Heart Surgery

An Brief Introduction to Open Heart Surgery

Any surgery where the chest is opened and surgery is performed on the heart is directly called open heart surgery. The term "open" refers to which may or may not be open heart, depending on the type of surgery involved.

Open heart surgery includes surgery on heart arteries, muscle, valves or other related fields.

The definition of open heart surgery is sometimes used for operations that include techniques that are performed through small incisions. However, this form of invasive surgery remains classified as open-heart surgery.

Open Heart Surgery - it is necessary

Non-surgical techniques like diet and exercise are not effective in the treatment of heart disease, medication may be prescribed.

If heart disease continues to cause discomfort, an invasive procedure is then performed.

Diagnosis

To locate arterial blockages in the heart, coronary angiography (mapping of the coronary arteries) is done using a procedure called cardiac catheterization.

A plastic tube (called a catheter) is passed through an artery in the arm or in the coronary arteries leading leg. A liquid dye is then injected into the catheter. X-rays are then taken following courses dyeing and monitoring the flow dyeing, blocking areas are identified.

There are many kinds of procedures which are commonly carried out:

1. Coronary angioplasty

It is a common operation called percutaneous transluminal coronary angioplasty (PTCA), also known as angioplasty or balloon angioplasty.

A catheter is inserted into the blocked area of ​​the artery. 2nd catheter with a small balloon is passed through  first catheter. When the balloon touches the blocked area, the balloon is inflated, which widens the artery allowing blood to flow more freely.

2. Coronary Artery Bypass Surgery

CABG is a common operation.

A healthy vessel is needed and is used to create a detour around the blocked coronary artery.

One end of the vessel is attached below the lock, the other is attached to the above the following obstruction and blood flows more freely.

3.Heart transplant

The most operations in open-heart surgery is that the graft is necessary.

The operation is complicated because so many blood vessels must be disconnected and re-connected as one replaces the other heart. If the operation takes place, the patient is connected to a heart-lung machine, which maintains the blood circulating around the body.

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Medical care in Indian private hospitals is world famous, is that the expertise of Indian doctors.

The expertise and facilities are available that patients receive the best treatment available at an affordable cost.

ECG

Electrocardiography (ECG ) is a graphical representation of the electrical activity of the heart . This electrical activity is related to changes in electrical potential of specialized cells in the contraction  and specialized cells in automatism and conduction of impulses. It is collected by surface electrodes on the skin .

The electrocardiogram is paper tracing of the electrical activity in the heart . The electrocardiograph is the apparatus for an electrocardiogram . The cardiac monitor ,or scope , is a device to display the route on a screen .

This is a quick review taking only a few minutes , painless and non-invasive , devoid of danger. It can be done in doctor's office , hospital or home . However, its interpretation is complex and requires some experience of the clinician . It allows to highlight various cardiac abnormalities and has an important place in the diagnostic tests in cardiology, such as for coronary artery disease .

The Electrocardiograph

The ECG records the electrical activity of the heart . The position of the electrodes relative to the heart determines the appearance of deflections on the recording.

The detected electrical signal is of the order of millivolt . The required timing accuracy is less than 0.5 ms. ( order of magnitude of the duration of a pacemaker spike .)

The appliances were , until recently , analog . Newest are digital. The sampling rate is nearly 15 kHz3 .

A digital filter eliminates the high frequency signals to high activity other than the heart muscle and interference electric apparatus . A low-frequency filter reduces the ripple of the secondary baseline breathing.

The signal quality can be improved by averaging more complex, but this function causes artifacts in case of irregular heart rhythm or extrasystoles, ventricular above . This averaging technique is particularly suitable for devices used in exercise tests where the route is heavily artéfacté by the patient moving .

Digital layout can then be stored on a computer system . The SCP- ECG standard tends to develop . DICOM (used in medical imaging ) can also store waveform data types including ECG4 5.

The twelve leads

The 12-lead ECG has been standardized by a internationale6 convention. These give a three-dimensional picture of the electrical activity of the heart .

The 12-lead ECG has six frontal leads ( aVR aVL DI DII DIII and aVF ) and six precordial leads (V1 to V6 ) .

Six frontal derivations

DI: bipolar measurement between right arm (-) and left arm (+).

DII : bipolar measurement between right arm (-) and left leg (+).

DIII : bipolar measure between left arm (-) and left leg (+).

The letter D for derivation is not in use in Anglo-Saxon countries that simply call I, II and III.

aVR : unipolar measurement on the right arm.

aVL : unipolar measurement on the left arm.

aVF : unipolar measurement on the left leg .

The letter "a " means " increased ."

DI , DII , DIII and describe the Einthoven triangle , and we can calculate the value of all these diversions from the signal of two of them. For example, if we know the values ​​of ( DI ) and ( DII ) : Statement of the Theory Einthoven : the heart is the center of an equilateral triangle formed by the upper limbs and the root of the left thigh.

III = II - I

aVF = II - I / 2

aVR = -I / 2 - II / 2

aVL = I - II / 2

These equations explain that the digital electrocardiogram not actually record that two derivations and restore the remaining 4 from them by simple calculation.

Six precordial leads

V1: 4th intercostal space right right edge of the sternum ( parasternal ) .

V2 : 4th left intercostal space left sternal border ( parasternal ) .

V3 midway between V2 and V4 .

V4 : 5th left intercostal space on the midclavicular line .

V5 : same horizontal and V4 , anterior axillary line .

V6: same horizontal and V4 , mid-axillary line .

Other derivations 

They are made in some cases to refine , for example, the topographic diagnosis of myocardial myocarde7 .

V7: same horizontal and V4 , posterior axillary line .

V8: same horizontal and V4 , under the tip of the scapula ( shoulder blade) .

V9 : same horizontal and V4 , midway between the posterior spinous and V8 .

