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An echocardiogram is a type of ultrasound scan used to look at the heart and nearby blood vessels.

 

It can help diagnose and monitor certain heart conditions by checking the structure of the heart and surrounding blood vessels, analyzing how blood flows through them and assessing the pumping chambers of the heart. It can help detect:

 

  • Damage from a heart attack –where the supply of blood to the heart was suddenly blocked
  • Heart Failure-where the heart fails to pump enough blood around the body at the right pressure
  • Congenital heart disease –birth defects that affect the normal workings of the heart
  • Problems with the heart valves – problems affecting the valves that control the flow of blood within the heart
  • Cardiomyopathy – where the heart walls become thickened or enlarged
  • Abnormal chest x-ray with enlarged cardiac shadow
  • endocarditis – an infection of the heart valves

 

An echocardiogram can also help doctors decide on the best treatment for these conditions.

 

Indications of Echocardiogram

  • Diagnose & quantity severity of valve disease
  • Evaluate Congenital Heart Disease
  • Assess Ventricular Function
  • Detect Pericardial effusions
  • identify vegetations in endocarditis
  • identify the source of embolism
  • Post mi evaluation of Ventricular Function
  • To assess Ventricular Function in hypertension & Diabetes
  • In cases of cardiomegaly
  • In cases of breathlessness
  • Routine Checkup
Contrast echocardiography is a technique for improving echocardiographic resolution and providing real-time assessment of intracardiac blood flow. Agitated saline contrast provides contrast in the right heart and enables detection of right to left shunts. Opacification of the left ventricular (LV) cavity by contrast agents developed to traverse the pulmonary vasculature permits improved endocardial border detection. Contrast echocardiography can also enhance the delineation of the Doppler signal. Additional uses of contrast echocardiography are to assess myocardial perfusion and viability.

Stress echocardiogram or stress echo is a procedure used to determine how well your heart and blood vessels are working. A stress echocardiogram (or stress echo) is a procedure performed in our rooms to assess cardiac function. This is performed in combination with a stress ECG. The patient’s ECG and blood pressure will be monitored throughout the test. After resting images are performed by a qualified sonographer, the patient will exercise on a treadmill. The length of time required to exercise varies from person to person and takes into account the person’s age and fitness level. The exercise component usually takes between 5 and 10 minutes. The sonographer will then take more pictures of the heart post-exercise to compare the heart function to the resting images. This test is safe and non-invasive. The patient will be closely monitored in a fully equipped exercise lab by experienced staff throughout the procedure. Results are available to the patient immediately after the procedure. Compared to stress ECG alone, a stress echo has much better diagnostic accuracy. Diagnosing coronary artery disease and assessing the risk for heart attacks early on can help prevent future complications.

Indications for stress echo include:

  • Evaluation of patients with chest pain
  • Prognosis & severity of disease
  • Evaluation of therapy
  • screening for latent coronary disease
  • Early detection of labile Hypertension
  • Evaluation of patients with congestive heart failure
  • Evaluation of arrhythmias
  • Evaluation of functional Capacity
  • congenital Heart Disease & vulvar dysfunction
  • the stimulus to motivate change in lifestyle
  • Sports Medicine
  • Routine Checkup

An electrocardiogram (ECG) is a simple, painless test that records the heart’s electrical activity. Electrodes will be attached to your arms, legs, and chest. The electrodes (sticky patches applied with a gel) will connect to some wires to help detect and conduct the electrical currents of your heart. If you have hair on the parts of your body where the electrodes will be placed, the technician may need to shave the hair so that the electrodes stick properly. The test normally only takes a few minutes.

A doctor may use an ECG to detect:

  • Irregularities in your heart rhythm (arrhythmias)
  • Heart defects
  • Problems with your heart’s valves
  • Blocked or narrowed arteries in your heart (coronary artery disease)
  • A heart attack, in emergency situations
  • A previous heart attack

Coronary Angiography is an important procedure in the diagnosis and treatment of coronary artery disease. The Coronary Angiogram procedure uses x-ray imaging iodine-based contrast (dye) and catheterization enabling your Cardiologist to see if the coronary arteries are narrowed or blocked and if necessary perform a procedure such as as an angioplasty immediately.

Part of a general group of procedures known as cardiac catheterization, a coronary angiogram is one of the most common types of heart catheterization procedures. 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 then rapidly takes a series of images, offering a detailed look at the inside of your blood vessels. If a problem such as a narrowed or block artery is found, your Cardiologist can usually begin immediate intervention during the procedure.

What is radial artery access?

While the femoral artery (near the groin) has been the traditional approach for coronary procedures, access via the radial artery (in the wrist) has shown to present a number of advantages making it an attractive alternative.

With femoral artery access, the patient will need to lie flat without bending the leg for 4 to 6 hours following the procedure to allow the artery to heal. In some rare cases, even with prolonged immobility, internal bleeding can occur. With radial artery access the risk of bleeding complication is significantly reduced.

As the radial artery is much smaller and located closer to the skin surface internal bleeding is eliminated and any external bleeding can be easily compressed. After the catheter is removed from the radial artery a compression device is placed around the wrist to apply pressure on the artery, and the patient is free to move around immediately.

