In the realm of cardiovascular care, Dr. C. Moorthy stands as a paragon of expertise, placing the utmost importance on combating Coronary Artery Disease (CAD). His dedication to patient well-being is unwavering, reflected in a personalized and comprehensive approach to diagnosis, treatment, and prevention. From heart-healthy diets to tailored medications, his approach is finely tuned to the unique needs of each patient. In cases requiring advanced interventions, His expertise shines in procedures such as angioplasty, stent placement, and coronary artery bypass surgery. His patient-centric approach ensures a holistic understanding of each patient’s health, emphasizing compassion and expert care that instils confidence in their journey to heart health.
Coronary Artery Disease (CAD)
It is the Disease of the Blood vessels supplying blood to the Heart Muscles for it’s Regular function.
Our Heart beats 1,40,000 times per Day Since our birth, for this action / function Heart requires proper – continuous Blood supply to the Muscles & Conduction fibers of the heart. As age advances there will be deposition of fat (Cholesterol Crystals) Calcium, Blood Cells, and Tissues producing block in the blood vessels of the heart. This condition is called CAD.
Is Heart Attack & Heart Failure Both are Same?
No.
Heart Attack means sudden damage of the heart muscles due to block in the blood vessels of the heart. The block may be due to Atheromatous plaque (or) Blood Clot.
Heart Failure means weakness of the Heart muscles due to various reasons including heart attack there by producing weak pumping action.
How Heart attack results in Heart failure?
If the Heart Attack is not treated in time can result in heart failure.
What are the symptoms of Heart Attack?
- Compressing type of chest pain.
- Jaw pain / Shoulder pain spreading to arm (mostly left arm)
- Sweating / epigastric pain / vomiting / Tiredness / Giddiness.
These are the symptoms in NON – DIABETIC patients.
Note : This above mentioned symptoms can happen in other conditions like peptic ulcer / Reflux Oesophagitis / aute pancreatic disease / Peri arthritis Shoulder some time lung related disease.
So one should be very carful in diagnosing heart attack which requires adequate knowledge in Cardiology and good experience and ECG supported by blood enzyme tests (Trop –T / Trop – I / CPK – MB).
In Diabetic patients – symptoms of Heart Attack are unusual and Atypical
Mostly there will not be chest pain (Silent attack) but there will be burning sensation in the center of the chest with unusual tiredness and vomiting with breathlessness for ordinary work. sometime patient may faint.
Structure of the Heart and Coronary Artery
Normal coronary Angiogram
- Left System
- Right System
Coronary Angiogram of Diseased Coronary Artery (CAD)
- Left System
- Right System
What is the Treatment for Heart Attack?
Treatment Depends upon
- Age of the patient
- Arrival time to the hospital after Heart Attack
- Clinical presentation of Heart Attack
- Associated medical problems like diabetes / Hypertension (High BP) / Kidney Diseases etc…
Three types of Treatments available for Heart Attack
- Conservative treatment
- Aggressive treatment
- Emergency treatment
Conservative treatment
Who requires this?
Mainly old age patients and young patients for that matter any patients with Heart Attack Clinically stable (Haemodynamically) Blood Pressure and Pulse rate with in normal limits, No chest pain at the time of arrival to the hospital, Oxygen Saturation normal, normal LV function or mild LV dysfunction can be managed conservatively with drugs like
- Injection Heparin
- Antiplatelets like ASPRIN and Clopidogrel
- Statins and Beta Blockers
Aggressive treatment
Patients in any age groups especially young patients / Middle age patients if they reach the hospital within 1-2 hours after the chest pain (GOLDEN HOUR) and if they have on going chest pain and clinically stable they require THROMBOLYSIS (Dissolving the Blood clot) in the Coronary Artery. There are many Thrombolytic drugs available. Commonly used drugs are injection STK and injection TNK etc…. The choice of drugs depends on socioeconomical status of the patients / age of the patients / clinical condition of the patients.
Emergency treatment
Some patients may develop Heart Attack with complications of the Heart Attack simultaneously. If the Heart Attack is severe patients may lose consciousness for various reasons mainly due to low BP / Complete Heart Block / Life Threatening arrhthmias like VT / VF and mechanical complications like acute MR / VSR (Ventricular septal Rupture) and severe heart failure may results in multi organ failure.
Such patients require aggressive emergency treatment like IABP / Temporary pacemaker / ECMO and emergency Angiogram and STENTING with ventilatory support. This situation requires team efforts with Anesthetist support.
ALL PATIENTS AFTER HEART ATTACK SHOULD UNDERGO CORONARY ANGIOGRAM TO KNOW THE STATUS OF BLOCK IN THE CORONARY ARTRIES.
Who requires Coronary STENTING?
Any patients with significant Coronary Artery Block require STENTING this can be done by two ways
1.Elective STENTING 2. Emergency STENTING
Who require Elective STENTING?
