101 year old patient admitted to the hospital with complaints of giddiness and history of loss of consciousness (also known as a syncope). His investigations showed slow heart rate, diagnosed as Complete Heart Block. It is a degenerative process affecting the wiring system of the heart which leads to slow heart rate resulting in unconsciousness. This can be dangerous as patient can suddenly lose consciousness resulting in sudden fall. There is a high risk of sudden death in these patients. The only treatment available for this condition is the insertion of a small battery-sized device known as the pacemaker.
Dr Niti Chadha Negi, Electrophysiologist at Metro Hospital counselled the patient’s family and told them that it is a minimally invasive procedure which will improve the patient’s quality of life. After taking consent from the family, patient underwent successful pacemaker implantation.
According to Dr. Niti, patient was very cooperative during the procedure. She says family positivity and excellent CCU level care made a huge difference in the patient outcome. We are ready to discharge the patient on the second day after the pacemaker implant. As a procedure, pacemaker implant needs skill and good intensive care. With the best intensive care facilities available at Metro Hospital, this procedure was possible. This case highlights that in experienced hands, pacemaker implantation procedure can be done at any age, with good outcome.
“Age is not a barrier for the treatment of heart ailments; patient cooperation and excellent medical facilities made it possible for us to treat 101 year old patient, said Dr. Jainendra Khash, CCU Head.
Metro hospital Faridabad is known for its excellent cardiac care. It represents one of the largest and most modern cardiac care facilities which are affordable and available to all.
Cardiac team at a Metro Hospital Faridabad has given a new lease of life to a 98 year old heart patient with multiple health conditions. Mr. Dewan came into the emergency department with complaints of severe pain in the left side of the chest and sweating. Patient is a known case of right sided kidney tumor, for which his ureter was removed surgically and patient had taken chemotherapy.
Initial investigations showed acute heart attack which is a life threatening condition which occur when blood flow to the heart muscle is cut off due to blockage of heart artery, causing tissue damage. This is usually the result of a blockage in one or more of the coronary arteries. In lieu of acute MI, patient underwent angiography by Dr. Neeraj Jain, Sr. Interventional Cardiologist & Medical Director of the hospital which revealed a critical block in the LAD artery which supply major part of heart.
Angioplasty stenting carries risk in patient as he can go into kidney failure, but it was his only chance of survival. After explaining the family about the risk involve and the procedure, consent was taken and Mr. Dewan underwent coronary angioplasty to LAD artery successfully, using single drug coated stent. Patient was stable after the procedure and got discharged in a stable condition.
Dr. Neeraj Jain, said that considering patient’s old age and multiple health conditions, it was a challenging case, a small delay in opening the vessel would have been proved fatal.” He further added “patients at this age can do quite well after angioplasty, providing they are appropriate candidate and treating doctor is well experienced to handle such complex cases,” said Dr. Neeraj Jain. Generally elderly patients ignore their sufferings and feared undergoing heart procedures. But that is just a myth, angioplasty is safe option and is lifesaving procedure.” Dr. Jain added.
Dr. Jainendra Khash, CCU Head said patient responded well to the treatment and was very happy at the time of discharge. He said, it is important for all of us to go for regular heart checkup after 30 yrs as it help in the prevention of heart diseases.
It’s a myth that angioplasty is not safe in old patients. We do lots of angioplasty procedure in more than 80 yrs old patients. Dr. Neeraj Jain, Sr. Interventional Cardiologist & Medical Director of the hospital said. We are doing such complex procedures on regular basis. Our hospital is known for its comprehensive heart care by highly skilled cardiac team. We have kept the high standards of care which is the keystone of our success and all equipment’s are of best in the world to provide 100% safety to our patients” He further added.
Recently a 98 years old gentleman was brought from Palwal to Metro Hospital, Faridabad with complaints of severe chest pain and sweating. His ECG was showing extensive heart attack. It was so major that large area of heart muscle got affected & his ejection fraction came down to 25% (Normal 70-75%). Considering his age & condition, primary angioplasty (opening of culprit coronary artery, responsible for heart attack) was risky but essential to save life of this old patient.
He was investigated thoroughly & after discussion with relatives he was taken for angiography which showed 100% blocked left anterior descending artery (LAD) a major blood vessel of heart supplying big area of heart. Primary angioplasty was done in which main artery of Heart was opened & stenting was done. Entire procedure was done using very safe dye which are kidney friendly and do not harm patient at all. He tolerated the procedure well & soon after procedure became painfree.