V3R , V3 symmetrical relative to the midline.

V4R , V4 symmetrical relative to the midline.

VE, at the sternal xiphoid .

The electrical axis of the heart

Electrical axis and frontal derivations .

Polarity of the QRS complex on the first 3 frontal derivations and electrical axis of the heart .

This is the angle of the electric field generated by the heart cells at the ventricular activation. This field to a single vector is assimilated in the frontal plane . The axis is measured by comparing the amplitudes (preferably surfaces ) of the respective QRS segment ( positive - negative ) in the end lead . The largest positive QRS (R wave ) gives a good idea of the axis of the heart . As the depolarization is physiological AV node to the ventricles of the tip , the center axis of the heart is located between 30 and 60 ° but may be normal between 100 ° and -30 ° . One speaks of axial deflection left beyond -30 ° deflection and axial right beyond 100 ° . In some configurations, the electrical axis is measurable because it is situated in a plane perpendicular to the frontal plane , this is not a sign of pathological path. The electrical axis of the heart in the horizontal plane is much less used in practice. Abnormal axis may indicate disturbance in the sequence of activation of the ventricles or even cellular damage .

Right axis :Axis of the heart between +90 and +120 ° ( surface QRS D3 > D2, D3 in VF comparable , negative VR ) . This angulation is physiological in children and in the lanky subject, it is abnormal in case of right ventricular overload ( as in acute or chronic pulmonary heart or mitral stenosis ) .

Left axis: Axis of the heart between +30 and -30 ° ( surface QRS D1 > D2, D2 VL comparable to almost isoelectric VF ) . This angulation is physiological in adults over 50 years and in obese , it is pathological if left ventricular overload (as in hypertension , aortic valve disease , mitral regurgitation ) .

Hyperdroit axis : Axis of the heart > 120 ° ( surface QRS D3 > D2, D1 negative and positive VR ) . This angle is always pathological and can evoke a congenital heart disease, a left posterior hemiblock beyond 100 ° or right ventricular overload.

Hypergauche axis :Axis of the heart < -30 ° ( surface positive and negative QRS D1 D2- D3). This angulation evokes a left ventricular overload or left anterior hemiblock beyond 45 °.

Axis indifferent: Axis of average heart , between 30 and 60 ° ( surface QRS D2 > D1 > D3 , positive in VL , VF comparable to D1 ) , which is physiological .

Axis in the no man's land :Axis in the no man's land ( 180-270 °). If there is no error in the position of the electrodes , such an axis refers QRS ventricular origin for a ventricular tachycardia . It reflects activation of the tip to the base of the heart and therefore the opposite of what happens in the case of activation via the bundle of His .

Axis perpendicular : Heart since incalculable axis perpendicular to the frontal plane ( QRS all have substantially the same amplitude and the same morphology ) . This is secondary to toggle the heart to the sagittal plane.

Vertical axis: Axis of the heart between 60 and 90 ° ( surface QRS D2 > D3 > D1, negative in VL , and comparable to D2 VF ) , physiological adolescent or slender subject. In older or obese patient , it can evoke a right heart overload.

Medical use of ECG

A good ECG  must have

The analysis starts with an ECG monitoring the interpretability of the path. The calibration of the unwinding speed of the paper must be 25 mm / s , and the amplitude of 1 cm to 1 mV . In this case , 0.1 mV = 0.04 s = a 1 mm square on the line side .

It must include:

12 leads some having complex , and a longer path at least one bypass , allowing to visualize the heart rate

the identity of the patient ,the date and time of the track, and possibly the circumstances of the latter (systematic , pain, palpitations ... )

correct calibration : calibration of the unwinding speed of the paper of 25 mm / s and amplitude calibration of 1 cm / mV . These two pieces of information are systematically reported on the trace and calibration amplitude is shown by a calibration signal visible on the plot. A good calibration is essential for analyzing the trace . The Ashmann unit is defined as 0.1 mV equal 0.04 s , which corresponds to a square of 1 mm side. Any change in calibration changes the amplitude deflections and makes the ECG uninterpretable under references conventionally used .

The route must be also free as possible from electrical noise on all leads and a baseline straight (not wavy ) .

Search a malposition of electrodes must be made. The P wave should be negative in aVR and positive in D1 , D2 and V6. Furthermore, the QRS complex must have a morphology and amplitude progressing harmoniously in the precordial leads .

Basics of ECG interpretation

Reading and ECG interpretation requires a great habit that can be acquired by the physician as a regular practice. There are software programs come with some electrocardiographs can assist in the diagnosis , but they can not substitute the doctor.

A normal ECG does not eliminate any cases of heart disease . An abnormal ECG can also be quite trivial. The doctor uses this test as a tool among others to provide arguments to support his diagnosis.

After the checks mentioned above on the interpretability of the plot , the ECG analysis continues with the study of rhythm and heart rate (number of QRS per unit time ) :

A normal heart rhythm is called a sinus rhythm,  cardiac activity under the control of the sinus node is characterized by:

a. a steady pace with a constant R -R space

b. the presence of a P-wave and before each QRS QRS after each of a P wave ,

c. P wave axis and normal morphology ,

d. a constant PR interval .

If the rate is regular , we can determine a heart rate which is equal to the inverse of the RR interval 
( multiplied by 60 , to be expressed as a number of beats per minute ) . In practice, it may be determined by dividing 300 by the number of small squares of 5 mm between two QRS complexes ; storing the sequence "300 , 150, 100 , 75, 60, 50 " and allows rapid estimation of the frequency, for example if there are 2 squares between two QRS frequency is 150 beats per minute, s' 4 there is 75 square , where currently it is of square 6 508.9 .

