Archive For The “Diagnosis and Treatment of Heart Diseases” Category
Congestive heart failure diagnosis is based on certain aspects such as the relevant medical history of a patient, risk factors, selected medical test and a prudent physical examination. A thorough history of the patient may divulge the presence of one or more warning signs of cardiac failure. Additionally, a history of prior cardiac arrest, significant use of alcohol, diabetes, hypertension or coronary heart disease can be clues. The physical evaluation focuses on detecting the quantity of the fluid accumulated in the body (neck veins, leg swelling, or breath sounds) as well as cautiously characterizing the heart’s condition (murmurs, heart sounds, pulse and heart size).
The doctors who deal with the heart related issues are called cardiologists. Some doctors have training in advanced and additional areas which involve non-invasive studies where they use radioactive drugs or dyes for studying the function and structure of the heart (nuclear cardiology), echocardiography, cardiac rhythm disorders or abnormal heart beats (electrophysiology), cardiac catheterization and radiologic heart imaging.
Why Tests and Exams ?
Once the patient visits the cardiac center, the doctor will examine his/her signs and symptoms of cardiac failure:
- Edema (swelling on the leg)
- Breathing problems or fast breathing
- Veins in the neck are distended
- Swelling on the abdomen or liver
- Abnormal heart sounds with fast, irregular or uneven heart beat
- Doctors use their stethoscope to listen the sound that develops during the build up of fluid (crackles) into the lungs.
Many tests are performed to find the cause, monitor the cardiac failure and diagnose the exact condition.
An X-ray, echocardiogram, electrocardiogram and MRI are best for having a visual idea about the cardiac system. The cardiologists often use these images as a guide for opting the right treatment.
- Diagnosing and monitoring heart failure
- Finding out possible causes and other disorders that may lead to this medical condition
- Identifying the risk factors
- Monitoring the side effects of drugs that a patient might be taking
Medical Tests for Diagnosing Congestive Cardiac Failure
Cardiac specialists use various medical tests for diagnosing the cardiac failure. The most preferred tests are as below:
Chest X-ray: This technique helps to get an x ray image that shows the shape and size of the heart and lungs. In cardiac failure, the accumulated fluid in the lungs can be seen and the enlarged shape of the heart is also visible. An X ray is also used to detect other medical conditions.
Blood Tests: This test may indicate the presence of other disorders that impair the cardiac system. A blood test is helpful in checking the levels of B-type natriuretic peptide or BNP (hormone). When your heart overworks, it tends to secrete B-type natriuretic peptide in excess or at greater level, and this levels indicates that a patient is undergoing heart failure.
Electrocardiogram (ECG): Electrocardiogram is used to measure the electrical impulses produced by your heart. In this process, doctors locate electrodes or sensor patches attached with wires on your skin. Electrocardiogram helps to reveal any damage to the cardiac system and heart rhythm disorder due to a previous attack.
Angiogram or Coronary Catheterization: This test uses a catheter (a thin, elastic tube), which is inserted into a blood vessel of the elbow or groin (upper thigh) and guided to the heart. A dye that makes the arteries visible under the x-ray is injected into the arteries that move towards the heart. Angiogram helps to identify the narrowed arteries moving towards the heart (coronary heart disease), which may develop congestive cardiac failure. This test is also beneficial to know the health of the heart valves and the strength of the left ventricle (main pumping chamber of the cardiac system).
Myocardial Biopsy: In this test, a tiny flexible biopsy cord is inserted into a vein in your groin or neck to take off some tiny pieces of the cardiac muscle. Myocardial biopsy is performed to detect certain forms of cardiac muscle diseases that may result into cardiac failure.
Magnetic Resonance Imaging or MRI: In this technique, radio waves and magnetic field are used to develop detailed and clear visuals of the cardiac system.
Echocardiogram: This technique uses sound waves to create a clear and detailed picture of certain factors such as the size, function and stricture of the cardiac system. These images allow doctors to determine the pumping capacity of the heart and differentiate between various forms of heart failure. An echocardiogram also measures the ejection fraction (how much percentage of blood is pumped by the major blood supplying chamber of the heart).
Right Heart Catheterization: This technique requires a catheter (a thin elastic tube) to be inserted into a vein (blood vessel) in the groin or neck of the patient. They direct the catheter to the cardiac system and thus measure the pressure within the chambers of the heart. This process helps to opt for heart failure treatment.
Multiple-gated Acquisition Scanning(MUGA) or Radionuclide ventriculography: This is a nuclear medicine test in which a small amount of radioactive dye is injected into the vein and a special camera is used to see the percentage of blood pumped by your heart with each beat. Outcome of these tests allows the doctors to determine the causes of the symptoms and schedule a treatment plan. Cardiologists categorize or measure the cardiac failure on the basis of a standard scale that ranges between I to IV. A cardiac failure of class I type is considered as the moderate form, in which the patient is able to perform the routine activities normally without feeling stressed, fatigued or winded, whereas the patients at class IV level are considered to be in the extreme severe condition in which they experience shortness in breathing even while resting.
