INDIA  :   Health

Treatment options for coronary heart disease in India

Saturday , 27 February 2016

According to the World Health Organisation, an estimated 7.4 million people died due to Coronary Heart Disease (CHD) in 2012. In this article, we will explore treatment options like coronary bypass surgery and angioplasty

The American Heart Association defines CHD as a process, wherein there is a build-up of plaque in the heart’s arteries which leads to clogging the blood flow. If not treated on time, the clogging of the heart arteries can result in a heart attack and even, sudden death.

“In CHD, the major blood vessels that supplies blood, oxygen and nutrients to the heart is damaged, due to clogging by cholesterol containing deposits (plaque). The process of plaque accumulation in the coronary arteries decreases the blood flow to the heart,” explained Dr Sudhir Pillai, Cardiologist at PD Hinduja Hospital-Mumbai. He further elaborated that eventually, the decreased blood flow may lead to symptoms like chest pain (angina), shortness of breath, or other coronary artery disease signs and symptoms.

“The process of plaque accumulation in the coronary arteries, often takes over decades. A person may not notice the problem, until there is a significant blockage or a heart attack,” added Dr Pillai.

Causes and diagnosis

According to Mayo Clinic, the causes of Coronary artery disease (CAD) are smoking, sedentary lifestyle, high blood pressure & cholesterol levels and uncontrolled blood sugar levels.

“Men are known to be more prone to develop CAD, than women. Also people with family history of CAD are at a higher than others,” said Dr KK Agarwal, Cardiologist and Secretary of Indian Medical Association (IMA)-New Delhi. Obesity and stress also adds to the risk factor for getting CAD, according to Dr Agarwal.

To diagnose CAD, a cardiologist may like to know the patient’s family history, along with his/her medical history. This is generally followed by a physical exam and routine blood tests. To confirm CAD, the doctor may suggest the following diagnostic tests:

1) Electrocardiogram (ECG). An electrocardiogram can often reveal evidence of a previous heart attack or one that’s in progress.

2) Echocardiogram- It is a type of ultrasound test where the sound waves produce images of the heart and helps a physician determine if all parts of the organ are functioning properly.

3) Stress test. A walk on a treadmill or ride on a stationary bike, during an ECG or echocardiogram, is called a stress test. These days, there are advanced forms of stress tests available, like a nuclear stress test which helps measure blood flow to the heart muscles. During the test, a tracer is injected into the bloodstream, and special cameras can detect areas in the heart that receive less blood flow.

4) Cardiac catheterization or angiogram. Commonly known as angiography, this test is performed to view blood flow, through the heart. A special dye into the coronary arteries is injected for this procedure.

5) Computerized tomography (CT) of the heart. This non-invasive test uses X-Rays with the help of a computer, to create detailed pictures of the heart and its blood vessels.

Treating CHD

Preventing and controlling plaque accumulation in coronary arteries, plays a key role in CAD management. A cardiologist will generally prescribe cholesterol modifying medications like statins, niacin, fibrates and bile acid sequestrants. The doctor may also prescribe a blood thinning drug, like aspirin to reduce blood clotting. Beta blockers and nitroglycerin are other drugs that may be prescribed to treat CAD.

For advanced stages of CAD, however, a cardiologist may prescribe aggressive treatment options, like angioplasty or coronary bypass surgery. According to Mayo Clinic, the two procedures are, as follows:

1.) Angioplasty and Stent Placement (percutaneous coronary revascularization). A long, thin tube (catheter) is inserted into the narrowed part of the artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against the artery walls. A stent is often left in the artery to help keep the artery open. Some stents also slowly release medication, to help keep the artery open. In India, doctors are performing angioplasty using biodegradable stents that gets dissolved in two years.

2.) Coronary Artery Bypass Surgery. A surgeon creates a graft to bypass blocked coronary arteries, using a vessel from another part of the patient’s body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires open-heart surgery, it’s most often reserved for cases of multiple and calcified narrowed coronary arteries.

CAD treatment in India

Indian corporate hospitals like Fortis Malhar in Chennai; Manipal Heart Foundations, Bangalore; Escorts and Indraprastha Apollo Hospital, New Delhi; have gained reputation of being specialists, in the field of cardiac care. With their world class facilities and team of expert surgeons and cardiologists, these medical institutions have distinctive identity in Indian Medical industry, for providing comprehensive cardiac care, spanning from basic facilities in preventive cardiology to the most sophisticated curative technology.

Medical tourism in the area of heart care has grown rapidly in India, as treatment costs are low compared to other developing and developed countries.

“Off-pump Coronary Artery Bypass Grafting (OPCAB) is the latest innovation in cardiac surgery. Many centres in India are performing robotic heart surgery, minimally invasive valve and coronary heart bypass techniques that requires shorter hospitalisation, less blood loss, and a faster recovery,” asserted Dr Ajay Chaughule, Heart Surgeon at Global Hospital-Mumbai.