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CARDIOLOGISTS IN DEVARABESANAHALLI BANGALORE Complex congenital heart disease: Fontan repair Anatomy and physiology Babies with a single ventricle or equivalent defect are often treated during childhood with a palliative operation to connect venous return directly to the pulmonary arteries—a Fontan repair. The prognosis is usually good: 75% of these patients survive at least 20 years. Complications Problems develop because of failure of the systemic ventricle, obstruction of the venous to pulmonary connection, atrial enlargement and AV valve regurgitation. Atrial arrhythmias become increasingly common. Sinus node dysfunction may necessitate pacing, which requires an epicardial electrode in most cases. Follow-up Echocardiography allows assessment of ventricular function and the AV valve. Obstruction in the Fontan connections can be examined with Doppler. MRI is increasingly useful for this assessment. Treatment Severe AV valve regurgitation, cyanosis and ventricular dysfunction are indications for intervention, including transplant or revision of the Fontan. Atrial arrhythmias can be treated with radiofrequency ablation. Pregnancy and contraception Pregnancy is possible in some patients with excellent Fontan function, good LV function and minimal AV valve regurgitation. Maternal risk is high if the Fontan is failing. There may be problems with the need to withdraw ACE inhibitors and with anticoagulation.
Echocardiologist in Kattigenahalli, Bangalore • Pulmonary hypertension Treatment of pulmonary hypertension that is secondary to an underlying respiratory or cardiac condition begins with an attempt to optimise treatment or fix the underling condition. 1 COPD: bronchodilators, steroids, continuous oxygen. 2 Pulmonary fibrosis: oxygen. Aggressive treatment of an underlying connective tissue disease may halt or slow progression of the pulmonary pressures. 3 Pulmonary embolus: anticoagulation, vena caval filter and occasionally pulmonary embolectomy. 4 Mitral stenosis: valvotomy or replacement. 5 Mitral regurgitation: repair or replacement if left ventricular function remains reasonable. 6 Atrial septal defect: surgery or, if suitable, closure in the catheter laboratory, for example with an Amplatzer closure device. There must be evidence of reversibility of the pulmonary pressure if it is nearly as high as systemic pressure, otherwise closure will not improve the prognosis. 7 Eisenmenger’s syndrome: repair of the defect responsible for the shunt is not usually possible once reversal of shunting has occurred. Consider heart and lung transplant if conservative treatment (diuretics, digoxin and sometimes ACE inhibitors) has failed. General measures include continuous oxygen, diuretics, digoxin and aldactone for problems with right heart failure. Patients with pulmonary hypertension that is idiopathic or secondary to connective tissue disease can now be treated with bosentan. This drug is an endothelin receptor antagonist. Endothelin 1 is a potent vasoconstrictor whose levels have been shown to be elevated in patients with idiopathic pulmonary hypertension. Moderate or better improvements in functional capacity and pulmonary artery pressures have been demonstrated after treatment for these patients. The drug is available only for patients with class III symptoms and right atrial pressure greater than 8 mmHg. Patients must demonstrate stable or improved symptoms (usually via a six-minute walk test) for treatment to continue. The drug is very expensive. Its side effects include teratogenicity, an increase in liver enzymes and possibly male infertility. Prostacyclin analogues such as iloprost, which is taken by inhalation, can be effective. Similar restrictions apply to their prescription because of their cost. Continuous intravenous epoprostenol is available in some countries and has been shown to improve symptoms and prognosis in a number of small randomised trials for at least idiopathic pulmonary hypertension patients. Sildenafil (a phosphodiesterase inhibitor) is the most recent vasodilator to become fashionable for idiopathic pulmonary hypertension. A long-acting form has recently become available.