Stress Tests: This is an exercise test in which the patient is asked to workout on a stationary bicycle or a treadmill or take a dose of drug that will boost the activity of the heart during the workout. An electrocardiogram is used to monitor each activity of the heart when a person in performing activities. The stress test allows your doctor to judge the effectiveness of your therapy and plan for more advanced therapies. Various form of stress examinations measure the response of the cardiac system to workout in various manners and situations. Few cardiac centers throughout the world have the advanced equipment to measure the relaxation effect of the cardiac system to the exercise. They perform a test to analyze diastolic cardiac failure.
The above mentioned medical techniques require expertise and specialization for appropriate diagnosis. All the methods are commonly used for congestive heart failure diagnosis. The symptoms of this medical condition develop with build up of plaque deposits and the process of deposition is gradual. If the patient observes the symptoms in the early stages and gets it diagnosed immediately, his/her chances of recovering from this medical condition increases.
Congestive heart failure indicates that the power of the heart to pump blood throughout the body reduces drastically than normal and a person starts developing its symptoms. After observing any of the symptoms, the patient should immediately consult a doctor for further diagnosis, confirmation and treatment. During diagnosis, the doctor will carry out certain medical and physical examinations along with considering the risk factors and medical history of the patient. When treating this medical condition, the goals are to improve symptoms, treat the core causes of heart failure and increase the chances of prolonging the life of the patient. Certain changes in lifestyle (such as exercising, changing eating habits and quitting smoking) and medications (such as diuretics and beta-blockers) are initial forms of treatment. For patients with severe cardiac failure, cardiologists may suggest heart transplant or mechanical heart pump.
Congestive heart failure treatment proves significantly helpful to improve the symptoms and aid the weakened cardiac function as effectively as possible. Heart failure specialists treat some patients by correcting the inexplicit cause of their condition, for example, by controlling the fast or abnormal heart beats, repairing or opening clogged arteries or replacing diseased valves. Cardiologists also treat other medical conditions that may contribute in aggravating the underlying cardiac problems such as anemia, thyroid problems, sleep apnea and other blood related abnormalities.
Few health care centers have doctors or cardiologists that are well equipped with advanced training in cardiac failure to treat the congestive heart failure patients. They have vast experience in all types of surgery for treating various heart related diseases. Surgeons often perform heart transplants, implant ventricular assist devices and minimally invasive cardiac surgery.
Doctors have Certain Goals for Treating Congestive Heart Failure (CHF)
While most victims with heart failure cannot be cured, changes in lifestyle and diet, medications and specialized treatment and care for those in advanced stages can often help to relieve symptoms and drastically enhance the quality of their lives. Specialized treatments can also prolong the life of a person by soothing the worsened condition to some extent. Since the causes of CHF vary for each person, the treatment options opted by the cardiologists may also differ.
The goals of CHF treatment are to:
- Improve the symptoms of a patient along with the quality of life
- Treat the core causes of heart failure
- Prolong the life of the victim
- Eliminate the causes and stop the condition from getting worse.
The doctor may also continue to treat other conditions or diseases that causes CHF (such as diabetes, high blood pressure or coronary artery disease).
What are the Options for Congestive Heart Failure Treatment?
Treatments for congestive cardiac failure may include medical devices, surgery, lifestyle changes and medications.
Biventricular Cardiac Heart Pacemaker: This can also be called cardiac resynchronization therapy (CRT) device. It sends electrical impulses to the lower chambers of the heart in a specific time. This device is used to treat the patients whose heart’s electrical conduction is abnormal or irregular and who have moderate to intense cardiac failure.
Ventricular Assist Device (VAD): This device is used for the patients whose weakened heart needs assistance in pumping blood. Surgeons implant VAD into the abdomen of the patient and connect it to the cardiac system. This can also be called mechanical cardiac pump that can be used as a bridge to cardiac transplant or as a permanent solution for patients who cannot undergo transplantation. VAD is suitable for most patients who are not left with any other treatment options.
Internal Cardiac Defibrillator (ICD): Surgeons implant internal cardiac defibrillator under the skin to monitor the abnormal or fast rhythms (arrhythmias) in patients undergoing heart failure. This device sends electrical signals to the cardiac system; if it detects abnormal or high rhythm, it will transform the beats into slow and more effective pumping.
Heart Transplant: Some patients with completely damaged cardiac system have to choose this treatment option.
Coronary Bypass Surgery: According to the diagnosis, if severly narrowed coronary arteries are found to be the reason for heart failure, most heart specialist may suggest coronary bypass surgery.
