Heart care


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Heart care

  1. 1. (http://www.armancare.com/heart_care.html)Interventional cardiac proceduresCoronary angiographyAngioplasty and stentingBalloon Valvuloplastypacemaker procedureShoulder ReplacementCardiothoracic and vascular surgery proceduresCoronary artery bypass surgery- link should open to detailsConscious off pump coronary artery bypass surgery
  2. 2. Valve repair and replacement surgeryThoracic and pulmonary surgeriesAdult and pediatric open heart surgeriesAngiography / Coronary Angiography Angiography Is a minimally invasive medical test that helps physiciansdiagnose and treat medical conditions.Angiography can be used tolook at arteries in many areas of the body, including the brain, neck(carotids), heart, aorta, chest, pulmonary circuit, kidneys,gastrointestinal tract, and limbs.Angiography uses one of three imaging technologies and, in somecases, a contrast material to produce pictures of major bloodvessels throughout the body.
  3. 3. It is is performed using:X-rays with cathetersComputed Tomography (CT)Magnetic Resonance Imaging (MRI)In catheter angiography, a thin plastic tube, called a catheter, isinserted into an artery through a small incision in the skin. Oncethe catheter is guided to the area being examined, a contrastmaterial is injected through the tube and images are capturedusing a small dose of ionizing radiation (X-rays).Coronary Angiography Itis done if a patient has symptoms of coronary arterydisease, an unexplained pain in your chest, jaw, neck or arm, acongenital heart disease or congestive heart failure.
  4. 4. During angiography, a small incision is made in the upper thigh inorder to gain access to the femoral artery. Next, a guide wire isinserted into the femoral artery and is threaded to the aorta. Acatheter is then inserted along the guide wire.Once the catheter reaches the aorta, a contrast dye is injected.When the dye flows from the aorta to the coronary arteries, an x-ray, or angiogram, is obtained. The image taken duringangiography will show if there is any blockage, aneurysms,narrowing or other abnormalities in the arteries.Following the angiography, the catheter and guide wire areremoved. If treatment is necessary, the physician can recommendappropriate therapy.Angioplasty and StentingDepending on the findings of the angiography, your doctor mayadvise you to undergo angioplasty/stenting or bypass surgery.
  5. 5. Both procedures restore the blood flow to the blood – deprivedareas of the heart thereby, eliminating or reducing the number ofepisodes of angina pain. The choice between angioplasty/stentingor bypass surgery for treatment of such blockages is made on thebasis of the extent and location of blockages in your coronaryarteries.What is balloon angioplasty and stenting During the procedure, you would be given a mild sedativeand some pain killers to ensure that you remain relaxed. Yourdoctor will insert a long, thin tube called a catheter, which has asmall balloon on its tip, directed to your blocked artery via eitheran artery in your leg or arm. The balloon is then inflated in yourartery, at the blockage site. This flattens or compresses the plaqueagainst your artery wall, thus opening up the path of blood flowthrough your artery. Depending on the location and nature of yourblockage, your doctor might decide to place a stent, which is ahollow metal tube that acts as a scaffold to keep the artery open.
  6. 6. In a small number of cases, a special catheter with a small,diamond tip is used to drill through hard narrowing with calciumthat is causing the blockage. This is called rotational artherectomy.What is a stent A stent is an expandable metallic tube which is crimped onto a thin balloon. A stent is implanted to support the artery andkeep the After the angioplasty, patient is required to stay in thehospital for 2 -3 days. And can resume full activity within a fewdays of returning home.Angioplasty is not a cure, but a treatment to reduce the effects ofcoronary artery disease. Following angioplasty, diet andmedications have to be strictly followed to reduce the risk ofrecurrences.
  7. 7. Cardiac rehabilitation Cardiac rehabilitation is a medically supervised programto help heart patients restore their normal life after treatment oftheir cardiac disease. Cardiac rehabilitation, when combined withmedicine and surgical treatments, can help you recover faster, feelbetter, and develop a healthier lifestyle. Cardiac rehabilitationoften begins in the hospital after a heart attack, heart surgery, orother heart treatment. Rehabilitation continues in an outpatientsetting after you leave the hospital.Coronary artery bypass grafting ( CABG ) The most effective treatment forCoronary Heart Disease(CAD) – a condition in which plaque (a substance made up of fat/cholesterol/ calcium) builds up inside the coronary arteries therebynarrowing them & affecting the regular flow of oxygen rich bloodto the heart. CABG significantly improves the chances of survival ofpatients who are at high risk.
