogram)
- Stress Test
- Holter Monitor
Treatment Pace maker implantation
A pace maker is a device used to manage arrhythmias. It helps in optimizing the heart rate to the desired level. The device sends electrical impulses to the heart muscle and keeps tracks of the hearts activity.
- Implantable Cardiac Defibrillators (ICD) Insertions
- Medical Management
- Radio Frequency Ablation
- Maze Procedure (Surgery)
- Pulmonary Vein Isolation with LD reduction
The heart has 4 main valves mitral, tricuspid, aortic and pulmonary valve. The blood flow out of the heart is through valves. They regulate the flow of the blood for the heart. When these valves do not function correctly it affects the entire functioning of the heart. There are 2 different types of valve dysfunctions a) valvular stenosis b) valvular regurgitation.
Valvular stenosis: Stenosis or narrow valve obstructs the blood flow and the heart has to pump harder resulting in lower blood flow.
Valvular regurgitation: Here the valve does not close properly once the blood flows in resulting in backward flow of blood in to the atria when the heart contracts
Valve diseases can be genetic and children are born with valve dysfunctions or in adults valve diseases occur due to other conditions like rheumatic fever, endocarditis.
The other causes basically are existing heart related problems like hypertension or confirmed heart diseases like cardiomyopathy,coronary artery disease, aneurysms, heart attacks etc.
Breathlessness, Usual weight gain, palpitations, swelling of legs and ankles etc
- PETCT SCAN
Treatment : Interventional Procedures
Though surgery is ideal in some scenarios patient is unable to withstand a surgery due to their physical condition in such patients interventional procedures are required like PERCUTANEOUS MITRAL, AORTIC AND PULMONIC VALVOTOMY FOR STENOSIS which is performed the cardiac interventional team at Apollo Health City.
Congenital Heart Diseases ( BIRTH DEFECTS OF HEART)
Types of Congenital Heart Diseases & Surgeries
INCIDENCE: At least 8 of every 1000 infants born have some form of heart defect. In India, approximately 1-1.5 lak children are born with some form of heart defect every year. The symptoms vary from mild with a apparently normal child to very severe becoming sick soon after birth. Some of the common pediatric cardiac problems have been listed below to provide a basic introduction to the problems and their treatment.
Ventricular Septale Defect (VSD):
VSD is a hole in the heart between the left and right ventricles (lower chambers). This is the most common heart defect in children. These holes can vary in their size. Babies with large holes develop heart failure, increase in lung pressure, and quite often not grow well.
These large holes need early surgery and can be closed with very little risk. Babies with small holes close on their own and rarely require surgery. Location of holes, their size and number determine whether they close spontaneously or require surgery.
Patent Ductus Arteriosus (PDA):
A PDA is an abnormal opening communication (tube) between the aorta and the pulmonary artery. This opening causes too much blood flow to the lungs, and gets the lungs all wet.
Kids with a PDA can get winded pretty quickly, and babies with a large PDA may not grow normally. A PDA can be easily ligated by a heart surgeon. Small PDA’s can be closed with a catheter using special devices.
Atrial Septal Defect (ASD):
ASD is a hole in the heart, located between the left and right atria (upper chambers). This type of “hole in the heart” can be readily closed by a special device that is placed to plug up the hole or can be closed by a heart surgeon.
Not all ASD’s are suitable for device closure and such cases can be closed surgically. Surgery for ASD’s can be performed through a right posterior thoracotomy approach (back of the chest for girls), which gives a cosmetically appearing scar compared to midline sternotomy scar.
Tetralogy Of Fallot (TOF):
There are four major defects in TOF. The two defects of importance are the VSD and the narrowing in the pulmonary artery (pulmonay stenosis). The other two are hypertrophy of the right ventricle and over riding of the Aorta.
This condition requires surgical repair to fix these abnormalities and is recommonded at 3-4 months of life. In exceptionalcases, a severly blue child or a very scik child , a minor surgery called BT shunt is performed.
Transposition Of The Great Arteries (TGA):
In TGA, the two great vessels swap their positions with the heart chambers (ventricles), such that the aorta is where the pulmonary artery should be, and the pulmonary artery is where the aorta is.
TGV is repaired by “switching” the position of the two great vessels, thereby bringing them to normal position with the chambers and is performed soon after the diagnosis without much waiting.
Coarctation Of The Aorta (COA):
A coarctation is an abnormal narrowing in the main blood vessel of the body, called the aorta. A coarctation can be readily repaired by a surgeon and can be opened with a balloon catheter by a Cardiologist without surgery.
Certain types of narrowing of Aorta can be better managed by surgery alone.
In truncus, the pulmonary arteries come off the aorta instead of the right ventricle. In addition, there’s also a large hole in the heart, called a VSD.
Truncus is repaired by dividing the pulmonary artery off the aorta and connecting it to the right ventricle with a valve conduit. The VSD is also closed to get the circulation back to normal.
