Guide on Heart Disease

Which is the most important organ of our body? The heart or the brain? The debate rages.

While some like to believe that it is the brain that is the most important part of the body as it administers the entire system, the brain too needs blood to be alive and active, and it is the heart that pumps blood to the brain!

Today, we throw light on this ever so important organ that works relentlessly for us to stay alive and healthy.

The heart is nothing but a mass of muscle that pumps blood throughout the body. It is roughly the size of a large fist, and weighs no more than 10 to 12 ounces in men and 8 to 10 ounces in women.

This powerhouse beats approximately 72 times(1) a minute and pumps the blood that carries the vital nutrients that our body needs to function, while also removing the waste products, carbon-di-oxide, and toxins we do not need.

For instance, the brain needs oxygen and glucose, without which we may lose consciousness. Our muscles need oxygen, glucose and also amino acids, apart from the right ratio of calcium, sodium, and potassium salts to be able to contract normally.

Likewise the glands need a sufficient supply of raw material to manufacture specific secretions. It is the heart that provides these nutrients to various parts of the body via blood. Like all other muscles in the body, the heart too contracts and expands. Each time it contracts, it does so with all its force.

To better understand how the heart works, it is necessary to understand its anatomy.

• The human heart is divided into two separate pumping systems - the left side and the right side.
• It is the right side of the heart that received oxygen deficient blood from the veins and pumps it into the lungs, where the carbon dioxide is removed and the blood is enriched with oxygen.
• The left side of the heart receives oxygen-rich blood from the lungs and pumps it through the arteries to the rest of the human body.
• The human heart has 4 separate chambers that pump blood. Two of them are on the right side, while two are on the left.

It is the right atrium that receives oxygen poor blood from the body and pumps it into the right ventricle via the tricuspid valve. The right ventricle, then pumps the blood to the lungs via the pulmonary valve. The left atrium kicks into action and receives the oxygenated blood from the lungs and pumps it into the left ventricle via the mitral valve. This blood flows through the aortic valve to the rest of the body.

The right and left atria are smaller chambers that pump blood into the ventricles and the left and right ventricles are stronger pumps. It is the left ventricle that is the strongest and pumps blood out to the entire body. When the heart functions normally, all the four chambers work in unison in a continuous and coordinated effort to ensure that oxygen-rich blood circulates throughout your body. The human heart has its own electrical system that coordinates the work of the heart chambers also referred to as the heart rhythm and also controls the frequency of beats.

The ventricles and atria work together, contracting and relaxing alternately in order to pump blood through the heart. The heart beat is triggered by electrical impulses that are generated by the electrical system of the heart.

The electrical impulse starts in a small bundle of cells known as sinoatrial node that is seated in the right atrium. This node is also known as the heart’s natural pacemaker. The electrical activity triggered by the impulse spreads through the walls of the atria and makes them contract.

A cluster of cells located in the center of the heart right between the ventricles and atria called as the atrioventricular node(2) acts like a gate that slows down the electrical signal before it enters the ventricles. It is this delay that gives the atria time to contract before the ventricles contract. His-Purkinje a pathway of fibers sends the impulse to the walls of the ventricles to make them contract.

At rest, the normal heart beats anything between 50 to 99 times a minute and pumps out about 2000 gallons of blood(3) a day. Exercise, fever, and even emotions can cause the heart to beat faster and in some cases well over 100 beats(4) a minute.
When the heart begins to beat abnormally, it struggles to pump blood, and this can cause various heart diseases. Thickening of the wall with age and due to blood cholesterol may also lead to a heart disease.

The heart is like any other organ or muscle in the body and requires adequate blood supply to be able to pump blood to the rest of the body. The heart not just pumps blood to the whole body, but also to itself via coronary arteries that originate from the base of the aorta and branch out at the surface of the heart. When these coronary arteries narrow, it can make it hard for adequate blood to reach the heart. This can cause the muscles of the heart to ache. If the arteries continue to narrow, it will lead to stress to the heart and provoke symptoms such as chest pain, shortness of breath and pressure to the shoulders, arms and beck due to ASHD- atherosclerotic heart disease or CAD - coronary artery disease(5).

In short, heart disease is an umbrella term that refers to any type of disorder that can affect the normal functioning of the heart. This can include cardiovascular diseases, coronary heart diseases, valvular diseases, cardiomyopathy, and even heart infections.

What causes coronary heart disease?

According to research, coronary heart diseases start when certain factors damage or rupture the inner layers of the coronary arteries. These factors are:

• Smoking
• High blood pressure
• High levels of cholesterol and certain fats in the blood
• High sugar levels due to diabetes
• Blood vessel inflammation

Plaque may begin to build up where the arteries of the heart are damaged. This buildup may start as early as in childhood. Over time this plaque may harden and narrow the coronary arteries and reduce the flow of oxygenated blood to the heart. This causes chest pain and discomfort medically known as angina.

When one of the coronary arteries in the heart becomes completely blocked -- usually due to a rupture in plaque buildup that causes a blood clot to form -- blood supply to a certain part of the heart may be lost. This leads to that piece of the heart muscle to die. This is referred to as heart attack(6) or myocardial infarction (myo=muscle + cardia=heart + infarction= tissue death).

Heart attack claims thousands of lives worldwide and it is caused by the death of a part of the heart muscle, which in turn is triggered by loss of blood flow. The blood flow is generally cut off when an artery carrying blood to the heart is clogged by a blood clot. The event is also known as cardiac infarction, coronary thrombosis and myocardial infarction. It is however not the same as a cardiac arrest. A heart attack may lead to cardiac arrest in which the heart stops pumping blood as it does normally.

