heart disease | Dr Raghu

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There are many scenarios where you might want to see a doctor and find out whether you’ve developed heart failure. Perhaps you have a history of heart disease in the family and would like to assess your risk levels.

Or you might have developed symptoms, such as shortness of breath, chest pain, and swollen feet, that are indicative of heart failure. (Check out our previous article for a detailed glimpse of heart failure symptoms.)

Or you might have completed an initial round of investigation and want a closer look at the root cause of heart failure. In any case, it’s essential to have a fair idea of the steps involved in diagnosing heart failure. Let’s take a look.

Family History and Medical Background

Diagnostic efforts for heart failure serve two primary purposes :

To determine the underlying cause
To assess the extent of the heart’s malfunction

The first thing a doctor will do is get a complete picture of your medical history. They’ll want to know the details of any symptoms you might have been experiencing. Also, they’ll ask about your diet and lifestyle, including your habits pertaining to exercise, smoking, and alcohol consumption.

Additionally, they’ll ask one or more of the following questions:

Do you have pre-existing conditions like high cholesterol levels, hypertension, diabetes, etc.?
Have you undergone treatments like chemotherapy?
Do you have a family history of cardiovascular diseases?

Your answers to these questions will give your doctor a better idea of your current physical condition.

Physical Examination

Next, the doctor will perform a thorough physical exam to analyze your heart activity. They’ll likely start by calculating your BMI and body fat percentage. Also, they’ll measure your vitals, including blood pressure and heart rate.

Additionally, they might use a stethoscope to identify abnormal heart sounds or murmurs that indicate a faulty heart valve. They’ll also watch out for soft noises or bruits to identify the narrowing of arteries.

They’ll examine your skin to see if it feels cold or looks discolored. They’ll also check your feet and abdomen for signs of fluid buildup. By the end of the physical exam, the doctor will have a better idea of your cardiovascular health.

Related : High Blood Pressure – Symptoms & Treatment

Diagnostic Tests

While a physical exam can indicate abnormal heart function, your doctor will likely run a few diagnostic tests to confirm the underlying cause of heart failure.

The most common tests include:

Blood tests, such as complete blood count, lipid panel, liver and kidney function tests, and a fasting glucose test
Brain natriuretic peptide (BNP) test to determine the risk of hospitalization and death due to heart failure
Chest X-ray to detect enlarged heart muscle or fluid buildup around the heart
12-lead ECG to monitor the heart’s electrical activity and identify signs of a heart attack or irregular heartbeat
Echocardiography for a closer look at the heart’s chambers and pumping action in real time
Coronary angiography to identify coronary artery disease

Other tests like radionuclide ventriculography, exercise testing, and endomyocardial biopsy may also be prescribed.

Related : What is Coronary Angiogram?

In Conclusion

Diagnosing heart failure involves a combination of physical examination, blood tests, and non-invasive procedures like X-rays and ECG. The key is to identify the underlying cause of heart failure, so that your doctor can decide the right course of treatment.

Dr. C Raghu is an experienced cardiologist who specializes in interventional cardiology. If you or anyone you know is at risk of developing heart failure, reach out to Dr. Raghu for a thorough diagnosis.

Diagnosing Congestive Heart Failure Blog

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In our previous articles, we’ve discussed the symptoms of heart failure and the steps to diagnose the same. However, the course of treatment varies for every patient based on the type of heart failure they’ve developed.

Depending on the part of the heart’s pumping cycle that’s been affected, there are two types of heart failure. In this blog, we’ll take a closer look at diastolic dysfunction and its symptoms.

What Causes Diastolic Dysfunction?

The diastolic phase refers to the part of the heart’s pumping cycle when the ventricles (lower chambers) relax and let blood flow in from the atria (upper chambers). Diastolic dysfunction is a condition in which the ventricles don’t relax enough. That, in turn, prevents the normal amount of blood from entering the heart.

Diastolic dysfunction is caused when the heart muscles become thicker and stiffer than usual. It’s more common in older women with hypertension and diabetes. If left untreated, it can lead to diastolic heart failure (also known as heart failure with preserved ejection fraction).

Related : Understanding Congestive Heart Failure Symptoms

What Does Preserved Ejection Fraction Mean?

Ejection fraction refers to the volume of blood pumped out from the heart’s left ventricle with each contraction. For a healthy heart, the number falls in the range of 55% to 65%. A lower ejection fraction is one of the most common indicators of heart failure.

However, it’s worth noting that many people with diastolic dysfunction have an ejection fraction of 50% or more (which is known as preserved ejection fraction). That means the left ventricle expels an adequate amount of oxygenated blood.

However, the heart muscle doesn’t relax enough to let a sufficient quantity of blood in. That, in turn, causes the excess blood to back up in the lungs and results in fluid buildup in the feet and abdomen.

How to differentiate systolic from diastolic dysfunction ?

