ARTICLES ON Heart Care

A team of skilled doctors consultant interventional cardiologists Dr Ankur Phatarpekar, Dr Haresh Mehta, Dr Kayan Siodia alongwith cardiothoracic surgeon Dr Mangesh Kohale , interventional radiologist Dr Bhavesh Popat, anaesthetist Dr Neeraj Barnwal, physician Dr Brajesh Gupta and Consultant Physician Dr Zaheer Virani successfully treated an 83-year-old woman suffering from a heart attack. She got a new lease of life through a minimally invasive, life-saving procedure called Transcatheter Aortic Valve Replacement (TAVR) wherein a Third Generation Leak-Proof Valve was placed high up in the heart to regulate the obstructed blood flow to the heart, which improves the survival chances of the patient. 83-year-old Dnyaneshwari Swami, a resident of Mumbai suddenly encountered chest pain and shortness of breath. The family panicked and admitted her to Wockhardt Hospitals in Mumbai Central wherein she was diagnosed with a heart attack. Doctors carried out Angioplasty and saved her life. Dr Ankur Phatarpekar said, “On arrival, the patient underwent, ECG & 2DEcho where it was revealed that she suffered from a heart attack and one of her three arteries of heart was occluded (occlusion means the partial or complete obstruction of blood flow in a coronary artery). The patient also had other co-morbidities such as low blood pressure and kidney problem. The blood clot was removed using aspiration, and the affected session was treated using a drug-eluting stent, and she took about 7 days to recover completely. During the 2DEcho it was also found that the patient had severe Aortic Stenosis (that is a narrowing of the aortic valve opening). It restricts the blood flow from the left ventricle to the aorta and may also affect the pressure in the left atrium (one of the four chambers of the heart, located on the left posterior side) with heart-pumping of 35 per cent.” Instead of performing high-risk open-heart surgery, a novel transcatheter aortic valve replacement (TAVR), was carried out to aid the normal function of heart valves. “TAVR is a minimally invasive procedure to replace a narrowed aortic valve that fails to open properly (aortic valve stenosis). It is a boon for the patients who are not candidates for other treatment options because of their age, overall health or other medical issues. The goal of TAVR is to implant a new, artificial valve to take over the job of the damaged aortic valve,” explained Dr Phaterpekar. Dr Haresh Mehta added, “A catheter was used to manoeuvre and place the new Third Generation Leak-Proof Valve, which slips inside the old valve. Once placed, the new valve expands and pushed the damaged valve parts out of the way and regulated the blood flow into the aorta. The shallow implant of the valve was carried out, placing it high up due to the lack of calcium in the patient. Third Generation Leak-Proof Valve is the first-of-its-kind valve used in Western India at Wockhardt Hospitals. It helps improve the survival rate of the patient. Normally in such cases, there are 15 per cent to 20 per cent, chances of causing death.  With the help of new technology, chances have come less than 1 per cent.” The procedure took about 45 minutes.  “In this procedure, there is only a small puncture instead of a large incision and it is less painful. There are a minimized hospital stay and a speedy recovery. In three days, the patient could breathe easily, and her co-morbidities have been tackled,” said Dr Phaterpaker. “After I suffered a heart attack, I was immediately rushed to Wockhardt hospitals. Since my family was aware of the symptoms, I could receive timely treatment.  I thank the doctors and the team at Wockhardt Hospitals for helping me get back on track,” concluded patient Dnyaneshwari Swami.