How Does a Heart Attack Happen?

The muscles in your heart require a constant supply of blood enriched with oxygen to function normally. The coronary arteries in body supply the heart with this vital blood supply. If you develop coronary artery disease, then these arteries get narrow and blood flow is affected adversely. Over time, plaque develops inside artery walls and accumulation of substances like proteins, inflammatory cells and calcium may make the situation graver. When the plaque’s outer shell cracks, blood clots may form and it may block the artery eventually. This starves heart muscle of oxygen and muscle cells in the heart die – leading to serious damages.

Heart Attack Signs and Symptoms

Top symptoms of heart attack are:

• A feeling of pressure, pain, tightness in chest and it may extend to neck or back.
• Nausea
• Vomiting
• Dizziness
• Shortness of breath
• Feeling awful, overall
• Cold sweat

The pain may be constant or it may fluctuate. The signs may last for as long as 30 minutes. In some cases, people may get a heart attack without having any of these symptoms and it is called a silent heart attack. It is seen more in people with diabetes.

How to Diagnose Heart Attack Properly?

A specific series of medical tests are carried out to diagnose cases of heart attack. These are:

ECG/ electrocardiogram- It is carried out to reveal the extent of damage that has affected heart muscles. It also monitors heart rate along with rhythm.

Blood tests- Blood tests are carried out to find out heart muscle damage.

Echocardiography- Echocardiography is an advanced clinical imaging test carried out after a heart attack for figuring out pumping state of the heart. The test can also reveal if any heart part has received damage or not.

Cardiac catheterization- Cardiac catheterization is used to let the doctor determine the best way to treat arterial blockage.

Heart Attack Treatment

For treating cases of heart attack, timing is as vital as is the method itself! Getting the affected person hospitalized makes things easier for the doctors.

• CPR-If the person coping with heart attack stops breathing- CPR or cardio-pulmonary resuscitation is administered on the spot.
• Medications- The medications are given to prevent blood clots or break one that has developed. Aspirin is given to thwart blood clots. Thrombolytic therapy is also administered to dissolve existing blood clots.
• Procedures like angioplasty may be carried out in some cases. In some instances, a bypass surgery (16) may be carried out on the victim. However, this surgery is carried out a few days after the attack.

However, you should remember undergoing surgical procedures like angioplasty do not guarantee you will not have another heart attack in the future.

How to Prevent Heart Attack?

It is not too hard to reduce your chance of getting a heart attack. You need to make some vital diet and lifestyle related changes for that. These include:

• Healthy eating habits- It is best if you use plenty of green vegetables and fruits in your diet. Eating lean meat and fish can also be ideal.
• Stop eating fast food- Eating processed and fried foods can pave way to heart attack. It is ideal that you reduce eating junk and sugary foods as far as possible. It is also advisable to evade eating foods rich in trans-fat.
• Relax and unwind- Stress is a major factor leading to treat ailments and heart attack too. Find ways to bust stress both at both your workplace and home.
• Cut down smoking and boozing- To keep heart attack risk at bay, reduce smoking and bring down alcohol consumption.
• Check blood sugar level- People with elevated blood sugar levels are more prone to heart attack than those with normal levels. So, keeping a tab on blood sugar is necessary.

Are the symptoms of heart attack different for men and women?

A heart attack like you already know is a condition in which blood, which flow to the heart is hampered and blocked. The heart does not get oxygen rich blood and a section of the heart muscle dies. Until and unless the blood flow is restored quickly, the heart muscles get affected. Due to lack of blood supply, the heart tissues die. The muscles in the heart need oxygen-rich blood with constant supply for keeping the heart nourished. It is the coronary artery which provides the heart with this kind of critical blood supply. For people who suffer from coronary artery disease, their arteries become narrow and hence blood flow is hampered. Plaques in different sizes are built inside the arteries. These are formed from build-up of calcium, inflammatory cells, proteins, fatty matter etc. In case of hard plaques, there is crack in the outer shell and blood clots are formed around the plaque. When the blood clot blocks the artery, the heart muscles do not receive oxygen. Within a very short span of time, the heart muscle cells die leading to permanent damage.

Heart attack is a leading cause of death for both men and women. In the US, it is the leading killer (66). It is quite surprising to know that the symptoms of heart attack vary greatly for men and women. Though the early symptoms might be the same in both, the advanced symptoms vary for men and women.

• Heart Attack Symptoms in Women

The symptoms of heart attack in women are completely different from that of men. In fact, it has been found that many women did not even feel chest pain during the attack. For 80% women, at least one symptom started appearing almost a month ago of the heart attack (67). Mentioned below are some symptoms of heart attack in women:

1. Lightheadedness
2. Exceptional fatigue continuing for several days or severe fatigue suddenly
3. Anxiety
4. Sleep disturbances
5. Gas-like pain or indigestion
6. Shortness of breath
7. Pain in throat, upper back or shoulder
8. Pain or pressure in the center chest area, which goes to the arm
9. Jaw pain or pain that extends to the jaw line

• Heart Attack Symptoms in Men

The chances of heart attacks are more in men when compared to that of women. If there is a history of heart disease, high blood pressure, smoking, high cholesterol levels, obesity and other risk factors, the person has higher risks of heart attack. Some of the symptoms of heart attacks in men include:

1. Discomfort or pain in upper body part. The discomfort can extend to left shoulders, arms, neck, back, stomach, jaw area etc.
2. A numb and standard chest pain with a kind of squeezing sensation. The sensation might come and go or remain constant and severe.
3. Stomach discomfort with a feeling of indigestion
4. Irregular or rapid heartbeat
5. Dizziness or sense of passing out
6. Shortness of breath, even while resting
7. Cold sweat

Each heart attack is different from the other. All the symptoms might not be applicable for all. If some of the symptoms match, be alert and take immediate steps.

