Some tips to avoid #Heart #Disease #Threats

Few risks that contribute to Heart Diseases in most of the humans. Kindly look after them and stay cautioned.

http://thepharmatimes.in/index.php/extras/jstuff/content-views/category-list-view/1230-protect-your-body-and-heart-from-diwali-crackers-warns-dr-sa-merchant

This year saw a significant increase in heart problems

Soluble stents - Dr S A Merchant MD (Med), DM (Cardiology) one of the pioneers in Soluble Stent technology

Soluble stents

Despite the development and progression of metallic stents, they continue to have limitations such as stent thrombosis, which requires prolonged antiplatelet therapy, and mismatch of the stent to the vessel size, which often results in a smaller lumen after stent implantation. Further, metallic stents prevent the lumen expansion associated with late favorable remodeling.Permanent metallic stents impair the vessel geometry and often jail and obstruct side branches. Drug-eluting stents are a breakthrough in the development of stents, with their ability to significantly reduce restenosis rates and the need for repeat revascularization. Nevertheless, they are still associated with subacute and late thrombosis, and necessitate prolonged antiplatelet therapy for at least 12 months. Further, the polymer used as a vehicle for drug delivery may induce vessel irritation, endothelial dysfunction, vessel hypersensitivity and chronic inflammation at the stent site.Excessive use of stents in the coronary vasculature (full metal jacket) may interfere with traditional reinterventional techniques such as bypass graft surgery. Finally, metallic stents pose artifacts with modern imaging technologies such as magnetic resonance imaging (MRI) and multislice computerized tomography (MSCT), which eventually will become the default noninvasive imaging modality for the coronary anatomy.

In contrast, bioabsorbable stents, once they are bioabsorbed, leave behind only the healed natural vessel, allowing restoration of vasoreactivity with the potential of vessel remodeling. Late stent thrombosis is unlikely since the stent is gone, and prolonged antiplatelet therapy is not necessary in this instance. Bioabsorbable stents can also be suitable for complex anatomy where stents impede on vessel geometry and morphology and are prone to crushing and fractures, such as is seen in saphenous femoral and tibial arteries. Bioabsorbable implant stents can be used as a delivery device for agents such as drugs and genes, and will perhaps play a role in the treatment of vulnerable plaque. Transferring genes that code key regulatory pathways of cell proliferation inside the cells of the arterial wall using polymer stents as vehicles is feasible. Regardless of which agent (drug or gene) will finally conquer restenosis, a polymer stent remains an optional vehicle for such delivery. Finally, bioabsorbable stents are compatible with MRI and MSCT imaging.

Polymeric stents have the potential to act as local drug delivery systems. Polymeric material, especially biodegradable polymers, have been widely utilized for the controlled release of drugs, Therefore, it is possible to design a biodegradable polymer stent, not only offering a physical barrier to the vessel wall, but also presenting a pharmacological approach in the prevention of thrombus formation and intimal proliferation. These bioabsorbable polymers are currently loaded on the metallic stent for the purpose of drug or gene delivery, and completely erode by the time the drug has been released; yet the stent itself is still maintained in the vessel wall. The discussion of these bioabsorbable polymers is beyond the scope of this review, however.

There are several conditions to consider when selecting a polymer or alloy for the bioabsorbable stent. These include the strength of the polymer to avoid potential immediate recoil, the rate of degradation and corrosion, biocompatibility with the vessel wall and lack of toxicity. The change in the mechanical properties and the release profiles of drugs from bioabsorbable stents would directly depend on the rate of degradation of the stent, which can be controlled by selection of the stent alloy, passivation agents and the manufacturing process of the stent. Currently there are two types of materials used for bioabsorbable stents: polymeric-based and metallic-based.

Polymers have been widely used in cardiovascular devices and are currently primarily used as delivery vehicles for drug coatings.Among the polymers suggested for bioabsorbable stents are Poly-L-lactic acid (PLLA), polyglycolic acid (PGA), poly (D, L-lactide/glycolide) copolymer (PDLA), and polycaprolactone (PCL).Each of these polymers was designed as either self-expanding or balloon-expandable stents. Another proposed design is the hybrid stent, which combines polymeric absorbable stents with a metallic backbone to enable strength and prevent recoil.

