DR KAMAL GUPTA

15/09/2021

A pacemaker is a small device that's placed (implanted) into the chest to help control the heartbeat. It's used to prevent our heart from beating too slowly. Implanting a pacemaker in the chest requires a small surgical procedure.
A pacemaker is also called a cardiac pacing device.
Types
Depending on the condition, one might have one of the following types of pacemakers.
• Single chamber pacemaker. This type usually carries electrical impulses to the right lower chamber(ventricle) of the heart.
• Dual chamber pacemaker. This type carries electrical impulses to the right ventricle and the right upper chamber(atrium) of the heart to help control the timing of contractions between the two chambers.
• Biventricular pacemaker. Biventricular pacing, also called cardiac resynchronization therapy, is for people who have heart failure and heartbeat problems. This type of pacemaker stimulates both of the lower heart chambers (the right and left ventricles) to make the heart beat more efficiently.
A pacemaker has two parts:
• Pulse generator. This small metal container houses a battery and the electrical circuitry that controls the rate of electrical pulses sent to the heart, is placed under the skin.
• Leads (electrodes). One to three flexible, insulated wires are each placed in one or more chambers of the heart and deliver the electrical pulses to adjust the heart rate. However, some newer pacemakers don't require leads. These devices, called leadless pacemakers, are implanted directly into the heart muscle.
Risks
Complications related to pacemaker surgery or having a pacemaker are uncommon, but could include:
• Infection near the site in the heart where the device is implanted
• Swelling, bruising or bleeding at the pacemaker site, especially if you take blood thinners
• Blood clots (thromboembolism) near the pacemaker site
• Damage to blood vessels or nerves near the pacemaker
• Collapsed lung (pneumothorax)
• Blood in the space between the lung and chest wall (hemothorax)
• Movement (shifting) of the device or leads
Special precautions
It's unlikely that your pacemaker would stop working properly because of electrical interference. Still, you'll need to take a few precautions:
• Cellphones. It's safe to talk on a cellphone, but keep cellphone at least 6 inches (15 centimeters) away from the pacemaker. Don't keep the phone in a shirt pocket. When talking on phone, one should hold it to the ear opposite the side where pacemaker was implanted.
• Security systems. Passing through an airport metal detector won't interfere with pacemaker, although the metal in the pacemaker could sound the alarm. But avoid lingering near or leaning against a metal-detection system.
To avoid potential problems, carry an ID card stating that you have a pacemaker.
• Medical equipment. Make sure all doctors and dentists know you have a pacemaker. Certain medical procedures, such as magnetic resonance imaging, cancer radiation treatment, electrocautery to control bleeding during surgery, and shock wave lithotripsy to break up large kidney stones or gallstones could interfere with pacemaker.
• Power-generating equipment. Stand at least 2 feet (61 centimeters) from welding equipment, high-voltage transformers or motor-generator systems. If you work around such equipment, ask your doctor about arranging a test in your workplace to determine whether the equipment affects your pacemaker. For more info visit us at http://www.drkamalgupta.in/latest-update/devices/16?utm_source=facebookpage