What to do in case of heart attack?

Attending to patients suffering from a heart attack is important and that can save his/her life. The first thing that needs to be done is call for an ambulance and shift the patient to the hospital at the earliest. Medical professionals often start treatment on the patient right on the way to hospital. There are instruments for reviving a person, in case the heart stops working. If you are the patient, ask help from someone so that you can be taken to the hospital.

Acting quickly is important in tackling a patient with heart attack. It can save lives for sure. As soon as the symptoms of heart attack appear, you can provide medications for clot-bursting and artery opening. This can help in preventing severe heart attack. But you have to know the medicines and be sure that it is case of heart attack only. Longer it takes for the treatment, lower are the chances of the patient making it. Even if the patient survives, the heart becomes damaged greatly.

• Things that can be done before the paramedics arrive

1. The most important thing that needs to be done is to ensure that the person suffering from the attack should be kept calm and quiet. He should be made to lie down or sit down, whichever position seems comfortable for him.
2. If the patient is not allergic to aspirin, give him a baby aspirin and let him chew and swallow the same
3. In case the person seems to stop breathing, start CRP right away. However, you must be trained in CRP so that it can be implemented in the right manner.

Risk factors for heart disease that you can’t change:

Age: The risk of contracting heart diseases increases as you age. The risk begins to climb for men at about the age of 45, when 10 out of every 1000 men tend to develop signs of heart diseases. By the time they turn 55, the risk doubles and every 21 out of 1000 men can contract a heart condition. This continues to rise until at around 85, 74 of every 1000 men report having a cardiovascular condition (7). The risk of cardiovascular diseases increases with age for women too. However, the trend kicks in about 10 years later than seen in men and more so with the onset of menopause.

Gender: According to studies, men tend to develop cardiovascular diseases more than women, but this difference thins out after women undergo menopause. It is very important to understand that women, too, develop heart diseases and suffer from heart attacks contrary to common belief. It has been established that the number one killer of the women folk in the U.S is cardiovascular disease.

Family History of Heart Diseases: This is something you have absolutely no control of just as with gender and aging. Your risk of heart disease doubles if a parent or sibling developed a heart ailment early in life. Likewise, certain racial minorities such as African Americans and Hispanic Americans have a higher risk of heart disease risk factors such as hypertension, obesity and diabetes.

While no one can control the risks associated with age, gender, and family history, there are many risk factors that you do have reasonable control over. The more risk factors you manage to eliminate or reduce, the better are your chances oat preventing and controlling cardiovascular diseases. Read on to know more!

Risk factors for heart disease that you can do something about:

As mentioned earlier, when it comes to your heart health and general wellbeing, there are a few of risk factors you cannot control. While it may not be possible to change your genetic pre-disposition and family history, you can certainly reduce your risk for heart diseases by making a few changes to your lifestyle.

Making these simple changes, can help you control as well as lower your overall risk for heart disease, and make the many uncontrollable factors less of a threat. Listed below are a few risk factors you can control with some willpower and perseverance.

1.Unhealthy Diet

Any doctor will tell you that the best way to lower your risk of heart disease is to make changes to your diet. Start by minimizing your intake of saturated fat, sodium and cholesterol. This will instantly make your diet more heart friendly and also help you shed a few pounds, which in turn will also decrease your risk. Ditch the fries and include lean meats and fish while doubling your fiber intake by consuming more veggies and fruits.

2.Smoking

There isa multitude of reasons why you should quit smoking. But, the one that tops the list, is it reduces your risk of heart disease. According to the CDC(8), smoking is the culprit behind one in three deaths due to cardiovascular disease. When you smoke, your heart lungs, and blood vessels are exposed to carbon monoxide, nicotine and several other harmful substances that cause the blood vessels to constrict, elevate blood pressure, and make cholesterol levels climb – all of which can contribute to causing heart diseases. That is not all. Smoking also deprives the body’s tissues oxygen, allows plaque to grow in the arteries, and damages the inner lining of the blood vessels of the heart that makes it more likely for blood clots to form. Get the help that you may need and quit smoking as soon as you can.

3. Being Overweight or Obese

Carrying around way too much body weight not only makes it hard to control high blood pressure, high cholesterol levels, and diabetes but also puts a strain on your heart. According to studies middle aged women who are overweight are 32 percent (9) more likely to develop cardiovascular diseases sooner than others. Being obese is a lot more dangerous and increases the risk of contracting heart diseases by 46 percent in men and 64 percent in women folk.

Research also indicates that a person’s waist size can be a predictor of cardiovascular risk. Women must try and keep their waist size well less than 35 inches while men should aim for 40 (10).

Take at least three 15- minute brisk walks to improve your heart health. If you are new to exercise and have lived a sedentary lifestyle, you can start slow, and find an activity that raises your heart beat for at least 30 minutes a day. Your doctor will be able to guide you on the best exercise options based on your current health and physical fitness. It goes without saying that the two best strategies to maintain good heart health are- being physically active and eating a heart friendly diet.