  8. 8. Bypass surgery or CABG is usually performed with the heartstopped, thereby entailing the use of Heart Lung Machine. Thesurgery can also be performed on a beating heart, so known as ‘Off-Pump Surgery’. What happens during the procedure• Before the procedure, you will undergo some routine bloodtests, an ECG, a chest X-ray and an angiography. This will give yourdoctor a clear picture of your current health status.• In the operation theatre, you will be given generalanesthesia for a painless procedure. A heart-lung machine - referredto as a "pump" because it continues to mechanically pump oxygenand nutrients to the body during the surgery will ensure blood flowthrough your body while your heart is stopped and being operatedupon. A graft (a long piece of vein or an artery) will be taken fromyour leg or the inside of your chest wall or forearm and attached toone end of the graft will be attached to a coronary artery below
  9. 9. your blocked area. The procedure can take from 2 to 6 hours,depending on the number of bypasses needed.• Off-pump or beating-heart surgery: This is anothertechnique for performing bypass surgery. It reduces the need forlarge incisions or a heart-lung machine This procedure allowssurgery to be done on the still-beating heart using specialequipment to stabilize or quieten the area of the heart, thesurgeon is working on.• Minimally invasive surgery: In this procedure, a surgeonperforms coronary bypass through several smaller incisions in thechest. This technique is used only under certain conditions.Variations of minimally invasive surgery are called port-access orkeyhole surgery.What is coronary artery bypass graft ( CABG ) surgery Coronary artery bypass graft surgery is an open-heart
  10. 10. operation in which arteries or veins are taken from another part ofthe body to channel needed blood flow to the coronary arteriesDuring surgery these arteries or veins are connected directly to thecoronary arteries on the surface of the heart beyond the blockages.This way, blood can flow through them to bypass the narrowed orclosed points. CABG operations usually last from three to six hours,their duration depending on the number of vessels to be grafted.Each operation varies in complexity, so its duration can only beestimated. What is conscious off-pump coronary artery bypasssurgery (awake bypass surgery)Awake bypass surgery is a break through step in “Fast-track care “ofbypass surgery patients. Awake bypass surgery is the latestadvance where a patient undergoes bypass surgery while actuallyawake and can converse with the operating surgeon and his team.
  11. 11. How is it performed A new type of beating heart surgery which is performedwith epidural anesthesia, eliminating the need and risks ofgeneralanesthesia. The technique is a highly precisionbasedmethodology, which involves injection of micro doses of localanesthetizes only the chest region while the rest of the system isfully awake. This enables a painless bypass surgery and makes thesurgery sage for patients who are at high risk for generalanesthesia.Advantages of awake bypass surgery• Avoidance of tracheal intubation• Avoidance of Ventilation• Avoidance of cardiac depression due to general anesthesia
  12. 12. • Avoidance of ischemic events related to intubation• No dizziness, nausea• Reduced ICU stay and hospital stayValve replacement surgery / balloon valvotomy• Balloon valvotomy is a non-surgical procedure performedin the cardiac catheterization laboratory. A thin flexible tube isinserted through an artery in the groin or arm and threaded intothe heart. When the tube reaches the narrowed valve, a balloondevice located on the tip of the catheter is quickly inflated. Thisrelieves the obstructed valve.• During a valve repair surgery, parts of a stenotic valve thatare stiff or hardened may be cut and separated to help
  13. 13. them open wider. If a valve cant be repaired, it may be replacedwith a prosthetic (artificial) valve.• During valve repair or replacement surgery, thebreastbone is divided, the heart is stopped, and blood is sentthrough a heart-lung machine while the valve is being replaced. If medicines are not effective in controlling your symptomsof mitral valve stenosis or if your doctor determines that you needmore aggressive treatment, you may need surgery to repair orreplace your mitral valve. Valve surgery is common and usuallysuccessful. But a degree of risk is associated with this invasiveprocedure. There are generally three options: a balloon valvotomy,a closed (or open) commissurotomy surgery, or valve replacementsurgery.