Patients with Heart Attack and clinically stable with NO symptoms at rest / or Haemodynamically stable (Stable BP / Pulse rate / O2 saturation) or patients with NO heart failure with normal LV function are mild LV dysfunction require elective STENTING. This enables patients to recover from Heart Attack and to manage financial and domestic arrangements.
Who require Emergency STENTING?
Any patients or any age group with Heart Attack with ongoing chest pain low blood pressure with moderate – severe LV dysfunction with heart failure and clinical evidence of organ Hypoperfusion to shifted to cathlab and undergo emergency Coronary Angiogram followed by Emergency STENTING.
HOW STENTING DONE ?
CASE: 1
43 years old lady Diabetic with mild chest pain with Giddiness came to NN Hospital
Angiogram findings
Critical Block 99% in Right Coronary Artery in Different Angles
Note : Since the patient is Diabetic she had only mild chest pain but significant breathlessness with giddiness for the critical block. This block was cleared by STENTING.
- Before Stenting
- After Stenting
CASE: 2
22 Years Old Engineering Student from North East develop Chest pain and Cardiac Arrest after smoking and substance abuse revived by stenting because of early arrival to the Hospital.
- Developed VF (Venticular Fibrillation) and Cardiac Arrest – Revived by STENTING
This Young man 22 Years developed heart attack due to 100% Block by blood Clot .This Blood Clot Can be dissolved by injections if the patients is clinically stable but this patient had cardiac arrest and revived by DC shock.He was haeodynamically unstable hence he requires emergency clearence of blood Clot by stenting therby he was saved . Disolving blood Clot by Injections takes some time so Emergency Situation it is better to do Emergency Angiogram and clear the Block by Stenting.
CASE: 3
45 Years Old Smoker Bus Driver on Duty developed chest pain and giddiness could not drive the bus and the driver brought to the hospital by the ambulance
- Before Stenting
- After Stenting
CASE: 4
46 years old lady developed Heart Attack after stabilization under gone Conoary Angogram which showed 90% critical block in RCA which was cleared by STENTING
- Same problem in different angles / Views
- Block cleared by STENTING
CASE: 5
73 years old lady severe chest pain with Low BP & Low pulse rate. EMERGENCY SITUATION EMERGENCY Coronary Angiogram done showed Critical BLOCK in main Blood vessel. BLOCK cleared by STENTING.
- BLOCK CLEARED AFTER STENTING
CASE: 6
64 years old lady Developed Heart Attack she reached the hospital 12 hours after the heart attack ( missed the GOLDEN HOUR) since she continued to have chest pain EMERGENCY Coronary Angiogram done Showed critical block which was cleared by STENTING
ECG- NORMAL ECHO -NORMAL BLOCK IN THE CORONARY ARTERY POSSIBLE
CASE: 7
58 years old man Chest pain on WALKING & climbing stairs case border line Diabetic. No Heart Attack but stable Angina.ECG normal, ECHO normal Undergone coronary Angiogram showed Critical block in Two blood vessels cleared by STENTING
- AFTER STENTING
CASE: 8
58 years old man Chest pain on WALKING & climbing stairs case border line Diabetic. No Heart Attack but stable Angina.ECG normal, ECHO normal Undergone coronary Angiogram showed Critical block in Two blood vessels cleared by STENTING
CASE: 9
42 years old Bank officer Breathing difficulty on WALKING Obesity with border line Diabetic. ECG & ECHO Normal. Coronary Angiogram Showed Critical Block in RCA which was cleared by STENTING
PRIMARY PCI (EMERGENCY STENTING WITHOUT THROMBOLISIS)
CASE: 10
48 years old lady developed acute IWMI (Heart Attack) underwent emergency angiogram showed critical block in RCA underwent successful STENTING BOLISIS)
- AFTER STENTING – BLOCK CLEARD
CASE: 11
58 years old lady developed acute AWMI (Heart Attack) due to 100% blocked LAD (main blood vassal) block cleared by STENTING
CASE: 12
74 years old lady developed severe chest pain developed IWMI (Heart Attack) Emergency Angiogram showed 100% RCA block cleared by STENTING
All Heart Attacks not require STENTING
CASE: 13
49 years male, chest pain TW 2 hours; thrombolysed with SK
Message – any patient if they reach the hospital with in one – two hours after chest pain (after Heart Attack) it is good for the patients.
If the patient reaches the Hospital within one- two hours after the heart attack and if the patient is clinically stable thrombolysis(Dissolving the Blood Clot) will be useful block will be clear by the drugs and they may NOT REQUIRE STENTING.
CASE: 14
31 Years old Phd Scholar developed chest pain after over night heavy stress full work.
Due to delay in decision making and consent by the patient friends there was a delay in shifting the patient to CCU. On arriving CCU patient developed Cardiac arrest due to fatal Ventricular Arrhthmia