4. High Stress Levels

Mental health can also have a rather large impact on your physical health. Prolonged periods of having to deal with mental issues can put a lot of stress on your heart. It is therefore important that you take steps to reduce your stress levels. You may indulge in stress relief methods such as heading out on a vacation, yoga, meditation, watching a movie, or simply reading a book!

5. High Cholesterol Levels and High Blood Pressure

Stress, and unhealthy eating habits can lead to high levels of LDL cholesterol, which in turn can increase the build-up of plaque in the arteries of the heart. It is also unhealthy to have abysmally low levels of HDL, or “good” cholesterol. It is therefore important to keep a check on your cholesterol levels in order to ward off heart diseases.

Likewise, if your blood pressure is way too high, you stand the chance of contracting heart diseases. A BP above 140/90 mmHg(11) for long periods of time can cause extensive damage to the blood vessels. This will lead to the formation of cholesterol plaques and also cause the artery walls to become thicker, stiffer and less flexible to expand and contract with changes in activity and physical demands.

6. Avoiding doctor visits

As you age, it is important to pay regular visits to the doctor to ensure you are doing everything you possibly can to keep your heart disease risk factors in check. Be sure to have your doctor write out a blood work to check your blood sugar levels, C-Reactive protein levels, cholesterol, and blood pressure during these visits. By controlling these factors you can reduce your heart disease risk to a great extent and make those many other risk factors you cannot control as minimized as can be.

Diagnosis of heart diseases at the right time can help in curing the ailment to quite an extent. However, in most cases, the diagnosis happens at a later stage leading to various kinds of complications and problems.

Different Tests to Diagnose All kinds of Heart Disease

Different kinds of tests and investigations are done to diagnose heart diseases. Some of them are as follows:

• Electrocardiogram (ECG) – With the help of an electrocardiogram (ECG), the heart’s electrical impulses can be read. Wire leads are placed on the arms, chest and legs of the patient and the leads are attached to the ECG machine. The electric impulses are recorded and these can help in detecting irregularities in the rhythm of the heart beats. Abnormal heart rhythms and heart attack can be diagnosed with an electrocardiogram (54).
• Blood Tests – Heart diseases can be diagnosed with the help of various kinds of blood tests as well. Initially the cardiologist will prescribe doing various kinds of cholesterol tests for determining the level of risk of heart disease and heart attack. The tests which are done include total cholesterol test, high density lipoprotein (HDL), low density lipoprotein (LDL) and triglycerides.If a patient has already suffered a heart attack and there has been damage in the heart muscles, different kind of blood test is done to understand the extent of damage caused. When heart muscles are damaged due to heart attack, there is release of different substances in the blood. The levels of the harmful substances are visible via the blood test. The most common blood test in this regard is checking levels of troponin in the blood (55). Blood fats and mineral levels are also tested after an attack.
• Chest X-Ray – Chest X-ray is probably the first test done for diagnosing any kind of health problem, including heart ailments. Chest X-ray reveals the image of organs and structure inside the chest like the lungs, heart and blood vessels. In case there is heart failure, clear signs are displayed in the X-ray.
• Holter monitoring – Holter monitoring is done for monitoring the heart over a long period of time, say 24 to 72 hours. The patient needs to wear a Holter monitor device. Continuous ECG readings are recorded in the machine. This kind of monitoring is required for detecting irregularities in the heart rhythm (56). A general ECG might not be able to detect these irregularities much.
• Echocardiogram – Also known as heart ultrasound, this is a common test for diagnosing heart ailments including heart attack and heart failure. Ultrasound is used for getting images of the heart. The probe used for the test is placed on the chest generally. However, in some cases, it needs to be passed down through the oesophagus as well. This test helps in detecting problems in the heart’s valves and chambers. It can also measure the strength of the heart with which it pumps blood. Echocardiogram is done before and after exercise to understand the blood supply and flow in both conditions (57).
• Stress test – For diagnosing heart problems, it is important to check the functioning of the organ when one does some kind of strenuous activity. During the stress test, the patient is asked to walk fast or run on a treadmill or ride a stationary bicycle for some while. The body’s reaction to stress is monitored with the test. Usually during these activities, the heart rate increases significantly and functioning of the heart can be understood in the best manner. However, all patients might not be able to take the stress test. The cardiologist should be able to understand the patient’s condition and recommend the test likewise.
• Cardiac catheterization – In this diagnostic test, a sheath (short tube) is inserted into an artery or vein in the arm or in the groin area. A guided catheter is then placed into the sheath. With the help of X-ray images on a monitor, the doctor will guide the catheter inside the artery till it reaches the heart. Measurement of the pressure inside the heart chamber can be done and then the dye is injected. When the dye is injected it can be seen in the X-ray on the monitor. If the dye flows smoothly, it indicates that there are no blockages in the valves, blood vessels and arteries. In case there are blockages, the dye is not able to pass and the abnormality can be detected (58).
• (CT) scan – Multiple, detailed X-ray images are used in a computed tomography (CT) scan. Cross-sectional image of the heart is created in a CT scan. There are actually different kinds of CT scans done for diagnosing heart ailments. For instance, calcium score screening heart scan is used for checking calcium depositions in coronary arteries (59). Again coronary CT angiography is used for checking calcium and fat depositions in the arteries.
• MRI – Magnetic resonance imaging (MRI) is an extremely detailed diagnostic test for detecting heart ailments and abnormalities. Very strong radio and magnetic waves are used for creating detailed images of the heart on a computer screen. Still, as well as moving images of the heart can be taken in MRI. MRI does not involve radiation. In some cases, a dye is used for making coronary arteries and some part of the heart more clearly visible. The structure of the heart with all details can be seen with the help of MRI. Coronary artery ailments as well as heart muscle diseases can be diagnosed with the help of MRI (60).
• Coronary Angiography – Coronary angiography and coronary catheterization are the same.
• CT Angiogram – Coronary computed tomography angiogram (CCTA) is a special kind of scan used for diagnosing and detecting coronary artery disease. It is possible to get a 3 - dimensional image of the heart chambers. Complete and detailed image of the coronary arteries can also be seen, which supply blood to the heart. The best thing about CT angiogram is that it is non-invasive. People with unusual cardiac symptoms are often recommended to carry out this test.
• Myocardial Biopsy – Myocardial biopsy, also known as heart biopsy or cardiac biopsy is a kind of invasive procedure for detecting heart ailments. A bioptome is used for obtaining a small piece of muscle tissue from the heart. This is then sent to the laboratory for testing and analysis. Cardiac disorders like rejection after heart transplant, cardiac amyloidosis or cardiomyopathy can be detected with this test.
• Carotid ultrasound – This diagnostic test involves use of ultrasounds in creating pictures of the carotid arteries on both sides of the neck. The doctor can understand if there is build up of plaque in the arteries with the help of this test. It is also possible to assess the risk of stroke with this particular test.

