Coronary Artery Disease (CAD)
The heart is a beating muscle which continually pumps the blood to the rest of the body. The coronary arteries supply the heart itself with the necessary oxygen and nutrients it needs for effective function. The fatty deposits called plaque can build up inside the arteries over time, which clogs the passages and reduce the blood flow. Eventually, the blood flow to the heart muscle gets reduced and since the blood carries much needed oxygen, the heart muscles are not able to receive the amount of oxygen it needs. The reduced or cut off blood flow and oxygen supply to your heart muscles may lead to the following:
- Angina: Chest pain or discomfort due to lack of blood flow to the heart.
- Myocardial Infarction (MI): It happens when a blood clot at the site of narrowing in a coronary artery suddenly cuts off most or all the blood supply to the part of the heart. Due to lack of oxygen rich blood, the cells in the heart muscle begin to die which can cause permanent damage to it or may even result in death.
Overtime, if CAD is left untreated then it can weaken the heart muscle and contribute to:
- Arrhythmias: These are abnormalities in the normal beating of the heart that can be life threatening.
- Heart Failure: The heart can’t pump the blood effectively to the rest of the body. It doesn’t mean that the heart has stopped or is about to stop, instead it means that it is failing to pump enough blood the way that it should.
A person with significant narrowing in the coronary arteries may experience the following:
- Shortness of breath
- A squeezing or suffocating pain arising in the center of the chest and sometimes migrating to your neck, arm, jaw, back or throat
- Loss of sensation or abnormal sensation in the arms, wrists or shoulders
After taking the detailed medical history, doctors will conduct a thorough physical check-up and may advise the following tests:
- ECG (Echocardiogram)
- Exercise Thallium Test
- Coronary Angiography
- Exercise ECG/ Treadmill Test (TMT)
Depending on the severity of the blockages and your general health condition, there are four treatment options to choose:
- Lifestyle changes: It can help to treat CAD.
- Quit smoking
- Eat a healthy diet to prevent or reduce the high blood pressure and high cholesterol and to maintain an appropriate weight
- Lose weight if you are obese or overweight
- Exercise as directed by your doctor
- Reduce mental stress
- Medicines: Your doctor will prescribe one or a combination of medicines- some will reduce the workload on the heart while others reduces the chances of having a heart attack.
- Percutaneous coronary interventions (angioplasty and stenting): You may have to resort this for restoring the blood supply to your heart muscles, if both the treatments do not change the status of your symptoms or disease.
- Heart Bypass surgery: The coronary artery bypass surgery includes bypassing the blood flow around one or more narrowed vessels by using a vein or an artery from another part of your body as a graft.
Facilities/Special Care Units/ Diagnostic Equipments
- Echocardiography (Colour Doppler)
- Treadmill test (TMT)
- 24 hour Holter Monitoring
- Stress echocardiography
- 64 slice CT angiography
- Ambulatory BP monitoring
- Coronary and peripheral angiograph
- Stress thallium test
- Flat panel cath labs with stent boost technology
- Endovascular suite
- Electrophysiology study
Cardiothoracic and Vascular Surgery
Cardiac Surgery is done to treat the diseases or complications of the ischemic heart disease, correct the congenital heart disease or treat the valvular heart disease due to various causes such as rheumatic fever and endocarditis.
Cardiac surgery can be done in the following diseases/complications:
- Coronary artery disease
- Valvular heart disease
- Congenital heart disease
- Thoracic aortic aneurysms
- Tumors of the heart
In order to diagnose and determine the treatment for a specific heart disease, the doctor obtains a complete medical history, performs a thorough physical exam and orders special diagnostic tests.
Major types of cardiac surgeries include heart valve surgery, coronary artery bypass graft surgery (CABG), minimally invasive surgical procedures, congenital repairs and thoracic aortic aneurysm repair, transmyocardial laser revascularization (TMR).
Open heart surgery
When the patient’s chest is opened and the surgery is done on the heart, it is open heart surgery. Here the tesm “open” refers to the chest and not to the heart itself. Depending on the type of surgery, the heart may or may not be opened. During this surgery, sometimes a heart-lung machine is used to support the patient’s circulation while the surgeon opens the chest and makes changes to the heart or the arteries on the surface of the heart. There are variety of types of open heart surgeries which are done depending on the condition being treated and the overall health of the patient.
It is a specialty of surgery in which the diseases of the vascular system i.e. the veins, arteries and lymphatic system are managed by medical therapy, minimally invasive catheter procedures and surgical reconstruction.
The main types of arterial diseases are occlusive and aneurysmal disease. Occlusive disease is the narrowing of the arteries in the heart that happens anywhere in the body but people are aware of the symptoms if it happens in the legs or in the tummy or the neck arteries.
The peripheral vascular disease affect the smokers and also the patients who have undergone the coronary stenting or bypass surgery. A large portion of people with the long diabetes develop the vascular problems. In India, it is estimated that over four crore people have diabetes, the number of people to have vascular problems is estimated as large. A diabetic patient is at higher risk of lower limb amputation that the general population. However a lot of them can be prevented with the involvement of a vascular surgeon.
At Artemis Hospital, we will be offering the basic and advanced screening for the vascular diseases. The prevalence of venous disease has been under estimated. A clot in the deep veins if it travels to the lungs can cause sudden death. Individuals are predisposed to form the clots if the blood lacks few proteins that keep it fluid. This can also be caused if the patient is immobilized or if the lining of the vessels are damaged. The unilateral painful calf swelling must be taken seriously. Varicose veins are also a common problem, if left untreated it can lead to itching, ulcers and skin changes. The treatment for lymphatic disease is mainly conservative.
Paediatric Cardiology and Cardiac Surgery
To ensure high quality medical care, our team of experts such as pediatric cardiologists, pediatric cardiac surgeons, cardiovascular nurses, cardiac anaesthesiologists and specialists who are exhaustively trained to treat pediatric heart conditions work in collaboration with other departments as well as with the family’s local paediatrician and/or cardiac specialist.
From birth to adulthood, we are geared to provide the top-rated cardiac care and support the child’s medical, emotional and physical needs. Pediatric cardiothoracic surgery and cardiology division provides the heart surgery and cardiac interventions for infants, children and young adults with the congenital cardiac and vascular diseases.
Conditions we treat
- Aortic regurgitation/aortic stenosis
- Anomalous left coronary artery from the pulmonary artery (ALCAPA)
- Atrioventricular canal defects
- Atrial septal defect
- Congenitally corrected transposition of the Great Arteries
- Coarctation of the aorta
- Ebstein’s anomaly of the tricuspid valve
- Double outlet right ventricle
- Interruption of the aortic arch
- Heart block
- Patent ductus arteriosus (PDA)
- Hypoplastic left heart syndrome (HLHS)
- Pulmonary Atresia
- Mitral valve defects
- Pulmonary stenosis
- Single ventricle heart defects
- Rheumatic fever and rheumatic heart disease
- Vascular ring
- Tetralogy of Fallot
- Transposition of the great arteries
- Total anomalous pulmonary venous return (TAPVR)
- Ventricular septal defect (VSD)
- Tricuspid Atresia Truncus arteriosus
Team of Specialists
Dr. Manjinder Sandhu
Dr Nidhi Rawal
Dr. Prakash Yadav
Dr. Amit Bhushan Sharma
Dr. Monik Mehta
Dr. Hemant Gandhi
Dr. Balbir Kalra
Cardiothoracic and Vascular Surgery
Dr. Akhil Govil
Paediatric Cardiology & Cardiac Surgery
Dr. Aseem R. Srivastava
Dr. Shamveer Singh