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.)

Congestive Heart Failure

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.

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    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?

      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 ?

      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.

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        What Are the Symptoms of Diastolic Dysfunction ? – 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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          Clinics- weekly basis/monthly basis/ Yearly basis
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          Prevention of cardiovascular diseases
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            Heart is a complex organ and can get affected by diseases that can affect various systems of the heart. The common heart ailments that would be observed include:

            Coronary Artery Disease (CAD) – accumulation of cholesterol plaques within the walls of the blood vessels (coronary arteries) supplying the heart. This leads to obstruction to blood flow of the heart that can cause chest pain or heart attack. 

            Valvular heart disease: Heart valves are flap-like structures akin to doors between rooms. They control the blood flow between various chambers of the heart. They play a key role in blood circulation. 

            There are four valves in the heart

            • mitral and aortic valves on the left side of the heart 
            • tricuspid and pulmonary valves on the right. 

            These valves can either get narrowed (stenosis) or get “leaky” (regurgitation).

            Cardiomyopathy: This disease affects the heart muscle leading to inefficient heart pumping efficiency. Cardiomyopathy can be either due to:

            • Direct heart muscle diseases – Hypertrophic Cardiomyopathy, Dilated Cardiomyopathy and Restrictive Cardiomyopathy.
            • Indirect heart muscle diseases –
              • Consequent to 
                • heart attack (ischemic cardiomyopathy)
                • infective (myocarditis) and 
                • heart rhythm problems
            • Heart Rhythm problems (Arrhythmias)- Normal heart rate is between 50-100 beats per minute. The maintenance of heart rhythm within a specific range is possible due to an efficient electrical system of the heart also called the conduction system.
              • Slow heart rate – Bradycardia usually due to retardation of conduction within the conduction system of the heart. The most common cause is due to age related degeneration of the conduction system. The garden variety disease causing slow heart rate is called complete heart block.
              • Fast heart rate – Tachycardia in this disease there is an accelerated conduction of electrical impulses – if the fast heart arises in the lower chambers of the heart (ventricles) it is called ventricular tachycardia if it arises in the upper chambers (atria) of the heart it is called supraventricular tachycardia.

            Doctors usually recommend a battery of tests based on the system of the heart that has been affected. Based on a detailed history followed by a detailed physical examination, appropriate battery of tests would be suggested. The diagnosis of the heart ailment is critically dependent on the results of tests.

            In addition to confirming the diagnosis, test results might indicate the disease complications and thus your doctor is able to stage the disease and the possible outcomes.

            Related : Basics about Heart Failure

            Blood tests:

            1. Complete blood count (CBC): A complete blood count helps to detect infection, anaemia and other blood disorders. Anaemia is a common finding in heart failure, plus it also contributes to worsening of heart failure. A low platelet count may be caused by medications such as diuretics or heparin.
            2. Cardiac troponins (cTn1, cTnT, high sensitivity troponins): It is an important blood biomarker useful for the detection and predicting outcomes of chest pain or heart attack. Cardiac troponins may also be high in other heart related conditions like acute myocarditis, coronary vasospasm and non-cardiac conditions (e.g. sepsis, chronic kidney disease).
            3. Electrolytes, urea and creatinine: Assessment of kidney function is essential in all cardiac patients. Both kidney and cardiac disease share the same risk factors and either disease can lead to poor outcomes of the other disease. In addition, cardiac drugs’ doses need to be modified considering the kidney function.
            4. Liver function tests:: Certain drugs such as statins and amiodarone, which are commonly prescribed for patients with heart disease, can trigger liver failure. Liver failure could also be a consequence of heart failure.
            5. Thyroid function test: Medication for heart disease like amiodarone may cause hyper or hypo thyroidism. Altered thyroid hormone can also cause heart dysfunction and responsible for coronary artery disease.
            6. Brain Natriuretic Peptides (BNP or N-terminal pro BNP): BNP is a useful tool to differentiate between cardiac and non-cardiac causes of shortness of breath. High levels of BNP and N terminal pro BNP is associated with increased severity of heart disease and greater risk of hospitalization.
            Related: Types of Heart Failure

            Electrocardiography(ECG):

            This test detects and records the electrical activity of the heart. This is a simple, non-invasive test which is very useful to determine abnormalities in the heart rate, rhythm and to identify risk of damaged heart muscle or other structural changes in the heart. This test detects the presence of arrhythmias and coronary artery disease.

            Exercise stress testing:

            Exercise makes your heart work harder. Exercise stress testing is done either on a treadmill or cycle ergometry with the patient connected to an electrocardiogram. Exercise stress testing may identify myocardial ischaemia, haemodynamic/ electrical instability, or other exertion-related signs or symptoms. When an individual is not able to exercise, medications are given to stress the heart and the response is evaluated.

            Chest X-ray:

            Chest X ray is very useful to differentiate whether shortness of breath is due to a respiratory disease or heart disease. It can also help in detecting complications of heart failure such as cardiomegaly, interstitial oedema, pulmonary oedema and pleural effusions.

            Coronary angiography:

            Coronary angiography is useful to determine the health of the coronary arteries. In this test, a catheter is inserted into the coronary arteries and a dye is injected to produce clear X ray images of the coronary arteries. This helps to find out the presence, location and extent of vessel narrowing. The results also help to decide which type of treatment would be most appropriate for correction of heart problem.

            Echocardiography:

            This test gives an ultrasound image of the heart. Echocardiography can provide information about the size and shape of heart chambers, blood flow velocities, heart muscle function when they contract and relax, abnormalities of the movement of the heart wall, valve function, and presence of thrombus (blood clot) in the heart.

            Stress echocardiography helps in detecting decreased blood flow to heart during exertion. In this test, echocardiography is done immediately post stress. The stress can be exercise or could be induced by medications.

            Myocardial perfusion scanning (MPS):

            MPS is a non-invasive test which helps to determine how well blood flows through your heart muscles. In this test, a small amount of a radioactive substance is injected into the blood. The test evaluates the severity of coronary artery disease and provides guidance regarding the need as well as success of invasive procedures like angioplasty and stent insertion. 

            Cardiac Computerized Tomography (CT):

            Cardiac CT provides detailed images of the heart. This helps to identify structural abnormalities in the heart and blood vessels such as aneurysms, valve dysfunction and damage to the pulmonary vasculature. Cardiac CT also provides information about patency of grafts following coronary artery bypass graft.

            Cardiac Magnetic Resonance Imaging (MRI):

            Cardiac MRI uses strong magnetic fields and radiofrequency to provide detailed 3D images of the heart and surrounding structures. The image provides accurate information about cardiac volumes, muscle mass, contractility, and how efficiently the heart is pumping. Like cardiac CT, cardiac MRI also helps to provide information about patency of grafts following coronary artery bypass graft.

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