Cardiologists are doctors who specialize in the treatment of various heart ailments, including cases of heart failure. After working as interns- the cardiologists have to train extensively in cardiovascular ailments. A cardiologist is capable of diagnosing people afflicted with serious cardiac diseases like-hypertension, coronary artery disease and heart failure. They often need to work with other type of doctors for proper diagnosis and treatment for patients afflicted with such serious disorders.

Different types of cardiologists

There are different types of cardiologists and they have specific roles to play in the diagnosis and treatment of people afflicted with various cardiovascular diseases.

General Cardiologist

Nearly all cardiac specialty hospitals and even general hospitals have general cardiologists. They usually have expertise is diagnosing commonplace cardiovascular disorders and syndromes. Upon successful diagnosis of such ailments, they may refer a patient to other types of cardiologists. They usually deal with patients afflicted with cardiovascular conditions like cardiac arrhythmias, Heart valve disorders, Coronary artery disease, Coronary artery disease and Congestive heart failure. These Cardiologists also go through the medical history of such patients and conduct extensive tests. They carry out tests like Echocardiography, Arrhythmia monitoring, Cardiac CT and MRI for proper diagnosis and figuring out an apt treatment plan.

Cardiac Electrophysiologist

Human heart has two primary functions- like you already know. It pumps blood throughout the body and the second task is carrying on the first task. Pumping blood can be compared with a plumbing system and it is electrical in nature. While the general Cardiologists deal with the pumping process and related issues, cardiac Electrophysiologists deal with the Electrophysiology. They focus on the bio-electrical system running the heart and resolve issues leading to irregular heartbeats called arrhythmias. Electrophysiologists are qualified for performing special tests to check the electrical system of the heart like Electrophysiology study. They are also capable of installing devices like a pacemaker or defibrillator. However, some electrophysiologists may hail from different disciplines than cardiology. When an arrhythmia is triggered by a heart attack, cardiac Electrophysiologists may be called to restore the rhythm. They may prescribe both invasive and non-invasive therapies to treat cases of arrhythmia (61).

Interventional Cardiologist

If your cardiologist advises you to undergo a process called angiogram, which is required to get correct information on artery blockage- an Interventional cardiologist may examine you. An Interventional cardiologist performs advanced treatments and tests than non-invasive and invasive cardiologists. They are capable of placing small mesh stents inside the arteries and performing balloon angioplasty. Andreas Gruentzig is deemed as the pioneer in interventional cardiology. In Canada and the USA, 7-9 years of post-graduate level medical education is prerequisite for pursuing advanced structural heart procedures.

Typically, Interventional cardiologists have additional training and education in treating as well as diagnosing cardiovascular diseases. They are also expert in treating congenital heart conditions.

Cardiac surgeon

When a cardiologist concludes that the best way to treat your cardiac ailment is surgery- he refers you to a cardiac surgeon. A surgeon performing cardiac surgeries belongs to a different discipline than typical cardiologist. A cardiac surgeon may do different types of operations on heart and related organs. These surgeons perform procedures and operations like heart valve repair, coronary artery bypass, heart defect repair and complicated procedures like heart transplantation. At times, cardiac surgeons perform implantation of VADs or ventricular assist devices. They also conduct special tests to find out the suitability of patients for undergoing such complex procedures. They may also conduct follow up on patients undergoing such surgical procedures.

For becoming a cardiac surgeon, undergoing extensive medical education and experience in cardiovascular disorder treatment. A Cardiac surgeon has to acquire a college pre-med degree, complete medical school term, get license and complete at least two residencies. These can take up as long as 15 years in some instances. The exact duration may vary from one place to another (62). Those cardiac surgeons who want to specialize in either heart transplant surgeries or paediatric cardiology may have to undergo more intensive training.

