Ischaemic Heart Disease Treatment and Surgery in India

Ischaemic Heart Disease/ Coronary Heart Disease

Ischaemic Heart Disease, also known as Coronary Artery Disease, is a condition that affects the supply of blood to the heart. The blood vessels are narrowed or blocked due to the deposition of cholesterol on their walls. This reduces the supply of oxygen and nutrients to the heart muscles, which is essential for proper functioning of the heart. This may eventually result in a portion of the heart being suddenly deprived of its blood supply leading to the death of that area of heart tissue, resulting in a heart attack.

As the heart is the pump that supplies oxygenated blood to the various organs, any defect in the heart immediately affects the supply of oxygen to the vital organs like the brain, kidneys, liver, etc. This leads to the death of tissue within these organs and their eventual failure. Ischemic Heart Disease is the most common cause of death in many countries around the world.

Symptoms of Ischaemic Heart Disease

The most common, and often the first signs of Ischemic Heart Disease are :

• Chest pain that can radiate to the arms, jaw, back, chest discomfort, nausea, anxiety, and lightheadedness condition also known as angina pectoris.
• Physical effort and intense emotions can trigger an angina attack; the pain can last up to 20 minutes and it was described as a sensation of a sensation of tightness and compression in the center of the chest sometimes accompanied by sweating.
• Heredity can influence the development of ischemic heart disease in young patients.
• Other signs of ischemic heart disease can be anemia and obesity; also patients with peripheral vascular disease and thyroid are at high ischemic heart disease risk.
• Heart attack or a myocardial infraction.
• The lethal symptom of ischemic heart disease is sudden death also known as massive heart attack and it is caused by an abnormal heart rhythm, ventricular fibrillation, that prevents the heart to contract and pump oxygenate blood to the brain and vital organs.

Coronary Artery Bypass Graft(CABG) Surgery in India
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Causes of Ischaemic Heart Disease

• A multitude of factors are responsible for the development of Ischaemic Heart Disease.
• The major risk factors are smoking, diabetes mellitus and cholesterol levels.
• Those with Hypercholesterolaemia (elevated blood levels of cholesterol) have a much higher tendency to develop the disease.
• There is also the theory that Hypertension is a risk factor in the development of Ischaemic Heart Disease.
• Genetic and hereditary factors may also be responsible for the disease.
• Stress is also thought to be a risk factor, though there has been a great deal of debate on this factor of late. The disease process occurs when an atheromatous plaque forms in the coronary vessels, leading to narrowing of the vessel walls and obstructing blood flow to the musculature of the heart.
• Complete blockage results in deficient oxygenation and nutrient supply to the heart tissues, leading to damage, death and necrosis of the tissue, which is known as Myocardial Infarction (heart attack).

Diagnosis and Tests of Ischaemic Heart Disease

• Electrocardiography (ECG)
• An Echocardiogram may help in showing any functional abnormalities in the various cardiac chambers and in assessing the pumping efficiency of the heart.
• An exercise testing (Treadmill Test-TMT) is often indicated in patients who have symptoms but have normal ECG patterns.
• Myocardial perfusion scanning with radioactive thallium may also be helpful in the diagnosis.
• Coronary Angiogram provides accurate information about the actual site and extent of the stenosis (narrowing) and helps in deciding the method of therapy required.

Ischaemic Heart Disease/ Coronary Heart Disease Treatment

Treatment includes the following options:-

• Drug Therapy
• Less Invasive Therapies

Drug Therapy

• Drug therapies with Nitrates, which dilate the diseased coronary arteries, administered sub-lingually are very effective in relieving the pain in a few minutes.
• Drugs such as Isosorbide Dinitrate and Isosorbide Mononitrate belong to the category of Nitrates. These drugs are also used as a prophylactic to prevent the pain from occurring.
• Beta-blockers like Propranolol are also highly effective in relieving pain by reducing myocardial oxygen demand, mainly by decreasing the heart rate.
• Calcium channel antagonists produce vasodilatation and relieve the symptoms by reducing the excitability and conductivity of cardiac muscle and by reducing blood pressure. For patients with hypercholesterolaemia, drugs may be used to lower cholesterol levels.
• Aspirin: When taken daily or every other day, aspirin reduces the risk of developing angina or heart attack by reducing the tendency of your blood to clot.
• It reduces the chance that a clot will form over a rupturing plaque in the coronary artery, a common underlying phenomenon in heart attack (myocardial infarction).
• Statins: Statin drugs work by reducing the amounts of lipids (cholesterol and other fats) in your blood.

Less Invasive Therapies

Surgical therapy is indicated when medical treatment has failed to relieve symptoms or when the Angiogram shows significant disease in the blood vessels. When symptoms worsen despite medications, you may need an invasive procedure in the cardiac catheterization lab to clear the blocked artery. These procedures are performed by a cardiologist, not a cardiac surgeon, and have fewer complications.