  14. 14. Valve repair (balloon valvotomy) Balloon valvotomy (percutaneous mitral balloonvalvotomy) is the method of choice for treating mitral valvestenosis in select patients. A thin flexible tube (catheter) is insertedthrough an artery in the groin or arm and threaded into the heart.When the tube reaches the narrowed mitral valve, a balloonlocated on the tip of the catheter is quickly inflated. The balloon,pressing against the narrowed mitral valve leaflets, separates andstretches the valve opening and allows more blood to flowthrough the heart. This procedure does not require open-heartsurgery, so recovery is easier.A balloon valvotomy is usually recommended if you havesymptoms, moderate to severe stenosis, and most of your mitralvalve is a normal shape.A balloon valvotomy may also be used to treat people with mitral
  15. 15. valve stenosis who do not yet have symptoms (asymptomatic) ifthey have:• A higher risk of dangerous blood clots(thromboembolism). This includes people with an irregular heartrhythm called atrial fibrillation, as well as those who have had ablood clot before.• High blood pressure in the lungs ( pulmonaryhypertension ).• Mitral valves that are still in fairly good condition.Your doctor may recommend a balloon valvotomy if you areplanning to have another surgery (not on your heart), if you arepregnant, or if you are planning a pregnancy.People with signs of blood clots in the left atrium, widespreadcalcification of the mitral valve structures,
  16. 16. or moderate to severe mitral valve regurgitation are notconsidered good candidates for a balloon valvotomy.The mitral valve may narrow again (restenosis) after 10 to 20 years.Valve surgery Depending on the amount of damage to your mitralvalve, your doctor may recommend surgery to repair or replaceyour mitral valve. If the valve is damaged beyond repair, it will needto be replaced. Mitral valve surgery may be done as an open-heartsurgery, or a minimally invasive surgery.During open-heart surgery, your heartbeat is stopped, and you areplaced on a heart-lung machine to deliver blood to your body. Theheart-lung machine temporarily serves in place of your heart andlungs by mixing oxygen with the blood, removing carbon dioxidefrom the blood, and pumping the blood throughout your body.During minimally invasive surgery, your doctor makes asmaller incision than the incision made in open-heart surgery.
  17. 17. You may still be placed on a heart-lung machine. Valve repair orreplacement is similar for minimally invasive surgery and open-heart surgery.Valve repair In open commissurotomy, a surgeon removes calciumdeposits and other scar tissue from the mitral valve leaflets, whichopens the valve. This procedure is used for people who havesevere narrowing of the valve and are not good candidates forballoon valvotomy.Valve replacement The damaged heart valve is removed and replaced with anew valve. This is generally done when your mitral valve isdamaged beyond repair. With improved technology, mitral valvereplacement is an important surgical option. Some doctors believethat replacement mitral valves are now more durable.
  18. 18. Also, more of the original mitral valve and its support structure(such as the chordae tendineae) are preserved during valvereplacement. The long-term results of surgery are generally betterwhen more of the original mitral valve structure is preserved.Balloon mitral valvotomy Balloon valvotomy is used to increase the opening of anarrowed (stenotic) valve. It is used for:• select patients who have mitral valve stenosis withsymptoms• older patients who have aortic valve stenosis, but are notable to undergo surgery• some patients with pulmonic valve stenosis
  19. 19. This balloon valvotomy procedure can be performed on the mitral,tricuspid, aortic or pulmonary valves.How is a balloon valvotomy performed ? Balloon valvotomy is a non-surgical procedure performedin the cardiac catheterization laboratory by a cardiologist and aspecialized team of nurses and technicians.Long, slender tubes called catheters are first placed into bloodvessels in the groin and guided into the chambers of the heart. Thecardiologist then creates a tiny hole in the wall between the uppertwo chambers of the heart. This hole provides an opening for thecardiologist to access the left atrium with a special catheter thathas a balloon at the tip.The catheter is positioned so the balloon tip is directly inside thenarrowed valve. The balloon is inflated and deflated several timesto widen the valve opening.