Representation of a normal ECG

The plot has several repetitive electrical accidents called " waves ", and intervals between waves. The main measures to be carried out during the analysis of ECG are those of the P wave , PR interval , QRS complex , the registration of intrinsécoïde deflection time , the J point , space QT , ST segment and T wave finally.

P wave corresponds to the depolarization ( and contraction ) of the atria , right and left . Its morphology ( in positive or biphasic and monophasic V1 or V2 in all other derivations ) , duration ( which is 0.08 to 0.1 seconds ) is analyzed , its amplitude ( less than 2.5 mm 2 and D2 the V and V2 mm ) , its axis ( determined in the same manner as the axis of the QRS , normally between 0 and 90 ° , typically about 60 ° ) and synchronization with the QRS wave .

PR interval ( or PQ ) is the time between the beginning of the beginning of the P and QRS . He is the witness of the time required for the transmission of electrical impulses from the sinoatrial node to the atria myocardial tissue of the ventricles ( atrioventricular conduction) . The normal duration , measured from the beginning of the P wave to the beginning of the QRS complex is 0.12 to 0.20 seconds . The duration of the PR interval decreases when the heart rate increases. It normally is isoelectric .

QRS wave ( also called QRS complex ) corresponding to depolarization ( and contraction ) of the ventricles , left and right . The Q wave is the first negative wave complex. The R wave is the first positive component of the complex . The S wave is the second negative component . Following the derivation and shape, hence the term aspect " QS ", " RS" or "SERP " '( for M-shape with two positives ) . The shape and amplitude of the QRS vary according to diversions and possible pathology of the heart muscle underneath. The QRS complex has a normal duration of less than 0.1 seconds , often less than 0.08 s . The normal QRS axis is between 0 and 90 ° . The transition zone corresponding to the precordial lead wherein the isoelectric QRS are normally located in V3 or V4 .

Point D is the point of transition between the QRS complex and the ST segment . It normally is isoelectric .

Segment ST corresponds to the time between the beginning of the ventricular depolarization represented by the QRS complex and the beginning of the T wave . The normal ST segment J is isoelectric point at the beginning of the T wave

QT interval measured from QRS onset to the end of the T wave is the set of ventricular depolarization and repolarization ( time electrical systole ) . Its length varies depending on the heart rate , it decreases the heart rate increases and increases when the heart rate decreases. Elongation or shortening its is bound in certain circumstances the occurrence of complex ventricular rhythm disorder called " torsades de pointes " potentially fatal. And the QTc ( corrected QT ) is the measure of the QT interval corrected by the frequency with the formula QTc = QT / square root of RR space does one use . Cardiac hypoxia and disorders of the blood calcium concentration affect this intervalle10 .

T wave corresponds to most of the repolarization ( relaxation ) of the ventricles , the latter starting from the QRS for a few cells. Its length is 0.20 to 0.25 seconds , the duration of the analysis is in the analysis of the duration of the QT interval . The normal line of the T-wave , calculated in the same way that the axis of the QRS , is between - 10 and 70 ° , often around 40 ° . The T wave is normally pointed, asymmetrical and ample in most derivations . It can be negative in V1 or in D3 and aVF . Its amplitude generally depends of the R-wave that preceded , it is between 1/8 and 2/3 of that of the R-wave and does not usually exceed 10 mm .

T-wave is masked by the atrial wave in the QRS and repolarization ( relaxation ) of the atria . This is negative .

U wave is a small deflection sometimes seen after the T wave in the precordial leads V to V4. It is positive in all leads except aVR , its origin is discussed.

In case of failure, the route should ideally be compared with an old ECG in the same patient : an abnormal ventricular repolarization has not the same meaning if it has existed for several years if it is recent.

Normal ECG

Features ECG normal:

Rhythm: sinus ( the majority of QRS complexes are controlled by a sinus P wave after the sinoatrial )

P wave : time < 0.12 s ; Amplitude < 0.25 mV ; Positive and monophasic in all leads except aVR (where it is negative) and V1 (where it is biphasic ) ; Axis between 0 and 90 °

PR interval : isoelectric ; between 0.12 and 0.20 s

QRS complexes : Time < 0.11 s ; Time to onset of deflection intrinsécoïde <0.04 s and 0.06 s in V1 V6 ; Axis between 0 and 90 ° ; Transition zone in V3 or V4

Repolarization : Point J and isoelectric ST segment; positive T waves , asymmetric , close to that of the QRS axis. U waves absent or below the waves under T. QT interval heart rate.

NB . Many variations exist to the normal , and make the interpretation difficile12 .

Complementary techniques

Holter heart:  This is a portable device for recording one or more ECG leads during several hours.

ECG during the exercise test

Patient monitor : Surveillance monitor , to monitor the patient's rhythm . The number of electrodes is variable , ranging from three ( two electrodes for a bipolar lead and a neutral electrode ) , 5 (for recording standard derivations : four electrodes plus neutral ) or higher . The monitoring console can be located close to the patient or to offset distance ( in a nursing station , for example) connected thereto via a wired or wireless system . This is called " telemetry ". The device can also monitor other physiological parameters such as respiratory rate , blood pressure ... and includes a computer to process the data and present it in the form of reports. Several transmission frequencies without son were reserved for strictly medical purposes, to minimize the risk of interference with other appareils13 . Among the transmission frequencies without dedicated to medical son , we find particularly WMTS and ISM bands .

High amplification ECG : This record is used mainly for detecting the occurrence of arrhythmia and ST -T change over a period of segment 24 hours . The electrodes are used as for all ECG electrodes Ag / AgCl . Recommendations related to the choice of channels recorded on the acquisition of ECG Holter were the subject of several studies . Records are either analogue or digital .