He added that due to availability of very highend gadgets, state of art Cath Lab system & safe drugs, dye and expertise of the team, such complicated, high risk cases can be done at Metro Hospital, Faridabad. Both pre-procedure & post procedure care of such patients where age related problem already exist needs lot of dedication of both medical & paramedical staff. A team of 5 cardiologists is working round the clock with world class cardiac intensive care unit where all facilities to handle critical emergency are available.
Recently a 22 years old male, Mr. X was brought to Metro Hospital, Faridabad with complaints of severe chest pain, sweating & pain in both arms for one day. On investigation it was found that he suffered from massive heart attack due to occlusion of one of the major coronary artery, Left anterior descending artery (LAD) which was responsible for anterior wall MI.
As a result of occlusion of major vessels, his ejection fraction of heart dropped down to 40% (Normal ejection fraction 60-70%).
He did not give history of any chronic ailment like high blood pressure or diabetes but was obese (>75 kgs) with high BMI (body mass index) and is a heavy smoker, both as independent risk factors for premature atherosclerotic disease and early heart attacks.
He immediately was taken for coronary angiography after consent and Culprit vessel was opened by angioplasty using drug electing stent. Post procedure, he did well.
Although CHD is an uncommon entity in young adults but in recent times, it has been observed that incidence is increasing in youngsters also due to premature onset of process of atherosclerosis.
Amongst risk factors for developing CHD, smoking is a top ranker & most modifiable risk factor. 65-95% younger patients, suffering from CHD are smoker.
Positive family history of premature CHD is seen in 64% young CHD case, In addition, the offspring’s of patients with premature CHD are more likely to have coronary risk factors than those without such family history which includes excess body weight and high levels of serum cholesterol, glucose and insulin. This association can be genetic or environmental. High blood levels of lipids/Fat especially triglycerides are common in young CHDs.
Diabetes & high blood pressure in young patients of CHD, it has been observed that they have impressed glucose tolerance rather than overt diabetes which in again a risk factor for CHD.
Obesity is an independent risk factor for heart disease in a study. 23% of the cases have been attributed due to obesity (Framingham heart study).
Besides these major risk factors, oral contraceptives in female, frequent cocaine abuse, factor V leiden high bloods levels, are other factors to cause premature CHD.
High levels of HSCRP and homocysteine have been found to be associated with greater risk of premature atherosclerosis and has the potential to play an important role as an adjunct for global risk assessment in the primary prevention of cardiovascular disease.
Mr. S.K. Jain father of a Doctor, visited Metro Hospital with complaints of breathlessness for long time. On investigation, he was found to have “ALCAPA” which was further confirmed by coronary angiography. His Echo Cardiography was showing severe leakage of mitral valve & 35% ejection fraction.
“ALCAPA” is a very rare birth defect occurring 1 in 4-5 lac live births & if left untreated more than 90% patients die in first year of life due to heart failure. He added that as a result of developmental birth defect, left coronary artery which carries oxygenated blood to heart muscles, start supplying impure blood to heart, leading to major heart attack and death early after birth. Mr. X was lucky to survive so long with this defect but had poor heart function & severe leakage of mitral valve. Cardiothoracic team of Metro Hospital, headed by Dr. Mitesh Sharma alongwith other team members closed the abnormal connection and made a new coronary bypass graft to correct the defect alongwith replacement of leaking valve with bioprosthatic tissue valve.
Patient recovered fully & discharged after a week.
Literature review suggest that this is the oldest patient with ALCAPA to have success fully been treated with complex coronary artery bypass alongwith MVR using a tissue valve.
Padma Vibhushan Dr. Purshotam Lal Chairman Metro Group of Hospitals has congratulated Dr. Mitesh Sharma and entire team for this difficult surgery.
Recently a 60 years old Iraqi patient Mrs. X came to Metro Hospital Faridabad with H/O chest pain and breathlessness on exertion and severe pain in right leg for one month. Her right toes were having blackish discoloration for last 4 days suggesting gangrene.
She is a known case of Diabetes for many years and her Echo showed 30 % ejection fraction with moderate to severe MR. Her Arterial Doppler showed blocked right Superficial Femoral artery. After initial evaluation, her coronary and peripheral angiography was done which showed single vessel disease (LAD) and complete occlusion of right superficial femoral artery. She underwent angioplasty for LAD and peripheral vascular disease was treated by a latest technique “Turbo Hawk” (Peripheral plaque excision system) successfully.
This technique has been recently introduced in the world and we are honored to be associated with Dr. Sven Braunlich who is a Senior Cardiologist in Park hospital, Lupzig. Germany. Dr. Braunlich has done pioneer work in “Turbo Hawk” technique.