  20. 20. Once the cardiologist has determined that the opening of thevalve has been widened enough, the balloon is deflated andremoved.During the procedure, the cardiologist may perform anechocardiogram (ultrasound of the heart) to get a better picture ofthe mitral valve.• Able to treat patients with thinner corneas• Reduced incidence of flap complications• Lower rate of dry eye syndromeWhat should I expect before the procedure ?• Most patients will need to have blood tests, a chest x-ray,electrocardiogram, and an echocardiogram before the procedure.These tests are usually scheduled the day before the procedure.
  21. 21. • Ask your doctor what medications should be taken on theday of your test.» If you are diabetic, ask your physician how to adjust yourmedications the day of your test.» Tell your doctor or nurse if you are taking any bloodthinning medications such as Coumadin (warfarin). An alternatemethod for thinning your blood may be prescribed a few daysbefore the procedure.• You will not be able to eat or drink after midnight theevening before the procedure.• Leave all valuables at home. If you normally weardentures, glasses or a hearing assist device, plan to wear themduring the procedure to help with communication.• Tell your doctor and/or nurses if you have any allergies.
  22. 22. How long does the procedure last ? The procedure lasts about 1 hour, but the preparation andrecovery time add several hours. Please plan on staying at TheCleveland Clinic all day for the procedure and remaining in thehospital overnight. Patients usually go home the day after theballoon valvotomy procedure. When you are able to return home,arrange for a companion to bring you home.What should I expect during the recovery ?• You will need to lay flat for about 6 hours after thecatheter has been removed from your groin to prevent bleeding.You will have a tight bulky dressing on your groin area while youare resting in bed. Do not bend your legs during this time toprevent bleeding. A sheet may be placed across your legs toremind you to keep them straight. Your nurse will tell you whenyou may sit up and get out of bed.
  23. 23. • You should not eat anything until the catheter has beenremoved from your groin.• Notify your nurse immediately if you have a fever, chestpain, swelling or pain in your groin or leg, or bleeding at your groinsite.• You will have an echocardiogram the morning after yourprocedure.• Medications may be prescribed. Ask your doctor if it is safeto continue taking the medications you took prior to theprocedure.• Once you have recovered from the procedure and havetalked to your doctor about your follow-up appointments andcare, you will be able to go home.
  24. 24. • You will be able to return to most of your normal activitiesthe day after the procedure. Ask your doctor when it is safe todrive, return to work or begin or continue an exercise program.• Once your cardiologist has successfully opened thenarrowed mitral valve, your symptoms of valve disease shoulddecrease or disappear completely.What is medical tourism? Medical tourism, also known as health tourism or health travel, isa term that describes travelling to a foreign country for medical,dental, or cosmetic treatment. It involves the benefit of costeffective treatment, private medical care, in collaboration with thetourism industry. The concept of medical tourism is fast growing inIndia and people from different part of the world are choosingIndia as their desired destination.
  25. 25. Why Choose India?Medical tourism is a rapidly growing sector in India and millions ofmedical tourists from all over the world have come here toexperience a world-class healthcare service.In 2010, about 600,000 patients travelled to India from over 30countries for treatment, including the USA, Canada, UK, Russia, theMiddle East and Africa.According to a study by the Confederation of Indian Industry (CII)on healthcare, after software, the medical tourism industry ispoised to be the next big success story in India. It has predictedthat the industry will grow to earn additional revenue of $2.3billion by 2012 and will soon account for a major share of thecountry’s revenue.
  26. 26. There are several reasons behind this tremendous growth:Patients come to India to get specialized treatments not availablein their home country. Indian hospitals excel in performingcomplex cardiac surgeries, kidney transplants, bone marrowtransplants, orthopedic surgeries, infertility treatments amongsttheir wide repertoire.India provides world-class quality treatments at a fraction of theprice of developed countries. The cost of medical treatment inIndia is generally one tenth of western countries and among thecheapest in Asia.India has state of the art medical institutes and hospitals ofinternational standards with highly qualified medical professionals.These centers are backed by high quality equipment andtechnology. This fusion of highly qualifiedstaff assisted by the latestequipment gives India the edge over other countries.
