Know about your Heart
Shifa Heart Center is providing a wide range of general and specialized cardiac services, including but not limited to angiography, angioplasty, stents, intra aortic balloon pump, EECP and Cardiac MR. The scope of services encompasses critical areas and conditions and treatments of heart like Heart Failure, Interventional Cardiology/ PCI, CHD/Valve Replacement, Peripheral Vascular Disease & Peripheral Artery Disease (PVD & PAD), Electrophysiology/Arrhythmias, Cardiac Imaging and Cardiac Rehabilitation.
We are providing EP studies with Cardiac ablation, Cardiac Resynchronization Therapy and Implantable Cardiac Defibrillator. We have Cardiac CT (640 slice) that is advance and fast Technology and has made it possible to record coronary angiogram without placing catheters in the heart and without the risk associated with conventional coronary angiography. Shifa Heart Center including cardiology and cardiac surgery is considered one of the best heart health centers in Pakistan.
The heart is a muscle that pumps blood through your body. The blood carries oxygen and nutrients that your body needs to work correctly. For the heart to be able to do this work it must be fed with oxygen-filled blood. The blood vessels that feed that heart muscles are called coronary arteries
Coronary arteries are the special blood vessels of the heart, supplying it with oxygen and other useful chemicals. Any blockage, plaque or disease of these arteries is called coronary artery disease.
The disease may cause chest pain, heart attack or even death. Unfortunately this disease is a lifelong problem. Smoking, high cholesterol, high blood pressure, diabetes, and heart disease in family are the conditions, which increase the likelihood of this disease. These are the risk factors for coronary artery disease. There are three main coronary arteries; the right coronary artery, the left anterior descending and the left circumflex artery.
A history of your symptoms and your risk factors (including over-weight, smoking, high cholesterol and family history of coronary artery disease) are important to consider in making a diagnosis.
While there are many tests to indirectly test the blood flow in these coronary arteries, only angiography can reliably give us the real picture.
Once coronary angiography shows that there is coronary artery disease, treatment options are;
- PTCA Angioplasty
- Bypass Surgery
To look for narrowed or blocked coronary arteries, your doctor may perform a special X-ray test called a coronary angiogram, sometimes called a “heart catheterization”. This test is performed in the cardiac catheterization laboratory (cath lab), a room designed especially for this procedure. This test takes between 20 to 40 minutes.
During the procedure the cath lab staff and you doctor will;
- Insert a small intravenous (IV) tube into your arm. This IV allows fluids and medications to be given to you
- Place electrodes on your chest to monitor your heart rate and rhythm
- Shave and wash the area where the catheter will be inserted (your arm or groin)
- Cover your body with sterile sheets
- Give you a mild sedative to help you relax
- Use medication to numb the area that has been cleansed
- Insert a hollow tube into the artery in your groin or arm. Through his hallow tube, the doctor can move or advance guide wires and catheters to the arteries in your heart
- Inject a special X-ray called contrast through the tube to allow your doctor to see the chambers, valves and coronary arteries of your heart on an X-ray monitor similar to a television screen. You may be able to look at the monitor during the procedure
- Ask you to take deep breath as the X-rays are taken. After the X-rays are taken, you may be asked to cough to clear the dye from the coronary arteries
After the angiogram, you will go to a recovery area for monitoring before returning to your hospital room or going room.
What should I do to prepare for Angiography:
- Your doctor needs to know if you have had an allergic reaction to contract (X-ray dye) or iodine
- If you are diabetic and on insulin: Since you will not be eating your usual diet, your doctor should inform you to adjust your insulin dose the morning / day of the exam. You should not have solid food 6 hours prior to your procedure and clear liquids only, 2 hours prior to the procedure
- Your doctor needs to know if you are on any bllod thinning medicines (e,g. Coumadin, Warfarin, Plavix, Aspirin, etc.)
- Better yet, bring all the prescription medicines with you
- You must have a responsible adult available to drive/ escort you home from the hospital
Balloon angioplasty is a procedure that uses a catheter with a small balloon on it. The balloon is inflated to push apart the plaque in the clogged arteries. This improves the blood flow in the artery. This procedure is similar to a coronary angiogram.
It is normal to have some chest pain when the balloon is inflated. Tell your doctor or nurse if feel any pain during the procedure. Risk of restenosis (i.e., the artery again narrow down due to the growth of plaque) of the treated artery is 40 – 50% in a patient.
Your doctor may recommend placing a coronary stent in the diseased area to help keep the artery open. The stent is placed on a uniquely designed balloon catheter and then delivered to the diseased area.
The balloon is inflated to expand the stent and to flatten the plaque against the artery wall. This increases blood flow by holding the artery wall open.
Once the stent is fully expanded, the balloon is deflated and removed. The stent stays in place permanently. It may be necessary to place more than one stent, depending on the length of your blockage.
Stent implantation is a alternative to coronary artery bypass, which requires open-heart surgery. It can also be used to open blocked arteries in your brain, neck, kidney, hip, abdomen, thigh, and knee. More than one blockage can be treated during a single session, depending on the location of the blockages and the patient’s condition. Risk of restenosis (i.e. the artery again narrow down due to the growth of plaque) of the treated artery with bare metal stunt is 20-30%. With due eluting stunt, it has been reduced to less than 10%.
Getting Ready for Angioplasty:
It is important to follow a few simple precautions before angioplasty. Talk to the doctor about how to prepare for the procedure.
- Do not eat or drink anything after midnight the night before
- Ask the doctor about taking regular medications the morning of the angioplasty
What Happens Afterwards?
Sedatives take a while to wear off and many patients sleep after the procedure
- It is important to stay in bed for about 6 hours after angioplasty. Later, a nurse will assist the patient in getting out of bed and walking around
- You will be required to stay in the hospital for at least 2 days
After Arriving Home:
After angioplasty, it’s a good idea to relax and take it easy for a few days.
- Avoid driving a car with a standard transmission for a few days to rest the leg where the catheter was inserted
- It is safe to return to a desk job almost immediately. However, your doctor may advise waiting for several days before returning to a job that involves using the legs a lot or bending or lifting
- Many patients take some type of blood-thinning drug to prevent blood clots angioplasty. Talk to the doctor about exactly how to take the drug
- You will require 2 weeks for clinical evaluation and routine blood tests
- If chest pain or other cardiac symptoms return, contact the doctor immediately