New Delhi, May 19, 2017: In a meeting with staff journalist of healthysoch.com, India’s leading cardiologist Dr TS Kler, a Padma Bhushan awardee, who is presently the Executive Director and head of cardiology, Fortis Escorts Heart Institute, New Delhi said –”Angioplasty is very well established therapy, and now more and more patients of coronary artery diseases are treated with angioplasty rather than by-pass surgery.”
Q.1 Sir, What are the treatments available for Heart Diseases ?
A.1 I am happy you asked me this question, because there are lot of treatments available for heart failure. Whenever we have a patient of heart failure, we have to investigate why the heart failure occurred. For example heart failure may occur because of person has blockage in coronary artery or somebody has valve problem, either the valve becomes very narrow or start leaking. Whatever is the etiology or cause we should treat that. Suppose you reach a situation you have already done that treatments for example if somebody has blockage you have done angioplasty or undergone bypass surgery and still your heart is weak, then that is a real problem. Because there are many patients all over the world who have refractory heart failures means which is not responding to usual treatment. For refractory heart failures there are three modalities of treatment
- CRT (Cardiac Re-synchronization Therapy ) : This is a specialized pacemaker which we can implant on the individual and patients feel better. CRT is useful only in around 35% of individuals who have broadening of their ECG QRS Complex . If ECG shows broadening of QRS complex is particularly more than 130 ms those patients can be benefited by this pacemaker or CRT Therapy. We have seen some patients respond remarkably well. This is not a complicated surgery and is done in local anesthesia.
Some patients are not suitable for CRT then we are left with two modalities :
- Cardiac Transplant : Which is very much possible in India now. In our hospital we have done on 5-6 patients and fortunately all have done well. It is a very effective treatment now roughly 5 years survival of cardiac transplant is around 80% and 10 years survival of heart transplant is 60-70%. It is a good result.
- The main problem with heart transplant is that we need a heart , supposing heart is not available or patients age is more than 65-70 years then transplant is not offered. Then they can have artificial heart, it is also called left ventricular assist device, which is being done in the country, we have done that and lot of patients have improved. The only major limitations of artificial heart is, it is expensive. It costs around 60-70 lakh because the device , the artificial heart machine costs itself 40-50 lakh. In a private set up patient has to spend around 70-75 lakhs and in govt. sector it will be less of course.
So these are the treatments available for heart failure patients. If the patients has the understanding and they have resources lot can be done in heart failure patients.
Q.2 What happens when heart disease is left untreated?
A.2 If the heart disease is left untreated, obviously , patients will have bad quality of life, ultimately most of them will die. Heart is the central axis in the person living. If the heart is not able to pump enough blood in the body ultimately people die.
Q.3 What is Angioplasty and Stunting Procedure ?
A.3 Angioplasty or stunting procedure which is used to treat coronary artery disease blockages. This is a technology which is done under local anesthesia without any surgery. We can go into the heart with specialized equipment and open those arteries with balloon dilation, after that and can implant a stunt.
Q.4 When is the need of Angioplasty or Why it is done ?
A.4 Whenever patient has blockage in the major artery which produces symptom, or which is likely to produce heart attack, jeopardizing the patients quality and quantity of life , those are the situations where stunting is advised.