Director

Chandan Heart Institute

Dr. Deepak Tewari

MD (Internal Medicine)
DM Cardiology
Ex Consultant Interventional Cardiologist, Saroj Superspeciality Hospital, New Delhi

Cardiology at Chandan Hospital includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heartdisease and electrophysiology.

Heart disorders : hypertension

Hypertension, also known as "high blood pressure"", is a long term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long term high blood pressure, however, is a major risk factor for coronary artery disease, stroke, heart failure, peripheral vascular disease, vision loss, and chronic kidney disease.

Lifestyle factors can increase the risk of hypertension. These include excess salt in the diet, excess body weight, smoking, and alcohol. Hypertension can also be caused by other diseases, or as a side-effect of drugs.

Blood pressure is expressed by two measurements, the systolic and diastolic pressures, which are the maximum and minimum pressures, respectively. Normal blood pressure at rest is within the range of 100–140 millimeters mercury (mmHg) systolic and 60–90 mmHg diastolic. High blood pressure is present if the resting blood pressure is persistently at or above 140/90 mmHg for most adults.

Essential hypertension is the form of hypertension that by definition has no identifiable cause. It is the most common type of hypertension, affecting 95% of hypertensive patients, it tends to be familial and is likely to be the consequence of an interaction between environmental and genetic factors. Prevalence of essential hypertension increases with age, and individuals with relatively high blood pressure at younger ages are at increased risk for the subsequent development of hypertension. Hypertension can increase the risk of cerebral, cardiac, and renal events.

Secondary hypertension is a type of hypertension which is caused by an identifiable underlying secondary cause. It is much less common than essential hypertension, affecting only 5% of hypertensive patients. It has many different causes including endocrine diseases, kidney diseases, and tumors. It also can be a side effect of many medications.

Complications of hypertension are clinical outcomes that result from persistent elevation of blood pressure. Hypertension is a risk factor for all clinical manifestations of atherosclerosis since it is a risk factor for atherosclerosis itself. It is an independent predisposing factor for heart failure, coronary artery disease, stroke, renal disease, and peripheral arterial disease. It is the most important risk factor for cardiovascular morbidity and mortality, in industrialized countries.

Cardiac arrhythmia, also known as "cardiac dysrhythmia" or "irregular heartbeat", is a group of conditions in which the heartbeat is irregular, too fast, or too slow. A heart rate that is too fast – above 100 beats per minute in adults – is called tachycardia and a heart rate that is too slow – below 60 beats per minute – is called bradycardia. Many types of arrhythmia have no symptoms.

There are four main types of arrhythmia: extra beats, supraventricular tachycardias, ventricular arrhythmias, and bradyarrhythmias. Extra beats include premature atrial contractions, premature ventricular contractions, and premature junctional contractions. Supraventricular tachycardias include atrial fibrillation, atrial flutter, and paroxysmal supraventricular tachycardia. Ventricular arrhythmias include ventricular fibrillation and ventricular tachycardia. Arrhythmias are due to problems with the electrical conduction system of the heart. Arrhythmias may occur in children; however, the normal range for the heart rate is different and depends on age. A number of tests can help with diagnosis including an electrocardiogram (ECG) and Holter monitor.

Coronary artery disease, also known as "ischemic heart disease", is a group of diseases that includes: stable angina, unstable angina, myocardial infarction, and sudden cardiac death. It is within the group of cardiovascular diseases of which it is the most common type. A common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Occasionally it may feel like heartburn. Usually symptoms occur with exercise or emotional stress, last less than a few minutes, and get better with rest. Shortness of breath may also occur and sometimes no symptoms are present. The first sign is occasionally a heart attack. Other complications include heart failure or an irregular heartbeat.

Risk factors include: high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol, among others. Other risks include depression. The underlying mechanism involves atherosclerosis of the arteries of the heart. A number of tests may help with diagnoses including: electrocardiogram, cardiac stress testing, coronary computed tomographic angiography, and coronary angiogram, among others.

Cardiac arrest is a sudden stop in effective blood flow due to the failure of the heart to contract effectively. Symptoms include loss of consciousness and abnormal or absent breathing. Some people may have chest pain, shortness of breath, or nausea before this occurs. If not treated within minutes, death usually occurs.

The most common cause of cardiac arrest is coronary artery disease. Less common causes include major blood loss, lack of oxygen, very low potassium, heart failure, and intense physical exercise. A number of inherited disorders may also increase the risk including long QT syndrome. The initial heart rhythm is most often ventricular fibrillation. The diagnosis is confirmed by finding no pulse. While a cardiac arrest may be caused by heart attack or heart failure these are not the same. Prevention includes not smoking, physical activity, and maintaining a healthy weight. Treatment for cardiac arrest is immediate cardiopulmonary resuscitation (CPR) and, if a shockable rhythm is present, defibrillation. Among those who survive targeted temperature management may improve outcomes. An implantable cardiac defibrillator may be placed to reduce the chance of death from recurrence.

A congenital heart defect, also known as a "congenital heart anomaly" or "congenital heart disease", is a problem in the structure of the heart that is present at birth. Signs and symptoms depend on the specific type of problem. Symptoms can vary from none to life-threatening. When present they may include rapid breathing, bluish skin, poor weight gain, and feeling tired. It does not cause chest pain. Most congenital heart problems do not occur with other diseases. Complications that can result from heart defects include heart failure.


Cardiac Surgery

Coronary-artery-bypass-surgery

Cardiac surgery at Chandan is surgery on the heart or great vessels performed to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to correct congenital heart disease; or to treat valvular heart disease from various causes, including endocarditis, rheumatic heart disease, and atherosclerosis.