Electrophysiology percutaneous: Examination of percutaneous cardiac electrophysiology is often called " Electrophysiological Study ." This is an examination performed under local anesthesia . Catheters are inserted , usually , in a femoral and guided under fluoroscopy to the heart vein . These catheters are provided with one or more electrode (s ) connected (s ) to an amplifier, to record the potential differences . The signal is interpreted as a function of the location of the catheter and the surface electrocardiogram .

To learn more on ECG visit  ECG made easy

Angiography

Coronary angiography

Coronary angiography (coronary angiogram ) is a test that involves taking x-rays of the coronary arteries and vessels that supply the heart. During this operation, a special stain, or an iodinated product is injected into the coronary artery from a catheter (tube narrow and long) inserted into a blood vessel; each of which then becomes visible in the radiograph. Angiography allows doctors to see the blood flow in the heart, separately, and sometimes even to identify potential problems in the coronary arteries.

Coronary angiography may be recommended for people with angina (chest pain) or those with symptoms of coronary heart disease. It provides physicians with important information about the state of the coronary arteries, which may especially be affected by atherosclerosis, regurgitation (backward pumped through a valve damaged blood) or accumulation of blood in a cavity caused by a malfunctioning heart valve.

What should you expect?

Angiography is performed in a hospital. patient will be to lie on a table and the area around where the catheter will be inserted (groin or arm) we disinfect. Through local anesthesia that will administer your skin will be numb, preventing you from feeling any pain. Then the catheter is carefully guided into a vein or artery to the vicinity of the heart. Once the catheter is in place, it will release the special dye into the bloodstream; this dye facilitate decision clear radiographs and detailed coronary arteries. It should be noted that the injection of the dye may cause a brief sensation of heat, which should, however, be absorbed quickly enough. The duration of an angiogram and a can vary between two hours; However, you can check with the center where you will undergo review to determine the estimated duration of the intervention.

Angiography is a very common procedure that, in general, is considered safe.

How to prepare?

 You should avoid eating or drinking during the 6 to 18 hours before coronary angiography. Consult your doctor about how you prepare for this test, particularly with regard to food, beverages and medicines. If you have questions, check with the center where you are having surgery for specific details in preparation.

coronary artery disease

What is coronary artery disease ?
Coronary artery disease is the narrowing or blockage of the coronary arteries , usually caused by atherosclerosis. Atherosclerosis ( sometimes called "hardening" or " fouling " of the arteries) is the accumulation of cholesterol and fatty deposits ( called plaques ) on the inner walls of arteries. These plaques can restrict blood flow to the heart muscle by blocking the physically or by causing your artery and abnormal artery function .

Without adequate blood supply , the heart becomes starved of oxygen and essential nutrients it needs to function properly. This can cause chest pain called angina . If the blood supply to part of the heart muscle is completely cut off , or if the energy demand of the heart become much larger than its blood supply , heart attack ( damage to the heart muscle) may occur.

What causes the coronary arteries to narrow ?

Your coronary arteries are hollow tubes through which blood can flow freely . The muscular walls of the coronary arteries are normally smooth and elastic and are covered with a layer of cells called the endothelium. The endothelium provides a physical barrier between the blood and the walls of the coronary arteries , while the regulation of the function of the artery by releasing chemical signals in response to various stimuli .

Coronary artery disease begins when you are very young. Before your teen years , the walls of blood vessels begin to show streaks of fat. As you get older , the fat accumulates , causing a minor injury to your blood vessel walls . Other substances that pass through the blood, such as inflammatory cells, cellular waste products , calcium and proteins begin to stick to the vessel walls. The grease and other substances are combined to form a material called plate .

Over time, the arteries expand plates of different sizes. Many of the plaque deposits are soft inside with a "plug" hard fibrous covering the outside. If cracks or tears hard surfaces , soft, fatty inside is exposed. Platelets ( disc shaped particles in the blood coagulation aid ) from the region , and blood clots are formed around the plate . The endothelium can also become irritated and does not work properly, which causes the muscle to tighten artery at inopportune times . This causes the artery to narrow even more .
Sometimes the blood clot breaks, and the blood supply is restored. In other cases , the blood clot ( coronary thrombus) may suddenly block the blood supply to the heart muscle ( coronary occlusion) , causing one of three serious conditions known as acute coronary syndromes

What are the acute coronary syndromes ?

Unstable angina : This may be a new symptom or a change of stable angina . The angina may occur more frequently , occur more easily at rest , feel more severe or last longer. Although this can often be relieved by oral medications, it is unstable and can lead to a heart attack. Usually more intense medical treatment or procedure is necessary to treat unstable angina.

Non -ST-elevation myocardial infarction  segment : This type of heart attack, or MI , does not cause major changes on an electrocardiogram (ECG) . However , chemical markers in the blood indicate that damage has occurred to the heart muscle . In NSTEMI , the blockage may be partial or temporary , such that the extent of the damage is usually relatively small.

ST-segment elevation myocardial infarction  : This type of heart attack, or MI , is caused by a prolonged period of blocked blood supply period . It affects a large area of the heart muscle , resulting in changes of the ECG as well as levels of blood chemical markers key .

Although some people have symptoms that indicate they may soon develop acute coronary syndrome , some may have no symptoms until something happens , and still others have no symptoms of coronary syndrome acute at all.
All acute coronary syndromes require assessment and emergency treatment.

What is ischemia ?

Ischemia is a condition described as " heart muscle cramps . " Occurs when the ischemia narrowed coronary artery reached a point where it can not supply enough oxygen-rich blood to meet the needs of the heart . Cardiac muscle becomes" starved " for oxygen.

Ischemia of the heart can be compared with a cramp in the leg . When someone exercises for a very long time , the leg muscles contract because they are starved for oxygen and nutrients. Your heart is also a muscle, needs oxygen and nutrients to keep working. If the blood supply to the heart muscle is insufficient to meet its needs , ischemia occurs, and you may feel chest pain or other symptoms .