Aortic Stenosis (AS):
Stenosis means narrowing and aortic stenosis is narrowing of the aortic valve or narrowing of the aorta directly above (supravalvar) or below (subvalvar) the aortic valve.
Depending on the severity of the stenosis, surgery is needed to correct the defect. Another option may be a balloon valvuloplasty if the narrowing involves valve alone. This procedure is done by the cardiologist.
Pulmonary Stenosis (PS):
PS is a narrowing of the pulmonary valve. Normally the pulmonary valve opens to let the blood flow from the right ventricle to the lungs where the blood gets oxygenated. Because of the narrowing the right ventricle has to work harder to get past the stenotic valve.
This can sometimes lead to enlargement of the right ventricle. Depending on the severity of the pulmonary stenosis, open heart surgery may be indicated to correct the defect. Another option is balloon valvuloplasty. This procedure is done in the cardiac catheterization lab.
Total Anomalous Pulmonary Venous Return (TAPVR):
Pulmonary veins normally bring oxygenated blood back from the lungs to the left atrium. In total anomalous pulmonary venous connection all the pulmonary veins drain into the right atrium. Open heart surgery is needed in early infancy.
Early open heart surgery is needed for this condition.
Atrio Ventricular Septal Defect (AVSD):
In this condition, there are holes in the upper and lower chambers (ASD and VSD) along with common atrio ventricular valve (instead of two valves – Tricuspid and Mitral).
Early surgery is the treatment of choice, where in the surgeon closes both the holes and reconstruct the common valve into two valves (Tricuspid and Mitral).
Detecting Congenital Heart Diseases
The Pediatric Cardiologists at the Heart Institute in Apollo Health City use various diagnostic procedures to determine the heart diseases in children. The congenital heart defects can be diagnosed even when the child is in the mother’s womb through Fetal Echocardiography.
The following diagnostics are generally carried out
- ECHO-The pediatric cardiologist performs the echo to determine the heart disease.
- Chest X Ray
- TEE Transesophageal Echocardiogra
- PET CT – In most scenarios the consultants use the help of PET CT which gives accurate results. Apollo Health City has the PET and 16slice, please browse the site to know more about the Apollo Gleneagles PET CT Centre
- Lab Investigations
- Cardiac Catheterization
- Balloon Valvotomy
- PDA Device closures
- Patent Foramen Ovale Closures
Noninvasive tests are those that don’t involve inserting needles, instruments or fluids into the body. Some examples of non-invasive tests used for detection of heart disease are
- Resting electorcardiogram (ECG or EKG)
- Chest X-ray
- Holter monitor (Ambulatory electrocardiogram)
- 3D cardiovascular cartography
- Computed Tomography (CT) scan – Ultrafast CT,Electron Beam CT, Spiral CT
- Magnetic resonance Imaging (MRI)
- Magnetic resonance Angiography (MRA)
What are other imaging tests that are available ?
A:The following tests are invasive and require a needle puncture in an arm vein.
- MUGA scan
- Thallium stress test
- Pharmacological stress test
- PET test The following test may require insertion of a catheter
- Transesophageal echocardiogram (TEE)
- Cardiac Catheterization – also known as Coronary Angiography (CAG)
- Intravascular ultrasound.
Q: Why is Chest X-Ray done in routine “Master Check ups for the Heart”?
A: A chest X-ray is most .commonly used to detect abnormalities in the lungs, but can also detect abnormalities in the heart, large blood vessel like aorta, and the bones of the thoracic area.
- ECG AND STRESS ECG (TMT)
Q: What is an Electrocardiogram?
A: Electrocardiogram or ECG is the oldest heart test that is still in routine use today. The ECG is a method of recording the electrical activity of the heart. Each heartbeat is caused by a section of the heart generating an electrical signal, which then conducts through specialized pathways to all parts of the heart. These electrical signals also get transmitted through the chest to the skin where they can be recorded.
Q: How is the test performed?
A: An ECG is performed by placing 12 recording leads at certain specific locations on the body. They only record the heart’s electrical activity. They do not produce any electricity of their own. The recording itself takes only a few seconds, Including the setup time and the time to disconnect the leads, the whole procedure takes about 5 minutes.
Q: How to prepare for taking the ECG?
A: It does not require any preparation, except for possibly shaving chest hair to get a better recording Before the ECG, tell your doctor if you are taking any medications. There are no restrictions for food or fluids.
However, ingestion of cold water immediately before an ECG may produce changes in one of the waveforms recorded (the T wave). Exercise (such as climbing stairs) immediately before an ECG may significantly increase your heart rate. You may be asked to remove all jewelry and to wear a hospital gown.
Q: How will the test feel?
An ECG is painless. The test has no know side effects When first applied, the electrodes may be cold and in rare circumstances, you may develop a localized rash or irritation where the patches are placed.
Q: What is TMT?
A: Treat Mill Test. The most common way to stress a person’s heart is to have them perform exercise. Walking on a treadmill is most commonly used. For patients who are unable to exercise, intravenous medicines can be given in place of exercise to make the heart work as hard as if the person was running.
