FAQ

What is a heart attack ?
A heart attack is injury or death of a part of the heart muscle. It is also called a ‘myocardial infarction’. There are 2 major ways in which a heart attack can occur:

Blockages get worse: As the blockages get larger there is less blood flow to the heart muscle. At one point the heart muscle no longer can get the blood and oxygen it needs. When the blood supply is cut off for more than about 30 minutes, the heart muscle cells begin to die, and a heart attack occurs.

The atherosclerotic plaque cracks: Most heart attacks are caused as a result of ‘cracking’ or ‘rupture’ of the plaque (blockage). The plaque becomes unstable and cracks, forming a blood clot which travels and completely blocks the flow of blood through the artery, and causes a heart attack.

What is angina ?
Angina is a pain or discomfort that is usually felt in the chest, and spreading to other parts of the body, such as the neck, jaw, shoulders or arms. In some cases discomfort is only felt in these areas and not in the chest at all.

Recognize the symptoms of a heart attack The typical presentation of a heart attack is an unpleasant squeezing pain which typically occurs in the middle of the chest or the back.

It often radiates to both arms or the throat and jaw, and is accompanied by sweating and / or nausea.

This typical presentation does not always occur. Some may just experience heart burn, or ‘stomach upset’ not relieved by antacids or not related to food intake, breathlessness at rest, accompanied by a ‘run down’ feeling.

Some may only experience chest ‘pressure’ and not ‘pain’, or pain only in the jaw, teeth or arms.

Immediate steps to take
» Chew a tablet of aspirin
» Place a tablet of sorbitrate (nitroglycerin) under your tongue. (if you have a prescription for it)
» Keep the patient calm » Rush the patient to the hospital.

CARDIAC TESTS
ECG: This measures the electrical activity of the heart. A change in the ECG pattern can be indicative of the presence of heart disease. The doctor usually looks for two types of changes:

1.Those which indicate a block in the coronary arteries
2.Those which indicate a problem with the rhythm of the heart beats, such as palpitations.

Stress Test / Stress ECG: The stress ECG provides more information than a rest ECG since the oxygen demand on your heart is greater while exercising. A positive stress test indicates that there are changes on your ECG.

Thallium Stress Test / Nuclear Medicine Stress Test:This stress test is similar to a regular stress test, but in this a dye is injected into the heart and pictures are taken of the heart, before and after the stress test.This can detect areas of the heart muscle that have been damaged by a heart attack and areas that are not getting enough oxygen due to partial blockages of the coronary arteries. Nuclear medicine tests can also provide information on the functioning of the left ventricle.

What is bypass surgery ?
This is a surgery in which a healthy blood vessel (artery) is used to form a detour (bypass) around a blockage in a coronary (heart) artery. The new blood vessel used is called a ‘graft’ and therefore the procedure is correctly termed as ‘Coronary Artery Bypass Graft’ surgery. The original blockage in the artery remains as it is, but now there is adequate blood supply to the heart muscle beyond the blockage. Today coronary artery bypass is one of the most frequently performed surgical procedures.

How is it done?
The ‘graft’ used can be either an artery or a vein. However, these days most advanced heart centers such as the Asian Heart Institute prefer to use ‘arterial grafts’ since they have been shown to have a longer life. Studies performed at the Cleveland Clinic by Dr. Floyd Loop and others have shown that arterial grafts remain open even after 20 years of surgery. When surgery is done only using arteries as grafts (also called ‘Total Arterial Revascularization’), the chances of getting recurrence of angina are very slim, and in most cases the patient does not need a second bypass surgery. In the past ‘venous grafts’, usually from a vein in the leg called saphenous vein were used often, but they have a higher rate of developing fresh blockages.The most common artery used is an artery from your chest called the Left Internal Mammary Artery (LIMA). This artery is detached from the chest wall and the open end attached to the coronary artery below the blockage. The RIMA can also be used in select cases. The radial artery is another very commonly used conduit vessel in bypass surgeries. It’s typically taken from the non-dominant hand.

What is ‘beating heart’ or off-pump surgery ?
To perform this delicate surgery the surgeons always used a heart-lung machine in the past. This machine allowed the heart to be ‘stopped’ for a while to perform the grafting. However, over the past few years some of the surgeons also perform the surgery on a ‘beating heart’ and do not use the heart-lung machine. In this method a device called ‘OCTUPUS’ is used and the surgery is done while the heart is beating. This method has several advantages but is technically more demanding. At the Asian Heart Institute almost all surgeries are done on the beating heart and have resulted in the patients spending less time in the ICU, less blood transfusions and complications as well as a shorter hospital stay.

Risk factors for heart disease
Scientific studies have shown that certain traits and lifestyle habits increase the risk of a heart attack. These danger signs are called “risk factors”. The progression of heart disease is a long-term process in which cholesterol and other substances build up in the inner lining of artery walls. They form plaques, which block the flow of blood to the heart muscle. Risk factors tend to speed the development of plaque, and by reducing them, we can stop the progression of plaque growth and thus, decrease the chances of having a heart attack. There are two types of risk factors- those which can be modified and those which cannot.

NOTE: You are considered to have the risk factor of hypertension, even if your BP is controlled with medications.Source: Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7).