Ischemia is most likely to occur when the heart demands extra oxygen . This is more common during exercise (activity) , food, excitement or stress, or exposure to cold .

When ischemia is relieved in less than 10 minutes with rest or medications you may be told that you have " stable disease coronary artery " or " stable angina . " Coronary artery disease may progress to a point where ischemia occurs even at rest.

Ischemia, and even a heart attack can occur without warning signs and is called "silent" ischemia. Silent ischemia can occur in all people with heart disease , although it is more common in people with diabetes.

What are the symptoms of coronary artery disease ?

The most common symptom of coronary artery disease is angina ( also known as angina ) . Angina is often referred to as chest pain. It is also described as chest discomfort , heaviness, tightness , pressure , aching , burning , numbness , fullness , or compression. It can be mistaken for indigestion or heartburn . Angina is usually felt in the chest , but may also be felt in the left shoulder , arms , neck , back or jaw.

Other symptoms that can occur with coronary artery disease include:

• Shortness of breath
• Palpitations ( irregular heart beats , skipped time or a feeling of " flip - flop " in the chest)
• A rapid heartbeat
• Dizziness
• Nausea
• The extreme weakness
• sweating

If you experience any of these symptoms, it is important to call your doctor, especially if they are new symptoms or if they become more frequent or severe .

If any of these symptoms occur, it is important to get medical help right away - call 108 or have someone take you to the nearest emergency room.

What should you do if you have symptoms :

• If you or someone you are with has chest, left or back pain that lasts more than 5 minutes, with one or more of the symptoms listed above arm , call 108 to get emergency aid . DO NOT WAIT ! Prompt treatment of a heart attack is very important to reduce the amount of damage to your heart.

• Aspirin : After calling 108 , emergency personnel may tell you to chew one full turn ( 325 mg) aspirin slowly, so you do not have a history of allergy to aspirin or bleeding active . Aspirin is especially effective if taken within 30 minutes after the onset of symptoms . Do not take aspirin for symptoms of a stroke.

• If your symptoms go away completely in 5 minutes, always call your doctor to report your symptoms.

• Call your doctor if this is the first time you have experienced these symptoms so you can be evaluated.

• Learn to recognize your symptoms and the situations that cause them.

• Call your doctor if you have new symptoms or if they become more frequent or severe.

How is coronary heart disease diagnosed?

Your doctor diagnosed coronary artery disease by talking about your symptoms, review your medical history and risk factors, and perform a physical exam.

Diagnostic tests , including blood tests, an electrocardiogram (ECG), stress tests or cardiac catheterization may be necessary to properly diagnose and treat coronary artery disease . These tests allow your doctor to assess the extent of your coronary artery disease , its effect on the functioning of your heart, and the best form of treatment for you.

Research on new test procedures as CT coronary angiography (CTA ) can change the way coronary artery disease is diagnosed in the future.

Procedures to treat coronary artery disease 

1.Interventional procedures(PTCA)

Common interventional procedures to treat coronary artery disease include balloon angioplasty ( PTCA) and stent or stent drug eluting . These procedures are considered non-surgical , because they are made by a cardiologist ( heart doctor ), which accesses the heart with a long, thin tube (catheter) that is inserted into a blood vessel, rather by a surgeon through an incision . Several types of balls and / or catheters are available for treating plaque buildup within the vessel wall . If you need an interventional treatment, your doctor will determine which type is best for you based on your individual needs.

2.Coronary artery bypass graft (CABG )

One or more blocked coronary arteries are bypassed by a blood transplant to restore normal blood flow to the heart vessel. These grafts are usually from own arteries and veins located in the patient's chest, arm or leg. The graft goes around the blocked artery (or arteries) to create new pathways for oxygen-rich blood flow to the heart .

When these traditional treatments are not options for you, doctors may suggest other less traditional treatments, such as the strengthening of external counterpulsation ( EECP ) .
Enhanced external counterpulsation ( EECP )

For patients who have persistent symptoms of angina and have exhausted standard treatments without positive results, EECP may stimulate the openings or formation of small branches of blood vessels ( collaterals ) to create a natural bypass around narrowed or blocked arteries. EECP is a noninvasive for people who have angina chronic stable treatment ; who do not receive adequate relief of angina taking nitrate-based drugs ; and who are not eligible for a procedure such as bypass surgery , angioplasty or stenting .

Important Note:

These procedures increase the blood supply to the heart, but they do not cure coronary artery disease. You will still need to reduce the risk factors by making lifestyle changes , taking prescribed medications and following the recommendations of your doctor to reduce the risk of future disease development .

Follow-up care

Your cardiologist will want to see you on a regular basis for a physical examination and may perform diagnostic tests. Your doctor will use the information obtained from these visits to monitor the progress of your treatment. Check with your cardiologist to know when to schedule your next appointment .

Heart attack symptoms

What causes a heart attack?

The most common underlying disease of heart attacks is atherosclerosis, where fatty plaques accumulate on the inner wall of coronary arteries.This is known as coronary artery disease (or coronary artery disease), and is a gradual process that slowly limit the blood supply to the heart muscle. The biggest risk factor for heart attack is smoking.

Other causes include:

    High cholesterol
    Hypertension
    have diabetes
    A family history of heart disease.

Signs and symptoms

Some heart attacks are sudden and intense, but most heart attacks start slowly, with mild pain or discomfort. People are often not sure what's wrong and wait too long before seeking help.

The warning signs of a heart attack vary, it is possible to have no pain (especially among women and people who have diabetes) or the only sign may be a pain indigestion kind. If you have chest pain that lasts more than a few minutes, it may be a sign of a heart attack.