In contrast to systolic dysfunction where the heart muscle is “weak”, in diastolic dysfunction the heart is “stiff”. This means that the heart is unable to pump blood out of the heart in systolic dysfunction whereas the heart is unable to accept further blood in diastolic dysfunction. Both conditions lead to congestion or fluid accumulation in various organs of the body. Differentiation of heart failure from systolic and diastolic dysfunction is not possible as both diseases present with similar symptoms.

Which conditions lead to Diastolic dysfunction?

Diastolic dysfunction appears consequent to uncontrolled or long-standing diabetes
Hypertension
Obesity as well as elderly people
Women and atrial fibrillation

The best way to prevent and treat diastolic dysfunction is by effective control of the diseases mentioned above.

Symptoms of Diastolic Dysfunction

The most common symptom of diastolic dysfunction is congestion and shortness of breath due to the buildup of blood and fluid in the lungs. Breathing difficulties can get particularly worse during exertion or when lying.

Other symptoms of diastolic dysfunction include:

Coughing and wheezing (due to lung congestion)
Loss of appetite and nausea (due to fluid buildup around the liver and in the stomach)
Swollen feet, legs, and abdomen (due to fluid accumulation)

If you experience any of the given symptoms, it’s crucial to consult a doctor for a proper diagnosis.

Treatment of Diastolic Dysfunction

Treatment of diastolic dysfunction involves a combination of medications (diuretics or water pills) and lifestyle changes. In severe cases, a patient might need left ventricular assist devices or a heart transplant.

Is Diastolic Dysfunction Serious?

In the long run, diastolic dysfunction can lead to diastolic heart failure. That, in turn, increases your risk of hospitalization and death. Therefore, you should pay close attention to your symptoms and reach out to a doctor whenever you notice anything unusual.

Dr. C Raghu is a renowned cardiologist who specializes in interventional cardiology. He has decades of experience in treating patients with different heart conditions. If you or anyone you know has developed symptoms like shortness of breath, swollen feet, loss of appetite, etc., contact Dr. Raghu to explore your treatment options.

What Are the Symptoms of Diastolic Dysfunction ? – Blog

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Congenital heart diseases are diseases that are present from birth and affect the normal heart functioning. These are the most frequently occurring congenital disorder, responsible for 28% of all congenital birth defects. The birth prevalence of CHD is reported to be 8-12/1000 live births. Considering a rate of 9/1000, about 1.35 million babies are born with CHD each year globally.

What are the Causes of Congenital Heart Defects?

In most cases, no obvious cause of congenital heart disease is identified. However, some things are known to increase the risk of the condition, including:

Down’s syndrome – a genetic disorder that affects a baby’s normal physical development and causes learning difficulties
the mother having certain infections, such as rubella, during pregnancy
the mother taking certain types of medicine during pregnancy, including statins and some acne medicines
the mother smoking or drinking alcohol during pregnancy
the mother having poorly controlled type 1 diabetes or type 2 diabetes
other chromosome defects, where genes may be altered from normal and can be inherited (run in the family)

Many cases of congenital heart disease can be diagnosed before a baby is born during an ultrasound scan in pregnancy. At times a focused foetal heart scan called foetal echocardiography in specialized centers helps to diagnose the cardiac problem before birth. However, it’s not always possible to detect congenital heart defects in this way.

Signs and Symptoms of Congenital Heart Disease

Congenital heart disease can have a number of symptoms, particularly in babies and children, including:

Rapid heartbeat
Rapid breathing
Swelling of the legs, tummy or around the eyes
Extreme tiredness and fatigue
A blue tinge to the skin or lips (cyanosis)
Tiredness and rapid breathing when a baby is feeding

These problems are sometimes noticeable soon after birth, although mild defects may not cause any problems until later in life.

Types of Congenital Heart Disease

There are many types of congenital heart disease and they sometimes occur in combination. Some of the more common defects include:

Septal defects – where there’s a hole between 2 of the heart’s chambers (commonly referred to as a “hole in the heart”)
Coarctation of the aorta – where the main large artery of the body, called the aorta, is narrower than normal
Pulmonary valve stenosis – where the pulmonary valve, which controls the flow of blood out of the lower right chamber of the heart to the lungs, is narrower than normal
Transposition of the great arteries – where the pulmonary and aortic valves and the arteries they’re connected to have swapped positions
Underdeveloped heart – where part of the heart doesn’t develop properly making it difficult for it to pump enough blood around the body or lungs.

Treating Congenital Heart Disease

Treatment for congenital heart disease usually depends on the defect you or your child has.

Mild defects, such as holes in the heart, often don’t need to be treated, as they may improve on their own and may not cause any further problems.

Surgery or interventional procedures are usually required if the defect is significant and causing problems. Modern surgical techniques can often restore most or all of the heart’s normal function.

However, people with congenital heart disease often need treatment throughout their life and therefore require specialist review during childhood and adulthood. This is because people with complex heart problems can develop further problems with their heart rhythm or valves over time.

