electrocardiogram | Dr Raghu

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Role of ECG in Heart Failure 

ecg

ECG is a simple inexpensive test to asses heart function. ECG is the short form for electrocardiogram  or electrocardiography.

ECG equips the doctor with basic heart information such as

  • Rhythm of heart – Regular or irregular. The most common irregular heart rhythm is atrial  fibrillation and frequently seen in heart failure patients. 
  • Heart rate – Normal heart rate is between 50-100 beats per minute. A slow heart rate (less  than 50) is called bradycardia and a fast rate (more than 100) is tachycardia.
  • Heart enlargement – Heart chambers enlargement can also be reasonably assessed. But the  best test to assess heart chamber enlargement is cardiac magnetic resonance imaging (Cardiac MRI).
  • Heart attack – current and those in the past can be identified by predefined patterns on ECG.

Advanced information from ECG in Heart Failure 

  • Reduced blood supply to heart – if a patient had a previous heart attack it usually can be  diagnosed through an ECG. It is not necessary that all patients with reduced blood supply  can be identified through ECG. Coronary angiography is a common test performed by  doctors to estimate the blood supply to the heart.
  • Pumping efficiency of the heart – presence of an abnormal ECG usually indicates abnormal  heart efficiency. The common abnormalities on ECG include but not limited to – complete  bundle branch block, hemiblock, features indicating a previous heart attack or chamber  enlargement.  
  • Left bundle branch block (LBBB) – presence of LBBB (if the QRS duration is more than 150 m  seconds on ECG) and a reduced EF on echo (less than 35%) is a indication for specialized  therapies such as cardiac resynchronization therapy (CRT). Resynchronization means re  establishing the synchronous beating of the heart. 
  • Abnormal rhythm may indicate need for advanced therapies such as pacemaker in heart  block, implantable cardioverter defibrillator (ICD) if EF is less than 35% on echo, catheter  ablation in atrial fibrillation and abnormal ventricular rhythm.  
  • Unique and uncommon problems of the heart such as infiltrative disorder (amyloidosis,  restrictive cardiomyopathy) and rare diseases such as or arrhythmogenic RV dysplasia can be  identified on ECG.

Does a normal ECG rule out a heart attack? 

An ECG is a simple yet powerful tool to assess the heart function. But at the same time a normal ECG  does not rule out a heart attack or other diseases if the disease is quite early stage. If the disease is  advanced the ECG remains a quite predictable and powerful tool. So, if the person had a heart  attack, we do not entirely rely upon ECG but we additionally incorporate the value of high sensitive  troponin to make a confirmed diagnosis of heart attack.

ECG complements advanced investigations 

Information obtained from ECG is utilized while interpreting advanced tests such as  echocardiography (echo), coronary angiography, cardiac MRI, PET CT scan etc.  

ECG is a powerful tool in advanced disease but in the early disease too it could be used as an adjunct  to other tests.


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      Coronary arteries are the blood vessels that delivers oxygenated blood to the heart muscle. But, sometimes these blood vessels may get narrowed or blocked due to accumulation of cholesterol plaque. To open the blockage and restore the function of arteries, coronary angioplasty is performed.

      A coronary angioplasty involves the temporary insertion of a tiny balloon inside the artery to open the blockage. It is usually combined with the placement of a stent (a metal mesh tube) to widen the artery and prevent the further chance of narrowing.

      coronary angioplasty

      Why is coronary angioplasty done ?

      Coronary angioplasty is done to treat narrowing or blockage of the heart’s blood vessels:

      • during or after a heart attack.
      • Blood vessel narrowing leading to poor heart function.
      • For relief of chest pain (angina) due to reduced blood supply to heart.

      Risks of coronary angioplasty

      Usually, it is a safe procedure, but like all other procedures, it also carries certain risks like:

      Common Issues/Risks after angiography
      Bruising Common to have bruise at groin or arm Lasts for few weeks Not to be worried about
      Allergic reactions Usually related to contrast medicine used History of previous allergy – higher risk Present as rash and headache
      Bleeding at the site of entry (Hematoma) Usually subsides in a few days But in case swelling is increasing and painful contact your physician immediately

      Serious complications after coronary angiography Less than 1 in 1000 chance People with severe heart disease are at high risk Discuss with Cardiologist before procedure
      Heart attack A serious medical emergency where the heart’s blood supply is suddenly blocked
      Stroke A serious medical condition that occurs when the blood supply to the brain is interrupted
      Loss of blood supply to limb Damage to the artery in the arm or groin in which the catheter was inserted, with the blood supply to the limb possibly being affected
      Kidney injury Damage to the kidneys caused by the contrast dye
      Radiation injury Tissue damage caused by X-ray radiation if the procedure is prolonged

      What happens before the procedure?

      A physical examination and blood test are done to evaluate the overall health condition. The person needs to follow instructions provided before undergoing the procedure:

      1. Inform the doctor about:

      • Any allergies
      • The use of current medicines, including vitamin and mineral supplements
      • Any blood disorder
      • Any surgery you may had
      • The past and present medical condition

      2. Medicines:

      Tell the doctor if you are using blood thinners or any anti-diabetic medicines. The doctor will either advise you to stop or change the dose of the medication.

      3. Food and fluid restrictions:

      • Avoid heavy meals, such as meat, fried or fatty foods eight hours before the procedure. Take light foods such as toast and cereal.
      • Fast for six hours before the procedure.
      • Stay hydrated, drink plenty of fluid up to two hours before the procedure.

      In most of the cases, you will be discharged on the same day of the hospital, so ask someone to accompany you to the hospital.

      What happens during the procedure?

      Local anaesthesia would be administered to numb the area where the catheter would be inserted. Mostly, a catheter is inserted through the wrist, and sometimes through the groin. Under fluoroscopy (a type of X-ray), the catheter will be guided to the diseased artery. Then a special medicine (called contrast or dye) will be injected into the blood vessels supplying the heart. This will delineate the presence of obstruction to blood flow. 
      Then a wire is passed across the obstruction and a balloon is inflated at the site of obstruction to compress the obstructing plaque in the artery. The balloon expansion will compress the plaques into the wall of the blood vessel and improve the blood flow. Once the blood flow is improved, the catheter will be removed, and a stent would be placed to prevent the risk of further blockage. Finally, the catheter will be removed and the puncture site is sealed.

      What to expect after the procedure?

      The nurse will check the vitals of the patient. Depending on the condition, the doctor would advise you the hospital stay. You will be advised not to bend or cross the leg for a few days if the procedure is performed through the groin region. Additionally, some other tests like X-rays and an electrocardiogram (ECG) would be done to check the condition. Before discharge, the doctor will give you certain instructions regarding wound care, medications and lifestyle.

      Recovery after coronary angioplasty

      Recover quickly and keep your heart healthy by following these tips:

      • Quit smoking.
      • Limit the intake of alcohol.
      • Take the prescribed medicines.
      • Check the cholesterol levels regularly.
      • Maintain a healthy body weight.
      • Have a healthy and well-balanced diet.
      • Exercise regularly.

      Know your numbers

      It’s important to periodically monitor and maintain the following numbers to prevent future cardiac events

      • LDL cholesterol – less than 55 mg/dL
      • Blood pressure – less than 120/80 mm Hg
      • Blood sugar – HbA1C less than 7.0%

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