'surgery'

Coronary artery bypass surgery Coronary artery bypass surgery, also known as coronary artery bypass graft (CABG, pronounced “cabbage”) surgery, and colloquially heart bypass or bypass surgery, is a surgical procedure to restore normal blood flow to an obstructed coronary artery. A normal coronary artery transports blood to and from the heart muscle itself, not through the main circulatory system. There are two main approaches. In one, the left internal thoracic artery (internal mammary artery) is diverted to the left anterior descending branch of the left coronary artery. In the other, a great saphenous vein is removed from a leg; one end is attached to the aorta or one of its major branches, and the other end is attached to the obstructed artery immediately after the obstruction to restore blood flow. CABG is performed to relieve angina unsatisfactorily controlled by maximum tolerated anti-ischemic medication, prevent or relieve left ventricular dysfunction, and/or reduce the risk of death. CABG does not prevent myocardial infarction (heart attack). This surgery is usually performed with the heart stopped, necessitating the usage of cardiopulmonary bypass. However, two alternative techniques are also available, allowing CABG to be performed on a beating heart either without using the cardiopulmonary bypass, a procedure referred to as “off-pump” surgery, or performing beating surgery using partial assistance of the cardiopulmonary bypass, a procedure referred to as “on-pump beating” surgery. The latter procedure offers the advantages of the on-pump stopped and off-pump while minimizing their respective side-effects. CABG is often indicated when coronary arteries have a 50 percent to 99 percent obstruction. The obstruction being bypassed is typically due to arteriosclerosis, atherosclerosis, or both. Arteriosclerosis is characterized by thickening, loss of elasticity, and calcification of the arterial wall, most often resulting in a generalized narrowing in the affected coronary artery. Atherosclerosis is characterized by yellowish plaques of cholesterol, lipids, and cellular debris deposited into the inner layer of the wall of a large or medium-sized coronary artery, most often resulting in a focal partial obstruction in the affected artery. Either condition can limit blood flow if it causes a cross-sectional narrowing of at least 50 percent.