Polymeric biodegradable stents are radiolucent, which may impair accurate positioning. Hence, this procedure requires extreme care and a highly experienced cardiologist to perfectly implant the stent. The polymer alone has a limited mechanical performance and a recoil rate of approximately 20%, which requires thick struts that impede their profile and delivery capabilities, especially in small vessels.Metal bioabsorbable stents are intuitively attractive since they have the potential to perform similarly to stainless steel metal stents. So far, two bioabsorbable metal alloys have been proposed for this application: iron and magnesium. The biocompatibility of these stents depends on their solubility and their released degradation products. Their local toxicity is related to the local concentration of the elements over time. The tissue tolerance for physiologically occurring metals depends on the change of their tissue concentrations induced by corrosion. Thus metals with high tissue concentrations are the ideal candidates for bioabsorption stents.

Case Studies

Acute Heart Attack with plaque rupture Mr. A. nalwala, 58 years old, finance controller of ITC group complained of chest pain in the morning on 3rd july 2014. ECG normal, stress test at 4th stage Bruce protocol was normal. After 12 hours, at 11 P.M, he had a heart attack. how do we explain the validty of the ECG and stress test to detect the heart blockages? Pharmaco-invasive approach was used, 40 mg IV cot buster was given at 2 A.M in the night and within 8 hours the main heart artery blockage and clot was treated with aspiration and deployment of medicated stent. Life saved from massive heart attack at night with a normal ECG and stress test on the same morning.

PTCA in acute heart attack in diabetic patient Mrs. Gada, 62 years old, diabetic had acute chest pain. She reached the hospital in one hour and had cardiac arrest in the casualty. A DC shock was given and she was shifted to cathlab. Angiography showed 100% block of main artery which wa streated with clot aspiration catheter and stented with a mesh covered stent[M-guard]. She is now fit and fine and back to household work. This is a typical case of silent heart atatck in diabetic patients

Angioplasty in shock patient mr. R Sammy, 71 years old, diabetic, had symptoms of acute breathlessness, chest pain, fatigue and feeling of collapsing. He was stabilized n the ICU on life saving machine like ventilator, balloon pump, heart support medicines. 2D Echo and angiography showed low heart pumping and with only one heart artery functional which also had critical blockages.He was successfully treated with 2 overlapping soluble stents. Mr. Sammy now feels quiet good and daily walks for one hour from his home to the church. Timely treatment at the hospital with state of the art life saving machines, devices and skilled team makes a difference. This is achieved through quality control by JCI and NABH accreditation. In the treatment of critically ill patients these factors play a very vital role.

Innovative devices for heart failure Mr. P. D'Souza, 44 years old, diabetic on insulin had symptoms of acute breathlessness, palpitation and feeling of sinking. ECG showed rapid irregular heart beats. 2D echo showed low heart pumping. he underwent a successful device implant which consisted of biventricular therapy with Defibrilator. two months later, Mr. D'Souza now walks for 30 minutes without symptoms. 2D-echo shows better heart pumping. The combo device is a bridge to heart transplant in patients with low heart pumping when availability of heart, the facility of heart transplant and cost matters.

Giddiness, Blackout treated with dual Chamber pace maker Mr. B. Raut, 72 years old presented with sudden blackout and feeling of sinking. ECG showed slow heart rate with complete block of electrical system of the heart. Mr. raut was treated with dual chamber pacemaker. he is full of life now at this retired age. pace maker is life saving for elederly patients with degenerated system of the heart.

Cardiac Defibrillator implant to prevent sudden death S. Patil, 20 year old girl, had symptoms of giddiness and blackout repeatedly. Holter showed irregular heart rhythm at very high rate of 220 beats per minute. Cardiac Defibrillator was implanted. She now feels secure since the ICD device will shock her to normal rhythm incase she has fast irregular beating of the heart and prevent sudden death. great innovation where the patient carries the defibrillator the size of a coin implanted in the left shoulder to prevent sudden death known as arrythmias.