Heart Valve Replacement or Repair: Replacement or repair of heart valve is recommended to treat the underlying symptoms that have caused heart failure. This surgery will not only help to relieve the symptoms, but will also improve the quality of the patient’s life.
Myectomy: In this therapy, the overgrown septal muscle in the cardiac system is removed to eliminate the clogging that occurs in hypertrophic cardiomyopathy. Myectomy is usually performed when medications fail to relieve the symptoms.
Heart care specialists often use medications that are proven to increase the chances of survival and prolong life and relieve symptoms. The heart specialist may also prescribe certain medications that help to improve circulation, lower blood pressure and prevent clogging in the arteries or blood thinners to dissolve clots or prevent clotting.
A number of drugs may aid to treat the heart’s inability to pump enough blood through the respective chambers.
- Beta Blockers: These drugs help to lower blood pressure, slow the heart beat and reduce the risk of abnormal or irregular rhythms of heart.
- ACE (Angiotensin-Converting Enzyme) Inhibitors: These inhibitors improve blood flow, reduce blood pressure and decrease the workload of the heart.
- Angiotensin II (A-II) Receptor Blockers (ARBs): A-II receptor blockers have several benefits as compared to the angiotensin converting enzyme without any potential side effects such as persistent cough. It is useful in lowering down the blood pressure and enhance the heart efficiency to pump blood. These drugs may also amend the survival chances of the pateint following a heart attack. Candesartian and valsartan are the common forms of ARBs.
- Diurectics: This drug is used to prevent the accumulation of fluid in the body and lessen the accumulated fluid in the lungs by making breathing easy.
- Inotropes: These medications are intravenous and are used for the patient with severe heart failure. Inotropes help to improve the pumping action of the heart and keep the blood pressure under control.
- Digoxin: This drug can also be called digitalis. It helps to elevate the heart’s contraction strength, tends to reduce the fast heartbeat and controls the irregular heartbeat.
- Aldosterone Antagonists: These drugs may help to repeal scarring of the heart, encourage the cardiac system to work better, and prolong the life of the patient even with severe condition.
- Nesiritide: This medication is intravenous (given through vein). Nesiritide is a synthetic form of BN (B-type natriuretic peptide), a hormone that is produced naturally in the human body.
In some cases, cardiac failure becomes so severe that the patient needs to be kept under observation in the hospital. During treatment, the patient may be given some medications that help the heart to relieve the symptoms and pump appropriately.
Doctors may also provide supplement oxygen. Patients with severe condition may require supplemental oxygen for a long time.
Doctors may ask the patient to make few changes in their lifestyle; this can help the patient in relieving symptoms and preventing the disease from worsening. The possible changes in the lifestyle may include:
- Cutting off the intake of excessive sodium and fat in diet
- Limiting or avoiding the intake of alcohol
- Quitting smoking
- Limiting or avoiding caffeine intake
- Losing extra pounds if the patient is overweight or maintaining the healthy weight
- Exercising according to the schedule structured by the cardiac rehabilitation program or by their own
- Reducing stress and thus the chances of high blood pressure.
A typical congestive heart failure treatment program may usually include all the above practices compositely. There may be a few changes in this program for each individual.
Heart attack (myocardial infarction) is sudden failure in the functioning of the heart due to the interruption in the oxygen-rich blood supply to any section of the heart. If a person experiences severe chest pain or any of the heart attack symptoms, he or she should immediately consult a doctor. Heart attack diagnosis and treatment are performed at the same time when a patient undergoes severe pain in the middle part of the chest. The risk factors and symptoms of cardiovascular diseases should not be ignored because if they remain untreated, it may lead to death of a person.
Heart Attack Diagnosis
First of all, doctors take the medical and physical history of the patient. Then they carry out certain tests and examinations for the diagnosis of coronary artery disease. These tests can be:
Electrocardiogram (EKG or ECG)
This is a simple, quick and painless test that analyzes and records the electrical activity of the heart. It measures the heart’s electrical activity and its conduction in the cardiac muscles. Electrocardiogram helps to direct what exactly happens in the ER. This test makes a graph that indicates how speedily the heart is beating along with its rhythm (abnormal or steady). It also records the timing and strength of electrical signals, as they move from every single part of the heart.
An ECG can show signs of a current and previous coronary heart disease along with the signs of damage to the heart because of the coronary heart disease. If the heart has undergone huge damage due to an attack, it can be seen in the EKG record, in case of damage to small portions of the heart muscle; the ECG may look comparatively normal.