24/08/2021

Heart failure occurs when the heart muscle doesn't pump blood as well as it should. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath. Certain heart conditions, such as narrowed arteries in the heart (coronary artery disease) or high blood pressure, gradually leave the heart too weak or stiff to fill and pump blood properly.
Heart failure can be ongoing (chronic), or it may start suddenly (acute).
Heart failure signs and symptoms may include:
• Shortness of breath with activity or when lying down
• Fatigue and weakness
• Swelling in the legs, ankles and feet
• Rapid or irregular heartbeat
• Reduced ability to exercise
• Persistent cough or wheezing with white or pink blood-tinged mucus
• Swelling of the belly area
• Very rapid weight gain from fluid buildup
• Nausea and lack of appetite
• Difficulty concentrating or decreased alertness
• Chest pain if heart failure is caused by a heart attack
If you have a diagnosis of heart failure and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. This may also be the case if you gain 5 pounds (2.3 kilograms) or more within a few days. Contact your doctor promptly.
Heart failure is a chronic disease needing lifelong management. However, with treatment, signs and symptoms of heart failure can improve, and the heart sometimes becomes stronger.
Heart failure can sometimes be corrected by treating the underlying cause. For example, repairing a heart valve or controlling a fast heart rhythm may reverse heart failure. But for most people, treatment of heart failure involves a balance of the right medications and, sometimes, use of devices that help the heart beat and contract properly.
• Implantable cardioverter-defibrillators (ICDs). An ICD is used to prevent complications of heart failure. It isn't a treatment for heart failure itself. An ICD is a device similar to a pacemaker. It's implanted under the skin in your chest with wires leading through your veins and into your heart.
The ICD monitors the heart rhythm. If the heart starts beating at a dangerous rhythm, or if your heart stops, the ICD tries to pace your heart or shock it back into normal rhythm. An ICD can also work as a pacemaker and speed your heart up if it is going too slow.
• Cardiac resynchronization therapy (CRT). Also called biventricular pacing, CRT is a treatment for heart failure in people whose lower heart chambers (ventricles) aren't pumping in sync with each other. A device called a biventricular pacemaker sends electrical signals to the ventricles. The signals trigger your ventricles to contract in a more coordinated way, which improves the pumping of blood out of your heart. CRT may be used with an ICD, known as CRT-D.
For more info visit us at http://www.drkamalgupta.in/latest-update/happens/15?utm_source=facebookpage

23/05/2021

There has been a remarkable improvement in the treatment strategy of a hole in the heart most commonly atrial septal defect (ASD) over the last few decades. It is located between the upper two chambers of the heart. Indebted to the improvement in device technology and procedural techniques.The percutaneous closure of PFO and ASD is performed using a special closure device. The device is folded or attached on to a special catheter, similar to the catheter used during your catheterization. The catheter is inserted into a vein in the leg and advanced into the heart and through the defect. The device is slowly pushed out of the catheter allowing each side of the device to open up and cover each side of the hole (like a sandwich), closing the hole or defect.Transcatheter closure of ASD is currently accepted as the treatment of choice in most patients with secundum ASD. Recent generation devices enable easy and safe deployment of device with the properties of adequate flexibility, re-capturability and repositioning. Use of biocompatible materials with improved device design and refined equipment finish may promote re-endothelialization and reduce potential damage to nearby structures. Most of currently available devices show excellent efficacy and comparable outcome with its own advantages and disadvantages. In addition to improvement of device properties and performance, there has been distinct improvement in procedural technique from numerous experiences of device closure of ASD. Our Cardiac team has good experience in closing the ASD using percutaneous approach.. For more info visit us at http://www.drkamalgupta.in/latest-update/-there-has-been/14?utm_source=facebookpage

25/04/2021

Catheter directed thrombolysis – A new paradigm in the treatment of Deep Vein Thrombosis
Deep vein thrombosis (DVT) is a major health problem. The risk of life threatening pulmonary embolism following DVT is well established, but the long-term vascular sequelae of DVT are often underappreciated, costly to manage, and can have extremely detrimental effects on quality of life. Treatment of DVT classically involves oral anticoagulation, which reduces the risk of pulmonary embolism but does not remove the clot. Anticoagulation therefore does little to prevent the venous damage and scarring that occurs following DVT, leaving the patient at risk for permanent venous insufficiency and development of post-thrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) is a endovascular treatment that is used as an adjunct to anticoagulation. CDT lowers the risk of PTS by reducing clot burden and protecting against valvular damage. A catheter is advanced directly to the site of thrombosis under fluoroscopy followed by a slow, prolonged infusion of a relatively low dose of thrombolytic agent. CDT restores venous patency faster than anticoagulation, which hastens the relief of acute symptoms. Numerous observational and retrospective studies have consistently shown a benefit of CDT plus anticoagulation over anticoagulation alone for prevention of PTS. Patients with long life expectancy and acute thrombosis involving the iliac and proximal femoral veins (iliofemoral DVT) have the greatest benefit from CDT, which may decrease the risk of PTS and/or decrease the severity of PTS symptoms if they do occur. CDT also plays an important role in those with acute limb-threatening venous occlusion or severe symptoms from DVT. Adverse outcomes are rare, which include risk of bleeding including intracranial haemorrhage. We did CDT in ~20 patients over a span of 7 yrs with 100% recanalization rate with one patient needed blood transfusion for drop in hemoglobin, the other patient developed local hematoma, and none of the cases developed intracranial bleed. For more info visit us at http://www.drkamalgupta.in/latest-update/catheter-directed-th/13?utm_source=facebookpage