  27. 27. With hospitals and clinics in every region including urban, semi-urban, or rural parts of the country, India has ample choice interms of preferred destinations.In countries such as Canada and the UK, patients almost alwayshave to wait weeks and sometimes months to avail of medicaltreatments. In India the consultations with the doctors are promptand patients receive a turnaround to their treatment plan at aquicker pace.As English is a commonly spoken language in India, the patient willbe comfortable communicating with the doctors.Medical tourists find that the cost of their treatment (including thereturn airfare, holiday and accommodation) leaves them with atotal bill substantially less than they would have spent just onhaving the procedure in the UK.
  28. 28. Why Arman There are several concerns that flicker in the minds of theforeigners who come for treatment to India, particularly for firsttime fliers. The first among them is which hospital to choose fortheir treatment.India is flooded with hospitals, medical centers and hotels whichhave their websites that attract the foreign patients. This makesthem even more confused and the complexity of decision makingbecomes a challenging task.We, at Arman can address all these concerns and issues by actingas intermediary with hospitals, clinics, surgeons, hotels.Arman is a healthcare facilitator that has painstakingly broughttogether highly qualified professionals and hospitals of repute andhealth care providers.
  29. 29. We take the responsibility of screening the hospitals by checkingtheir track record, accreditations, associations and have partneredwith the best internationally accredited hospitals in India.Arman update and monitor our network of hospitals on a regularbasis and maintain a database on the hospital’s certifications, typeof facilities and other factors critical in choosing a medical center.Arman also negotiate a lower price from the hospital which foreignpatients would not get by directly approaching the hospitals Thishelps the patient to save a lot on the medical procedure costsWe provide assistance with logistics, documentations, permits andother travel arrangements required for medical tourism.Our coordinators are highly trained to foresee every need of thepatient and make the entire process hassle free from start to finish.
  30. 30. They help the patient plan his medical procedures before leavinghome, and schedules all his appointments, surgery, treatmentsand plans for recuperation.This in turn helps the patient to choose the hospital according tohis convenience and also get a clear picture of the cost oftreatment, accommodation beforehand that helps them toarrange their finance.We are aware that a lot of trust is put in our hands and ensure thatthis trust is well placed by serving each patient individually withcare and comfort.How We WorkPatient query received by the patient himself or his doctor/hospital.
  31. 31. This query along with medical reports is forwarded to theconcerned hospitals to get expert opinionsAfter the hospitals respond, we create a package for the patientwhich includes recommendation on the treatments, duration ofstay, and the costs involved.The patient reviews the various options presented to him andmakes a decision based on budget and the line of treatmentrecommended by the doctors. Occasionally, a patient may clarifyhis concerns or questions he may have regarding the treatmentwith the doctor by telephone.In liaison with the patients, Arman representatives will make priorbookings with the hospital, airlines, hotels.Patient travels and checks into hospital to start the treatment. Weprovide assistance through out your stay in the hospital which
  32. 32. include pre and post opeartive care.Once fit and able to travel, the patient if wishes can enjoy the vasttourist destinations within India before returning to their homecountry fully rejuvenated. (at an additionalcost)(ebranding/mum/ts/19)Arman Health Care FacilitatorsOUR OFFICE IN INDIA422, Bonanza, B Wing,Sahar Plaza Complex, Next to KohinoorHotel,Andheri Kurla Road, Andheri East Mumbai India 4000059.Contact: land line No: ( 022-28387433 )Email :enquiry@armancare.com
  33. 33. OUR OFFICE IN CONGOArman Health care Facilitators,Gallery Saint-Pierre, 36 localUtexAfrica Advanced ,AV 374 VolonelMondjiba,Kinshasa /Ngaliema,DRC Mobile : +243998290384OUR OFFICE IN KENYAArman Health Care Facilitators C/O Doctor Pharma Kenya LimitedVision Tower, Muthithi Road,Westlands, Nairobi,Kenya.Contact: Telefax:(+254)722330329Email : doctorpharmamt@gmail.comWeb:- http://www.armancare.com/heart_care.html ebrandingindia_s21