Echocardiologist in Kattigenahalli, Bangalore • Pulmonary hypertension Treatment of pulmonary hypertension that is secondary to an underlying respiratory or cardiac condition begins with an attempt to optimise treatment or fix the underling condition. 1 COPD: bronchodilators, steroids, continuous oxygen. 2 Pulmonary fibrosis: oxygen. Aggressive treatment of an underlying connective tissue disease may halt or slow progression of the pulmonary pressures. 3 Pulmonary embolus: anticoagulation, vena caval filter and occasionally pulmonary embolectomy. 4 Mitral stenosis: valvotomy or replacement. 5 Mitral regurgitation: repair or replacement if left ventricular function remains reasonable. 6 Atrial septal defect: surgery or, if suitable, closure in the catheter laboratory, for example with an Amplatzer closure device. There must be evidence of reversibility of the pulmonary pressure if it is nearly as high as systemic pressure, otherwise closure will not improve the prognosis. 7 Eisenmenger’s syndrome: repair of the defect responsible for the shunt is not usually possible once reversal of shunting has occurred. Consider heart and lung transplant if conservative treatment (diuretics, digoxin and sometimes ACE inhibitors) has failed. General measures include continuous oxygen, diuretics, digoxin and aldactone for problems with right heart failure. Patients with pulmonary hypertension that is idiopathic or secondary to connective tissue disease can now be treated with bosentan. This drug is an endothelin receptor antagonist. Endothelin 1 is a potent vasoconstrictor whose levels have been shown to be elevated in patients with idiopathic pulmonary hypertension. Moderate or better improvements in functional capacity and pulmonary artery pressures have been demonstrated after treatment for these patients. The drug is available only for patients with class III symptoms and right atrial pressure greater than 8 mmHg. Patients must demonstrate stable or improved symptoms (usually via a six-minute walk test) for treatment to continue. The drug is very expensive. Its side effects include teratogenicity, an increase in liver enzymes and possibly male infertility. Prostacyclin analogues such as iloprost, which is taken by inhalation, can be effective. Similar restrictions apply to their prescription because of their cost. Continuous intravenous epoprostenol is available in some countries and has been shown to improve symptoms and prognosis in a number of small randomised trials for at least idiopathic pulmonary hypertension patients. Sildenafil (a phosphodiesterase inhibitor) is the most recent vasodilator to become fashionable for idiopathic pulmonary hypertension. A long-acting form has recently become available.
Echocardiologist in Kattigenahal bangalore Pulmonary hypertension Treatment of pulmonary hypertension that is secondary to an underlying respiratory or cardiac condition begins with an attempt to optimise treatment or fix the underling condition. 1 COPD: bronchodilators, steroids, continuous oxygen. 2 Pulmonary fibrosis: oxygen. Aggressive treatment of an underlying connective tissue disease may halt or slow progression of the pulmonary pressures. 3 Pulmonary embolus: anticoagulation, vena caval filter and occasionally pulmonary embolectomy. 4 Mitral stenosis: valvotomy or replacement. 5 Mitral regurgitation: repair or replacement if left ventricular function remains reasonable. 6 Atrial septal defect: surgery or, if suitable, closure in the catheter laboratory, for example with an Amplatzer closure device. There must be evidence of reversibility of the pulmonary pressure if it is nearly as high as systemic pressure, otherwise closure will not improve the prognosis. Eisenmenger’s syndrome: repair of the defect responsible for the shunt is not usually possible once reversal of shunting has occurred. Consider heart and lung transplant if conservative treatment (diuretics, digoxin and sometimes ACE inhibitors) has failed
Echocardiologist in Kattigenahal bangalore Pulmonary hypertension Treatment of pulmonary hypertension that is secondary to an underlying respiratory or cardiac condition begins with an attempt to optimise treatment or fix the underling condition. 1 COPD: bronchodilators, steroids, continuous oxygen. 2 Pulmonary fibrosis: oxygen. Aggressive treatment of an underlying connective tissue disease may halt or slow progression of the pulmonary pressures. 3 Pulmonary embolus: anticoagulation, vena caval filter and occasionally pulmonary embolectomy. 4 Mitral stenosis: valvotomy or replacement. 5 Mitral regurgitation: repair or replacement if left ventricular function remains reasonable. 6 Atrial septal defect: surgery or, if suitable, closure in the catheter laboratory, for example with an Amplatzer closure device. There must be evidence of reversibility of the pulmonary pressure if it is nearly as high as systemic pressure, otherwise closure will not improve the prognosis. Eisenmenger’s syndrome: repair of the defect responsible for the shunt is not usually possible once reversal of shunting has occurred. Consider heart and lung transplant if conservative treatment (diuretics, digoxin and sometimes ACE inhibitors) has failed