Heart failure specialists

Heart failure does not affect everyone in the same manner and it is deemed as a complex disorder. Many factors may lead to its onset, including lifestyle and genetic roots. If the cardiologist seeing you feels you face the risk of heart failure or there are similar instances in your family history, a heart failure specialist may be referred to. With the help of a heart failure specialist, evading fatality may be possible. They may also handle people coping with heart rhythm problems and those who have undergone severe heart attacks in the past.

Cardiothoracic Surgeon

A Cardiothoracic surgeon specializes in surgical procedures pertaining to the lungs, heart, chest organs. So, the term Cardiothoracic surgeon encompasses the cardiac surgeons, general thoracic surgeons, cardiovascular surgeons as well as congenital heart surgeons. A general cardiologist may refer you to them if he or she thinks you need specialized treatment for heart ailments.

Cardiothoracic surgeons typically graduate from medical schools to go on and complete 5-year general surgery residency (63). This is succeeded by a 2- 3-year long Cardiothoracic surgery residency. They may also get into a 6-year Cardiothoracic surgery residency.

The Cardiothoracic surgeons treat various types of diseases affecting inner cavity of the chest and tissues forming the cavity. They often treat patients coping with Coronary artery disease. They also treat disorders like blockages of the arteries, Leaking heart valve, Heart failure, Coarctation of the aorta, Atrial fibrillation.

Paediatric Cardiologist

As evident from the name, a Paediatric Cardiologist is a type of paediatrician with extensive expertise and skill in diagnosing and treating cardiac problems and conditions affecting the kids(64). While the majority of Paediatric Cardiologists treat kids as young as a few months or even younger. They also handle various cases of congenital heart defects. Now, these treatments may start even before birth of the child as fetus can be checked for cardiac problems.

In most instances, a paediatrician refers a child with heart problems to a paediatric cardiologist to get best results. The paediatric cardiologists treat cases of heart murmurs, palpitations and chest pain. These cardiologists receive specialized training to perform cardiac ailments diagnostic test on young kids. They often work with paediatric cardiac surgeons for treatments and surgical procedures. In some cases, follow ups may be required even after the child undergoes operation successfully.

Non-Invasive Cardiologist

A non-invasive cardiologist resorts to diagnostic tests and treatments that do not require making incisions and inserting anything in the body of patients for curing heart related disorders. Such cardiologists attend medical school to cover three year residency thereafter and fellowship training follows. They are not surgeons and so their treatment methods are mostly based on procedures focusing on lifestyle changes and medications. They typically treat more patients in a day compared to the invasive cardiologists (65). A number of people with various types of cardiac ailments can do well by availing such treatments. However, at times they refer some patients to the invasive cardiologists. This is required when they reach the conclusion non-invasive measures will not yield results.

The non-invasive cardiologists use varying diagnostic tests for detecting presence and state of cardiovascular ailments and the tests include electrocardiogram, stress tests, and echocardiogram. He may also perform a CT scan to get a closer look at arteries for any blockage at times. In recent times, they are conducting heart MRIs to get accurate images of the heart sans any risk of radiation damage.

Angioplasty

Angioplasty is usually performed on a victim of heart attack to restore normal blood flow to the heart. The coronary arteries, blood vessels carrying blood to the heart get choked with plaque and other substances over time. When the inner walls of the arteries get choked with plaque, blood flow stops and a heart attack occur. In most cases, surgeons perform a coronary artery stent after angioplasty. This ensures free flow of blood and prevents the arteries from narrowing. To obtain benefits and prevent further heart attacks, angioplasty should be executed within 24 hours of a person suffering a heart attack.

This process is performed using anesthesia. The doctors make an incision in the arm or groin and then insert a catheter with inflatable balloon. This is inflated to widen the coronary artery. It may take up several hours. Angioplasty sometimes eradicates need to perform open-heart bypass surgery. Approximate cost of Angioplasty in India can be between INR 1.2L to 1.6L.

Heart Bypass Surgery

Heart bypass surgery, also called coronary artery bypass surgery, is performed to replace the damaged arteries in muscles of heart in the human body. The surgeons typically use blood vessels from other regions in the body to repair those damaged arteries. This surgery is chosen when the coronary arteries become totally clogged or damaged. In such situations, they cannot carry blood to the heart and the condition is called atherosclerosis. This can eventually cause heart failure.

There are few types of this surgery and the doctor will choose the apt one after examining your heart health condition in details. Single bypass is required when one artery is blocked. Based on number of arteries that have to be cleared, time of the procedure can vary. Typically, bypass surgery is decided by the doctors when methods like Balloon angioplasty seem unsuitable. In India, Bypass surgery cost can range from INR 1.5Lakh to INR 4.5 lakh approximately in NABH/JCI accredited hospitals.

Heart Valve Disease Treatment

Heart valve disease takes place when any of the 4 types of valves attached with your heart malfunctions. The 4 valves positioned at 4 chambers of heart ensure proper blood flow. There are several kinds of heart valve disorders including Valvular stenosis and Valvular insufficiency or regurgitation. In the first, valve opening is smaller than normal and in latter, valves do not close well. These can lead to heart failure and other complications. The root cause can be congenital or unknown at times. When lifestyle changes and medications fail to work, doctors recommend performing heart valve repair or replacement surgery. Usually, heart valve repair is chosen over replacement. It depends on type of valve and other heart health factors eventually. Average cost of heart valve surgery in India can range between INR 70,000 to INR 85,000 or $1325.

