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All You Need to Know About Open Heart Surgery

Open heart surgery is performed when the coronary arteries supplying blood to the heart are blocked and is the gold standard treatment for the same. The condition arising due to blockage of coronary artery is known as coronary artery disease. Open heart surgery is done to regulate the flow of blood through the arteries and prevent damage to the heart. In the procedure, blood vessels from other parts of the body are used to create a bypass. Generally, two to four coronary arteries are grafted for regulating blood flow to the heart.

There are three types of bypass surgeries depending on the number of bypasses done, namely double bypass, triple bypass, and the quadruple bypass.

Open Heart Surgery – Open heart surgery is considered only if the blockage is such that placing the stent is not feasible. Also, if there is severe coronary disease in the left main artery or in multiple arteries and there is high risk of heart damage. To check the exact blockage scenario cardiac surgeons advice on having a complete testing done. An angiogram is used for checking the severity of coronary disease. The other tests done before and after the surgery include electrocardiogram (EKG), blood tests and specific dietary instructions.

Open Heart Surgery

Types of Open Heart Surgeries

  • On Pump Open heart surgery

During the on pump open heart surgery the surgery is performed under general anesthesia while keeping the patient on ventilator support. The primary step in the surgery is harvesting the blood vessels. Generally, the saphenous vein in the leg is used as it is long enough to create multiple grafts. Alternatively, if it cannot be used then vessels from the arm can be used. After the saphenous vein work is done, the chest is opened by making an incision along the breastbone. The surgeon cuts the sternum to gain access to the heart.

In traditional or off-pump CABG procedure, the heart needs to be stopped using potassium so that the surgeon does not have to perform the surgery on a beating heart. The blood circulation is kept on with the help of a heart-lung machine and the ventilator is switched off. The machine then does the work of the heart as well as the lungs. The surgeon either removes the existing blood vessel and replaces the same to remove the blockage or reroutes the blood around the blockage. There could be one or more grafts to be performed. Once the grafting is completed the heart is restarted. The sternum is placed in its original position and closed with the help of a surgical wire. The surgical wire helps in providing strength to the bone for healing. Lastly, the surgeon closes the incision.

On pump, surgery is recommended for unstable patients. The surgeon performs the surgery on a still heart so the process is quicker and even the bleeding is minimal. Alternatively, the cons include inflammation/ clotting after surgery, transfusion and fluid retention. Though after on-pump surgery the risk of stroke does increase.

  • Off Pump Open heart surgery

The off-pump surgery is very much similar to on-pump except that the blood flow through the body is maintained by the heart only and not the heart-lung machine as in on-pump surgery. The area to be grafted is held with the help of surgical instruments while the heart keeps pumping. This surgery is done on tentatively 20% of the CABG patients undergoing the surgery for the first time.

This surgery is less expensive surgery compared to on pump and it also reduces the risk of stroke. Also, blood loss and transfusions are less compared to on pump. The hospital stay required is also less. 70% of the patients are not recommended to do the surgery due to the condition. The surgery is not recommended for unstable patients.

Recovery
The recovery period includes staying in Intensive care unit for 24 hours. The chest tubes are removed post 48 hours and then the patient is shifted out of ICU. Once the patient is awake the breathing tubes are removed so that the patient can breathe on his/ her own. Though supplemental oxygen may be given through the nose to help with breathing. The patient will be monitored closely and if he/she is unable to breathe, the breathing tube might be inserted again. Once the patient starts breathing on his/her own, swift rehabilitation steps are put into place. This includes sitting up on the edge of the bed, walking while taking care of the wound and preventing pain, etc.

Life Expectancy
The life expectancy has greatly increased over the years up to 98% people undergoing the surgery can easily lead a normal life as that of the others who haven’t undergone any surgery.

” Vydehi Institute of Cardiac Sciences is a well equipped super speciality centre located in Vydehi Hospital designed to serve your hearts needs. It is equipped to treat all cardiac, cardiothoracic and vascular cases.  It uses all the latest equipment and technology coupled with the years of experience in its faculty.”

*Sourced from the Internet

Hypertrophic Cardiomyopathy – Heart Attack at Young Age

Hypertrophic cardiomyopathy (HCM) is condition that is caused due to abnormal thickening of the myocardium or heart muscle. As a result the heart struggles in pumping blood and ultimately leads to a heart attack. This is not a common heart condition and hence this condition many a times goes unnoticed. Furthermore, some people who suffer from it might or might not experience any symptoms and are able to live routine normal lives. Only a few might experience symptoms like chest pain, issues with the heart’s electrical system , shortness of breath leading to abnormal heart rhythms of dangerous nature.

Heart Attack at Young Age

CAUSES & RISK FACTORS
Thickening of the heart muscle is a condition which is genetic. It has been found that people with this condition do have their heart muscle cells abnormally arranged, thus causing arrhythmia in them.
Well, as the condition is a hereditary condition there is almost over 50% chance that a child may inherit it from the parent or first degree relative like siblings and hence a screening is advisable if anyone in the family is having the condition.

SYMPTOMS
Not everybody suffering from the condition experiences symptoms but the ones who do may experience the following –
1. Chest pain particularly while exercising
2. Palpitations of rapid pounding heart beats
3. Shortness of breath more during exercising
4. Fainting particularly after exertion or exercise
5. Heart murmur detectable by the doctor

COMPLICATIONS
Hypertrophic Cardiomyopathy (HCM) can cause serious heart complications resulting in a life-threatening situation and hence it’s wise to act fast as far as treatment is concerned.
Resulting Conditions
Sudden Death – People suffering from the condition are at a high risk of suffering from a cardiac death due to Ventricular Fibrillation and Ventricular tachycardia, though the chances are extremely rare. It usually affects people at a younger age much below 30 but can occur in all ages.

Atrial Fibrillation – Due to the abnormal structure of the hear cells or thickened muscle it can affect the heart’s electrical system causing irregular heart-beats.

Mitral Valve Problems – Due to the thickened heart muscle, the space for blood flow is limited and hence it could cause the blood to rush or move forcefully into the heart. As a result, the hearts left and right ventricle will not close properly further causing the blood to flow in the reverse direction into the left atrium and worsening the symptoms.

Dilated Cardiomyopathy – This condition can occur in a chunk of people due to the weakening of the heart muscle after it thickens. It can further enlarge the ventricle and decrease the pumping ability.

Heart Failure – Thickening can sometimes lead to making the heart muscle stiff thus avoiding any sort of blood accumulation into it and further as the heart is not able to pump blood, it can cause heart failure.

Prevention
As the cause of the condition primarily is genetic, it can’t be prevented but taking care and carrying out procedures like cardioverter-defibrillator transplant can help you avoid risks like sudden death. Further, the symptoms clearly pinpoint to the fact that when doing strenuous exercise or exertions these symptoms pop up, hence it’s advisable to get your heart checked if someone in the family is having this condition and avoid participating in exercises and sports competitions which can cause exertion to the body.

Vydehi Institute of Cardiac Sciences is a well equipped super specialty center located in Vydehi Hospital designed to serve your hearts needs. It is equipped to treat all cardiac, cardiothoracic and vascular cases.  It uses all the latest equipment and technology coupled with the years of experience in its faculty.  All surgeries conducted at the department have been successful resulting in a 100% success rate.