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Cardiovascular Disease
Cardiovascular Disease
The Treatment of  Cardiovascular Diseases

Cardiovascular Disease is a general term that includes many types of diseases of the heart and blood vessels. More common

•    Coronary heart disease (CAD):  The blood vessels supplying the heart muscle lose their supplying (pumping) capacity, caused by atherosclerosis (hardening and narrowing) of the coronary arteries, producing blockages in the vessels that carry blood to the heart. This disease occurs mostly in older people and may result in excess fluid backing up into the lungs and other tissues. Symptoms include weight gain, swelling in the abdomen, feet ankles and legs; fatigue, dizziness, shortness of breath. It is usually the cause of heart attack, stroke, and peripheral vascular disease.

•    Heart Attack: Also called "myocardial infarction" (MI),  can be described as  the damage or death of part of the heart muscle which occurs when blood flow to the heart is severely reduced or cut off, due to the hardening and narrowing of the coronary arteries from the build-up of fat, cholesterol, and other substances, known together as "plaque." A blood clot forms around the plaque, blocking blood flow.

•    Arrhythmia: This condition refers to any change in the normal sequence of the heartbeat. It involves the electrical impulses of the heart—not the arteries or blockages. These electrical impulses may happen too fast, too slow, or irregularly, which causes the heart to beat the same way. When the heart doesn’t beat normally, it can’t pump blood effectively to the lungs, brain, and other organs, causing them to potentially shut down or become damaged.

•    Heart Failure: While a serious condition, heart failure does not mean that the heart is no longer working. Heart failure is when the heart’s ability to pump is weaker than normal. Blood moves through the heart and body at a slower rate, pressure increases in the heart, and the heart can’t supply enough blood and oxygen to the body’s cells, resulting in fatigue and shortness of breath.

•    Congenital Heart Defects: Different than other types of heart conditions, congenital heart defects are present at birth. These defects are not a disease, but rather an abnormality that occurs while a fetus is developing. Examples include a leaky heart valve or malformations in the walls that separate the heart chambers. Some heart defects may produce symptoms at birth or during childhood, while others aren’t discovered until a person is an adult. Treatment may or may not be needed, depending on the severity of the defect.

•    Cardiomyopathy: A progressive disease that causes the heart to become abnormally enlarged, thickened, and/or stiffened, cardiomyopathy (also known as heart muscle disease) limits the heart muscle’s ability to pump blood effectively. This often leads to other heart conditions such as heart failure or arrhythmia.

•     Peripheral Artery Disease: A type of vascular disease (diseases that affect the circulatory system), peripheral artery disease occurs when fat and cholesterol deposits, or "plaque," build up in the peripheral arteries, which are the blood vessels outside the heart. This build up (also called atherosclerosis) narrows the artery walls, restricting the amount of blood flow to the body’s tissues. Depending on the arteries where the blockage occurs, this can lead to stroke,  heart attack, renal (kidney) artery disease, and other serious conditions.

According to the data published by World Health Organization:

KEY FACTS
•    CVDs are the number one cause of death globally: more people die annually from CVDs than from any other cause.

•    An estimated 17.3 million people died from CVDs in 2008, representing 30% of all global deaths. Of these deaths, an estimated 7.3 million were due to coronary heart disease and 6.2 million were due to stroke.

•    The number of people who die from CVDs, mainly from heart disease and stroke, will increase to reach 23.3. million by 2030 (1,3). CVDs are projected to remain the single leading cause of death.

•    Most cardiovascular diseases can be prevented by addressing risk factors such as tobacco use, unhealthy diet and obesity, physical inactivity, high blood pressure, diabetes and raised lipids.

•    9.4 million deaths each year, or 16.5% of all deaths can be attributed to high blood pressure . This includes 51% of deaths due to strokes and 45% of deaths due to coronary heart disease.

Diagnosis of Heart Disease

•    Blood tests. You may need to have your blood drawn and tested for substances that could indicate you have heart disease. Your doctor may check the levels of your cholesterol and triglycerides, blood cell counts, or other blood tests that might show damage to your heart.

•    Chest X-ray. An image is created by directing X-rays at your chest and positioning a large piece of photographic film or a digital recording plate against your back. The X-ray machine produces a small burst of radiation that passes through your body and produces an image on the film or digital plate. A chest X-ray shows an image of your heart, lungs and blood vessels. It can reveal if your heart is enlarged, a sign of some forms of heart disease.

