Heart attack | Dr Raghu


The heart is a vital organ that supplies blood to the muscles and tissues and keeps your body running. In our previous articles, we’ve discussed common conditions that affect the heart, such as congestive heart failure and atrial fibrillation. Take a look at our blog for more information.

While much is discussed about these common ailments, other conditions like patent foramen ovale (or PFO) can also affect the heart. So, what exactly is PFO? And how does it affect your cardiac health? In this article, we’ll explore the ins and outs of this lesser-known condition.

What is Patent Foramen Ovale?

Patent Foramen Ovale (PFO) is a hole in the heart that can be congenital or acquired. The foramen ovale is a flap-like opening between the heart’s upper chambers. It usually closes within three to six months after birth and becomes a part of your heart’s septum.


patent foramen ovale

But if that doesn’t happen, you may have a PFO. In most cases, a PFO is present at birth (congenital). However, one can also develop it as an adult due to injury, infection, or inflammation of the tissue around the heart (acquired). 

Should You Be Worried About Patent Foramen Ovale?

If you’ve been diagnosed with a patent foramen ovale, you’re likely wondering if it poses a threat to your cardiac health. Fortunately, this condition is usually asymptomatic and does not require treatment. However, it can be a risk factor for stroke and heart attack in some people.

PFO can also be the underlying cause of other conditions, such as:

  • Hypoxemia (low blood oxygen)
  • Pulmonary hypertension
  • Paradoxical embolism
  • Migraine
  • Atrial Fibrillation

That makes it crucial to stay in touch with your doctor and monitor your heart health to keep these conditions at bay.

Signs and Symptoms of PFO

If you’re lucky, a PFO will cause no noticeable symptoms. However, if it results in a drop in your blood oxygen levels, you may experience a variety of symptoms, including:

  • Headaches
  • Dizziness
  • Chest pain (angina)
  • Shortness of breath 
  • Fatigue or weakness that does not go away with rest
  • Feeling faint

What Are the Treatment Options for Patent Foramen Ovale?

Treatment options for a PFO include:

  • Device closure procedure, is necessary only for patients who have had a stroke or heart attack caused by the condition
  • Anticoagulant or antiplatelet medication for those with a complex morphology PFO
  • Watchful waiting if you have no symptoms (that means you will be monitored regularly for any problems caused by your condition)

If you experience symptoms, your doctor may recommend lifestyle changes or medication as treatment options.

In Conclusion

Now you know what a patent foramen ovale is and why it’s so important to get checked out if you have symptoms. If you are diagnosed with a PFO, your doctor may recommend treatment based on your symptoms and medical history. That said, PFO does not always require treatment. Some people have been living with it for years without any issues at all.

Dr. C Raghu is an eminent cardiologist who specializes in interventional cardiology. If you or anyone you know has been diagnosed with a patent foramen ovale, feel free to consult Dr. Raghu to explore your treatment options.

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      Heart failure is an umbrella term for a set of physical symptoms arising due to the gradual deterioration in the heart’s pumping ability. The term “congestive heart failure” was traditionally used because the condition resulted in fluid buildup and congestion in the lungs.

      However, doctors and medical researchers have found that it causes a wide array of other symptoms. That’s why they now refer to the condition as heart failure.

      What Happens in Congestive Heart Failure?

      A healthy human heart relaxes and contracts nearly 100,000 times a day and pumps more than 2,000 gallons of blood throughout the body. The cardiovascular system also includes a network of arteries and veins to transport deoxygenated and oxygenated blood to and from the heart. If any part of the system falters, it can disrupt the flow of blood to vital organs.

      Heart failure is characterized by a progressive decline in the heart’s power to pump blood. When that happens, the heart goes through a series of structural changes (knowns as cardiac remodeling) and beats faster to pump more blood.

      Also, the blood vessels constrict to stabilize blood pressure and restrict blood supply to non-critical organs like the skin and kidneys. When blood flow to the kidneys reduces, it compels the body to retain more fluid and sodium.

      All these short-term fixes result in more damage and cause even more stress to the heart muscles. That, in turn, results in further deterioration of the heart’s pumping action.

      Congestive Heart Failure Symptoms: A Closer Look


      The symptoms of heart failure vary depending on whether they’re caused due to a lack of oxygen or an increase in fluid build.