The pain may:

    first come and go
    be in one or both arms (most commonly the left)
    go in your neck, back, jaw, stomach and abdomen

It can feel like:

    compression
    pressing
    stiffness
    fullness
    pain

You can have one or more of the following symptoms, with or without chest pain / discomfort:

    sweating
    feeling faint
    malaise
    vomiting
    shortness of breath

Learn the signs, but remember: Even if you're not sure it's a heart attack, he checked.

Minutes matter! Quick action can save lives - maybe yours. Do not wait more than 5 minutes - call 108.
Calling 1081 is almost always the fastest way to get lifesaving treatment means. Emergency medical services staff can begin treatment when they arrive - up to an hour sooner than you do not receive treatment if you go to the hospital by car.

How a heart attack is diagnosed and treated?

The diagnosis of heart attack is based on your symptoms, your personal and family medical history and the results of diagnostic tests.

Once you are in the hospital:

    You will be treated in the emergency department. Physicians should determine whether or not you have had a heart attack.

    Tests include an ECG and blood tests for cardiac enzymes (cardiac enzymes are released into your body cells damaged heart muscle)

    You will receive medication to help you recover. It can be a thrombolytic drug that will clot breakdown.

    You may need angioplasty.

Once your condition is stable, you will be transferred to a specialized service called the Coronary Care Unit (CCU). As your heart becomes more stable the ECG monitoring will be removed. You will be able to walk slowly around the room with the audience. You may be given medication and as prescribed aspirin, which helps reduce the risk of developing more clots. Additional blood tests will be needed before leaving and if there are no more problems that you can expect to go home in a few days.

Heart Diseases

Cardiology is concerned about the normal functioning of the heart and away from a healthy heart . Many disorders involving the heart itself , but some are outside the heart .

1.Disorders of the coronary circulation

Unlike a basic understanding of the cardiovascular system , the heart can not receive enough oxygen and nutrients from the blood pump and that it must be supplied with blood as if it were another body in the body. Otherwise systemic organ perfusion in a heart receives the diastole phase rather than systole. This way circulation of the blood is called the coronary circulation . Coronary circulation is of coronary arteries and coronary veins .

Disorders of the coronary circulation can have devastating effects on the heart from heart damage may reduce the coronary circulation which causes further damage. Some examples are as follows :

Acute coronary syndrome (ACS) :Acute coronary syndrome is a broad term that encompasses many symptoms of acute myocardial infarction .

Angina: Angina literally means " chest pain " which refers to the pain caused by ischemia of the heart.

atherosclerosis : Atherosclerosis is the condition in which an artery wall thickens as the result of an accumulation of fat (eg , cholesterol). Atherosclerosis coronary artery leads to coronary heart disease .

Coronary artery disease:Coronary heart disease is a general term for a reduction in the coronary circulation. Such a condition is atherosclerosis .

Myocardial infarction ( heart attack) :Myocardial infarction is the death of a part of the heart which is typically caused by a blockage of the coronary circulation and coronary disease.

Restenosis: means narrowing of a coronary artery in the  coronary circulation .

Heart failure :Cardiac arrest refers to the stop ( stop ) the normal systemic circulation due to failure in proper contraction of the heart. There are many several conditions that can cause cardiac arrest.

Asystole ( " flatline " ):Asystole refers to the absence of electrical activity of the heart and is sometimes referred to as a " flatline " because the electrocardiogram shows a solid line because of the absence of electrical activity .

Pulseless electrical activity (PEA):Pulseless electrical activity is when the electrocardiogram shows a rhythm that should produce a pulse , but it does not. PEA is often caused by 6 H 6 and T .

Pulseless ventricular tachycardia: no pulse is felt due to ineffective cardiac output which causes cardiac arrest.

Sudden cardiac death : Sudden cardiac death is a concept of natural death rather than a specific medical condition . There are several causes of sudden cardiac death and is distinct from a cardiac arrest.

Ventricular fibrillation :Ventricular fibrillation is a fibrillation of ventricles of the heart . Rhythmic contraction is necessary for the efficient movement of blood and fibrillation disrupts the rhythm enough to cause cardiac arrest.Treatment  includes  CPR and defibrillation according to the exact cause of cardiac arrest.

2. Disorders of the myocardium (heart muscle )

Cardiomyopathy : Cardiomyopathy is a deterioration of the myocardium.

Ischemic cardiomyopathy : cardiomyopathy causing ischemia of the heart due to coronary artery disease .

Nonischemic cardiomyopathy : Cardiomyopathy not caused by ischemia of the heart.

Amyloid cardiomyopathy :Cardiomyopathy caused by amyloidosis .

Hypertrophic cardiomyopathy : Cardiomyopathy induced by an enlarged heart .

Hypertrophic obstructive cardiomyopathy : dilated cardiomyopathy caused by the heart .

Alcoholic cardiomyopathy : A type of dilated cardiomyopathy caused by chronic alcohol abuse.

Tachycardia induced cardiomyopathy : A type of dilated cardiomyopathy caused by chronictachycardia .

Takotsubo cardiomyopathy  :A type of dilated cardiomyopathy caused by a sudden temporary weakening of the myocardium.

Restrictive cardiomyopathy : Cardiomyopathy caused by excessive rigidity of the heart .

Heart failure : heart failure to produce enough to meet the metabolic needs of the body blood flow.

Pulmonary heart : untreated pulmonary heart can cause chronic right heart failure pulmonary hypertrophy .

VH hypertrophy of the ventricle.

LVH : left ventricular hypertrophy .

Right ventricular hypertrophy : hypertrophy of the right ventricle .

Primary tumors of the heart : initial tumors related to heart and not elsewhere in the body.

Myxoma : the most common tumor of the heart .

Myocardial rupture : a failure of the gross structure of the heart . Commonly following myocardial infarction .