The cardiologist may recommend a coronary angiogram:

  • In emergency situations such as during a heart attack, to unblock an artery as a life-saving procedure
  • For symptoms of coronary artery disease, such as chest pain (angina)
  • Following an abnormal Stress test/ Nuclear scan
  • For exertional Dyspnoea (shortness of breath) unexplained by other causes
  • Following an abnormal CT coronary angiogram and suspicious symptoms of angina
  • For pain in your chest, jaw, neck, or arm that cannot be explained by other tests
  • For new or increasing chest pain (unstable angina)
  • To evaluate a heart defect you were born with (congenital heart disease)
  • For a heart valve problem that requires surgery
  • To further assess heart failure and planning for treatment

Dr. Mukesh Goyal

MBBS, DM (CARDIOLOGY)

Coronary Angioplasty is the procedure used to treat coronary artery disease (the build-up of fatty plaque in the arteries of the heart). During the procedure, a catheter with a balloon at the tip is pushed into and inflated inside a narrowed coronary artery. This improves blood flow to your heart and reduces the risk of a heart attack.

Angioplasty is usually combined with stent placement. After the fatty plaque is pushed out and the blocked vessel is opened, a wire-mesh tube (stent) is then placed in this area. The stent is left in the artery permanently to help keep the artery open (scaffolding the vessel). With Angioplasty alone – without stent placement re-narrowing of an artery (restenosis) happens in about 30-40 percent of cases therefore stent placement is widely recommended.

There are two types of stents available. Drug coated Stent (drug-eluting stent – DES) stent and bare-metal stent (BMS). Your cardiologist will discuss which stent is suitable for you. You will require blood-thinning medication (antiplatelet agents) after stent implantation.

What is transradial access?

When the narrowed coronary artery is accessed via the radial artery in the wrist, this is called transradial access, or transradial intervention (TRI). TRI has a number of advantages for the patient.

In general, patients treated using transradial access have a faster recovery time, feel less pain, and have fewer bleeding complications than patients treated with transfemoral access. Coronary interventions require blood-thinning medication hence post-procedure bleeding from an access site may happen and result in unwanted complications. With transradial access, bleeding complications are reduced compared with femoral artery access. The patient can also stand up earlier and can go home sooner after the procedure.

When transfemoral access is used, a patient must often lie flat for 4 to 6 hours after the procedure to help prevent bleeding problems. If the wrist is used, the patient can sit up and walk immediately after the procedure.

Why it is done?

Angioplasty and stent placement are used to treat a coronary disease known as atherosclerosis. This is the slow build-up of fatty plaques in your heart’s blood vessels resulting in narrowing of the coronary artery lumen. Your cardiologist might suggest angioplasty as a treatment option when medications or lifestyle changes aren’t enough to improve your symptoms, or worsening chest pain (angina), or if you have a heart attack.

CT Coronary Angiography

Computed Tomography (CT) Coronary Angiography is a non-invasive scan of the coronary arteries which supply blood to the heart. The coronary arteries and heart chambers are visualized through the injection of a contrast medium during the scan. Unlike a traditional coronary angiogram, CT angiograms don’t use a catheter threaded through your blood vessels to your heart. Instead, a coronary CT angiogram relies on a powerful X-ray machine to produce images of your heart and blood vessels. Coronary CT angiograms are becoming a widely used modality for people with a variety of heart conditions.

A CT Coronary Angiogram is a test that can check your heart for various conditions, but it’s primarily used to check for narrowed arteries in your heart (coronary artery disease) that could explain chest pain (angina) or could put you at risk of a heart attack.

A Renal Angiogram is an x-ray study of the blood vessels leading to the kidneys and is done to assess the blood flow to the kidneys. X-rays (cine films) are taken as contrast dye is injected into a catheter (a tiny plastic tube) that has been placed into the blood vessels of the kidneys. The specialist then assesses the cine for any narrowings or other abnormalities affecting the blood supply to the kidneys. If a narrowing is found, the doctor may treat the affected area with a vascular balloon (PTA or percutaneous transluminal angioplasty) or even place a stent in the affected area.

 

If any narrowing of the arteries or other abnormalities affecting the blood supply to the kidneys are found during your renal angiogram, your specialist will proceed to treat the narrowing by passing a balloon catheter along the wire to the diseased area through a tiny incision in your groin. Once in position, the balloon is inflated and the narrowing is gradually widened. This procedure is called angioplasty.

 

In some cases the artery is successfully stretched open, but the narrowed portion of the artery can recoil as the balloon is deflated. If the dilation of the artery is not entirely satisfactory, your specialist may place a stent at the point of the persistent narrowing. A stent is a mesh tube made of a special metal alloy. On insertion, it is tightly squashed down on a balloon. Once positioned at the point of narrowing, the stent is opened up to a predetermined width and holds the kidney artery open.

A Holter monitor is a small portable battery-powered device that continuously records heart activity such as heart rate and rhythm over a period of time (usually 24-48 hours). The actual monitor is slightly smaller than a standard deck of cards and has 7 electrodes that will attach to your chest. A small pouch holds the monitor itself which can attach to the waistband of your pants, on a belt, or on a strap around your neck.

Holter monitoring is used to help explain what is happening to your heart rhythm and/or why you are having palpitations. The monitor may also be used

Indications of Holter monitoring

  • In detecting a transient episode of arrhythmia
  • In detecting transient episodes of ischemia in unexplained chest pain
  • In the case of palpitation
  • To identify the cause of syncope, dizziness, blackouts, vasovagal, seizures
  • Pacemaker function testing
  • Routine Checkup

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