1. ECG (Electro Cardiography) with 16 lead capability
2. TMT (Treadmill test or Stress test):
Stress test of the heart is an established method of detecting the functional reserve of the heart.
3. 2D Echo: Echocardiography (echo):
The use of ultrasound to examine the heart – is a safe, powerful, non –invasive and painless technique.
4. High-end Real-time 3D Echo/ 4D Echo:
This Echocardiography machine is capable of adult, paediatric, neonatal and fetal echo, transoesophageal echo, Q lab analysis, stress echo, myocardial perfusion imaging
5. Vascular Elasticity/Arterial Stiffness:
The instrument measures the arterial stiffness and determines the age of your vessels. The loss of vascular elasticity is the earliest change in vessels before the blocks starts developing.
6. Carotid intimal media thickness:
This again gives the earliest evidence of health of blood vessels and early treatment can prevent formation of new blocks.
7. TEE (Trans Esophageal Echocardiogram):
The TEE uses a transducer mounted upon a modified probe similar to those used for upper gastrointestinal endoscopy and allows examination of the heart without a barrier to ultrasound usually provided by the ribs, chest wall and lungs. By advancing the probe tip to various depths in the oesophagus and stomach, manoeuvring the tip of the transducer and by altering the angle of the ultrasound beam with controls placed on the handle, a number of different views of the heart can be obtained.
8. DSE (Dobutamine Stress Echo):
This type of echocardiography aids in the diagnosis of ischaemic heart disease. It helps to localize the site and quantifies the extent of ischaemia by the demonstration of regional wall motion and thickness abnormality with stress which is not present at rest.
9. Non Invasive Multi-slice CT Coronary Angiography (CTCA):
CT-Coronary Angiography is new, non-invasive direct procedure to assess blockage and condition of coronary arteries. The procedure is of just 5 minutes with overall duration of 1 hour in the hospital. For emergency cases CTCA can help to segregate non-cardiac chest pains. A normal CTCA has 100% negative predictive value. In addition, it helps to identify the types of plaques and degree of blockage along the arteries, the status of Heart Chambers, Cardiac Muscles, Valves, Aorta & Pulmonary vessels and Development of collaterals
Cardiac Arrhythmia Services
Non-Invasive Cardiac Arrhythmia Services:
- Cardiac arrhythmia and pacemaker clinic
- Transtelephonic monitoring
- Holter Monitor: This is a 24 hour ECG monitoring. The recorder is connected to the patient’s body, which he takes home and brings back after 24hours. The recorder is connected to the computer and ECG is analyzed for arrhythmia problems.
- V Patch System: Extended monitoring of heart rhythm up to 7 days is possible with continuous update on server through transmission using global sim card. The doctors can visualize your rhythm whenever they want.
Invasive Cardiac Arrhythmia Services:
- Intracardiac diagnostic electrophysiology investigations
- Therapeutic catheter ablation of supraventricular and ventricular arrhythmias
- Permanent pacemaker implantation
- Implantable cardioverter defibrillator implantation
- Anti heart failure devices (biventricular pacemakers)
IV Invasive Diagnostic and Interventional Services :
- Cardiac catheterisation
- Coronary angiography
- Coronary angioplasty, rotablator, rotational atherectomy and stent implantation
- Balloon valvuloplasty
- Intraaortic balloon counterpulsation
- Device closure of ASD/VSD/PDA
Dr L H Hiranandani Hospital treats heart attack patients with the most effective and advanced procedure available, namely primary angioplasty. It is the preferred treatment for heart attack according to the American College of Cardiology.
Heart attacks are caused when blocked arteries prevent the heart from receiving oxygen. Traditional treatment uses drugs to dissolve blood clots. While effective, it does not treat the underlying cause of the blockage, resulting in possible re-hospitalization and further procedures. With primary angioplasty a balloon is inflated to open the clogged artery and a stainless steel wire mesh, called a stent, is inserted. This acts as a scaffold to keep the artery open. The result: blockages are completely cleared, heart damage is lessened, the risk of stroke and/or subsequent heart attack is reduced and the hospital stay is shortened.
"There are basically two ways to treat someone having a heart attack,” "One way is to use clot-dissolving medications. But they only work about 70 percent of the time and do not address the underlying blockage. The safest way to treat an acute heart attack and avoid subsequent procedures is to open the blocked artery with a balloon and insert a stent. We have the trained personnel and the equipment to perform emergency primary angioplasty right away on our heart attack patients."
Patients experiencing symptoms of a heart attack are evaluated within minutes of arriving in the Accident & Emergency Department at the Hospital. When the diagnosis is a heart attack, most patients are transferred immediately to the Catheterization lab for emergency balloon angioplasty. The interventional Cardiologist inserts a balloon-tipped catheter into the artery, threading it towards the heart. When the balloon is inflated, it dislodges the obstruction and restores blood flow to the heart. A wire mesh stainless steel tube called a stent is inserted to keep the cleared artery open, acting as scaffolding to keep the artery open.
Dr L H Hiranandani Hospital offers 24X7 emergency primary angioplasty programme. Primary angioplasty complements the comprehensive cardiac services provided at the hospital - from the patient's doorstep and transport to the hospital with our cardiac ambulance units, to their safe return home. Don't ignore the warning signs of a heart attack - chest pain with or without nausea, shortness of breath, vomiting, profuse sweating, breathlessness, fainting, weakness and intense feelings of dread. Call us at 022 25763323, the sooner treatment starts the better. While you wait, chew on an aspirin to help dissolve the blood clot.
With an aging population on the rise in India, complex coronary cases are presenting frequently to the cardiologists. In these patients the arteries supplying the heart muscles (coronary arteries) are blocked by hard calcium laden plaques. A rotablator is used to treat such complex blockages which is much less invasive than surgery, can be safer than other minimally invasive catheter based procedures.