•    Electrocardiogram (ECG). In this noninvasive test, a technician will place probes on your chest that record the electrical impulses that make your heart beat. An ECG records these electrical signals and can help your doctor detect irregularities in your heart's rhythm and structure. You may have an ECG while you're at rest or while exercising (stress electrocardiogram).

•    Holter monitoring. A Holter monitor is a portable device that you wear to record a continuous ECG, usually for 24 to 72 hours. Holter monitoring is used to detect heart rhythm irregularities that aren't found during a regular ECG exam.

•    Echocardiogram. This noninvasive exam, which includes an ultrasound of your chest, shows detailed images of your heart's structure and function. Sound waves are transmitted, and their echoes are recorded with a device called a transducer that's held outside your body. A computer uses the information from the transducer to create moving images on a video monitor.

•    If the images from a regular echocardiogram are unclear, your doctor may recommend a transesophageal ultrasound. During this exam, you swallow a flexible tube containing a small transducer, about the size of your index finger, that is guided down your throat. The transducer will transmit images of your heart to a computer monitor.

•    Cardiac catheterization. In this test, a short tube (sheath) is inserted into a vein or artery in your leg (groin) or arm. A hollow, flexible and longer tube (guide catheter) is then inserted into the sheath. Aided by X-ray images on a monitor, your doctor threads the guide catheter through that artery until it reaches your heart. The pressures in your heart chambers can be measured, and dye can be injected. The dye can be seen on an X-ray, which helps your doctor see the blood flow through your heart, blood vessels and valves to check for abnormalities.

•    Heart biopsy. Sometimes a heart biopsy will be done as part of cardiac catheterization, especially if your doctor suspects you have heart inflammation and hasn't been able to confirm that with other tests. In a heart biopsy, a tiny sample of your heart tissue is removed through the catheter and is sent to a lab for testing.

•    Cardiac computerized tomography (CT) scan. This test is often used to check for heart failure or heart arrhythmias. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest. Some walk-in clinics may advertise heart scans that look for calcium buildup in your arteries, which may show you're at risk of having a heart attack. However, these scans are not recommended for most people, as the information they provide isn't often useful.

•    Cardiac magnetic resonance imaging (MRI). In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. Images of your heart are created from these signals, which your doctor will look at to help determine the cause of your heart condition

Common Treatments of Heart Diseases
Coronary Angioplasty:  This procedure is also referred to as percutaneous coronary intervention (PCI), percutaneous transluminal coronary angioplasty (PTCA), or balloon angioplasty. It might be performed as a plannced procedure when the patients has angina or as an emergency treatment during a heart attack.

Coroner Artery BYPASS Grafting
This surgery is  also known as bypass surgery, heart bypass, or coronary artery bypass surgery. It is one of the most commonly performed surgeries that is performed when the arteries are blocked or narrowed.

During bypass, the surgeon will make a 8-10 inch cut in the middle of the chest area and the breastbone will be opened. In most cases, the heart is stopped and the functionality is taken over by a heart-lung machine or bypass pump which sends oxygenated blood to the body. In fewer cases, a new technique called off-pump coronary artery bypass is used, in which the heart is not stopped. In both techniques, a healthy vessel taken from the leg, arm, chest or abdomen is attached below and above the narrowed part so that the blood can flow around. In some cases, there might be more than one blocked or narrowed so that the bypass might have to be performed in multiples places. After the graft has been done, the breastbone will be closed with wire that will stay inside the patient. The last step is to stitch the cut.

Success Rate of CABG
•    CABG has become a routine surgery for more than 30 years. The mortality rates are  as low as 2%.

•    CABG surgery has been shown to improve long-term survival in patients with significant narrowing of the left main coronary artery, and in patients with significant narrowing of multiple arteries, especially in those with decreased heart muscle pump function.

How to Prepare for the Surgery
•    The patient will be asked to stop smoking at least two weeks prior to the surgery. You might also be asked to stop taking some medication.
•    Contact your doctor if you have a cold, flu, fever, herpes breakout, or any other illness.

•    Prepare your after care before the surgery. You will need to have decent after care in the first weeks after you leave the hospital. A good recovery is a part of a successful treatment.

What to expect after the Surgery
•    Right after the surgery, the patient is transferred to intensive care, where he/she will stay at least for 24 hours.

•    The patient will have a chest tube to drain fluid placed during the surgery. These will be removed within a couple of days.