Open-heart surgery

Open-heart surgery includes a large incision (cut) in the chest to open the rib cage and operate on the heart. "Open" refers to the chest, not the heart. Depending on the type of surgery, the surgeon also may open the heart.

Cardiac-surgery-operating-room

Modern beating-heart surgery

In these operations, the heart continues beating during surgery, but is stabilized to provide an almost still work area in which to connect a conduit vessel that bypasses a blockage.The conduit vessel that is often used is the Saphenous vein. This vein is harvested using a technique known as endoscopic vessel harvesting (EVH).

Coronary artery bypass grafting

Coronary artery bypass grafting, also called revascularization, is a common surgical procedure to create an alternative path to deliver blood supply to the heart and body, with the goal of preventing clot formation. This can be done in many ways, and the arteries used can be taken from several areas of the body. Arteries are typically harvested from the chest, arm, or wrist and then attached to a portion of the coronary artery, relieving pressure and limiting clotting factors in that area of the heart. The procedure is typically performed because of coronary artery disease (CAD), in which a plaque-like substance builds up in the coronary artery, the main pathway carrying oxygen-rich blood to the heart. This can cause a blockage and/or a rupture, which can lead to a heart attack.

Minimally invasive surgery

As an alternative to open-heart surgery, which involves a five- to eight-inch incision in the chest wall, a surgeon may perform an endoscopic procedure by making very small incisions through which a camera and specialized tools are inserted.

CathLab at Chandan Hospital is the state of art unit used for Angiography and Angioplasty.

Diagnostic Cardiac Catheterisation -

Cardiac Catheterisation is a procedure to examine how well the heart is working. A thin hollow tube called catheter is inserted into a large blood vessel that leads to heart. It is performed to find out the disease of the heart muscle, valves or coronary arteries.

1. Coronary Angiography is done during cardiac catheterization. A contrast dye visible in X-ray is injected through the catheter. X-ray images show the passage of dye in heart arteries. It shows the blockage of arteries

2. Pressure of four chambers of the heart can be measured.

3. Ability of the pumping chambers to contract.

4. Measurement of the oxygen content in the four chambers of the heart by taking blood samples.

5. Defects of valves or chambers of the heart.

Biopsy - A diagnostic procedure to obtain a myocardial tissue sample from the ventricle of the heart aid in the detection of a disease process (i.e., myocarditis, cardiomyopathy, etc.) or to monitor rejection after heart transplant

Therapeutic Procedures

Catheter ablation is the least invasive option, in which a thin, flexible tube is put into a blood vessel in the leg or neck. Then, it's guided to the heart. Heat, cold, or radio energy is used to scar some tissue inside the heart, where the irregular beats are triggered. The treated tissue helps get the heartbeat regular again.

Angioplasty(balloon angioplasty) is a minimally invasive, endovascular procedure to widen narrowed or obstructed arteries or veins, typically to treat arterial atherosclerosis. A deflated balloon attached to a catheter (a balloon catheter) is passed over a guide-wire into the narrowed vessel and then inflated to a fixed size. The balloon forces expansion of the blood vessel and the surrounding muscular wall, allowing an improved blood flow. A stent may be inserted at the time of ballooning to ensure the vessel remains open, and the balloon is then deflated and withdrawn.

Coronary angioplasty is a therapeutic procedure to treat the stenotic (narrowed) coronary arteries of the heart found in coronary heart disease. These stenotic segments are due to the buildup of cholesterol-laden plaques that form due to atherosclerosis. A percutaneous coronary intervention is first performed.

Peripheral angioplasty refers to the use of a balloon to open a blood vessel outside the coronary arteries. It is commonly done to treat atherosclerotic narrowings of the abdomen, leg and renal arteries caused by peripheral artery disease. Often, peripheral angioplasty is used in conjunction with guide wire, peripheral stenting and an atherectomy.

Carotid angioplasty Carotid artery stenosis is treated with angioplasty in a procedure called carotid stenting for patients at high-risk for carotid endarterectomy.

Renal artery angioplasty Atherosclerotic obstruction of the renal artery can be treated with angioplasty with or without stenting of the renal artery. Renal artery stenosis can lead to hypertension and loss of renal function.

Venous angioplasty Angioplasty is occasionally used to treat venous stenosis, such as stenosis of the subclavian vein caused by thoracic outlet syndrome.

Stenting A stent is a small, metal mesh tube that is placed within a coronary artery after balloon angioplasty to prevent the artery from reclosing (restenosis). There are also drug-eluting stents coated with a special medication to further help prevent re-narrowing of the coronary arteries. Like other coronary stents, it is left permanently in the artery, and slowly releases a drug that prevents the build-up of tissue that leads to restenosis.

Septal closure devices A wire mesh device made out of nickel and titanium (Nitinol) and filled with a polyester thread is used to non-surgically close defects in the atrial septum (the wall between the two top chambers of the heart). A patent foramen ovale (PFO) and atrial septal defect (ASD) are two of the common defects that are closed with this technique.

Atherectomy If the plaque found in an artery has hardened and calcified, a cardiologist can use a rotational atherectomy catheter -- an olive-shaped diamond burr which rotates at very high speed -- to pulverize the plaque into harmless microscopic particles that are washed away by the blood stream. A laser atherectomy device could also be used in a similar fashion.

Thrombectomy If the artery is noted to have loose debris within it, there are various types of catheters designed to remove the debris from within the artery prior to either angioplasty or stenting.