      Lack of oxygen supply results in the following symptoms :

      • Confusion
      • Weight gain
      • Fatigue
      • Discolored or bluish skin

      Excess sodium and fluid buildup in the body causes the following symptoms:

      • Lung congestion
      • Shortness of breath
      • Coughing and wheezing
      • Loss of appetite
      • Swelling of feet and abdomen

      Causes and Types of Congestive Heart Failure

      The most common causes of heart failure include:

      • Coronary artery disease (Narrowing of arteries due to cholesterol buildup)
      • Damaged or dying heart tissue due to a heart attack
      • Cardiomyopathy (damage to the heart muscles)
      • Heart rhythm disturbances due to atrial fibrillation
      • Underlying medical conditions like hypertension and diabetes

      There are various ways to categorize congestive heart failure. Depending on the part of the heart’s pumping that’s affected due to heart failure, it can be of the following types:

      • Systolic heart failure or heart failure with a reduced ejection fraction
      • Diastolic heart failure or heart failure with a preserved ejection fraction

      Also, depending on the side of the heart that’s affected, heart failure can be categorized as left-sided failure and right-sided failure. The treatment approach a doctor will use depends on the type of heart failure a patient has developed.

      Stages of Heart Failure

      The American College of Cardiology and the American Heart Association has outlined four stages to denote the progression of heart failure. While Stage A is characterized by risk factors like underlying medical conditions, stage B shows structural changes in a patient’s heart. The more advanced stages (C and D) present visible symptoms.

      In Conclusion

      Heart failure (also known as congestive heart failure) is a progressive condition caused by the heart’s inability to pump blood adequately. It results in symptoms like shortness of breath, fatigue, weight gain, and brain fog.

      Dr. C Raghu is an eminent cardiologist with more than two decades of experience. If you or someone you know has developed congestive heart failure symptoms, consult Dr. Raghu to explore your treatment options.

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        Understanding Congestive Heart Failure Symptoms Blog


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          Heart failure is a common condition with no known cure. However, proper treatment can control the disease progression and thus improve a patient’s quality of life and longevity. To decide the proper course of treatment, a doctor must first determine the type of heart failure a patient has developed.

          Depending on the part of the heart’s pumping cycle that’s been affected, heart failure can be of two types – diastolic and systolic. You can learn more about the symptoms, causes, treatment of diastolic dysfunction and differentiation from systolic dysfunction in our previous article.

          In this blog, we’ll delve deeper into systolic heart failure and understand its causes and symptoms.

          Systolic Heart Failure: A Closer Look

          Systolic Heart Failure

          Systolic heart failure occurs due to a problem in the heart’s contraction (or systolic) phase. It’s characterized by stretching and weakening of the left ventricular muscle, due to which the heart pumps out less oxygenated blood to the body.

          It’s also known as heart failure with reduced ejection infraction. As the condition worsens, it can also weaken the right ventricle and take a toll on its pumping power too.

          Related: What Are the Symptoms of Diastolic Dysfunction?

          Causes of Systolic Heart Failure

          Systolic heart failure is caused by underlying medical conditions that damage the left ventricle. The most common causes include :

          • Hypertension (the left ventricle has to use increased pressure to pump blood through the body)
          • Coronary artery disease (buildup of cholesterol in the arteries) – with or without a heart attack.
          • Dilated cardiomyopathy (weakening of the left ventricle due to an infection or long-term exposure to alcohol and narcotics)
          • Abnormal heart rhythm (also known as atrial fibrillation)
          • Previous heart attack

          Additionally, people who are older or have diabetes are at a higher risk of developing systolic heart failure.

          Related: Understanding Congestive Heart Failure Symptoms

          Symptoms of Systolic Heart Failure

          In systolic heart failure, an adequate amount of oxygen-rich blood doesn’t reach all organs. The most common indicator of the condition is a lower ejection fraction.

          It can result in the following symptoms:

          • Breathlessness – initially on exertion and in later stages even at rest or lying down. 
          • Swelling of feet, face, abdomen – due to fluid accumulation in various organs 
          • Engorged and pulsatile neck veins
          • Confusion (due to a lack of oxygen supply in the brain)
          • Weight gain (due to a buildup of excess fluid in the body)
          • Fatigue (due to reduced blood supply to the muscles)
          • Pale or bluish skin tone (due to restricted blood supply to the skin and other vital organs).