What are electrophysiology studies? Electrophysiology studies (EPS) are tests that help doctors understand the nature of abnormal heart rhythms (arrhythmias). Quick facts Electrophysiology studies test the electrical activity of your heart to find where an arrhythmia (abnormal heartbeat) is coming from. These results can help you and your doctor decide whether you need medicine, a pacemaker, an implantable cardioverter defibrillator (ICD), cardiac ablation or surgery. These studies take place in a special room called an electrophysiology (EP) lab or catheterization (cath) lab while you are mildly sedated. Why do people have electrophysiology studies? When someone’s heart doesn’t beat normally, doctors use EPS to find out why. Electrical signals usually travel through the heart in a regular pattern. Heart attacks, aging and high blood pressure may cause scarring of the heart. This may cause the heart to beat in an irregular (uneven) pattern. Extra abnormal electrical pathways found in certain congenital heart defects can also cause arrhythmias. During EPS, doctors insert a thin tube called a catheter into a blood vessel that leads to your heart. A specialized electrode catheter designed for EP studies lets them send electrical signals to your heart and record its electrical activity. Doctors use EPS to see: Where an arrhythmia is coming from. How well certain medicines work to treat your arrhythmia. If they should treat a problem by destroying the place inside your heart that is causing the abnormal electrical signal. This procedure is called catheter ablation. If a pacemaker or implantable cardioverter defibrillator (ICD) might help you. If you are at risk for heart problems such as fainting or sudden cardiac death due to cardiac arrest (when your heart stops beating). During an EPS, about 3 to 5 electrically sensitive catheters are placed inside the heart to record electrical activity. What are the risks of EPS? Risks may include: Arrhythmia. During EPS you may have abnormal heart rhythms that make you dizzy. If this happens, your doctor may give your heart an electric shock to bring back a regular heartbeat. Blood clots sometimes can form at the tip of the catheter, break off and block a blood vessel. Your doctor may give you medicine to prevent blood clots. Infection, bleeding and bruising at the site where the catheter went in (groin, arm or neck). Your doctor or nurse will help you avoid these problems. How do I prepare for EPS? Don’t eat or drink anything for 6 to 8 hours before the test. Tell your doctor about any medicines you take, including over-the-counter medicines, herbs and vitamins. He or she may ask you not to take them before EPS. Don’t stop taking your medicine until your doctor tells you to. Have someone drive you to your appointment and take you home. If you usually wear a hearing aid, wear it during your procedure. If you wear glasses, bring them to your appointment. What happens during EPS? At a hospital or clinic, doctors and nurses do EPS in a room that has special equipment for the tests. You may hear this room called the electrophysiology laboratory, or EP lab. Some call it the catheterization laboratory (cath lab). During the test: A nurse will put an IV (intravenous line) in your arm. You’ll get medicine (a sedative) that will help you relax. But you’ll be awake and able to follow instructions during the test. Your nurse will clean and shave the part of your body where the doctor will be working. This is usually in the groin but may be the arm or neck. You’ll be given a shot – a local anesthetic will be given — to make the area numb. Your doctor will make a needle puncture through your skin and into your blood vessel. A small straw-sized tube called a sheath will be inserted into your artery or vein. The doctor will gently guide several specialized EP catheters into your blood vessel through the sheath and advance them to your heart. A video screen will show the position of the catheters. You may feel some pressure in the area where the sheath was inserted, but you shouldn’t feel any pain. Your doctor will send small electric pulses through the catheters to make your heart beat at different speeds. You may feel your heart beat stronger or faster. Electrical signals produced by your heart will be picked up by the special catheters and recorded. This is called cardiac mapping and allows the doctor to locate where arrhythmias are coming from, Your doctor will remove the catheters and the IV line. Your nurse will put pressure on the puncture site to stop any bleeding. EPS usually last 1 to 4 hours. If the type and location of the arrhythmia is identified and an appropriate therapy decided, cardiac ablation or insertion of a pacemaker or ICD may be performed during or immediately after the EPS. “I could feel my heart speeding up, which was weird. But it didn’t hurt. It was more like hiking up and down hills really fast.” Esmerelda, age 38 What happens after EPS? You’ll be moved to a recovery room where you should rest quietly for 1 to 3 hours. During this time: Stay still as long as your nurse tells you to. Be sure to keep the arm or leg used for the test straight. Your nurse will check on you often to see if there is bleeding or swelling at the puncture site. After the sedative wears off, your doctor will talk to you about your test results. Before you leave, you’ll be told what to do at home. What happens after I get home? Follow the instructions your nurse or doctor gave you, including taking any new medicines that were prescribed. Most people can start eating food and taking their medicines within 4 to 6 hours after the test. Most can do their usual daily activities the day after the test. Don’t drive for at least 24 hours. The puncture site may be sore for several days. A small bruise at the puncture site is normal. If the site starts to bleed, lie flat and press firmly on top of it. Have someone call the doctor or EP lab. What should I watch for? Call 9-1-1 if you notice: A sudden increase in swelling around the puncture site. Bleeding doesn’t slow down when you press hard on the site. Call your doctor right away if you notice: Your arm or leg that was used for the sheath feels numb or tingles. Your hand or foot feels very cold or changes color. The puncture site looks more and more bruised. The puncture site begins to swell or fluids begin to come from it. How do I learn the results of my EPS? Most of the time, doctors will ask you to make an appointment to discuss the results of your test. You’ll discuss your treatment at that appointment. How can I learn more about EPS? Talk with your doctor. Here are some good questions to ask: Are there medicines that I can use to control my abnormal heartbeats? Will I need a pacemaker or implantable cardioverter defibrillator (ICD) now or in the future? What caused my irregular heartbeat? Am I at risk of serious heart rhythm problems in the future?

Deep vein thrombosis (DVT) Deep vein thrombosis (DVT) is a serious condition that occurs when a blood clot forms in a vein located deep inside your body. A blood clot is a clump of blood that’s turned to a solid state. Deep vein blood clots typically form in your thigh or lower leg, but they can also develop in other areas of your body. Other names associated with this condition may include thromboembolism, post-thrombotic syndrome, and postphlebitic syndrome. DVT symptoms: According to the Centers for Disease Control and Prevention (CDC)Trusted Source, symptoms of DVT only occur in about half of the people who have this condition. Common symptoms include: swelling in your foot, ankle, or leg, usually on one side cramping pain in your affected leg that usually begins in your calf severe, unexplained pain in your foot and ankle an area of skin that feels warmer than the skin on the surrounding areas skin over the affected area turning pale or a reddish or bluish color DVT causes: DVT is caused by a blood clot. The clot blocks a vein, preventing blood from properly circulating in your body. Clotting may occur for several reasons. These include: Injury. Damage to a blood vessel’s wall can narrow or block blood flow. A blood clot may form as a result. Surgery. Blood vessels can be damaged during surgery, which can lead to the development of a blood clot. Bed rest with little to no movement after surgery may also increase your risk for developing a blood clot. Reduced mobility or inactivity. When you sit frequently, blood can collect in your legs, especially the lower parts. If you’re unable to move for extended periods of time, the blood flow in your legs can slow down. This can cause a clot to develop. Certain medications. Some medications increase the chances your blood will form a clot.