Cardioversion

Cardioversion is a clinical procedure which is deployed to restore normal heart rhythm in those afflicted with abnormal heartbeat related disorders (68). It is not equivalent of defibrillation- an emergency process used to restore heart ceasing to work. It may be scheduled in advance though doctors can also choose to deploy Cardioversion to override emergency complications. It is deployed through electric shocks delivered via electrodes that are placed on the chest of the victim. It is possible to do the process through medications too. Before performing the process, the doctor may give some medications to the patient to keep pain under control. Sometimes, the doctor may perform a transesophageal echocardiogram to make sure no blood clot is there in the heart. The approximate cost of cardio version is US$ 757.00 -917.00.

EECP

EECP or Enhanced External Counter Pulsation is one non-invasive treatment for lowering intensity and number of angina episodes. EECP is given through 6 external inflatable cuffs on buttocks, upper and lower legs. These cuffs inflate and deflate continuously between heartbeats and thus blood flow to the heart shoots up. With enhanced oxygen supply, the heart can function better and chest pain is effectively reduced. It comprises of 7 weeks of regular treatments, Monday to Friday. Those with coronary artery bypass and angina as well as those without stent or bypass, but with angina can opt for it. The doctor will consider heart health and past medical records before recommending EECP to anyone. Sometimes, deploying EECP can be a good substitute for complex surgical processes like angioplasty and bypass surgery. It also helps improve the condition in the body related to poor blood circulation.

Pacemakers

A pacemaker is a specific type of electrically-charged device which is implanted surgically under skin to rectify irregular heartbeats- typically condition known as arrhythmias. Modern pacemakers are composed of two parts. One contains battery and entropic parts and the second part sends electrical signals to the heart. Pacemakers are generally used to treat two kind of arrhythmias- bradycardia and tachycardia, slow and fast heartbeat related conditions respectively. Some people may require biventricular pacemaker. Implanting a pacemaker may require 2 hours and anesthetics are given. A small incision near shoulder is made to perform the process. The vein near collarbone is used to implant the device and wires. X ray is used to deploy the device (69). Approximate cost of heart pacemaker surgery is $4475 in India. This includes service cost, surgery cost and required tests that have to be carried out.

Heart Transplant

Heart transplant surgery is a complex open heart surgery and it requires a long time to be completed. The patients are given general anesthesia before the surgery can be done. A heart-lung bypass machine is connected before the actual surgery can take place. There are 3 surgeries required. In first surgery, the heart from the recipient’s body is removed and in the second heart from the body of donor is also removed. In the third surgery, the donor’s heart is implanted in body of the recipient. After the surgery, the patient is administered pain reliving medications. IV tubes are used to let the patient receive medications and fluids. The doctors watch out for complications and signs of body rejecting the new organ. Heart transplant is a costly procedure in India and the cost can vary from 10 to 30 lakh INR.

Left Ventricular Assist Device-LVAD

When the heart is unable to pump blood in body ad doctor deem it as advanced heart failure stage, the only option is installing LVAD(70). The (left ventricular assist device surgery can give such patients new lease of life. The LVAD is one mechanical pump surgically implanted and it is attached to the heart. There are different LVAD unit models and each come with unique engineering characteristics but they serve identical needs. The patients who are not suited for heart transplant get LVAD implanted as a lasting solution. In some cases, LVAD is used to handle temporary heart failure. While the procedure is very costly, individuals with LVADs implanted lead happy and healthy lives. In India, installing a LVAD may cost INR 30 lakh or so.

Lead Extraction

A pacemaker or ICD is implanted to deliver energy to muscles of your heart using wires that are called leads. When these wires are discarded the process is called lead extraction. It is required when the area gets infected or scar tissue forms at lead tip. The process may require several hours to be completed. It is done through the subclavian vein located in upper chest region or femoral vein which is located in the groin. After leads are removed, new leads may be put in their place immediately or later based on condition. Usually, the patient has to spend a night at the hospital for the process. Specific medication may be given to aid recovery. You may also require follow ups after the surgery is done.

Implantable Cardioverter Defibrillators

An ICD or Implantable Cardioverter Defibrillator is a tiny sized device which is used to aid people afflicted with serious abnormal heart rhythms. It transmits electrical pulses to normalize abnormal heart rhythms. It can be used when the doctors think your abnormal heart rhythms may lead to cardiac arrest. An ICD is deployed under your skin for monitoring your heart rate and thin wires link it to the heart. Usually, local anesthesia and sedatives are used before this is fitted. The device gets inserted under the collar bone. It is quite similar looking to the pacemaker. Once implanted, an ICD will work 24x7 nonstop. The average cost of ICD implant in India can be 4.5 lakh INR.

There are times when medications and therapies cannot help in curing heart ailments. In such cases, there is no other alternative left than resorting to surgeries. Along with minimally-invasive heart surgery procedures, there are also various kinds of advance heart surgeries carried out on patients as per their needs.

Minimally Invasive Cardiac Surgery (MICS)

It is evident from the name of the surgery that minimal incisions are needed in this kind of heart surgery. No open heart surgery is needed. It is also known as MICS CABG (Coronary Artery Bypass Grafting). The main advantage of this kind of surgery is that there are lesser chances of infections, less blood loss, minimal post-operative discomfort, and faster healing time and so on. Sternal wound infection is also reduced with this procedure. High risk cardiac patients can also undergo this surgery with lesser risks (71). Just 5-7 cm incision is made for the surgical procedure.