          Diagnosis and Treatment Options

          Typically, a doctor prescribes various tests, such as chest X-ray, ECG, and echocardiography, to diagnose systolic heart failure and its root cause. The treatment plan depends on the underlying cause.

          In most cases, systolic heart failure is treated using one or more of the following medications:

          • Beta-blockers
          • Diuretics or water pills
          • ACE inhibitors
          • Digoxin
          • Anticoagulants

          Additionally, doctors recommend a healthy diet and lifestyle changes to improve cardiac health and manage underlying conditions, such as hypertension and diabetes.

          Related: Diagnosing Congestive Heart Failure

          In Conclusion

          If left untreated, systolic heart failure can damage vital organs and even lead to death. It’s crucial that patients watch out for symptoms like swollen feet, mental confusion, and bluish skin color and seek medical treatment at the earliest.

          Dr. C Raghu is an experienced cardiologist who specializes in interventional cardiology and TAVR. If you or anyone you know is experiencing symptoms of systolic heart failure, connect with Dr. Raghu for proper diagnosis and treatment.

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            What Is Systolic Heart Failure ? – Blog

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              In our previous blogs, we’ve discussed the common symptoms and treatment options for heart failure. However, the plan of treatment depends on the side of the heart that’s affected.

              Heart failure is usually of two types – left-sided and right-sided. While left-sided heart failure is the result of the weakening of the left ventricle, right-sided heart failure is caused due to a weak right ventricle.

              right sided heart failure

              In this article, we’ll take a closer look at right-sided heart failure to understand its causes and symptoms. Let’s get started.

              What Is Right-Sided Heart Failure?

              Right-sided heart failure is a condition characterized by the weakening of the heart’s right ventricle. That means the right ventricle can’t pump deoxygenated blood into the lungs with maximum efficiency. It results in a buildup of blood in the veins, thus causing swelling in the legs and abdomen.

              What Causes Right-Sided Heart Failure?

              The most likely cause of right-sided heart failure is a weak left ventricle. In other words, left-sided heart failure eventually leads to right-sided heart failure.

              When the left ventricle becomes weak, it can’t pump an adequate amount of oxygen-rich blood into the body. It causes blood to back up into the lungs. That, in turn, means the right ventricle has to work harder to pump oxygen-depleted blood into the lungs. It results in the gradual weakening of the muscles and leads to right-sided heart failure. Left-sided heart failure is usually caused by coronary artery disease, hypertension, or a previous heart attack.

              Additionally, any condition that taxes the right ventricle’s pumping power can lead to right-sided heart failure. These include:

              What Are the Symptoms of Right-Sided Heart Failure?

              One of the most common right-sided heart failure symptoms is swelling in the legs and abdomen due to fluid buildup. Accumulation of fluid in the abdomen can also cause nausea, bloating, and loss of appetite.

              Other symptoms of right-sided heart failure include:

              How Is Right-Sided Heart Failure Diagnosed?

              Firstly, a cardiologist will ask you about your symptoms and medical history. Also, they’ll perform a physical examination to check your blood pressure and heart rate. They might even use a stethoscope to identify abnormal heart sounds.

              They can also recommend routine blood tests, such as complete blood count, lipid panel, and electrolyte tests. Additionally, they can order a brain natriuretic peptide test.

              Besides blood tests, doctors also order the following lab tests to diagnose right-sided heart failure:

              Right-Sided Heart Failure vs. Congestive Heart Failure

              Congestive heart failure is an outdated term that was used to refer to fluid buildup in the lungs due to a weak left ventricle. However, a more inclusive term – heart failure – is used now. Right-sided heart failure is a specific type of heart failure caused by a weak right ventricle.

              Final Thoughts

              The most common right-sided heart failure symptoms include swelling in the legs and abdomen, breathlessness, and chest pain. Doctors use a variety of tests, including ECG, coronary angiography, and chest X-ray, to diagnose the condition and determine the right course of treatment.

              Dr. C Raghu is an eminent cardiologist specializing in interventional cardiology. He’s helped several patients with serious heart conditions. If you or someone you know is experiencing symptoms of heart failure, reach out to Dr. Raghu today.

