How technology offers heart patients a better quality of life
Dr Harinder Singh Bedi

While it is true that heart disease is spreading fast in India, our management has also improved with the help of revolutionary new technologies and improved skills. The availability of finer imaging facilities, refined hardware and techniques have led to better patient care.

BETTER IMAGING MODALITIES

The first step is early diagnosis - the sooner a disease is identified, the better it can be controlled. Newer imaging techniques are a boon to the cardiac scientist.

Multi-slice CT scanner: This firstly identifies patients at risk by a method known as calcium scoring - the higher the score, the more the risk of heart disease. The newer 64-slice and above CT can give a very accurate 3D anatomical image of the heart (coronary) arteries . The details and spatial orientation given are unmatched by the previous imaging modalities. A new addition to CT - the Fractional Flow Reserve (FFR) — gives valuable information about the significance of a block on the heart function.

Cardiac Magnetic Resonance Imaging (CMRI): This gives an excellent view of the anatomy of the heart and is especially useful in understanding the complex anatomy in complicated cases

Positron Emission Tomography (PET) and Nuclear Heart Scan or Cardiac Viability Study): This has an excellent predictive value — it tells the cardiac scientist whether there are any areas in the heart which are at risk for developing a heart attack and if recovery is possible after an intervention.

Genetic testing and evaluation of bio-markers will help in identifying people at the risk of developing heart disease.

By these predictive tests a person at risk could be targeted with aggressive lifestyle modifications and other therapies so that he is saved from an avoidable heart attack.

New technology may predict heart attack in waiting.

A new imaging technology may hold the key to not only stopping heart attacks in their tracks but also preventing them for ever occurring. For the first time, researchers at Mount Sinai School of Medicine have shown the use of multi-detector computed tomography (CT) imaging along with a novel contrast agent that can detect dangerous, high-risk plaque which may cause heart attack and stroke.

VALVULAR HEART DISEASE

Repair of valves is now possible by a skilled cardiac surgeon. Such volves have an edge over artificial valves as they will not need any blood thinner and would hopefully last longer. A new technique called TAVI (Transcatheter Aortic Valve Implantation) has now crossed the research stage and is being used successfully on humans. In this technique a heart valve is implanted without putting the patient on a heart-lung machine or making any cut. This should be especially useful in old and high-risk patients.

For patients requiring conventional surgery, better quality valves are being developed. These need less or no anti-coagulation (blood thinners), are safe during pregnancy and last longer than before.

CORONARY ARTERY DISEASE

Bypass surgery has undergone a sea change with the advent of beating heart surgery. Patient mortality, morbidity, hospital stay and use of blood products have markedly got reduced.

Another new technology that has been developed is Minimally Invasive Cardiac Surgery (MICS). Here special instruments and cameras are used to do almost any kind of open-heart surgery, including valve and congenital heart surgery (in children) through a tiny incision.

NEWER CATHETER INTERVENTIONS

Here are some very interesting techniques:

l Intentionally scarring a part of the heart to stop a rhythm disturbance

l Routing a tiny umbrella-shaped device to patch a hole in the heart

l Cutting away excess calcium in arteries with a diamond-coated burr, a cutting instrument that rotates at 150,000 rpm (or about 15 times faster than a race car engine)

l Opening tough blockages using a cutting balloon with sharp blades

l Removing a blood clot within the heart arteries, using a suction catheter or a special jet catheter

l Using a catheter with an ultrasound probe (IVUS or intra-vascular ultrasound) at its tip to look at the inside of the heart arteries. This is done after an angiogram or a heart catheterisation study. It is done when we do not get a good enough picture of the calcium or plaque, and how bad the narrowing is. This gives us a circumferential view of the inside of the artery, like going through a tunnel.

l ICE or intra-cardiac echo to look at the chambers of the heart from inside

l Bio-degradable stents which will disappear after doing their job — reducing the incidence of restenosis

STEM CELL THERAPY

This is a novel approach and holds promise for patients with end-stage heart disease. The basis is the use of the stem cell from the patient’s own body. This miracle cell has the potential to develop into a heart tissue to replace the dead muscle. This concept has come a long way from the bench to the operating room and carries a lot of hope for the patients who otherwise would have needed a heart transplant.

GENE THERAPY

The unlocking of the human genome has thrown open vast possibilities in the total eradication of disease from the root. Thus, it may be possible to actually repair the ‘defective’ gene responsible for the higher incidence of heart disease in Indians.

Home-monitoring system of pacemakers, ICDs

This technology helps in continuous and automatic monitoring of congestive heart failure patients in their homes, resulting in fewer re-admissions to the hospital and lower healthcare costs. The home monitoring system observes any fluctuations or inconsistencies in the signals being received by heart-monitoring devices like the pacemaker and implantable cardioverter defibrillator (ICD) and sends the signals to the patient's physician via email, SMS or fax. This system allows physicians to remotely monitor their patients’ clinical and device status any time and from anywhere in the world.

Self-testing of blood coagulation profile

PT/INR self-testing kit allows patients to measure their blood's anti-coagulation levels — how long it takes their blood to 'clot' - at their places of residence.

BLOODLESS VASCULAR TRAUMA SURGERY

An interesting recent development has been the approval of a gel called LeGoo. This is a temperature-sensitive gel that is liquid at room temperature and solid at higher temperatures. When injected into a blood vessel, LeGoo forms a gel plug that molds to the shape of the blood vessel and stops blood flow for up to 15 minutes. This can give vital time in emergency cases to control blood loss.