If the ECG report does not find out the heart attack (an electrocardiogram can be normal even if the heart attack has occurred). In such case, the second step would be a blood test to indentify the level of heart damage. During myocardial infarction, cardiac muscle cells die and discharge chemicals into the blood vessels. These chemicals are proteins such as CPK, troponin and cardiac enzymes myoglobin, which are measured in combination or alone to detect whether the heart muscle is damaged. The most common type of blood tests to detect an attack include serum myoglobin tests, CK–MB or CK tests and troponin test. Blood test is helpful to measure how much proteins are present in the bloodstream and the higher level of protein in the blood indicates a heart attack.
Unfortunately, the chemicals take time for accumulating in the blood vessels after the muscles of the heart gets damaged. Samples of blood need to be taken after certain time so that the outcome can be interpreted. These tests are usually repeated to keep the track of changes with time.
This test may be carried out to find out various facts including the clarity of lung areas, width of the aorta and heart shape. If the X-rays fail to find out whether a heart attack has occurred, further tests such as CT scans, echocardiography, heart catheterization and stress test are taken. Doctors evaluate the overall condition of the patient and then decide the preferable diagnosis option. Diagnosis technique of cardiac attack may vary for each patient.
In this test, special x rays and dye are used to evaluate the coronary arteries from inside. Coronary angiography is often carried out during a heart attack; this helps to find the clogs in the arteries. The cardiac catheterization technique is used to insert the dye into the arteries.
A catheter (a thin elastic tube) is inserted into the blood vessel in your upper thigh (groin), neck or arm. The coronary artery is ribbed with this tube and a dye is injected into the bloodstream. The flow of the dye through the arteries and the heart is analyzed by the doctor with the help of special x rays. If your doctor finds any clogging, they recommended a technique called angioplasty. This technique helps to remove the blockage and restore blood supply through the artery. In some cases, a stent (a small mesh tube) is fixed in the artery to avoid further clogging after angioplasty.
Heart Attack Treatment
Understand your symptoms of cardiac arrest to take immediate medical assistance. Early treatment can help to limit or prevent impairment to the heart muscles. Taking quick action when you experience the first symptoms of cardiac failure can save your life. In some cases, doctors start diagnosing and treating the patient even before they reach the hospital.
Some treatments are initiated right away if a cardiac failure is suspected, even prior to the confirmation of the heart attack. These treatment options may include:
- Aspirin is given to the patient, as it helps to thin the blood and prevent it from further clotting.
- Oxygen therapy
- Chest pain treatment
- Nitroglycerin is used, as it helps to reduce the work burden on the heart and enhance the flow of blood through the arteries.
Once the cardiac arrest is strongly suspected or confirmed, more effective treatment options are adopted to promptly reinstate the flow of blood towards the heart. The two prime treatment options to open the clogged coronary arteries are angioplasty and clot busting.
This is a non surgical technique that clears up the narrowed and blocked arteries. This technique can also be referred as percutaneous coronary intervention (PCI). During angioplasty, a thin elastic tube with a balloon attached to its end is ribbed through a blood vessel to the clogged or narrowed coronary artery. In some cases, the balloon is replaced with some other device.
Once the tube is placed, the balloon is blown up to constrict the plaque against the artery wall. This helps to restart the blood supply through the artery. During angioplasty, the doctor may place a stent in the artery. This helps to prevent clogging in the artery for several months or year after angioplasty.
Clot Busting Medicines
These medicines are called clot busters (or Thrombolytic medicines), which are meant to dissolve the clots of blood that are clogging the arteries. Clot busters work best if given within few hours of the initiation of cardiac failure signs.
Other Treatment Options for Cardiovascular Diseases
Coronary artery bypass grafting (CABG) is a surgical process that is used to treat this medical emergency. During this process, a healthy vein or artery from the patient’s body is taken off to graft or connect it to the blocked artery. This grafted vein or artery bypasses the clogged area of the artery and provides a new path for blood to move towards the heart muscle.
ACE Inhibitors: They help to lower the strain on the heart as well as reduce the blood pressure. ACE inhibitors also reduce further debilitation of the heart muscle.
Beat Blockers: This medicine decreases the rate of workload on the heart. Beta blockers are also used to get relief from the discomfort due to chest pain and also forbids repeat cardiac attack. They can also be used for treating arrhythmias.
Anti-clotting Medicines: These medicines prevent the formation of unwanted blood clots and clumping of platelets. Clopidogrel and aspirin are the anti clotting medicines.
Anticoagulants: These are blood thinners which prevent the formation of blood clot in the arteries. Anticoagulants also restrict the existing clots from getting huge.
Doctors may sometimes give medicine to relieve anxiety and pain, lower the cholesterol level and treat arrhythmias. The treatment for heart attack is long lasting because after getting discharged from the hospital, you may have to continue with the medicines on a regular basis along with visiting the cardiac rehabilitation often. You may have to take the pneumococcal vaccine and flu shot every year.
Conducting heart attack diagnosis and treatment once you experience the first symptom can save your life and help you recover quickly.