Safe and Novel Sonic Boom technology to open hard blocked arteries

Occurrence of coronary artery calcification is high among patients with advanced age, chronic kidney disease, and diabetes. Percutaneous coronary intervention of heavily calcified coronary artery remains a significant challenge for interventional cardiologists.  A promising new addition to the armamentarium for treatment of severely calcified lesions in the coronary and peripheral vasculature is the adaptation of lithotripsy technology for vascular calcification.

Although there are several modalities available in treating calcified coronary arteries, Dr. Anil Mishra, consultant, Interventional cardiologist, BM Birla Heart research centre and his team performed a very novel procedure of ‘Shock Wave Therapy to open calcified blocked heart arteries. The arteries were not getting cleared by the usual procedure, so the doctor used the new and uncommon technology of ‘Acoustic Shock Wave’ known as Intravascular lithotripsy which has recently emerged as a beneficial option in treating calcified peripheral artery disease. However, coronary IVL is currently available only in a few centres, studies are ongoing in the safety and efficacy of this technology in treating coronaries.

“An 87 years old man was admitted to BM Birla with 90 percent blocked left Main artery. His left artery was densely calcified. Since rotablation was difficult and has a higher complication rate we tried a standard technique of non-compliant and cutting  balloon angioplasty at first, with an extremely high pressure but it became impossible to open such a blockage. These calcified blocks behave like hard rocks. Even if we put stents, they do not open up well causing very high chance of re-blockages. Such blockages are found in nearly 20% of the patients especially those who are elderly diabetic or have chronic kidney disease or have long-standing blockages or previous bypass surgery. Hence, we decided to go ahead with the Shockwave Coronary Lithotripsy, which is a major advancement over the previous techniques and used for such hard blockages since ultra-high-pressure balloons or rotatory drills are complex to use and carry the risk of rupturing the artery, explains Dr Mishra.

Dr. Mishra elaborates “Such blockages can now be opened with ease and safety to give patients the best results for the long term. The sonic pressure waves are produced when performing Intravascular Lithotripsy giving us a novel safe and proven treatment option to break up the calcified plaque with potentially least risk of injury to the artery compared to other treatments. The calcium hardened structure restricts normal artery movement and makes the rigid arterial tissue resistant to traditional balloon therapies that have been designed to compress the plaque within the artery wall to restore normal blood flow”.

The angioplasty was successfully conducted and the patient is doing well post the procedure. He has be discharged within a couple of days from the hospital. With a hospital stay of only two days and hardly any incision or blood loss, he is back to normal life .He is extremely happy and the family is  relieved.

Swasthya Sathi Scheme

The Swasthya Sathi Scheme was launched in December 2016 by the government of West Bengal to provide basic health insurance cover for families. The scheme was later merged with Prime Minister, Narendra Modi’s flagship health insurance plan ‘Ayushman Bharat’. Both plans came to collectively be called ‘Swasthya Sathi’ in West Bengal. The scheme aims to offer one medical insurance plan to the people of West Bengal particularly to informal contractual workers in the government department and other people living below the deprivation limit. The health insurance cover can be extended to provide financial protection to the family members including spouse, children and parents.

Scope of the Swasthya Sathi Scheme

The Swasthya Sathi Scheme initially covered 47 lakh beneficiaries in the state of West Bengal. However, in 2018, the plan included 6 crores, individuals. Moreover, the policy only offered insurance cover of Rs. 1.5 lakh earlier, whereas after the merger, the scheme now provides insurance coverage of Rs 5 lakhs. The expense, for the common beneficiaries of the state and the centre, will be shared between the centre and the state government.