For these complex hard and calcified blockages, an atherectomy or in plain language reducing the amount of calcified plaque within the artery by the rotablator (plaque debulking) actually puts less strain on the arterial walls than the routine balloon angioplasty.
What is a Rotablator?
The Rotablator is a sophisticated drill with a tiny olive shaped diamond- tipped burr. The burr travels through a catheter over a thin guide wire into the blood vessel supplying the heart (coronary artery). Once close to the hard calcific blockage, the rotablator spins between 140,000 to 200,000 revolutions per minute and is driven by turbine technology. As it crosses the blocked or narrowed area, it ablates or sands or pulverizes away the hardened calcific blockages (plaques). These small bits of plaques then harmlessly travel through the blood stream and are eventually eliminated from the body circulatory system.
How Is the Procedure Performed?
Like a routine angioplasty procedure, the patient is awake during the procedure and given a local anaesthetic. The interventional cardiologist makes a small incision at the top of the patients groin and inserts a catheter in to a blood vessel using an x-ray camera. A dye is injected to confirm the amount of blockage in the artery. At the end of this tube is the rotablator. Once the burr is in place, the cardiologist turns the turbine motor on with a foot paddle to break the plaque off the walls of the artery. These small pulverized calcific particles are eliminated from the body through the circulatory system.
After the Procedure
Once the calcific hard particles are removed and the lumen of the artery is restored, the case is completed by the usual stenting. At times it is combined with the routine balloon angioplasty. This combination has proven to be effective in treating severely hardened blocked arteries which a routine angioplasty fails to address it. It is specifically a choice of treatment for hard blockages which are more common in elderly age group (who are otherwise high risk for bypass surgeries) or post bypass repeat procedures and at time even younger patients with significant heart disease. After the procedure, the patient is kept overnight at the hospital, and can return to work within two or three days.
Is It Safe?
A Rotablator is designed not to damage artery wall. The Rotablator burr cuts away only inelastic, hard material as calcific plaque. Normal healthy tissue is elastic and is deflected out of the way. The mechanism of action is similar to shaving, in which the razor cuts the hard inelastic beard, while not damaging the soft, elastic surrounding skin. However it requires rigorous training to handle the equipment.
Is it routinely used device?
It is not a routinely used device, and only a handful of interventional cardiologists in the country are trained to operate this device. Dr Ganesh Kumar, consultant interventional cardiologist at the Dr L H Hiranandani hospital is one amongst them. The rotablator is marketed only by one company (Boston Scientific, USA), and to obtain their device, you need to be a certified operator to handle such complex cases. However, with the increasing number of complex cases that are being treated by Dr Ganesh Kumar, Dr L H Hiranandani hospital is the first hospital in Mumbai to permanently obtain this machine, so as to benefit the select group of highly complex coronary interventions that are being done routinely in this hospital.
What is IVUS?
Intravascular Ultrasound (or IVUS) allows us to see a coronary artery from the inside-out. This unique point-of-view picture, generated in real time, yields information that goes beyond what is possible with routine imaging methods, such as coronary angiography, performed in the cath lab, or even non-invasive Multislice CT scans.
This cross-section view can aid in stent sizing, and in confirmation that the stent has been placed optimally, is fully expanded and hugging the vessel wall. A growing number of cardiologists feel that the new information yielded by IVUS can make a significant difference in how a patient is treated, and can provide for more accurate stent placement, reducing complications and the incidence of stent thrombosis.
How Does IVUS Work?
IVUS uses ULTRASOUND: the same technology as the ultrasound imaging used echocardiography and many other medical exams. Very high frequency sound waves, called ultrasound, are emitted by a transducer. These ultrasound waves, which are beyond the range of human hearing, bounce off the various types of tissue structures in the body and the echo of these waves is then converted into a picture.
In the case of Intravascular Ultrasound, the transducers have been miniaturized to less than four hundredths of an inch and placed on the tip of a catheter. This catheter can be slipped into the coronary arteries over the same guide wire that is used to position angioplasty balloons or stents. It becomes, in effect, a tiny camera that gives us a cross-sectional view of the artery, a view that shows distinct circular layers, using shades of gray or colors, the major ones being:
When is IVUS Done?
Intravascular ultrasound is done in the catheterization laboratory in conjunction with angiography. Some cardiologists use it occasionally, in difficult cases, or to assist in the selection and sizing of stents and balloons. Others use it routinely, to confirm accurate stent placement and optimal stent deployment.
How Can IVUS Make Stenting More Accurate?
With the accurate measurements of both the true diameter of the artery and the diameter of the open lumen channel provided by IVUS, the guesswork is taken out of choosing the correct size balloon and stent. Using only angiography, a cardiologist may underestimate the size of a diseased artery.
IVUS can also measure the length of the diseased area, so the precise length of the stent needed can be determined ahead of time, reducing the need for overlapping stents which are known to increase the risk of thrombosis.
Once the stent has been implanted, IVUS can clearly show the stent struts in relation to the arterial wall and plaque. If the stent has been undersized or if there is any area that needs "touching up", a larger balloon can be directed to it and expanded to fit the stent optimally.
FFR (Fractional Flow reserve)
Fractional Flow Reserve, or FFR, is a guide wire-based procedure that can accurately measure blood pressure and flow through a specific part of the coronary artery. FFR is done through a standard diagnostic catheter at the time of a coronary angiogram. The measurement of Fractional Flow Reserve has been shown useful in assessing whether or not to perform angioplasty or stenting on "intermediate" blockages (50-70%blocks)
Both these technologies will help tremendously in improving the outcomes of angioplasties and better patient care.