The most common way to stress a person’s heart is to have them perform exercise. Walking on a treadmill is most commonly used for patients who are unable to exercise to make the heart work as hard as if the person was running. Stress tests are commonly used tests for initial screening for CAD. These tests are able to detect the presence of flow-limiting blockages in the coronary arteries, generally in the range of at least a 50% reduction in the diameter of at least one of the three major coronary arteries.
Q: Why is TMT done?
A: MT is done for the following reasons
- To see if an asymptomatic person has silent Coronary artery disease,i.e. blockages or hardening of the arteries of the heart. In many patients, the first manifestation of heart disease is a heart attack or death without any preceding warning symptoms.
- To determine if a person’s symptoms, such as chest discomfort or difficulty in breathing are due to heart disease or some other problem.
- To check whether the treatment given for a patient for blocked arteries is working properly.
- To assess a person’s exercise tolerance before beginning an exercise or cardiac rehabilitation program.
- To determine if exercise causes an abnormal heart rhythm (arrhythmia)
Q: How is the test performed?
A: All stress tests are performed with continuous monitoring of the electrocardiogram (ECG). As the heart works harder, certain characteristic abnormalities can develop in the ECG in patients who have underlying heart disease.
Q: What are the preparations required for a stress Test?
A: The only preparation for a stress test is that you must not eat or drink for the six hours preceding the test. If it is an exercise test, make sure you wear loose fitting comfortable clothes and good running shoes.
High heels don’t work on a treadmill! Your physician may want you to skip some of your usual medications on the day of the test. Be sure to check with your physician about this.
Q: What if I can’t perform an exercise test or am unable to exercise adequately for a TMT?
A: Sometimes you can’t do an exercise test because you’re too sick or have physical problems. In this case, some drugs are given. This drug increases blood flow to the heart and thus “mimics” an exercise test.
Q: What is an Echocardiogram? Why is the test performed?
This test is performed to evaluate the valves and chambers of the heart in a non–invasive manner.
The echocardiogram allows doctors evaluate heart murmurs, check the pumping function of the heart, and evaluate patients who have had heart attacks. It is a very good screening test for heart disease in certain groups of patients.
Q: What is the procedure?
highly trained technician or doctor places a hand–held plastic ultrasound probe against the patient’s chest.The probe is connected to large computer with a video screen. The probe emits sound waves that pass through the chest to the heart. The heart then reflects those sound waves back to the probe.
The probe transmits those reflected signals to the computer, which reconstructs them into a picture of the heart. This picture is displayed on the screen and recorded on videotape or on a digital storage medium.
Sometimes, an ultrasonic contrast agent is injected intravenously to enhance the quality of the sound wave pictures and give additional information about the amount of blood flow to the heart muscle.
Q: Is the Echocardiogram test safe?
There are no known harmful side effects from these sound waves. The test does not hurt because no needles are routinely used and nothing is placed inside the patient.
The average test takes about 10–30 minutes. No patient preparation is required for an enchocardiogram. The test can be done anywhere, at any time. You’re even allowed to eat before this test!
Q: What is a TEE?
Transesophageal echocardiogram (TEE) uses the same sound wave technology that a regular echocardiogram uses but the pictures are taken by inserting a special probe into the esophagus (the food tube that connects the mouth with the stomach) rather than by placing it on the patient’s chest wall. An overnight fasting is required for this test.
Q: What is Cardiac Catheterization and Coronary angiography?
A: A Cardiac catheterization is a method by which long, thin plastic tubes called catheters, are inserted into a blood vessel in the leg or arm using a local anesthetic and then pushed under x–ray guidance to the heart. Once they are in the heart, the catheters can measure the pressures within the chambers of the heart as well as how much blood the heart is actually pumping to the rest of the body. This lets doctors know how well the heart is working.
It is also used to assess diseases of the heart valves and congenital heart disease. However, the most common reason a cardiac catheterization is done is to perform a Coronary Angiogram(CAG), i.e. take a
picture of the arteries that supply blood to the heart muscle. This is done by injecting
an X-ray dye that can be seen on X–ray film through the catheters into the coronary arteries. Any constriction gives an indication of blockages in these arteries. An actual X-ray movie is made of the coursing through the arteries.
Q: What is Angiography indicated in patients with chest pain or heart attac
A: Angiography is advised when the decision to undergo angioplasty or by pass is made. This happens when the chest pain is not relieved in spite of adequate medical treatment or when the chest pain is unstable.
After a heart attack, if there is continued chest pain or exercise testing or if any other non-invasive methods show decreased blood flow, then to avoid future complications; angiography is done to know the extent and location of blockages.
Q: What are the preparations for Coronary Angiogram?
A: The only preparations for the procedure are that the patient should not eat or drink anything after midnight the night before. The patient#8217;s usual medications can be taken the morning of the test with a small sip of water.
Some medicines may have to be stopped the day of or several days before the test such as the power full blood thinner and diabetic medications. The test is done in a room in a hospital called a cardiac catheterization lab.