Cardiologist in Bettahalasur, Bangalore • Papillary muscle rupture When symptoms of cardiac failure occur in a patient who has developed a new murmur, the possibility of acute mitral regurgitation caused by a papillary muscle rupture should be considered. This is more often a complication of an inferior infarct (posteromedial papillary muscle) but can occur after an anterior infarct (anterolateral muscle). The diagnosis is made echocardiographically. The complication carries an adverse prognosis, but valve replacement or occasionally repair can be performed in suitable patients. The causal infarction can be quite small
Cardiologist in Bettahalasur, Bangalore • Papillary muscle rupture When symptoms of cardiac failure occur in a patient who has developed a new murmur, the possibility of acute mitral regurgitation caused by a papillary muscle rupture should be considered. This is more often a complication of an inferior infarct (posteromedial papillary muscle) but can occur after an anterior infarct (anterolateral muscle). The diagnosis is made echocardiographically. The complication carries an adverse prognosis, but valve replacement or occasionally repair can be performed in suitable patients. The causal infarction can be quite small
*Chappaties will soon become EXTINCT* A renowned cardiologist explains how eliminating wheat can IMPROVE your health. Cardiologist William Davis, MD, started his career repairing damaged hearts through angioplasty and bypass surgeries. “That’s what I was trained to do, and at first, that’s what I wanted to do, ” he explains. But when his own mother died of a heart attack in 1995, despite receiving the best cardiac care, he was forced to face nagging concerns about his profession. "I’d fix a patient’s heart, only to see him come back with the same problems. It was just a band-aid, with no effort to identify the *cause* of the disease.” So he moved his practice toward highly uncharted medical territory – prevention – and spent the next 15 years examining the causes of heart disease in his patients. The resulting discoveries are revealed in "Wheat Belly", his New York Times best-selling book, which attributes many of our physical problems, including heart disease, diabetes and obesity, to our consumption of wheat. Eliminating wheat can “transform our lives.” *What is a “Wheat Belly”?* Wheat raises your blood sugar dramatically. In fact, two slices of wheat bread raise your blood sugar more than a Snickers bar. "When my patients give up wheat, weight loss was substantial, especially from the abdomen. People can lose several inches in the first month." You make connections between wheat and a host of other health problem. samiksha heart and diabetic care
the best heart clinics near me When Do You Need Surgery? When the heart valves are seriously damaged and impairing blood flow to the rest of the body or causing heart muscle damage, surgery to replace the defective valve may be recommended. Shortness of breath, syncope (fainting), chest pain, and heart failure are common signs of aortic valve disease. These symptoms are warning signs that the heart is working too hard to pump blood-when these symptoms occur, surgery is usually warranted. Testing to further determine if you need surgery should include an echocardiogram of the heart, as well as coronary angiography to assess for blockages in the coronary arteries. These conditions are potentially serious impediments to heart function, often hindering or reversing the natural flow of blood through the heart. Failing to fix a diseased aortic valve can be life-threatening, and untreated patients have less than a 50% survival at 2-3 years. To treat aortic valve disease, surgeons either repair the patient's own valve, or most commonly replace that valve with a tissue or mechanical substitute. Choosing between a bioprosthetic valve versus a mechanical valve is a complex decision that involves many lifestyle factors, age, and whether a patient is able to tolerate blood thinners for the rest of their life.
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