Cardiology

 

 

Interventional Cardiology

Our Interventional Cardiology centre in Coimbatore is well known for its Primary angioplasty program, the gold standard treatment of Heart attack. Coronary angiograms and elective coronary artery stenting are being performed by the best specialists in high volumes every day in our cardiology hospital. Structural heart disease interventions like Transcatheter Aortic Valve Implantation (TAVI) and other catheter-based interventions like balloon mitral valvuloplasty, TEVAR, EVAR, renal artery stenting, subclavian artery stenting, etc., are being performed successfully by our heart specialists. Patients can go back home in a day or two with no complications.

FRACTIONAL FLOW RESERVE (FFR)/ INSTANTANEOUS WAVE FREE RATIO (iFR):

These techniques are used in cardiac catheterization laboratory to assess the pressure difference across a coronary artery narrowing. These help to determine if the narrowing really needs stenting or not.

INTRAVASULAR ULTRASOUND AND OCULAR COHERENCE TOMOGRAPHY:

The inside of the blood vessels can be clearly visualised by these imaging modalities. Presence and morphology of atherosclerotic plaques can be precisely determined in interventional cardiology treatment. These modalities also help in performing high precision angioplasty.

TEVAR- Thoracic Endovascular Aortic Repair. It is a percutaneous procedure, in which a metal stent is placed across the weak part of aorta (aneurysm) in the upper part of the body. Since it is a minimally invasive procedure, patients can be discharged home in another 3 to 4 days without much complications. Our cardiology centre has done a lot of TEVAR procedures with good success rate.

EVAR- Endovascular Aneurysm Repair. This is a minimally invasive percutaneous procedure in which a stent is placed across an aortic dissection or an aortic aneurysm in the lower part of aorta. The advantages are shorter procedure time, faster recovery, elimination of need for large incisions in the abdomen.

TAVI- Transcatheter Aortic Valve Replacement. A bioprosthetic valve is inserted across the aortic valve with the help of special equipments percutaneously, avoiding the need for opening the chest, which is done in traditional surgical valve replacement. Patients can go home safely after a few days of procedure without much complications. Our hospital is one among the few centres, which perform TAVI procedure successfully.

BMV- Balloon Mitral Valvotomy. It is an effective and safe procedure performed in cardiac catheterisation laboratory, for patients with severe mitral valve stenosis. Patients will be carefully selected for this procedure after proper clinical and echocardiographic characteristics. Rheumatic fever is a common disease in our country, one of its complications is mitral stenosis. Patients with this disease will benefit from BMV, another minimally invasive procedure. BMV has been performed with an excellent success rate in our hospital.

 

 

Heart Failure Clinic

Heart failure (HF) is a disease sometimes known as congestive heart failure, occurs when the heart muscle is not able to pump blood as well as it should. The prevalence of HF is approximately 1–2% of the adult population, rising to ≥10% among people more than 70 years of age. Among people more than 65 years of age presenting to primary care with breathlessness on exertion, one in six will have unrecognized HF.

Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently. Basically, the heart can’t keep up with its workload. Patients with HF may require repeated hospitalization, advanced investigations and advanced treatment options. A multidisciplinary team (MDT) approach is considered the gold standard model for the delivery of HF care.

Heart failure team

Recognizing the need for team work Heart Failure Clinic was inaugurated in GKNM Hospital in September 2014. The Heart Failure Clinic was rededicated on the 14th of September 2014 in a function at GKD Auditorium which was graced by Dr Richard Daly, the Chairman and Director of Heart failure, Transplantation from Mayo Clinic, Dr Catherine Sudarshan Cardiac Transplant Surgeon from Papworth Hospital, England and Dr Jai Raman Transplant surgeon from Portland, Oregon. The heart failure clinic will closely collaborate and work with these 3 institutions for the further development of this subspecialty. Recently the heart failure clinic has been expanded with more scope for effective treatment of its patients and the registry has been created. Dr Shanmugasundaram runs the Heart Failure Clinic. Dr P Chandrasekar the chairman of cardiothoracic surgery and Director of Heart Failure and Transplantation is heading this program.

Our team consists of a dedicated Cardiologist trained in Advanced Heart Failure & Heart Transplantation, an Electro physiologist who takes care of heart rhythm related abnormalities and advanced device based therapies, Cardiac surgeons who are trained in Left ventricular assist devices, and Cardiac transplantation, trained clinical Heart failure Nurse to educate you about your medications, adjust your medications, monitors and prevents adverse drug reactions, Trained Physiotherapists, who ensures effective rehabilitation of patients with Heart failure to improve quality of life and trained dietitian, who tailors salt and fluid prescriptions according to the clinical situations and reinforce whenever clinically indicated.

Heart failure counselling: Our trained paramedics counsel the patients, so that they understand their illness, medications and treatment options for the patients during their hospital stay.

Training in self-management: Patients are encouraged and trained in self-management, which included monitoring weight, urine output and adjusting the dosage of water pills (diuretics) accordingly. This improves the quality of life and decreases the rate of readmissions. Patients are advised to monitor for set of symptoms which helps them to identify de compensations early so that it can be acted upon.

Guideline directed medical therapy: Our team ensures optimization of medications which is essential for optimal outcome along with careful monitoring for adverse drug reactions.

Heart failure Rehabilitation Centre: Cardiac rehabilitation is a medically supervised program that includes exercise training, education on heart-healthy living, and in many cases, counselling to reduce stress. It helps patients recover and improve physical, mental and social function. The goal is to stabilize, slow or even reverse the progression of heart failure. This can help to reduce the risk of heart disease, another cardiac event or death.

Six minute walk test: We assess walking distance covered in 6 minutes with careful monitoring of symptoms, vital signs, which helps the treating physician in making treatment decisions.

Ambulatory Inotropic Therapy: It is used in selected patients with end-stage heart failure who are inotrope dependent can be treated at home while awaiting other definitive therapies.

Cardiac Resynchronization Therapy and Implantable Cardioverter Defibrillator

Implantation: Cardiac resynchronization therapy is a procedure to implant a device in your chest to make your heart‘s chambers contract in a more organised and efficient way. The signals tell your ventricles to contract at the same time, maximizing the amount of blood that’s pumped out of your heart. These are high end implantable devices which help the heart to improve its efficiency and also regulate its rate. They are lifesaving in many of the situations.

An implantable cardioverter-defibrillator or automated implantable cardioverter defibrillator is a device implantable inside the body, able to perform cardioversion, defibrillation, and pacing of the heart. The device is therefore capable of correcting most life-threatening cardiac arrhythmias.

Heart Transplantation

Heart transplantation is a surgical transplant procedure being performed on patients with end-stage heart failure, severe coronary artery disease or complex congenital heart diseases when other medical or surgical treatments have failed. Though this is an established method of treatment and is being performed routinely in western countries, it is being performed in routinely India only for the past one decade.