High BP Emergency Mrs. Doris, 62 years old patient with high BP on 5 medicines had symptoms of acute breathlessness, heart falure and partial kidney failure. Angiography showed both the kidney arteries with 95% blockage. She wa streated with stentng of both the arteries. Mrs. Doris was discharged on the 3rd day feeling better with normal BP and kidney function. High BP secondary to other factors can be permanently treated with intervention in cathlab with the novel renal denervation technology.

Lung clot due to Vein Thrombosis Mr. S. khare, 40 year old, sititng on computer for 8 hours, had symptoms of acute breathlessness, chest pain and sweating. in ICU he was diagnosed with multiple blood clots in the lungs which came from clot in the calf muscle. he was treated with clot busters and a filter to prevent further clots to go from calf muscle to the lungs. he is now on blood thinner and advises people to not sit for long hurs at the computer and during air travel. A life saved with timely treatment of clots in the lungs due to prolonged immobilisation.

Beware of Silent Attacks: You can have a heart attack without even knowing it!

Dr Shahid A. Merchant, Interventional Cardiologist, Lilavati Hospital

You’d certainly know if you were having a heart attack, wouldn’t you? After all, you would have heard of the symptoms of a heart attack as crushing chest pain or extreme shortness of breath. Not necessarily, says Dr Shahid A. Merchant, Interventional Cardiologist, Lilavati Hospital.

Farooque Shaikh, 58, was a typical case of a silent heart attack. He had no symptoms whatsoever and there was ‘no need’ for him to see a doctor. Since he was in his late 50s he went for a cardiac check-up. That’s when it was first brought to his notice that he had suffered a heart attack. An angiography shockingly revealed four blockages; two in the main artery and two in minor arteries. He was informed that unless he underwent an angioplasty, he would certainly suffer a major heart attack which could prove fatal.

More than one in five people over the age of 65 who have heart attacks have unrecognized ones, according to a study published in the January issue of the Journal of the American College of Cardiology.

WHAT IS A SILENT HEART ATTACK

Silent heart attacks are those attacks that have no warning symptoms or signs, or may appear with ordinary signs such as: nausea, sweating, headache and dizziness.

The cause of silent attack like any other heart attack is almost always the progressive narrowing of the heart’s arteries from accumulations of cholesterol plaque. In most instances, this reduction in blood supply generates a protest from the heart — the crushing pain called angina. But in perhaps many of the heart attack victims there may be no previous symptoms of these gradually developing blockages.

Silent heart attacks are the most dangerous ones because people don’t know what’s happening and hence do not consult a doctor. Despite the fact that it offers little or no warning signs, a silent heart attack is still life-threatening. Because these silent heart attacks go undetected, they can’t be treated.

This increases the chance of underlying heart disease becoming more advanced and can cause another more serious heart attack. But with simple awareness, you can do much to reduce the risk of overlooking a silent attack.

Silent heart attacks are common in people older than 65 years and diabetics and women.

You are most likely to have a silent heart attack if you…

• are diabetic

• suffer from high blood pressure

• have high cholesterol levels

• are obese

• lead a sedentary lifestyle

• Smoke regularly

• have suffered a prior heart attack or stroke

Though exact numbers aren’t known, many younger people also experience unrecognized heart attacks.

“Unless people start screening themselves for a heart attack, there’s no way to predict who’s likely to have them. Sometimes the first and only symptom of a silent heart attack could be sudden death.” saysDr. Shahid A Merchant.

In terms of heart damage, these unrecognized attacks aren’t necessarily less severe than obvious ones. Studies have found that death rates from silent heart attacks were the same as those from non-silent heart attacks.

Heart Tips

1. Always do regular check-ups when you are on heart medicines. You may not even know you are experiencing side effects of heart medicines.  Sometimes are symptoms are silent until they become serious.
2. Drug interaction can be serious. You should make certain that you doctor knows all the drugs you take including supplements and vitamins before you doctor prescribed any drug therapy.
3. Who should take cholesterol lowering medicine
   • People with allevated LDL.
   • People with allevated Apo B
4. Take your statin drug at night. The body makes more cholesterol at night and in the early morning hours, so it is more effective in blocking production if you take it at bed time.