Peripheral artery disease (PAD) primarily occurs, due to decreased blood flow to the limbs caused by a blocked artery. This can result in arm fatigue, pain, and weakness, particularly with use. Peripheral Artery Disease is most commonly associated with the legs and feet, although it does include conditions caused by the blockage of blood flow in the blood vessels of both the arms and hands. A 65-year-old patient, who was suffering from upper limb artery blockage in the right arm, came to the Wockhardt hospital, Mumbai Central, with symptoms of numbness and bluish discoloration in his right arm. The patient was also suffering from from diabetes and was on kidney dialysis, post-bypass surgery with multiple health problems. At Wockhardt Hospital Mumbai Central, he was advised colour Doppler and an angiography, to assess his circulation status in his arm. It was, diagnosed that there was severe blockage of the arteries in his hand and blood supply was cut off causing the numbness and discolouration. Arm artery disease is a circulatory disorder where arteries in the arm are blocked or narrowed, unable to carry oxygen-rich blood into the arms. It is caused due to several factors such as high blood cholesterol sedentary lifestyle, diabetes, high BP tobacco and much more. As the disease, develops one may experience bluish discoloration skin. These symptoms are caused by the narrowed arteries inability to supply the necessary oxygen to the muscles. This condition can lead to increased risk of amputation, heart attack, and stroke. Cardiologist and team at , Wockhardt Hospitals, Mumbai Central with their clinical expertise and quick intervention, performed a limb saving procedure and restored the circulation in the patient’s arm. Dr Gupta revealed “We used hard wires and balloon to open an artery so blood flow started in the palm. In this procedure, it was important to save not only limb but also AV Fistula which is necessary for his regular dialysis.” For information on treatment and management of peripheral arterial disease please visit our vascular surgery department at Wockhardt Hospital.

What is Minimal Invasive Cardiac Surgery (MICAS)? Minimally invasive heart surgery (also called keyhole surgery) is a newer form of cardiac surgery. In this type of heart surgery, small incisions are done, without dividing the central breastbone or sternum. That means instead of “cutting open the chest” from midline as they do with traditional open heart surgery, a small and cosmetic incisions using specialized instruments is used for procedure. How is the procedure carried out? MICS procedure is carried out through a small 5 cm incision on the side of the chest (mini thoracotomy) without damaging any bones. In females, the incision is under the breast fold making it even more cosmetic. Is MICAS CABG a beating heart operation? Yes, it is an off pump or beating heart operation. The support of a pump may rarely be required but the operation is still performed on the beating heart. Pump support may particularly be used when the heart is weak. What are the Common Indications of the MICAS? : How does it differ from conventional cardiac surgery? What are the contraindications for the surgery? What are the benefits of MININMAL INVASIVE cardiac surgery? What is the risk of infections after MICAS CABG? The risk of infection is close to zero. All infections are reduced dramatically in MICS CABG even in diabetics. It is due to the fact that the incision is small and no bone is fractured. What are the precautions I would have to take after MICS? After minimally invasive heart surgery, you may have an improved quality of life and reduced symptoms. To know more about Minimal Invasive Cardiac Surgery please Visit us at Wockhardt Hospitals in Mira Road Understand all your cardiac conditions with our experienced cardiac surgeons. Dr. Manish Hinduja M.S., M.Ch.(CTVS), D.N.B.(CTS) is a an internationally acclaimed Cardio Thoracic & Vascular Surgeon working as Full Time Consultant at Wockhardt Hospitals, Mira Road. He has over 9 years of experience and has operated more than 5000 cases in his field. He specialises in Minimal Invasive Cardiac Surgery at the hospital.

