SPECIALITIES
Cardiology
The dreaded heart attack is something most people are all too familiar with. Everybody knows somebody who has battled it and either survived or succumbed to it.
The Department of Cardiology at Sri Ramakrishna Hospital is one of the finest in any private institution in the state. We have decades of experience dealing with every eventuality and complication resulting from myocardial infarction, multi vessel disease, chronic total occlusion and so on.
Our physicians have performed countless procedures such as
- Angioplasties
- Balloon valvotomies
- Atrial septostomies and so on with great success.
Internationally, the acceptable benchmark for a primary angioplasty is a time of 90 minutes from ‘door to balloon’. Our specialists average just 60 minutes for the same procedure, easily on par with international standards. We also offer a host of cardiac implants for patients who have need of them. In short, our cardiac care is of the finest quality.
Medical Conditions
This is the medical name an unfortunately common condition – the heart attack. A heart attack happens when the flow of blood to a part of the heart stops. This causes damage to the heart muscle and can result in death.
Common symptoms include pain in the chest or discomfort which could radiate to the arm, shoulder, neck, back or jaw. High blood pressure, cholesterol and diabetes can increase the risk of a heart attack. The risk of a heart attack increases with age. Men are at greater risk of heart attack after the age of 45 while women are at greater risk after 55.
Multi vessel angioplasty is the non-surgical technique or procedure recommended for people with multi vessel disease.
(i.e.) People who have blockages in multiple arteries. Technically, multi vessel disease is defined as
a) 70% or more diameters of stenosis in two or more coronary arteries
b) 70% or more in one coronary artery and 50% or more in a second
c) 50% or more in two or more coronary arteries
Our team of expert interventional cardiologists at Sri Ramakrishna Hospital routinely performs cardiac procedures (angioplasty) to treat this condition.
Known as CTO for short, they are blockages, which are often present for more than two or three months. Fatty deposits or plaque build up within the arteries (known as atherosclerosis). It is one of the complications that can arise from Coronary Artery Disease (CAD). As the artery narrows, the heart does not receive adequate blood which results in chest pain, shortness of breath and sometimes a heart attack. They may occur at any time – while the body is being exerted or at rest.
Here at Sri Ramakrishna Hospital we offer patients suffering from CTOs relief through complex interventional procedures.
As the name indicates, bifurcation is the splitting of an artery into two branches.
A common feature, it is also a site where the buildup of plaque is common. This is due to the differences in flow, turbulence and stress which are placed on the site of the bifurcation. With the buildup in plaque, stenosis (narrowing) occurs. It is so commonly prevalent that nearly 15% to 20% of all coronary interventions are for this condition. Unfortunately, its treatment is as complex as the condition is common. On the positive side, our interventional cardiologists have a lot of experience dealing with it and meticulously plan the procedure.
As blood passes from one chamber of the heart to another, it passes through a valve. There are four such valves in the heart and they ensure that the blood flows in only a single direction. The mitral valve is situated between the upper and lower left chambers of the heart. ‘Stenosis’ is the narrowing of any opening. Stenosis of the mitral valve will limit the flow of blood between the left atrium and left ventricle. This could cause blood and fluid to back-up into the lungs. Mitral stenosis usually presents several years after rheumatic fever.
Symptoms include shortness of breath, fatigue, dizziness, weakness, swollen ankles, swollen distented abdomen and irregular heartbeat. Sometimes it can be treated with medication but most of the time it is treated by procedures such as balloon valvotomy or surgical valve replacement. We at Sri Ramakrishna Hospital are experts at procedures such as the balloon valvotomy.
Treatments & Procedures
A PCI is a procedure where a balloon is inserted into a blood vessel in order to crush or remove blocks which are inhibiting flow of blood.
Once this is done it is almost always followed by deployment of what is known as a stent.
A stent is a metal scaffold, which prevents the recurrence of the blockage at the site. This is a minimally invasive procedure.
A catheter is inserted and guided to the location of the block and a stent is deployed without any trauma to the body. Simple and elegant, our experts have been performing this procedure for many years. Our patients can rest easy knowing they are in the very best of hands at Sri Ramakrishna Hospital.