12/04/2021

Alcohol Septal Ablation - A Promising Treatment for Hypertrophic Obstructive Cardiomyopathy

Hypertrophic cardiomyopathy is a genetically determined disorder resulting in left ventricular hypertrophy. In a majority of the estimated 20 million people affected worldwide, left ventricular outflow obstruction is present at rest or with provocation. The presence and degree of obstruction influence the symptomatic presentation, treatment strategies and prognosis of affected individuals. Pharmacologic therapy with beta-adrenergic blocking drugs and calcium channel blockers is the principal treatment strategy in symptomatic patients with left ventricular outflow obstruction but is ineffective in many patients. When symptoms of exertional shortness of breath, chest pain and/or syncope prove refractory to medical therapy and there is persisting left ventricular outflow obstruction, or when there is drug intolerance, septal reduction strategies (surgical myectomy and alcohol septal ablation) are quite effective. Alcohol septal ablation is emerging as an alternative to surgical myectomy in the management of symptomatic cases of Hypertrophic obstructive cardiomyopathy (HOCM). This involves injection of absolute alcohol into 1st septal perforator thereby producing myocardial necrosis with resultant septal remodelling within 3–6 months. This results in reduction of septal thickness and LV outflow gradients with improvement in symptoms. Selection of the optimal septal reduction strategy for a given patient has become controversial and is determined largely by the medical system providing treatment strategies for the patient. Regretably, there are no randomized trials comparing myectomy and ablation and none are anticipated. The comprehensive Hypertrophic Cardiomyopathy Guideline Statements published in 2011 and 2014 differ significantly with the earlier statement favoring surgical myectomy and the more recent statement giving equal class I status to the two septal reduction strategies in adult patients with drug-refractory symptoms. Recently published studies of long-term followup of patients after alcohol septal ablation in Europe, where surgical myectomy is rarely performed, confirm long-term safety and effectiveness with survival free of cardiac events exceeding 96% at 15 years. The lesser degree of discomfort and more rapid recovery associated with the minimally invasive catheter-based alcohol ablation procedure coupled with the recently published long-term safety data favor an increased use of this strategy in symptomatic adult patients with hypertrophic obstructive cardiomyopathy (HOCM).

Alcohol Septal Ablation - A Promising Treatment for Hypertrophic Obstructive CardiomyopathyHypertrophic cardiomyopathy is a genetically determined disorder resulting in left ventricular hypertrophy. In a majority of the estimated 20 million people affected worldwide, left ventricular outflow obstruc...

29/03/2021

Why are heart attacks on the rise in young population

Cardiovascular diseases (CVDs) have now become the leading cause of death in India. A quarter of all deaths are attributable to CVD. Coronary artery disease(CAD) and stroke are the predominant causes and are responsible for >80% of CVD deaths. Myocardial infarction(MI) is considered as a disease in the older population. The incidence of mortality due to acute myocardial infarction has reduced in recent decades globally, due to better availability of resources and robust infrastructure.
Although, the same cannot be said for the younger population, where there has been a rise in cases of acute myocardial infarction. Individuals with age as low as 20-40 years have been seen to be affected by CVDs.
Myocardial infarction(heart attack) occurs when there is sudden rupture of the cholesterol plaque leading to occlusion of blood vessel and death of a portion of the cardiac muscle. In the Indian population, MI is seen to occur at a younger age, a decade earlier as compared to the western population.
Risk factors involved in the development of CAD in young individuals include smoking, obesity, diabetes, hypertension, dyslipidemia, recreational drug abuse and family history of premature CAD. Smoking is the most important risk factor which can trigger myocardial infarction in individuals with minimal atherosclerosis or even with normal coronary arteries. Childhood and adolescent obesity leads to the higher probability of development of diabetes and hypertension at a younger age. Diabetes and hypertension are leading risk factors for CAD and when not in adequate control, the risk rises several fold. Family history of premature CAD is one non modifiable risk factor which may lead to early onset of CAD. Erratic eating habits, sedentary lifestyle, stressful workplace environments are the most serious health risks amongst the employees, especially the younger adults. Apart from high levels of low-density lipoprotein cholesterol seen in dyslipidemics globally, Indians have a typically distinct lipid profile of having low levels of high-density lipoprotein cholesterol, with higher levels of triglycerides, which additionally add-on to the CVD risk. With more than 70 million people in India having diabetes, including the younger generation, the CV risk only adds up in the Indian population.
Recent legalization of ma*****na in some regions of the world and the illicit use of co***ne and other recreational drugs are related to cardiovascular mortality events in the younger individuals. India having >65% of its population below the age of 35 years, factors leading to morbidity & mortality in this particular age become a huge concern.
Leading a healthy and productive life requires the will to lead a healthy lifestyle. Smoking not only affects our heart but most organs of our body. The importance of quitting smoking cannot be overemphasized. Taking a diet rich in fruits and vegetables and avoiding fast food is necessary for a healthy heart. Almonds and walnuts are good for heart. Regular brisk walk, jogging, cycling and other cardiac friendly exercises not only lead to physical wellbeing but also relieves mental stress. Those with a family history of premature CAD should get themselves screened early in their 30's or 40's. CT coronary angiography and CT calcium scoring have emerging role in screening of low risk individuals. Last but not the least, one should keep the sugar, blood pressure and cholesterol levels under strict control.