This technique is very useful for those patients who are having severe peripheral vascular disease. This is a breakthrough for those cases as number of patient suffering from this disease is very high but they usually remain undiagnosed. Only 25% such patients are being presented to hospital and treated while rest go unnoticed.
It is a catheter based minimally invasive technique which is having a directional cutter which can be positioned in an area having high plaque load or cholesterol deposition. Very effectively, it cuts the deposits and thus circulation is established efficiently, and relieves of pain of ischemia.
Most important aspect of Turbo hawk technique is that it can be used as stand alone procedure and there is no need to put stent after atherectomy by turbo hawk. And so it is preserving future treatment options open for this progressive disease.
One important application of “Turbo Hawk” is to treat those peripheral blocks which are at places like back of knee joint (Popliteal Fossa) where stent for blocks to get fractured when the knee joint is bent, Dr. Neeraj Jain added.
This novel technique is now available in Metro Hospital Faridabad. Dept of Cardiology and Cardiothoracic surgery of the hospital is one of the most advanced setup where facilities like 3 state of art cath labs, IVUS (intravascular ultrasound), Rotablator (for hard, chronic blocks), electrophysiological studies and radiofrequency ablation and pressure wire technique (for 100% accurate angioplasties) are being available for heart patients.
A 48 yrs. old International patient from Nigeria has undergone a very complex heart surgery successfully at Metro Hospital, Faridabad.
Mr. Watson, came to us with complaints of breathing difficulty. On investigation, he was found to have an abnormal enlargement of the Ascending Aorta (main artery arising from the heart) along with a severely leaking aortic valve. The size of ascending aorta which is usually 2.5 – 3.5 cm in a healthy adult, had increased to 8.6 cm in size, in Mr. Watson’s case. The swelling of aorta (Aneurysm) was due to weakness in the wall of the artery and it could rupture anytime coming sudden death.
Dr. Mitesh Sharma, Chief Cardiac Surgeon studied the case & immediately planned an ascending aortic root replacement surgery (BENTALL OPERATION) which is considered as one of the most difficult & technically challenging heart operation.
A team of doctors headed by Dr. Mitesh Sharma removed the entire diseased aorta & inserted a special synthetic tube graft along with a artificial heart valve inside it. In this extensive 6 hours long operation Dr. Mitesh Sharma also removed the patient’s coronary arteries and reattached them to the new tube graft to restore blood supply to the heart with great precision & skill. Dr. Amit Srivastav, assistant surgeon & Dr. Ashish Gandhi, cardiac anesthetist were part of the surgical team. The patient is recovering well & will be ready to fly back to his country.
Dr. Neeraj Jain, Medical Superintendent & Cardiologist said that this type of surgery is very complex & requires a lot of expertise & skill to save the patient.
4 years old child a known case congenital heart disease (patent ductus arteriosus), presented with history of easy tiredness and inability to play with his friends of same age. The child had to stop playing with his friends as he developed tiredness and breathlessness with minimal exertion. The child’s parents were anxious about the well being of their child. Cardiac evaluation done with all routine tests like ECG, Echocardiography, CXR-PA, Blood tests revealed complete heart block with ventricular rate 44 beats/min.
In children with congenital complete heart block, when heart rate gets extremely slow, heart starts to fail. This means the child’s mental and physical growth is halted. This condition puts child’s life at risk. To save the life of the child, the only treatment was pacemaker implantation. Pacemaker is a small machine which is implanted under the skin beneath the collar bone. It is required in patients where the heart’s own electric current system fails to work properly just like in this 4 year old child. In the hands of experts, pacemaker implantation is a safe procedure which involves a minor surgery. The real challenge in this child was the small body size, which makes it difficult to introduce the pacemaker leads/wires through the veins into the heart without injuries nearby body structures. If not done carefully, there is a high risk of injuring lung tissue or nearby arteries and nerves. Hence,
keeping all these factors in mind, the child was taken up for pacemaker implantation by Dr. Niti Chadha, Consultant Cardiologist and Electrophysiologist, Metro Heart Institute, Faridabad and procedure completed successfully without any complication. In the whole procedure only 10ml blood loss was there. To avoid pain during the procedure, the child was given general anaesthesia by Dr. Manoj Gupta, Senior Anaesthesia, Metro Heart Institute,
Faridabad. The team of Metro Hospital is proud to report the successful recovery of the child without any complication thus giving a new life to this 4 year old child.
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