Constrictive pericarditis : Pericarditis that constricts the expansion of the heart and inhibits cardiac function.

Pericardial effusion : an abnormal accumulation of fluid in the pericardium , which can lead to tamponade.

Pericardial tamponade : accumulation of fluid in the pericardium that inhibits cardiac function.

Pericarditis : Inflammation of the pericardium .

3. Disorders of the heart valves

The heart has four valves that direct the flow of blood in one direction. failure to stop against the current is called regurgitation or insufficiency. Due to narrowing of the valves obstruct the flow,  is called stenosis.

a. Aortic valve

Diseases and the treatment of the aortic valve separates the left ventricle and the aorta
.

      • Aortic regurgitation / aortic insufficiency : Deficiency of the aortic valve which allows the aortic regurgitation into the left ventricle
.

       • Aortic stenosis: which reduces blood flow through the valve .

       • replacement of the aortic valve :The replacement of the aortic valve is the aortic regurgitation , aortic stenosis , or other reasons.

        • repair of the aortic valve : Repairing, instead of replacing the aortic valve .

        • aortic valvuloplasty :The valve repair using a balloon catheter for the opening force .

b. Mitral valve

Diseases and treatment of the mitral valve that separates the left atrium and the left ventricle.

       • prolapse of the mitral valve

        • Mitral regurgitation / mitral insufficiency:  Irregularity of mitral valve regurgitation that allows the left ventricle into the left atrium.

         • mitral steosis :Narrowing of the opening of the mitral valve , which reduces blood flow through the valve
.

          • replacement of mitral valve : Replacement of the mitral valve due to mitral regurgitation , mitral stenosis , or other reasons.

           • repair of the mitral valve :Repair instead of replacement of the mitral valve.

            • mitral valvuloplasty: The valve repair using a balloon catheter for the opening force .

 c. Pulmonary valve 

Diseases of the pulmonary valve that separates the right ventricle and the pulmonary artery.

• Pulmonary failure / pulmonary insufficiency: Deficiency of pulmonary valve regurgitation that allows the pulmonary artery into the right ventricle .

• pulmonary stenosis: The narrowing of the opening of the pulmonary valve that reduces blood flow through the valve .

d. Tricuspid valve

Diseases of the tricuspid valve separates the right atrium and the right ventricle.

• tricuspid regurgitation / tricuspid regurgitation: Insufficiency of the tricuspid valve regurgitation that allows the right ventricle into the right atrium.

4.Congenital heart defect (CHD)

CHD are defects in the structure of the heart that are present at birth.

• Atrial Septal : Defect in the atrial septum that allows blood flow between the atria , including a patent foramen ovale ( PFO )
.

• bicuspid aortic valve : Formation of two valve leaflets in the aortic valve leaflets instead of three .

• syndrome of hypoplastic left heart :Defect in the development of heart left as ishypoplastic ( underdeveloped ) .

• Patent ductus arteriosus (PDA): Failure to close the ductus arteriosus birth.

• The patent foramen ovale ( PFO ) :Atrial septal defect in that the foramen ovale does not close at birth
.

• Persistent truncus arteriosus: Failure in the arterial tree that is dividing.

• Tetralogy of Fallot: total Set of four anatomical abnormalities : aortic paramount,pulmonary stenosis , ventricular septal defect , and right ventricular hypertrophy.

• Transposition of the great vessels (TGV): Abnormal spatial arrangement of the great vessels ( superior vena cava , inferior vena cava , the pulmonary arteries , pulmonary veins , and the aorta ) .

• Ventricular septal defect:  Error in the ventricular septum which permits the flow of blood from the ventricles .

5.Diseases of the blood vessels ( vascular disease )

• Atherosclerosis : The thickening of the arterial wall due to increased cholesteroland macrophages .

• aneurysm : Balloon-like bulge of the artery.

• Aorta :Diseases of the aorta :

• coarctation of the aorta: Narrowing  at the ductus arteriosus / ligament.

• Aortic dissection : Dissection of the long length of the aorta between the layers of the aortic wall and filled with blood
.

• aortic aneurysm :Aortic aneurysm .

• carotid artery :Disease of the carotid arteries :

• carotid artery stenosis / carotid artery disease : Narrowing of the carotid artery , usually due to atherosclerosis.

• carotid artery dissection :Dissection along the length of the carotid artery between the layers of the wall of the carotid artery and filled with blood .

• Deep vein thrombosis (DVT) : The formation of a thrombus in a deep vein , usually in the legs .

• class syndrome thrombosis / economy travelers :DVT due to being sedentary during air travel .

• Varicose veins :Veins that have become enlarged and tortuous with valves failed , usually in the legs .

• Vasculitis :The inflammation of the blood vessels .

 6. Procedures fight against coronary disease

• bypass surgery of the coronary (CABG ) :Grafting of an artery or a vein from elsewhere ( usually the legs ) for a stenosed coronary artery bypass .

• Enhanced external counterpulsation ( EECP ) : Air assist to move blood to the heart using inflatable balloons on the legs .

• percutaneous coronary intervention (PCI) :The procedures for the treatment of stenosed coronary arteries , by accessing through a blood vessel .

• PTCA :The enlargement of the coronary artery lumen by forces developing with a balloon.

• atherectomy :The enlargement of the light of a coronary artery by removing the plaque .

• Stenting

• expands the lumen of a CA by the strength developing a tube with wire .

7. The devices used in cardiology

• Stethoscope: Acoustic device for the hearing internal sounds , including heart sounds .

• Devices used to maintain normal electrical rhythm

• Pacemaker : An implanted electrical device that replaces the heart's natural pacemaker .

• Defibrillator :Electrical appliances to change the rhythm of the heart with electrical energy.

• Automated External Defibrillator (AED ) :An external defibrillator that is commonly found outside of health care settings . Often designed for anyone to use .