• Coronary Angioplasty (PTCA) :
  • This procedure is similar to coronary angiography (cardiac catheterization or a dye study to visualize the inside of coronary arteries) but is therapeutic as well as diagnostic.
  • A similar but sturdier tube (guide catheter) is inserted into an artery in your groin or arm, and a hair-thin guide wire is threaded through it into your coronary artery.
  • A much thinner catheter is threaded over the guide wire into the blocked artery.
  • This thinner catheter has a tiny balloon at the end.
  • Once the balloon is positioned at the blockage, the balloon is inflated to widen your artery and improve blood flow. The plaque is still there, just flattened against the wall of the artery.
  • The balloon catheter is then withdrawn.
  • This procedure is sometimes referred to as PTCA, which stands for its full formal name: percutaneous (through the skin) transluminal (through the hollow center of the blood vessel) coronary angioplasty
• Stent :
  • A stent is a small, sieved, coil-like metallic tube or scaffold mounted over a balloon.
  • The balloon is inflated at the blockage, which expands the stent.
  • The balloon is then withdrawn, but the stent stays in place, keeping the artery from narrowing again.
  • Like arteries treated with angioplasty alone, arteries treated with a stent can eventually close up again.
  • The stent is a longer lasting solution for many people.
• Atherectomy :
  • Sometimes the plaques become too rigid, bulky, or calcified to be treated with angioplasty or a stent.
  • In such cases, the plaques must be removed by cutting with a drill-like device.
  • This works only if the narrowing or blockage is limited to a relatively small and self-contained portion of an artery.
  • Plaques also may be burned away with an excimer laser atherectomy (ELCA).
• Brachytherapy :
  • Radiation is applied to the blockage to clear it.
  • The radiation comes from a very tiny source placed inside or near the artery.
  • This procedure is used to treat arteries that have undergone angioplasty or stenting but have blockage that keeps coming back (restenosis).

Ischaemic Heart Disease/ Coronary Heart Disease Surgery

Surgery in coronary heart disease is reserved for people whose disease is either severe or is not improved or stabilized by medication and other less invasive therapies.

• Coronary Artery Bypass Grafting (CABG) : This is the standard operation for blockages of coronary arteries. The blocked parts of the arteries are bypassed with blood vessels harvested from chest, arm, or a leg. During the surgery, the heart is stopped temporarily and the patient is connected to a machine called a bypass pump that takes over the functions of the heart.
• Off-pump Bypass Surgery : Sometimes surgeons can perform open heart surgery without using a bypass pump and while the heart is beating.
• Minimally Invasive Coronary Bypass (MINI-CABS) : If only front or right coronary arteries require a bypass, a surgeon may replace the blocked artery with an artery from the chest via a small keyhole incision.
• Transmyocardial Laser Revascularization (TMR) : This procedure is suitable for people who are not good candidates for either angioplasty or bypass surgery. A surgeon uses a laser catheter to create multiple pinholes in your heart muscle. The holes encourage growth of new vessels into the diseased heart muscle. This procedure can be done by itself or in combination with coronary bypass surgery.

Benefits of Ischaemic Heart Disease Treatment

• With proper treatment, most patients will be able to lead normal and healthy lives.
• The graft bypasses the narrowed area, and relieves the blood blockage. In spite of its many advantages, recommendations for bypass surgery are lower due to the fact that scientists have proved that, bypass surgery improves patients’ quality of life by eliminating the symptoms but it doesn’t increase life expectancy. In modern medicine the emphasis is on medical treatment and techniques like angioplasty. With proper treatment, most patients will be able to lead normal and healthy lives.
• Whether the treatment is stenting or bypass surgery, the goal of coronary artery disease treatment is to restore blood flow in a clogged artery to a near-normal rate that helps patient live a better life.
• The treatment involves advice regarding a change in patients’ life style, avoiding unhealthy behavior like smoking, alcoholism and unhealthy diet in order to achieve the best results and increase life expectancy.

Ischaemic Heart Disease Treatment and Surgery in India

Indian hospitals use advanced methods for the early diagnosis, prevention and treatment of people with coronary artery disease. They assess cardiovascular risk in each patient and develop a personalized risk assessment plan based on his test results. Cardiologists and other specialist staff coronary heart disease clinics in India work together as a team to diagnose and treat all forms of heart diseases. The advanced facility in most of the hospitals is devoted specifically to surgical advanced heart disease treatment. Coronary heart procedure is a complex surgical exercise and need highly skilled consultants, ingenious technical staff and advanced technology working with perfect harmony, enormous dedication and team work. India offers a one stop solution for all those seeking cardiac treatment and surgeries.

