Heart failure describes the condition of the heart when it is no longer able to function effectively as a pump to supply adequate blood to meet the body's needs, or when the heart is unable to adequately fill up with blood, thereby causing insufficient blood to be sent to the rest of the body.
It is a common condition with serious consequences. The prevalence of heart failure increases as we get older. It is a progressive condition that will have an impact on the social, mental and physical well-being of the patient. Treatment not only targets the heart, but also aims to optimise risk factors and protect other key organs.
The most common tests are:
Common symptoms include:
Do not hesitate to consult your doctor should you start to experience the above symptoms.
In the acute/emergency setting:
In the long term:
Procedures that can help heart failure patients include:
Treatment modalities are very much dependent on the patient: how is his condition currently, what he was like before, and what precipitated the heart failure. The doctor will be able to advise on the best method to manage heart failure in the long run based on the whole picture.
Coronary artery narrowings may be treated using either medications that reduce the heart's demand for blood, or by procedures aimed at increasing the heart's blood supply. One of the two most common methods to increase the blood supply is coronary angioplasty, sometimes abbreviated as PTCA (Percutaneous Translunimal Coronary Angioplasty).
PTCA offers a non-surgical alternative to Coronary Artery Bypass Surgery.
In PTCA, a balloon mounted on a thin tube (a catheter) is advanced into your coronary artery until it lies within the narrow area. The balloon is then inflated at high pressure, often a few times, to dilate the narrowing. Upon balloon deflation, the arterial narrowing is often significantly reduced.
A stent is a small metal coil to provide support to the narrowed segment of the coronary artery after angioplasty, preventing the artery from collapsing and reducing the likelihood the narrowing will recur. Modern stents are made of stainless steel or a cobalt chromium alloy and are inert to the body. Some stents also have a medication coating and these may be preferred in certain situations to further reduce the chance of repeat narrowing of the heart arteries. Nowadays, stents are frequently placed directly over the narrowed segments (direct stenting) without prior balloon dilatation.
A stent is a small metal coil that provides support to the
narrowed segment of the coronary artery after angioplasty.
Before going through a PTCA, a coronary angiogram is done first to provide a 'roadmap'. Undergoing PTCA is also very similar to having a coronary angiogram procedure.
During balloon inflation, you may experience some chest discomfort, and you should report this to your attending cardiologist. Stenting is carried out in a similar manner. The procedure may take 1 to 2 hours or more depending on the complexity of the diseased artery.
Following the successful PTCA, you will be monitored in a special monitoring ward. During this period, the sheath may be kept in your groin artery for 4 to 5 hours. However, the sheath may be removed immediately after the procedure if the situation allows. After the sheath is removed, the puncture site will be compressed for about 30 minutes to ensure that there is no bleeding.
You will have to remain in bed for several hours or until the following day to ensure the puncture site is sufficiently healed before walking. Your cardiologist will determine how long you need to stay in bed before you can walk around. Following that, some blood tests and ECGs will be performed to monitor your condition. If there are no complications, most patients can be discharged on the same day or the day after.
The success rate of coronary angioplasty is usually about 95%, depending on the nature of your coronary narrowing. However, in about 5% of cases, the procedure may be unsuccessful and the artery remains narrowed. In very few patients (about 1%), urgent bypass surgery may be required if the procedure is complicated.
There is a possibility of a recurrence of the narrowing of the coronary artery in the 6 months following the initial successful angioplasty or stenting, and you would usually feel a chest discomfort should it happen. If you feel a chest pain, you should seek medical attention immediately and inform your doctor.
Major complications like heart attacks, abnormal heart rhythm, stroke and death occur in less than 1% of the patients undergoing PTCA.
Less serious complications like bleeding from the puncture site, bruising and swelling of the puncture site, and blood clot formation in the artery where the sheath is insert occur in 1-3% of the patients.
Overall, the procedure is very safe and well-tolerated.
As a patient:
Unlike a traditional Coronary Artery Bypass Surgery, the Off-pump Coronary Artery Bypass Grafting does not require the use of the heart-lung machine. Instead of stopping the heart, surgeons can now hold portions of the heart stabilise during surgery due to technological advances and new kinds of operating equipment. The surgeon can now bypass the blocked artery in a highly controlled and stabilised environment while the rest of the heart continues pumping blood to the rest of the body.
Only certain patients with Coronary Artery Disease can receive this surgery. At present, this procedure can be performed on all the arteries of the heart.
It would ideal for you if you are at an increased risk for complications from the traditional bypass. If you have
24-Hour Ambulatory ECG Monitoring
Dobutamine Stress Echocardiography
Exercise Stress Echocardiography
Transoesophageal Echocardiography (TEE)
Cardiovascular Magnetic Resonance
Treadmill Exercise Stress Electrocardiography Test
Adenosine Stress Magnetic Resonance Myocardial Perfusion Imaging