Use of mobile phones

The iPhone ECG is a device that turns the iPhone 4 into a heart monitor. Oklahoma physician David Albert invented a slim case that fits over the iPhone, featuring low-power electrodes. When pressed against the chest or fingers, it displays the electrical activity of a person's heart. The device can be used to detect heart blockage and unstable heartbeat, and can the monitor heart rate at rest and during exercise. A simple, yet ingenious kit has recently been developed in Africa that turns a low-cost mobile phone — not a smartphone — into a sophisticated stethoscope.

All good gyms have treadmills which monitor the heart rate continuously just by holding on to the handle bars. Small belt -worn devices tell you how much you walked in a day and how many calories you burnt.

NANOTECHNOLOGY

This is indeed a revolutionary concept in medicine. Microscopic implantable drug delivery systems and slow release capsules are changing the way drugs are being given. Bio-feedback mechanisms attempt to mimic the human body’s methods of keeping vital molecules — electrolytes, blood sugar etc — under tight control.

All these new technology-driven advances are patient-friendly and effective. They reduce mortality, morbidity and hospital stay. A better quality of life for the patient is the final aim. A word of caution: One should never forget the need for good history taking and a proper physical examination of the patient.

The writer, Head of Cardio-Vascular, Endovascular & Thoracic Surgery at Christian Medical College & Hospital, Ludhiana, and was earlier at the St Vincents Hospital, Sydney.

Email drhsbedicmc @gmail.com 

Twitter can help save lives in an emergency

Washington : Discussion about cardiac arrests on Twitter, which is a common practice, may represent a new opportunity to provide life-saving information about it to the public, a new study has suggested.

Researchers from the Perelman School of Medicine at the University of Pennsylvania evaluated cardiac arrest and resuscitation-related Tweets during a month-long period in the spring of 2011 and discovered that users frequently share information about CPR and automated external defibrillators (AEDs) and discuss resuscitation topics in the news.

“Twitter is an incredible resource for connecting and mobilising people, and it offers users a way to receive instant feedback and information. The potential applications of social media for cardiac arrest are vast,” Raina Merchant, Assistant Professor of Emergency Medicine said.

“Health care providers and advocacy groups can push information to the public about CPR training and best practices in cardiac arrest care, and participate in real-time discussions about cardiac arrest issues in the media.

“Twitter might even be harnessed to save lives in an emergency, by allowing bystanders who respond to cardiac arrests in public places to seek information about the location of the closest AED,” she said.

In one of the new studies, the researchers identified 15,324 tweets involving cardiac arrest specific information and found that 14 per cent referred to cardiac arrest events, with 5 percent of those messages relating to personal experiences.

Twenty nine percent of tweets referenced CPR performance or AED use, with 23 percent of those messages involving personal stories about real-life performance of CPR or classroom training in the technique and likes/dislikes regarding CPR/AED courses.

Six percent of the CPR/AED-related messages referenced what the researchers termed “information sharing”, like observations about someone giving CPR or using an AED in a public place, or commentary about the new “hands-only” CPR guidelines for bystanders.

Nearly 60 per cent of the tweets related to health education — such as advocacy group and training events — and the sharing of cardiac arrest-related news reports about celebrities, athletes, and young adults affected by the condition.

In the second study, they sought to understand what types of questions the public is asking about cardiac arrests on Twitter, in the hope of getting clues for how health care professionals can participate in the discussion to provide reliable information.

They found that 21 per cent were queries about symptoms, risk factors, prognosis, the difference between cardiac arrest and heart attack, treatment options, and the use of therapeutic hypothermia.

Thirty-nine per cent of question tweets identified were related to CPR, including guidelines for its use, proper technique, details about certification classes, and accuracy of the media portrayal of resuscitation.

Forty per cent of queries pertained to AEDs — costs, device safety and batteries, availability, proper use and effectiveness. — ANI

Health Notes
Alcohol behind alarming rate of throat, liver cancer

London: Alcohol and obesity are to be blamed for the alarming rate of throat and liver cancer in the UK as compared to anywhere else in Europe, a new study has claimed. The oesophagus is the tube that links the back of the mouth to the stomach, and around 8,000 oesophageal cancer cases are diagnosed in the UK each year and more than 7,000 die from it. According to the league table compiled by the World Cancer Research Fund, about 6.4 out of every 100,000 people develop cancer of the oesophagus in Britain each year, which is almost double the European average of 3.3. — ANI

More than 50 per cent Brits suffer from insomnia

London: More than half of the people in Britain are unable to get a good night’s sleep which is adversely affecting their health, a new study has revealed. For the study, sleep expert Professor Colin Espie of the University of Glasgow and co-founder of the organisation Sleepio collected interviews of 12,000 adults in Britain’s largest study on sleep patterns. “Insomnia affects people’s quality of life during the day, not just their sleep at night,” the Daily Mail quoted Espie as saying. “Living with poor sleep and its consequences is not only very common, but it is in all likelihood degrading Britain’s health.” The study found that in total, 51 per cent of adults struggle to nod off or remain asleep. Women suffer far more than men, with 75 per cent reporting problems compared to 25 per cent of men. — ANI

Common diabetes pill can cut risk of ovarian cancer by 40 pc

London: A drug widely used to treat patients with type two diabetes could be a major breakthrough in the prevention of ovarian cancer, according to a new study. The study of more than 1,600 British women reveals taking metformin for long periods could slash their risk of ovarian cancer by around 40 per cent, the Daily Mail reported. The researchers at the University of Basel in Switzerland found that women who had been prescribed metformin, which comes in tablet form, at least 10 times for their diabetes were less likely to develop a tumour than women who never took the drug, or had been prescribed it fewer than 10 times. Metformin belongs to a class of medicines known as biguanides, which have been used for decades to treat type two diabetes - the form of the disease that normally affects the middle-aged or elderly. — ANI