SAMIKSHA HEART AND DIABETIC CARE Welcome to samiksha heart and diabetic care. Our institution was initially started in yelahanka , north bangalore in may 2013. The reason why our centre was started to make available the basic and advanced Cardiac and diabetic services and treatment accessible early. Samiksha heart and diabetic care offers a vast array of outpatient cardiac services. Our centre is fully equipped to provide patients with all of the usual cardiodiagnostic services (ECGs, echocardiography, stress tests, holter monitors, ambulatory BP monitering etc.) needed to effectively manage your cardiovascular health. We diagnose and treat any cardiac disorder – simple or complex from diagnosis to intervention and comprehensive treatment. we share the common dream of giving you the compassionate healthcare that you deserve. Our specialized services have been designed to deliver the care that is best suited to your needs. Despite all the latest advances we feel that the old fashioned physician-patient relationship can be maintained here . We just don’t treat diseases, we care for you as a person. Accessibility, cost and care are optimal in our centre. We believe in making your concerns ours. Our services ensure your constant comfort and quick recovery. However, unlike the same services provided through the hospital our practice helps our patients reduce the cost of their health care. We look forward to seeing you in our practice, where we put our patients first. Success for us is the smile on our patients’ faces as they leave our hospital.

ECHOCARDIOLOGIST IN GANGAMMA CIRCLE Mitral regurgitation A regurgitant mitral valve allows part of the left ventricular stroke volume to regurgitate into the left atrium, imposing a volume load on both the left atrium and the left ventricle. Symptoms: Dyspnoea (increased left atrial pressure); fatigue (decreased cardiac output). General signs: Tachypnoea. The pulse: Normal, or sharp upstroke due to rapid left ventricular decompression; atrial fibrillation is relatively common. Palpation: The apex beat may be displaced, diffuse and hyperdynamic if left ventricular enlargement has occurred; a pansystolic thrill may be present at the apex; a parasternal impulse (due to left atrial enlargement behind the right ventricle—the left atrium is often larger in mitral regurgitation than in mitral stenosis and can be enormous). All these signs suggest severe mitral regurgitation. Auscultation Soft or absent S1 (by the end of diastole, atrial and ventricular pressures have equalised and the valve cusps have drifted back together); left ventricular S3, due to rapid left ventricular filling in early diastole; pansystolic murmur maximal at the apex and usually radiating towards the axilla. Causes of chronic mitral regurgitation: (i) Degenerative; (ii) rheumatic; (iii) mitral valve prolapse; (iv) papillary muscle dysfunction, due to left ventricular failure or ischaemia.

THE BEST CARDIOLOGISTS IN YELAHANKA Aortic regurgitation The incompetent aortic valve allows regurgitation of blood from the aorta to the left ventricle during diastole for as long as the aortic diastolic pressure exceeds the left ventricular diastolic pressure. Symptoms: Occur in the late stages of disease and include exertional dyspnoea, fatigue, palpitations (hyperdynamic circulation) and exertional angina. General signs: Marfan’s syndrome may be obvious. The pulse and blood pressure: The pulse is characteristically collapsing; there may be a wide pulse pressure. The neck: Prominent carotid pulsations (Corrigan’s sign). Palpation: The apex beat is characteristically displaced and hyperkinetic. A diastolic thrill may be felt at the left sternal edge when the patient sits up and breathes out. Auscultation): A2 (the aortic component of the second heart sound) may be soft; a decrescendo high-pitched diastolic murmur beginning immediately after the second heart sound and extending for a variable time into diastole—it is loudest at the third and fourth left intercostal spaces; a systolic ejection murmur is usually present (due to associated aortic stenosis or to torrential flow across a normal diameter aortic valve). Signs indicating severe chronic aortic regurgitation: Collapsing pulse; wide pulse pressure; long decrescendo diastolic murmur; left ventricular S3 (third heart sound); soft A2; signs of left ventricular failure. Causes of chronic aortic regurgitation: (i) Rheumatic (rarely the only murmur in this case), congenital; (ii) aortic root dilatation—Marfan’s syndrome, dissecting aneurysm. 8• THE PATIENT WITH A MURMUR 305 a b Valve cusps often thickened and calcified Left ventricle may be hypertrophied Ascending aorta may be dilated Systole Diastole S1 A2 P2 S1 Ejection click (Suggests congenital AS) Normal Mild S1 S1 Moderate S1 P2 A2 S1 Severe Reversed S2 Single (S2)

THE BEST CARDIOLOGIST IN YELAHANKA Mitral regurgitation A regurgitant mitral valve allows part of the left ventricular stroke volume to regurgitate into the left atrium, imposing a volume load on both the left atrium and the left ventricle. Symptoms: Dyspnoea (increased left atrial pressure); fatigue (decreased cardiac output). General signs: Tachypnoea. The pulse: Normal, or sharp upstroke due to rapid left ventricular decompression; atrial fibrillation is relatively common. Palpation: The apex beat may be displaced, diffuse and hyperdynamic if left ventricular enlargement has occurred; a pansystolic thrill may be present at the apex; a parasternal impulse (due to left atrial enlargement behind the right ventricle—the left atrium is often larger in mitral regurgitation than in mitral stenosis and can be enormous). All these signs suggest severe mitral regurgitation. Auscultation Soft or absent S1 (by the end of diastole, atrial and ventricular pressures have equalised and the valve cusps have drifted back together); left ventricular S3, due to rapid left ventricular filling in early diastole; pansystolic murmur maximal at the apex and usually radiating towards the axilla. Causes of chronic mitral regurgitation: (i) Degenerative; (ii) rheumatic; (iii) mitral valve prolapse; (iv) papillary muscle dysfunction, due to left ventricular failure or ischaemia. Mitral valve prolapse (systolic-click murmur syndrome) This syndrome can cause a systolic murmur or click, or both, at the apex. The presence of the murmur indicates that there is some mitral regurgitation present. Auscultation: Systolic click or clicks at a variable time (usually mid-systolic) may be the only abnormality audible, but a click is not always audible; systolic

best cardiologists in bangalore Murmurs Murmurs are produced by turbulent blood flow, and are described according to their location, intensity, timing, frequency, and radiation (Tables 15.1 to 15.3 and Figure 15.1). Innocent murmurs are due to pulmonary flow and can be heard in children, pregnancy, and high-flow states, such as hyperthyroidism and anaemia. They are heard over the left sternal edge and are ejection systolic, and there are no added sounds or thrill. The cervical venous hum is a continuous murmur, common in children and typically reduced by turning the head laterally or bending the elbows back. The mammary soufflé is a continuous murmur that may be heard in pregnancy. Dynamic auscultation manoeuvres may help bedside diagnosis of systolic murmurs (Table 15.2). 4, 5 Murmurs originating within the right-sided chambers of the heart can be differentiated from all other murmurs by augmentation of their intensity with inspiration and diminution with expiration. The murmur of hypertrophic cardiomyopathy is distinguished from all other systolic murmurs by an increase in intensity with the Valsalva manoeuvre and during squatting-to-standing, and by a decrease in intensity during standing-to-squatting action, passive leg elevation, and handgrip. The murmurs of MR and VSD have similar responses but can be differentiated from other systolic murmurs by augmentation of their intensity with handgrip and during transient arterial occlusion.