A primary angioplasty is different from the former in that it is done as an emergency procedure and is a life-saving measure. A patient who is in the process of undergoing a heart attack (known scientifically as a myocardial infarction) needs to undergo a primary angioplasty in order to avert permanent damage to the heart muscle. This is a far more complex procedure than an ordinary angioplasty given the condition of the patient and the emergency circumstances. In this procedure, time is of the essence. The less the time taken to complete the procedure, the better the outcome for the patient. A hospital’s ability to respond efficiently in this situation is measured from the moment the patient enters its doors.
Internationally, a time of 90 minutes from ‘door to balloon’ is considered acceptable.
Here at Sri Ramakrishna Hospital, our specialists are experts at the procedure. It takes many people across specialities working as a team in absolute harmony to execute a primary angioplasty well. Our team takes great pride in the fact that our response time averages just 60 minutes from door to balloon and are constantly at work to try and bring that figure even lower.
A balloon valvotomy is a minimally invasive procedure used to treat mitral valve stenosis.
It widens the heart valve and allows for free flow of blood. A minimally invasive procedure, it requires even greater skill and expertise when performed on children.
During the procedure, a cardiologist and specialised team of nurses and technicians insert a catheter (a thin flexible tube) into an artery in the groin or arm. It is then threaded through the body into the heart. Eventually it reaches the narrowed mitral valve at which point a balloon device that is located at the tip of the catheter is inflated. The narrowed mitral valve is stretched open.
When sufficiently opened, the balloon is deflated and removed at which point blood flow is restored.
This is a procedure which is is primarily carried out on infants. In the normal heart blood that is oxygen-depleted is pumped to the lungs from the right side of the heart. Here it is oxygenated. This is then returned to the left heart via the pulmonary artery and from there the aorta carries it to the rest of the body. In a condition called dextro-Transposition of the great arteries (d-TGA), some major blood vessels are improperly connected. This results in the oxygen-depleted blood from the right heart being pumped straight to the aorta and then to the rest of the body. This is life-threatening since the body is not receiving the required oxygen to survive.
In an ‘atrial septostomy’, a tiny hole is created between the two upper chambers of the heart (the atria).
A balloon catheter is guided to the hole in the atrial septum and inflated, making the hole larger. This improves the oxygenation process. The process is also sometimes carried out if the patient suffers from other cyanotic congenital conditions. It isn’t a cure in itself but is aimed at helping the patient survive and/or gain strength until a more permanent procedure can be carried out. It is also used as a bridge procedure when a patient requires a lung transplant and a donor isn’t immediately available. We at Sri Ramakrishna Hospital have had great success performing this procedure.
Cardiac Implants – Pacemaker, ICD & CRT Implants (Dual-chamber and MRI-compatible)
We at Sri Ramakrishna Hospital have extensive expertise stretching back many years in implanting devices which help patients with cardiac disorders live a longer, healthier, and a more productive life. Some of the devices that our cardiology team routinely work with are as follows.
Pacemakers:
Pacemakers are devices which provide electrical stimuli which cause cardiac contraction when the body’s normal electrical impulses are low or non-existent. They basically help your heart beat for you.
Implantable Cardioverter-defibrilator (ICD):
An ICD is a device, which is battery-powered. It is implanted under the skin where it tracks the patient’s heart rate. The ICD is connected to the heart via thin wires. If it detects a heart rhythm that is abnormal, the ICD delivers an electric shock to the heart. This restores the normal heartbeat. They have proven to be very valuable in preventing the sudden death of patients with documented dysrhythmias.
Cardiac Resynchronization Therapy (CRT) Heart Device:
A CRT device is used for treating severe heart failure and abnormal condition which could be caused by a number of factors such as heart damage, age, medication, genetics and so on. It sends small electrical impulses to the two lower chambers of the heart. These impulses help them beat together in a more ‘synchronised’ fashion, hence the name.
A CRT device sends small, undetectable electrical impulses to both lower chambers of the heart to help them beat together in a more synchronized pattern. This improves the heart’s ability to pump blood and oxygen to the body.
We have extensive experience using the latest technology including dual-chamber pacemakers and MRI-compatible devices. These allow greater freedom and higher levels of safety to patients than ever before. The outlook for cardiac patients has never been better and we are happy to extend to our patients the very best interventional care that the field has to offer.
Speciality Doctors
Dr. T. R. NANDA KUMAR