Congenital heart defect - corrective surgery Congenital heart defect corrective surgery fixes or treats a heart defect that a child is born with. A baby born with one or more heart defects has congenital heart disease. Surgery is needed if the defect could harm the child’s long-term health or well-being. Patent Ductus Arteriosus Patent ductus arteriosus (PDA) is a heart problem that occurs soon after birth in some babies. In PDA, abnormal blood flow occurs between two of the major arteries connected to the heart. Before birth, the two major arteries-the aorta and the pulmonary (PULL-mun-ary) artery-are connected by a blood vessel called the ductus arteriosus. This vessel is an essential part of fetal blood circulation. Within minutes or up to a few days after birth, the vessel is supposed to close as part of the normal changes occurring in the baby’s circulation. In some babies, however, the ductus arteriosus remains open (patent). This opening allows oxygen-rich blood from the aorta to mix with oxygen-poor blood from the pulmonary artery. This can put strain on the heart and increase blood pressure in the lung arteries. Atrial septal defect (ASD) repair: The atrial septum is the wall between the left and right atria (upper chambers) of the heart. A hole in that wall is called an ASD. In the presence of this defect, blood with and without oxygen can be mixed up and over time, cause medical problems and arrhythmias. Sometimes, an ASD can be closed without open-heart surgery. First, the surgeon makes a tiny cut in the groin. Then the surgeon inserts a wire into a blood vessel that goes to the heart. Next, two small umbrella-shaped “clamshell” devices are placed on the right and left sides of the septum. These two devices are attached to each other. This closes the hole in the heart. Not all medical centers do this procedure. Open-heart surgery may also be done to repair ASD. In this operation, the septum can be closed using stitches. Another way to cover the hole is with a patch. Ventricular septal defect (VSD) repair: The ventricular septum is the wall between the left and right ventricles (lower chambers) of the heart. A hole in the ventricular septum is called a VSD. This hole lets blood with oxygen mix with used blood returning to the lungs. Over time, irregular heartbeats and other heart problems can happen. By age 1, most small VSDs close on their own. However, those VSDs that do stay open after this age may need to be closed. Larger VSDs, such as small ones in certain parts of the ventricular septum, or ones that cause heart failure or endocarditis, (inflammation) need open-heart surgery. The hole in the septum is most often closed with a patch. Some septal defects can be closed without surgery. The procedure involves passing a small wire into the heart and placing a small device to close the defect.

What Does Cardiac Rehab Involve? Cardiac rehab doesn’t change your past, but it can help you improve your heart’s future. It’s a medically supervised program designed to help improve your cardiovascular health if you have experienced heart attack, heart failure, angioplasty or heart surgery. Think of cardiac rehab as three equally important parts: Exercise counseling and training: Exercise gets your heart pumping and your entire cardiovascular system working. You’ll learn how to get your body moving in ways that promote heart health. Education for heart-healthy living: Managing your risk factors, choosing good nutrition, quitting smoking…education about heart-healthy living is a key element of cardiac rehab. Counseling to reduce stress: Stress hurts your heart. This part of rehab helps you identify and tackle everyday sources of stress. Cardiac Rehab is a Team Effort You don’t need to face heart disease alone. Cardiac rehab is a team effort. It’s a medically-supervised program in which you partner with your doctors, nurses, pharmacists — plus family and friends — to take charge of the choices, lifestyle and habits that affect your heart. What’s Next? You’re in the driver’s seat…but here’s what we suggest to get started: Ask your doctor if you are eligible for cardiac rehab. If you are eligible for cardiac rehab, register for a program. In consultation with your medical team, set some heart-health goals and create a cardiac rehab plan. Take an active role in your care to achieve your goals. Keep taking your medicines correctly.