Why are heart attacks on the rise in young populationCardiovascular diseases (CVDs) have now become the leading cause of death in India. A quarter of all deaths are attributable to CVD. Coronary artery disease(CAD) and stroke are the predominant causes and are responsible for >80% of CVD deaths. Myo...

22/04/2020

ISCHEMIA Trial - 5, 179 patients with stable ischaemic heart disease (SIHD) and moderate or severe ischemia on stress testing, over a median of 3.3 years, were randomized to an invasive strategy of routine cardiac catheterization followed by optimal revascularization with PCI or CABG surgery vs. a conservative strategy, with cardiac catheterization, if there was failure of optimal medical therapy.
Results showed that the cumulative incidence of the primary endpoint – a composite of cardiovascular death, MI, resuscitated cardiac arrest, or hospitalization for unstable angina or heart failure – was 15.5 percent in the conservative group vs. 13.3 percent in the invasive group after 4 years. In addition, the cumulative incidence of the major secondary endpoint – cardiovascular death or MI – was 13.9 percent in the conservative group vs. 11.7 percent in the invasive group after 4 years.
Hence, an invasive management strategy may not demonstrate a reduced risk vs. a conservative management strategy of optimal medical therapy in patients with stable ischemic heart disease (SIHD) and moderate or severe ischemia, according to results of the ISCHEMIA trial presented Nov. 16 during AHA 2019 in Philadelphia, PA.
Meanwhile, in a separate ISCHEMIA quality of life outcomes analysis also presented during AHA 2019, they found "significant, durable improvements in angina control and quality of life with an invasive strategy if they had angina." However, in patients without angina, "an invasive strategy led to minimal symptom or quality of life benefits, " vs. a conservative strategy.
They conclude that moving forward, "in patients with angina, shared decision-making should occur to align treatment with patients' goals and preferences."

19/04/2020

Upto 40% of patients undergoing coronary angioplasty and stenting have high bleeding risk (HBR) characteristics. Guidelines recommend 3-6 months of dual antiplatelet therapy (DAPT) for HBR patients undergoing percutaneous coronary intervention (PCI). Resolute Onyx is a thin sturted conformable stent with biocompatible polymer and sustained drug release for several months. The Onyx ONE randomised control trial (RCT) demonstrated non inferior outcomes of Resolute Onyx compared to a polymer free drug coated stent in a broad range of patients receiving one month of DAPT. In conjunction with Onyx ONE RCT, Onyx ONE Clear, which is a prospective multicenter, single arm study supports the use of one month of DAPT in HBR patients.

Upto 40% of patients undergoing coronary angioplasty and stenting have high bleeding risk (HBR) characteristics. Guidelines recommend 3-6 months of dual antiplatelet therapy (DAPT) for HBR patients undergoing percutaneous coronary intervention (PCI). Resolute Onyx is a thin sturted conformable stent...

16/04/2020

Heart failure caused by damage to the heart that has developed over time can’t be cured. But it can be treated, quite often with strategies to improve symptoms.