TAVI/TAVR (Transcatheter Aortic Valve Implantation/ Transcatheter Aortic Valve Replacement)

TAVI and TAVR are the same. The surgery is called by different names just. This is a minimally invasive heart surgery procedure, which is used for repairing the heart valves. In this process, the old and damaged valves are not removed. Rather, a replacement valve is wedged into the place of the aortic valve.

The TAVI or TVAR process has many similarities with stent placement in an artery. In this process a fully collapsible replacement valve is delivered to the valve site with the help of a catheter. When the new valve expands, the old valve leaflets are pushed out of the way. The tissues in the replacement valve take over the job of carrying blood and regulate the flow as needed.

This procedure is mainly suitable for people with symptomatic aortic stenosis (50). Basically high risk patients in whom standard valve replacement surgery cannot be done can undergo this surgical procedure for valve implantation/replacement.

Robotic Surgery

Robotic surgery is also a kind of minimally invasive surgical procedure. Also known as computer-assisted surgery, these are technological developments and advancements in medical science. Robotic systems are being used in surgical processes and procedures quite frequently. Robot assisted Endoscopic Coronary Artery Bypass (TECAB) and MIDCAB are performed with Da Vinci system. Mitral valve replacements and repairs have been done with this system. Coronary stenting and revascularization have also been done with help from robotics. People who have ailments in multiple vessels have coronary bypass with the system.

Sutureless Valve Surgery

If you are looking for treatment of aortic stenosis, there is no better option than sutureless valve replacement for the same (72). The damaged sutures are not removed in the process. This procedure helps in reducing duration of cardiopulmonary bypass and reduces cross clamp successfully. The surgical outcome from the procedure is therefore much better when compared to many other procedures. This minimally invasive heart surgery process is highly beneficial for heart patients who are at high risks. In many hospitals in India, this procedure is being adopted for treating coronary ailments.

Pre Surgery Preparations

There are many preparations that a patient has to undergo for a heart surgery. Mentioned below are some preparations that need to be done before the surgery:

• Some routine tests need to be done before the surgery like chest X-ray or ECG.
• The complete health care team comprising of the cardiologist, cardiac surgeon, anesthetist and therapists will come and visit the patient. In case of any queries, the patient can ask the team.
• There might be some restrictions on foods and drinks on the day before the surgery and on the day of the surgery.
• Certain medications are stopped so that the process of surgery is not hampered in any manner. Medicines that affect blood clotting have to be monitored and administered as needed or stopped as per instructions.
• Blood tests are also done for further investigations
• Shaving of hair is done from the area where the surgery will be done so that there is no problem during the surgery. Removing the adhesive tapes also becomes convenient if the skin is shaved.

Post-Surgery Precautions

Heart surgeries are usually successful nowadays. However, what causes the problem is lack of post-surgery precautions.

• The incision should be kept dry and clean all the time. Don’t apply ointment if you are not prescribed.
• If there are symptoms like the wound opening, swelling, drainage, redness, high body temperature etc., consult the doctor immediately.
• Eating a healthy and balanced diet is very important. Avoid foods which have high saturated fat.
• Get enough sleep and rest as much as possible. Sleeping enhancing healing and helps in recovering faster. Take pain medication as instructed. Refrain from caffeine in the evening and after that.
• Follow the medications which are prescribed thoroughly and do not ignore them in any way.
• There will be restrictions on activities and movements. Follow them as said and do not jump into any kind of work just like that.
• Go for check-ups as recommended as it is very important in the initial stages post heart surgery.

The best thing about heart disease is that it can be prevented with a little care and precaution. However, if the heart disease is a hereditary thing, it is difficult. But still the problem can be kept under control and managed effectively. Mentioned below are some ways in which heart disease can be prevented:

• Eating a healthy and balanced diet – Diet plays a major role in controlling heart disease. Refrain from eating foods which are rich in saturated fat. Try eating a balanced and healthy diet as it will meet all nutritional requirements of the body and help in keeping you healthy.
• Keep stress under control – Stress is a major contributor to innumerable ailments in the body including heart problems. Find ways in which stress can be reduced or kept under control.
• Regular exercising can be of help – Get some or the other kind of exercise daily. It is not important to work out rigorously or get some heavy exercise, but some kind of physical activity is important for maintaining a healthy heart. Exercising also helps in dealing with anxiety, depression and stress effectively.
• Try maintaining healthy blood pressure and cholesterol levels – Usually people who suffer from cardiac problems have increased blood pressure or high cholesterol levels. Both these factors affect heart health adversely. Therefore, it is always recommended to check these two levels at regular intervals and take medicines if required. Apart from diet management, there are many other things which can be tried for maintaining healthy cholesterol and blood pressure levels. Follow them closely for best results.
• Know the risk factors well – To keep heart ailments at bay, it is very important to know the risk factors well. This helps in identifying the problems as soon as they start appearing. And early detection of the problem can help in curing the same right from the roots. If the risk factors are not known, it will be difficult to address the problems at the first place.
• Keep diabetes under control – Diabetes is a leading contributor to heart problems (73). Keeping blood sugar levels under control is therefore very important. If you have diabetes, get your sugar levels checked at regular intervals and keep a record. Follow restrictions in diet thoroughly. Take medicines as prescribed and follow the instructions as given.

With proper care and precautions, heart diseases can be averted. However, even after an attack or a heart surgery a person can lead a normal life provided they follows all instructions and precautions.