Most surgery and interventional procedures aren’t considered to be a cure. The affected person’s ability to exercise may be limited and they may need to take extra steps to protect themselves from getting infections.

It’s important that a person with heart disease and their parents or carers discuss these issues with their specialist medical team.

Basics of Congenital Heart Disease Blog

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An atrial septum is a muscular wall that separates the upper chambers of the heart called atria. An ASD is a common congenital heart disease where the septum is not formed properly producing a left-to-right shunt, which leads to mixing of oxygenated and deoxygenated blood. This causes pulmonary hypertension and right heart enlargement.

What are the treatment options for ASD?

Small atrial defects do not need any treatment and close on its own. Even in adulthood small ASDs may remain asymptomatic. Some large defects that persists in adulthood may become symptomatic and need closure. The ASDs can be closed by:

Percutaneous closure using a device
Closure through open heart surgery

Percutaneous device closure is the preferred treatment for certain defects type.

What is Percutaneous Closure of Atrial Septal Defect (ASD)?

A noninvasive procedure known as percutaneous transcatheter approach is considered depending on the size and severity of the defect. Moderate to large-sized ASD along with pulmonary hypertension requires to be closed. The procedure is performed by inserting a special closure device either folded or attached to a catheter into the vein of the leg and is advanced to the heart through the defect, which closes the hole by a special mechanism.

Are there risks associated with the procedure?

The success rate of the procedure is about 95%. But the risks involved, and their estimated incidence of occurrence include:

Device dislodgement leading to emergency heart surgery: 1%
Device erosion (device eroding through the heart walls): 0.3%
Death: less than 1% usually due to perforation of the heart chamber
Dislodgement of clot or air bubbles to the brain leading to other organs: less than 1%
Arrhythmia: 1 to 2%
Allergic dye reaction
Anaesthetic reaction
Injury to the artery/vein/nerves in the groin
Perforation of the oesophagus
Infection
Allergic reaction to the nickel component of the device

Patients with small ASD may not develop any complications, but large-sized defects may lead to serious complications which demands surgery and prolonged hospitalization.

What is the pre-procedure work-up?

Pre-operative tests to assess the general health of the patient include:

Chest x-ray
Electrocardiogram
Blood tests
Kidney function

A detailed diagnosis of the defect should be performed which includes transthoracic and transoesophageal echocardiogram used to assess the size, location and the suitability of the procedure.

How should I prepare for the procedure?

Patients wearing dentures, glasses or a hearing assist device can plan to wear them during the procedure.
Patient will be instructed about dietary restriction to be followed before the procedure.

Are there any specific instructions about medications?

The healthcare provider may ask you to stop certain medications, such as warfarin or other blood thinners.
If diabetic, consult the physician about how the medication needs to be adjusted.
Provide information about specific allergies regarding iodine, shellfish, X-ray dye, latex or rubber products etc.

What happens during the procedure?

The patient might be asked to have a shower before the procedure.
The patient is asked to wear a hospital gown and lie on an X-ray table where an X-ray camera will move over the chest during the procedure.
Arrangements for intravenous administration of medications or fluids during the procedure will be made.
The site where the catheter will be inserted is cleaned and sterile drapes were used to cover the site to prevent the infection.
Electrodes will be placed on the chest and are attached to an electrocardiograph monitor (ECG).
A sedative might be given to relax, and a local anesthetic is given to numb the site of catheter introduction.
A plastic sheath will be inserted in the groin, through which a catheter is inserted and threaded to the heart.
The physician may also inject a dye which may make you feel hot or flushed for several seconds. Inform the doctor if there is an allergic reaction like itching or tightness in throat, nausea and chest discomfort.
The X-ray cameras are used to obtain the measurements of pressures and oxygen content in the chambers.
The appropriate size and the location of the closure might be visualized using a small catheter connected with an ultrasound transducer.
A special catheter is used to advance the device into the heart and through the defect.
The device is slowly pushed out of the catheter allowing each side of the device to open and close each side of the hole in the septum.
The proper position of the device is ensured and is released from the catheter.
It may take 1-2 hours for the procedure, but preparations must be made to spend about 5-9 hours in the hospital.
The patient should be accompanied by someone who can drive him home, as the patient will not be allowed to drive on the same day.

What care should be taken after the procedure?

The catheter and the imaging probe are removed after the completion of the procedure.
Pressure on the incision site or occasionally a small suture is used to close the vein.
Bed rest is advised for several hours to prevent bleeding, but call the doctor if you notice any bleeding.
You might be advised to drink plenty of water to wash out the contrast material from the body.
Your heart rate and rhythm are monitored; you may be asked to stay overnight in the hospital.
Medications, such as aspirin are prescribed to prevent blood clots.
Strenuous activity and heavy lifting should be avoided for at least six months.
Antibiotic prophylaxis is required for at least six months or lifelong to prevent endocarditis, as per doctor’s advice.

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Device closure for Ventricular septal defect
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LA appendage closure
Fistuloplasty
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