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                  Role of ECG in Heart Failure 


                  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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                      What is Heart Failure? 

                      Heart failure is not a single disease instead it is a constellation of symptoms. In this disease the heart  is unable to meet the requirements of the body by its inability to pump or be able to do so by increasing the filling pressures so that it might pump effectively.

                      Heart Failure

                      Heart Failure is not a disease but a  group of symptoms. It is the result of  many diseases affecting not only the  heart but other organs of body.

                      Related : Types of Heart Failure

                      Heart Failure vs Heart attack vs Cardiac Arrest

                      All the three terms refer to different medical issues.

                      • Heart failure is consequent to inefficient functioning of heart.
                      • Heart attack is due to the interruption of blood supply to the heart.
                      • Cardiac arrest is a situation where the heart stops to beat.

                      Symptoms of Heart Failure

                      Inefficient functioning of the heart leads to fluid logging in the body

                      • Fluid logging in the lungs – presents as breathlessness – Left Heart failure in medical parlance Early stages of heart failure – breathlessness can be present on walking.
                      • Advanced stages of heart failure –Breathlessness can be present at rest or, Inability to lie flat or may be awakened from sleep.
                      • Fluid accumulation in other organs of the body – Right heart failure in medical parlance Legs causing swelling of the feet, Swelling of face, abdomen, Pain in upper right abdomen.
                      • Heart failure symptoms which are related to the lungs are called left heart failure symptoms, those symptoms which are related to other organs are called right heart failure symptoms.
                      • Concept of left and right heart
                      • failure is important in treatment
                      Related : What Is Systolic Heart Failure?

                      What causes heart failure?

                      Heart failure is a result of many disease processes in the body. Common among them being: Coronary artery disease

                      • The most common disease that is responsible for heart failure is coronary artery disease. • Coronary artery disease means accumulation of cholesterol in the blood vessels supplying the heart leading to interruption of blood supply to the heart.This interruption of blood supply can either directly reduce the blood supply to the heart resulting in dysfunction or can cause heart attack which can also reduce the heart pumping ability.
                      • Common diseases – such as diabetes, hypertension and sometimes abnormalities of the valves of the heart and fast beating of the heart of which most commonly atrial fibrillation can all result in reduced efficiency of the heart.

                      In addition, advanced age itself beyond the age of 65-70 the efficiency of the heart reduces leading to heart failure.

                      What tests are required for diagnosis of heart failure?

                      The tests for the diagnosis of heart failure are

                      • Imaging test
                      • ECG
                      • Blood test

                      Blood tests in heart failure :

                      • The most common blood test that is done is a pro-BNP test. If it is less than 125, we can safely exclude heart failure as the cause for breathlessness.
                      • In addition, we look at presence of Anaemia, Renal dysfunction and blood glucose elevation in a patient with heart failure.

                      Electrocardiogram (ECG) : This remains an important test

                      Electrocardiogram (ECG) : This remains an important test

                      ecg report

                      • Can detect the presence of previous heart attack.
                      • Irregular heart beat – most common is atrial fibrillation.
                      • Presence of any Bundle branch block.

                      Echocardiogram : The most common and important test for the diagnosis of heart failure is the  echocardiogram where we estimate the left ventricular ejection fraction (measures the pumping  ability of the heart) or in short called as EF.

                      Other test done to manage heart failure are cardiac MRI and nuclear test.

                      Related : Heart Failure – Role of Electrocardiogram (ECG)

                      What is the role of Angiography in heart  failure?

                      For every 3 patients with heart failure 2 have underlying obstruction to the heart’s blood supply. Identifying this is super important because removal of these obstructions by angioplasty and stent can lead to improved cardiac function. 

                      The blood vessels supplying the heart are the  coronary arteries and obstructions are called coronary artery disease. So, whenever there is a  coronary artery disease, we can identify that only by performing a coronary angiography.

                      The major advantage of this investigation is apart from diagnosis in coronary artery disease, in case  if any blocks in heart vessels are identified they can be treated by performing a balloon angioplasty  and a stent procedure.

                      The benefit of removing the cholesterol plaques in the heart vessels is that – there can be a strong  chance for the heart functioning to recover once the blood flow is restored back to the heart.

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