Cities in India offering Ischaemic Heart Disease/ Coronary Heart Disease treatment and surgery at some of the best cardiac hospitals are as follows :

Cost of Ischaemic Heart Disease Treatment and Surgery in India

In countries like United States, treatment procedures of Ischaemic heart disease is highly expensive. Hospitals in India offer minimally invasive cardiac surgery in highly attractive prices. The cost of less invasive cardiac procedure, medical treatment and cardiac surgery in India is less than 60% of the total cost incurred for the same treatment and surgery in US and other western countries. This includes the hospital fee, consultation charges, hotel accommodation, travel expenditure, etc. Hospitals in India are a perfect destination for medical tourism that combines health treatment with visits to some of the most alluring and awe-inspiring places of the world at an attractively low cost.

Some of the common countries from which patients travel to India for surgery are:

ABOUT INDIA

Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service.

• Mumbai - A city quite unlike any other in the whole of India, Mumbai (previously named Bombay) is an island city, being located on Salsette Island, alongside the Arabian Sea. With an appealing coastline, many of Mumbai's top resorts and tourist attractions lie around its main beaches, which include both Juhu Beach and also Girgaum Chowpatty Beach, where evening funfairs provide plenty of atmosphere.
• Hyderabad – Hyderabad city is the capital city of the Indian state of Andhra Pradesh, in the region of Telangana. Hyderabad city is known for its rich history, food and its multi-lingual culture, both geographically and culturally. Founded in the year 1591 by fifth Qutb Shahi Ruler Muhammad Quli Qutb Shah. Now known as the historic old city, home to the Charminar, Falaknuma Palace, Chowmallah Palace and Makkah Masjid, it lies on the southern bank of the river.
• Goa - Goa, a small enclave on the West Coast of India is one of the best holiday destinations in the World. Famous for its long stretch of beaches dotted with shacks, it is a favorite destination for the European tourists who flock to Goa during the winter months. Swaying palms, white sands and sparkling waters: the three essential elements that attract 2 million visitors annually to Goa’s balmy shores are plentiful in this tiny, glorious slice of India
• Bangalore - Bangalore, the capital of the Karnataka, is fifth largest city in India. Few Cities in the World has the power to attract and motivate a casual visitor to move there permanently. Bangalore is one of those rare cities, which makes people who are new to the City to call themselves proud Bangaloreans. Bangalore, with a wonderful climate is already a Pensioner's Paradise.
• Nagpur - Capital of the "land of oranges" and geographically at the virtual centre of India, Nagpur is endowed with rich forest resources and in itself is the second greenest city in India. The forests around Nagpur are full of best quality teak plantations. Shopping in Nagpur may turn out to be a pleasant experience for the discerning shopper. Nagpur is designed specifically for its many tourists and families to avoid any small annoyances.
• Kerala - The Land Kerala is a dramatic, narrow, leaf-shaped strip of land, flanked by the formidable Western Ghats on the east, and the Arabian Sea on the west. A land of unabashed wealth, its people are amongst the most progressive and literate of the Indian populace. This tropical spice garden has lured the Arabs, Chinese and Europeans for many centuries. Christianity and Judaism entered the subcontinent through the legendary white sand beaches of Kerala.
• Delhi - Delhi the capital of India main point of arrival for overseas visitors, and the major transport hub. Delhi is just not a city but it is a book that narrates the history of India. The city was built and destroyed seven times and has been witness to the various events, which has brought India through the history books.
• Pune - The city of Pune is situated in Maharashtra and is said to be the cultural capital of the state. Located at a distance of approximately 120 km from Mumbai, the city is one of major tourist destinations in India. The rich history, architecture and culture of the city makes it a must visit destination for the tourist coming to India.
• Jaipur – The city of Jaipur, painted in pink, grasp the appreciation of every visitor. One can see that hoary charm still alive in the avenues of Jaipur. Jaipur offers World Class Medical Facilities, comparable with any of the western countries. It has state of the art Hospitals and the best qualified doctors.
• Chennai - The Gateway to South India, Chennai is famous for its sandy beaches, parks and historic landmarks. With a very distinct culture, the people of Chennai have a special interest in music, dance and all other art forms of South India. Capital of the state of Tamil Nadu, Chennai has embraced both the new and the old with ease
• Gurgaon – Gurgaon, the commercial capital of Haryana, is one of the most sought after destination for MNCs, Corporate, residents and Investors as it offers world class standard of living and globally comparable business address in the form of IT parks and Business Centers and along with that very prominent medical hub.
• Chandigarh - Chandigarh is the best-planned city in India, with architecture which is world-renowned, and a quality of life, which is unparalleled. Chandigarh is a rare epitome of modernization co-existing with nature's preservation. It is here that the trees and plants are as much a part of the construction plans as the buildings and the roads.