•    How the patient will feel after the surgery depends on many factors, such as, age, overall health condition and how well the after surgery care is given.

•    Hospital stay will be between 3-7 days, depending on the health condition of the patient.

•    Sutures are removed from the chest prior to discharge and from the leg (if the saphenous vein is used) after 7 to 10 days.

•    The healing of the Breastbone takes between 6- 8 weeks. It might take up to 10 weeks for full recovery.

•    Most patients will be able to start driving after 4 weeks.

After Care
Heart bypass is a major surgery and after care is a crucial part of recovery. You will leave the hospital about a week after the surgery and you will be feeling a lot better by then. Even so, you will have to restrict your daily activities and rest as much as possible.  It is not advised to fly for 2 weeks after the surgery, so if you are having this surgery in another country, you should be sure to have the appropriate care even after you have been released from the hospital.

After Care Provided by MediPrima
After leaving the hospital and before flying back to your country, Mediprima will be sure to provide you with the excellent care you need. We are aware that after care is a critical part of your recovery. You will be staying in a luxury facility with house keeping and infirmary.  A healthcare professional will visit every day to make sure you are comfortable, that you have taken your medication, that your blood pressure is fine and that you do not running a  high fever. Your patient coordinator will also call you every day to ensure you lack not nothing. We can also provide you with a healthcare personnel who will accompany you until you are fit enough to fly back to your country. You will be accompanied to your hospital visits and finally to the airport. Before you arrive at the airport, your patient will have ensured to make the necessary are arrangements with the airline company to facilitate your check-in and boarding.


Bariatric Bypass

The term bariatric surgery includes various surgeries to treat obesity when it causes serious health problems. The aim is to make people lose weight, which cannot be treated by diet and exercise.

There are several techniques:

•    Gastric band: A silicone adjustable gastric band is placed in the upper part of the stomach to a create a small pouch above the band. In this way, eating small portions will give a feeling of fullness.  This technique is reversible and minimally-invasive. Food is digested and absorbed as it would normally, however, it reduces hunger, thus restricting calorie intake and leading to weight loss. This technique is performed either on a out-patient basis or requires only one night stay at the hospital.  

•    Sleeve Gastrectomy:  This technique includes removing approximately 80% of the stomach. Obviously, the much smaller stomach after the surgery can hold a little amount of food. However, the real impact is the effect of the surgery on the gut hormone, which causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety. This method can result in significant weight loss and is considered to be among the most effective treatments for obesity. The hospital stay is between 2-4 days, depending on the condition of the patient.

•    Gastric Bypass. This surgery, which is the most common obesity surgery performed, has three parts. First, the top part of the stomach is divided from the rest of the stomach, creating a small pouch. Then, the first portion of the small intestine is divided from the bottom end is connected to the newly created small stomach pouch. Lastly, the top portion of the divided small intestine is connected to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.

It works mainly three ways:  First of all, the food intake is restricted as the stomach gets smaller. Moreover, as in sleeve gastrectemy, the operation has an impact on the gut hormone, which suppresses hunger, reduces appetite and improves satiety. Lastly, there is less digestion of food by the smaller stomach pouch, and there is a segment of small intestine that would normally absorb calories as well as nutrients that no longer has food going through it, there leading to  less absorption of calories and nutrients.

Benefits of Weight Loss Surgery

•    Gastric bypass and sleeve gastrectemy lead to significant weight loss, on an average of 60% of total body weight
•    Gastric banding surgery leads to an average  40% weight los
•    Significant improvement in obesity related medical conditions, such as,
•    Diabetes
•    Severe arthiris
•    High blood pressure
•    High cholestrole
•    Sleep apnea

Life After Bariatric Surgery

•    Recovery time for gastric bypass and sleeve gastrectemy are usually between 2-4 weeks, depending on the general condition of the patient. You should wait about 8 weeks for more demanding physical activities.
•    Recovery time for gastric band is approximately 1 week.  You should wait at least 4-6 weeks for more demanding physical activities.
•    Bariatric surgery is not a quick fix. Diet is the most crucial part: calorie intake for a year should not exceed 1000 calories. The guidelines prescribed by the doctor should be followed. If the diet is not followed, excess food intake can cause problems, such as, vomiting and you should never forget that the stomach can stretch.  
•    Vitamin deficiency can become a problem, the prescribed vitamin supplement should be taken.
•    Exercise should become a part of daily life, starting with short walks. The aim should be 40-50 minutes of exercise 3-4 days per week.