The incidence of coronary artery disease (CAD) is increasing at an alarming rate, especially in developing countries such as India. It is often advocated that a vegetarian lifestyle could reduce the burden of CAD. However, in spite of a majority of Indians being vegetarians, the incidence of CAD is highest in this population. A 32-year-old man was admitted to the emergency department at Wockhardt Hospitals, North Mumbai. He was brought in gasping, with a sudden onset of crushing chest pain. Before reaching the hospital, he had an ECG at a private nursing home, and it showed that he had suffered a massive heart attack. While being transferred, he lost consciousness and was unresponsive on a few occasions.  Urgent PAMI (Primary Angioplasty Myocardial Infarction) was carried out by Dr. Anup Taksande Consultant- Cardiology salvaged this patient with complete neurological recovery. The hospital’s emergency medical team immediately carried out cardiac emergency procedures to revive the patient. He was rushed for a coronary angiography and stenting. He was discharged on day 4 in stable condition and was advised to follow lifestyle modifications along with his medications. What Is Coronary Artery Disease, and What Causes It? Coronary artery disease develops when the major blood vessels that supply your heart with blood, oxygen and nutrients (the coronary arteries) become damaged or diseased. Cholesterol-containing deposits (plaque) in the arteries, along with inflammation, are usually to blame. Coronary artery disease is thought to begin with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including: Smoking High blood pressure High cholesterol Diabetes or insulin resistance A sedentary lifestyle and physical inactivity Overweight or obesity High stress An unhealthy diet Over time, the plaque can narrow the arteries and reduce blood flow to the heart. If a plaque ruptures, a clot can form and block the artery completely, which is what leads to a heart attack. What Were the Doctors Looking For in This Young Patient? None of the factors above explained this case. The patient had no underlying heart condition and no family history of one. What the doctors did identify was that he was a pure vegetarian. Pure vegetarians with vitamin B12 deficiency may be at higher risk of premature acute coronary syndrome. A deficiency of vitamin B12 and folate, in turn, can cause hyperhomocysteinemia, meaning a raised level of homocysteine in the blood. Elevated serum homocysteine has been associated with a roughly 20% increased risk of circulatory problems and heart conditions. High homocysteine can damage the lining of the arteries and make blood clots form more easily than they should. That can raise the risk of blood vessel blockages and may be a factor in heart attacks. How Does Vitamin B12 Deficiency Affect the Heart? Vitamin B12 helps the body make red blood cells, keeps nerves healthy, and works with folate and vitamin B6 to break down homocysteine. When vitamin B12 runs low, homocysteine can build up. That’s the link researchers point to between vitamin B12 deficiency and heart disease. It’s worth saying that vitamin B12 deficiency is only one possible factor among many, and it doesn’t mean everyone with low B12 will develop heart problems. Still, it is common in India, particularly among vegetarians, so it deserves attention. What Are the Signs of Vitamin B12 Deficiency? Early on, the signs can be easy to miss. Common ones include: Tiredness and weakness Pale or slightly yellow skin Tingling or numbness in the hands and feet A sore, red tongue or mouth ulcers Dizziness or shortness of breath Memory trouble or low mood A simple blood test can check vitamin B12 levels, and a doctor may also test homocysteine in some cases. What Are the Coronary Artery Disease Symptoms to Watch For? Coronary artery disease symptoms can be mild at first, or absent until a heart attack happens. The ones to know include: Chest pain, pressure or tightness (angina), often brought on by effort or stress Shortness of breath Pain spreading to the arm, shoulder, neck, jaw or back Unusual tiredness, cold sweats or nausea Dizziness or palpitations Chest pain that is crushing, lasts more than a few minutes or comes with sweating and breathlessness is an emergency. Go to the nearest hospital or call for emergency help right away. Don’t wait to see if it passes. Which Vitamin B12 Foods Should You Add to Your Diet? Vitamin B12 foods come mostly from animal sources, which is why vegetarians are at greater risk. Options include: Milk, curd, paneer and cheese Eggs Fish and poultry, for non-vegetarians Fortified foods such as some breakfast cereals, plant milks and nutritional yeast Plant foods don’t naturally contain reliable amounts of B12, so strict vegetarians and vegans may need a supplement. Don’t start high doses on your own, though. A doctor can check your level and advise what’s right for you. What Else Helps Lower Homocysteine? Some preventive measures can help reduce serum homocysteine. Eating more fruits and vegetables can help lower your homocysteine level. Leafy green vegetables such as spinach are good sources of folate. Increase the amount of vitamin B6 and vitamin B12 in your diet as well. Regular exercise, not smoking and keeping blood pressure, cholesterol and blood sugar in check protect the heart too. When Should You See a Doctor? See a doctor if you have symptoms of vitamin B12 deficiency, a family history of heart disease, or several risk factors such as diabetes, smoking or high blood pressure. A vegetarian diet doesn’t guarantee protection, so a checkup that includes a B12 level and a lipid profile is worth considering, even if you feel fine. For further information or treatment, please visit our cardiac services at Wockhardt Hospitals. FAQs 1. Can vitamin B12 deficiency cause heart disease? It may contribute, although it is not a direct cause. Low vitamin B12 and folate can raise homocysteine levels, and high homocysteine has been linked to artery damage and blood clots. Many other factors