Diabetes

Smoking

To Calculate Your BMI
BMI = weight in kg / (height in meter)2 E.g. If you weigh 70 kg and are 1.7 m tall, your BMI will be 70/2.89 = 24.2 kg/m2

Physical Inactivity

Heart defects in Children
There are two types of heart disease in children - Congenital and Acquired. Congenital heart disease (also known as a Congenital Heart Defect) is present at birth. Some of the defects in this category are patent ductus arteriosus, (PDA) Atrial Septal defects, (ASD) and Ventricular Septal Defects (VSD). These defects (ASD and PDA) have been found to be more common amongst females. Earlier these defects needed complicated surgical procedures, but not anymore. Advancements in medical technology have ensured a smoother, non-surgical, minimally invasive procedure of closing these heart defects through a very small incision in the groin, performed under x-ray guidance in the cardiac catheterization laboratory instead of the operation theatre. This non-surgical method has success rates (almost 95 per cent) comparable to surgery, albeit without the trauma and risks associated with open-heart surgery.

Benefits to patient include:
1) Less time spent in the hospital
2) Quicker recovery time
3) Reduced post-procedure pain
4) Avoiding a scar on the chest.
Research for these methods had started in the ’70s and was attempted sporadically in the ’80s but it’s only in the last five years that they have almost been perfected

Let’s take a look at what these heart defects in children are and how they are rectified. ATRIAL SEPTAL DEFECT (ASD)

Atrial septal defect (ASD) is when there is a communication or hole between the left and right atrium (the right and left side of the upper chambers of the heart), which causes an increase in blood flow in the right side of the heart and to the lungs. Because it is receiving so much extra blood, the right side of the heart does more than its normal share of work. The heart can dilate, the muscle can become weak, and the pressures in the pulmonary arteries, supplying blood to lung, can increase (pulmonary hypertension) due to the increase in blood flow. If the defect closes on its own or with the aid of surgery, these consequences can be avoided.

Thus, the patient may feel tired, have difficulty breathing, and fail to grow normally, or be sick more often with respiratory infections such as colds or pneumonia. Larger ASDs can lead to heart failure and death. The unusual part about ASDs is that the symptoms rarely appear in newborns and infants and they are typically discovered at preschool routine examination when the doctor hears a "murmur" and investigates it. Sometimes ASDs go undetected and manifest themselves only when the patient is in his 20s or even 30s. To close this hole, the interventional cardiologist will insert a tube that carries the closing device through a blood vessel in the groin. The closing device could be an umbrella or a patch.

Once the tube passes through the hole and gets to the other side, the closing device is lodged on the hole and once it’s certain that the hole has been covered correctly, the tube is withdrawn. A Transesophageal Echocardiography (TEE) monitors the entire procedure. The colour visuals allow the cardiologist to be sure that the entire procedure has been done correctly, before letting the umbrella stay put on the hole. With most of the presently used umbrella devices, half of the device is connected to one side of the atrial septum, and the second half of the device attached to the other portion, forming a sort of "sandwich" of the defect. The device is held in place by the natural pressures generated within the atria.

Defects amenable to such device therapy tend to be smaller (less than 20 to 25 mm [3/4 to 1 inch] diameter). Importantly, these lesions must be centrally located within the atrial septum. Defects at the very upper or lower edges of the atrial septum (called ostium primum or sinus venosus) are not good candidates for this procedure, because these defects usually involve other abnormalities of the heart valves, or venous drainage from the lungs. The patient’s primary cardiologist can make this determination.

VENTRICULAR SPETAL DEFECTS (VSD)
The other defect is the Ventricular Septal Defect (VSD). In a case of VSD, there is a defect (hole) in the wall (septum) between the two lower chambers (ventricles) of the heart. VSDs are the most common type of heart defect. As in the case of the ASD, the heart can dilate, the muscle can become weak, and the pressures in the pulmonary arteries can increase (pulmonary hypertension) due to an increase in blood flow. Like ASDs, the size and therefore, the clinical course of these defects is quite variable. Some remain large, while others become smaller over time. It is not unusual for small-to-medium sized VSDs to eventually close spontaneously. Many, but not all that remain will require closure by the surgeon.

The VSD can cause symptoms such as growth failure, fatigue, difficult or rapid breathing or chronic respiratory infections. These kinds of defects are more difficult to close than the ASDs, especially if the holes are closer to the valves. If they are away from the valves, the same method by which the ASDs are treated can be applied. Our body’s regenerative system is so strong that within six weeks or so of the operation, tissue will grow over the device that covers the hole and that device functions in harmony with the body.

PATENT DUCTUS ARTERIOSUS (PDA)
Patent Ductus Arteriosus (PDA) is a heart defect that occurs when a blood vessel called the ductus arteriosus, which is normal while the baby is in the womb, fails to close after the baby is born. The ductus arteriosus should close permanently in most cases within 24 hours. This condition can cause symptoms such as fatigue, difficult or rapid breathing, or chronic respiratory infections. A patient with a PDA can also be asymptomatic (without symptoms). Large openings can lead to heart failure and death. Cardiologists close these defects with devices that look like springs or coils or even plugs. The larger holes can only be covered with the plugs, which are more expensive albeit more reliable. For all these procedures to be successful, the sizing of the hole has to be accurate. Generally, an inflated rubber balloon is passed through the hole and then pulled through. This allows the cardiologist to note the ‘stretched diameter’ of the hole.