• implantable defibrillator ( ICD ) :It i is used to avoid situations of life-threatening (eg , ventricular tachycardia, ventricular fibrillation) .

8. Devices used to maintain blood pressure

• The artificial heart :An internal pump that completely replaces the pumping action of the heart .

• Extracorporeal circulation (ECC ) / heart-lung machine :External pump to support the function of both the heart and lungs.

• pump intra -aortic balloon ( IAB ) :A balloon located in the thoracic aorta to complete the cardiac output of the heart.

• ventricular assist device: It is a Internal pump to supplement or replace the pumping action of the ventricle.

9.The tests and diagnostic procedures

• Blood tests

• Echocardiography ( "echo" ) : Ultrasound of the heart to inspect the rooms , valves and blood circulation.

Transthoracic echocardiogram • (TTE) :Echocardiogram of the heart in the thorax through the outer body .

• Transesophageal echocardiography (TEE ):Echocardiogram of the heart through a catheter placed in the esophagus.

• Cardiovascular magnetic resonance imaging (CMR) :Magnetic resonance imaging (MRI ) of the heart using ECG and trigger for watching specific mechanical functions of the heart .

• Cardiac Stress Test:Test the cardiovascular system through the controlled drug or exercise .

• Auscultation :Listen to sounds (eg , heart sounds ) with a stethoscope .

• electrocardiography (ECG):Measuring the electrical activity of the heart, typically 4 or 10 with the electrodes on the skin .

• Holter monitor:Mobile device for ECG monitoring.

• study of the electrophysiology:The study of the electrical activity of the heart through the use of catheters placed in the heart via the veins or arteries.

• sphygmomanometer :Cuff used to measure arterial blood pressure .

• cardiac marker: Test biomarkers in the blood that may indicate different conditions.

• coronary catheterization

• fractional flow reserve ( FFRmyo ):Testing the bloodstream through a stenosis of a coronary artery to determine the perfusion of the heart.

• intravascular ultrasound (IVUS ): Ultrasound of the coronary artery.

• optical coherence tomography (OCT): Trial using optical scattering 

Anatomy of the heart

Your heart is located under your rib cage in the center of the chest between the right and left lungs. Its muscular walls contracts and pumps blood to all parts of your body .

The size of your heart may vary depending on your age, size and condition of your heart . A normal healthy adult heart , is usually the size of a fist tight average adult. Certain diseases can cause the heart to enlarge .

The exterior of the Heart

The right side of your heart 
The superior and inferior vena vein(IVC) are blue left heart muscle .These veins are the largest veins in your body.

After the organs and tissues of your body used oxygen in the blood, the vein veins carry oxygen-poor blood to the right atrium of the heart .

The superior vena cava (SVC)carries oxygen-poor blood from the upper part of your body , including the head, chest, arms and neck. The IVC carries oxygen-poor blood from the lower part of your body.

The oxygen-poor blood from the vena cava flows into the right atrium of your heart, then to the right ventricle . The right ventricle, blood is pumped through the pulmonary ( PULL- mun -ary ) arteries  to your lungs.

Once in the lungs , the blood flows through numerous small , thin blood vessels called capillaries. There the blood takes more oxygen and carbon dioxide transfer in the lungs , a process called gas exchange .

The oxygen-rich blood passes from your lungs to the heart through the pulmonary veins .

The left side of your heart
Oxygen-rich blood from your lungs through the pulmonary veins . Blood enters the left atrium and is pumped into the left ventricle .

The left ventricle, the oxygen-rich blood is pumped to the rest of your body through the aorta. The aorta is the main artery , carries oxygen-rich blood to your body.

Like all your organs, your heart needs oxygen-rich blood. As blood is pumped out of the left ventricle of the heart , a portion of the flow in the coronary arteries  .

Your coronary arteries are located on the surface of your heart at the beginning of the aorta. They carry oxygen -rich blood to all parts of your heart .

Inside the Heart

Here is a picture of the inside of one healthy, normal human heart.

Interior heart
The blue arrow indicates the direction in which oxygen-poor blood flows through the heart to the lungs. The red arrow indicates the direction in which oxygen-rich blood flows through the lungs into the heart and then to the body.

Heart chambers
The inside of your heart and how it is divided into four rooms. The two upper chambers of the heart are called the atria. This receivse and collect blood.

The two lower chambers are called ventricles of the heart . The ventricles pump blood from your heart to other parts of your body.

the septum
Internal tissue wall divides the right and left sides of your heart . This wall is called the septum.

The area of the septum that separates the atria are called atrial or interatrial septum . The area of the septum that separates the ventricles is called or the interventricular septum .

heart valves
 Four valves of your heart.  these valves are the aortic ( ay- OR - tik ) valve, tricuspid (tri- CUSS - pid ) , pulmonary valve, and mitral (MI- trul ) .

bloodstream
The arrows  shows the direction that the blood flows through your heart . The light blue arrow shows that the blood enters the right atrium of the heart of the upper and lower vein cellars .

The right atrium , the blood is pumped into the right ventricle. From the right ventricle , the blood is pumped into the lungs through the pulmonary arteries .

The red arrow shows the light oxygen-rich blood from the lungs through the pulmonary veins into the left atrium of your heart. The left atrium , the blood is pumped into the left ventricle. The LV pumps blood to the rest of your body through the aorta.

Works well for the heart , blood must flow in only one direction. The valves in your heart that this is possible. Both ventricles of your heart have an "in" (inlet) valve from the atria and an "out " (outlet) valve leading to your arteries.

Healthy valves open and close in exact coordination with the pumping action of the atria and ventricles of your heart. Each valve has a set of leaflets or cusps that said seal or open the valve flaps . This allows blood to pass through the chambers and into your arteries without backing up or refluxing