TMT Or Stress Test It is very common to find the heart patients who have normal ECG. One must remember that the ECGs are taken at rest when the heart is beating at its lowest rate. In some of cases the patient would also agree that at the time of rest there is no pain in the chest, the angina symptoms would only come when they increase the heart rate, while doing some physical exertion like walking. In this condition,where we need a TMT test. The patients might gradually increase their heart rate, thus increasing the blood requirement of the heart muscles. Simultaneously ECG records are taken. Patients have to physically bring to bear for this test which uses a computerised machine. The continuous ECG monitoring during the exercise would reflect to the blood and oxygen deficit in the muscles of the heart during the exercise. TMT test is also called as Exercise Stress Test, Computerised Stress Test or simply Stress test. It is the very easy, popular and common test performed on heart patients to determine the severity of the heart disease. Taken at an interval, this test can also show the improvement or deterioration of patient’s angina. A negative TMT or Stress Test is declared when the patient can reach a certain heart rate without showing any ECG changes. This rate is known as target heart rate and it is also calculated by a formula (Target Heart Rate = 220 – age of patient). If this rate is reached by the patient without producing any ECG changes, though the TMT can be called negative, but it would not mean that the blockage is zero. It is meant only by the person performing the test probably has a blockage of less than 70%. A cardiac stress test (also referred to as a cardiac diagnostic test, cardiopulmonary exercise test, or abbreviated CPX test) is a cardiological test that measures a heart’s ability to respond to external stress in a controlled clinical environment. The stress response is induced by exercise or by drug stimulation. Cardiac stress tests compare the coronary circulation while the patient is at rest with the same patient’s circulation during maximum physical exertion, showing any abnormal blood flow to the myocardium (heart muscle tissue). The results can be interpreted as a reflection on the general physical condition of the test patient. This test can be used to diagnose coronary artery disease (also known as ischemic heart disease) and assess patient prognosis after a myocardial infarction (heart attack). The cardiac stress test is done with heart stimulation, either by exercise on a treadmill, pedalling a stationary exercise bicycle ergometer, or with intravenous pharmacological stimulation, with the patient connected to an electrocardiogram (ECG). People who cannot use their legs may exercise with a bicycle-like crank that they turn with their arms. The level of mechanical stress is progressively increased by adjusting the difficulty (steepness of the slope) and speed. The test administrator or attending physician examines the symptoms and blood pressure response. With use of ECG, the test is most commonly called a cardiac stress test but is known by other names, such as exercise testing, stress testing treadmills, exercise tolerance test, stress test or stress test ECG. A stress test may also use an echocardiogram (ultrasonic imaging of the heart) or a nuclear stress test (in which a radioisotope is injected into the bloodstream).

What is Cardiac Rehabilitation? What Does Cardiac Rehab Involve? Cardiac rehab doesn’t change your past, but it can help you improve your heart’s future. It’s a medically supervised program designed to help improve your cardiovascular health if you have experienced heart attack, heart failure, angioplasty or heart surgery. Think of cardiac rehab as three equally important parts: Exercise counseling and training: Exercise gets your heart pumping and your entire cardiovascular system working. You’ll learn how to get your body moving in ways that promote heart health. Education for heart-healthy living: Managing your risk factors, choosing good nutrition, quitting smoking…education about heart-healthy living is a key element of cardiac rehab. Counseling to reduce stress: Stress hurts your heart. This part of rehab helps you identify and tackle everyday sources of stress. Cardiac Rehab is a Team Effort You don’t need to face heart disease alone. Cardiac rehab is a team effort. It’s a medically-supervised program in which you partner with your doctors, nurses, pharmacists — plus family and friends — to take charge of the choices, lifestyle and habits that affect your heart. What’s Next? You’re in the driver’s seat…but here’s what we suggest to get started: Ask your doctor if you are eligible for cardiac rehab. If you are eligible for cardiac rehab, register for a program. In consultation with your medical team, set some heart-health goals and create a cardiac rehab plan. Take an active role in your care to achieve your goals. Keep taking your medicines correctly. Call 911 if you experience new or worsening symptoms.

What is Angiography ? A Coronary Angiogram is a procedure that uses X-ray imaging to see your heart’s blood vessels. Coronary angiograms are part of a general group of procedures known as heart catheterization.Heart catheterization procedures can both diagnose and treat heart and blood vessel conditions. A coronary angiogram, which can help diagnose heart conditions, is the most common type of heart catheterization procedure. During a coronary angiogram, a type of dye that’s visible by an X-ray machine is injected into the blood vessels of your heart. The X-ray machine rapidly takes a series of images (angiograms), offering a detailed look at the inside of your blood vessels. If necessary, your doctor can perform procedures such as an angioplasty during your coronary angiogram. What happens during Coronary Angiography? During the procedure, a long, thin and flexible tube called a catheter is inserted into a blood vessel in your groin or arm. Using X-ray images as a guide, the tip of the catheter is passed up to the heart and coronary arteries.A special type of dye called contrast medium is injected into the catheter and X-ray images (angiograms) are taken.The contrast medium is visible on the angiograms, showing the blood vessels that the fluid travels through. This clearly highlights any blood vessels that are narrowed or blocked.The procedure is usually carried out under local anaesthetic, so you will be awake while the procedure is carried out, but the area where the catheter is inserted will be numbed. After Coronary Angiography ? You will usually be able to leave hospital on the same day you have a coronary angiography after a period of rest and observation. Most people feel fine a day or so after having the procedure, although you may feel a bit tired afterwards and the wound site is likely to be tender for up to a week. Any bruising may last for several weeks. You will usually be advised to avoid certain activities, such as bathing, driving and lifting heavy objects, for a day or two after the procedure.While you are recovering, it’s important to look out for signs of any problems. You should seek immediate medical attention if swelling at the site of your wound gets worse, or if you experience excessive bleeding or circulation problems in your limbs.