Main Features of the Swasthya Sathi Scheme

Some of the main features of the Swasthya Sathi Scheme include:

  • The policy is a standard health insurance plan offering secondary and tertiary care of Rs. 5 lakh per annum per insured family.
  • It is a paperless, hassle-free, cashless and a completely smart card-based scheme.
  • The policy provides protection against all pre-existing medical conditions.
  • There is no upper limit on the size of the family. Moreover, the insurance cover can be extended to include both spouse parents.
  • The scheme also offers cover for any physically dependent or challenged persons in the family of the insured.
  • The policy offers benefits like pre-and post-hospitalisation costs, transport, medications, IPD, OPD consultation, etc.
  • The total insurance premiums under the scheme are paid by the State and the Centre government, with no contribution from the beneficiary.
  • The scheme offers an online Swasthya Sathi Smart card for each family. The card is given on the day of enrolment. It includes all details of the family members, their photographs, biometrics, addresses, mobile numbers, and SECC ID.
  • The insurance plan is completely paperless and is managed through a robust IT platform.
  • The scheme also promotes informed decision making by providing online empanelment and gradation of hospitals in accordance with their services and infrastructure.
  • The insurance plan allows 100% pre-authorisation online. The turn-around time is 24 Hrs.
  • The scheme sends authorised SMS and instant alerts in case of blocking or misuse of the card.
  • The management panel uploads all e-health records of the beneficiaries on discharge in real-time.
  • The insurance plan includes hospital claim reimbursement with a tentative timeline of 30 days. Failure or delayed payments will lead to a charge of interest.
  • You can seek query resolution or any assistance from the 24X7 toll-free call centre. You can also give feedback about the scheme on the toll-free number available on the website.
  • The Swasthya Sathi Scheme includes an online complaint monitoring mechanism.
  • The policy sends online triggers and specific alarms in case of probable frauds with escalation matrix.
  • The insurance plan offers Android-based Swasthya Sathi Mobile app for beneficiary assistance.

Hospitals covered under Swasthya Sathi Scheme

The list of network hospitals where cashless treatment is offered by the Swasthya Sathi Scheme is given at the time of issuance of the Smart Card. In case of any information related to the network hospital, you can call the free toll helpline number, which is mentioned at the back of the Smart insurance card. Alternatively, you can use the Mobile App to find a hospital in the ‘active hospital tab’ option. Lastly, the list is also available on https://swasthyasathi.gov.in.

Generally, the hospitals are selected according to their facilities and infrastructure services. These hospitals are then rated according to grades – Grade A, Grade B, Grade C and Grade R. Grade A being the most preferred choice. The selection or list of network hospitals comprises both public and private hospitals.

Overall, the Swasthya Sathi Scheme was launched to increase the penetration of insurance in those who are less privileged. With the rising medical costs coupled with an increase in the intrinsic and extrinsic risk factors, insurance plans like Swasthya Sathi Scheme, act as a blessing for people, especially those who are below the deprivation level and cannot afford an insurance cover.

How to Find the Best Heart Hospital Near You?

The heart is one of the most critical organs in the human body. Hence, it is important you protect and treat it well. In case, you face an issue, it is always advisable to consult a heart doctor, also known as a cardiologist, at the earliest possible.

In case you are looking for a heart hospital to visit near you, here are some easy steps that can help you find the best heart hospital near you:

  • Seek Referrals: Foremost, start with getting advice or a referral from your primary care doctor. Alternatively, you can seek suggestions from close friends, family or peers, as well as other healthcare professionals to finds the right hospital for your heart needs.
  • Evaluate the hospital: Once you have the list of hospitals,the next step is tonarrow your list by evaluating each referral. You can do exhaustive online research and check the patient reviews, hospital ratings, successful patient cases, records, history, brand name, and more. You should also assess the credentials of the hospital in terms of doctors, years of service, infrastructure facilities,certifications, licenses, discipline records, etc.
  • Consider the experience of the cardiologist: When assessing the hospital, one critical factor that must evaluate is the experience of the cardiologists and the cardiology department. Remember, when it is about your heart health, experience matters significantly. The more experienced your heart doctor is, the better will be the outcomes and treatment results. Be sure to ask the number of patients treated with a similar condition as yours, overall patient experience, total cases handled, etc.
  • Research about the quality of the hospital: The hospital where your doctor will treat you matters significantly. Top-rated hospitals tend to have fewer complications and better success rates. Do your research well because two hospitals near you could have very different patient outcomes. Additionally, check the location of the hospital. Always opt for a care facility which is closer to your home. This will ensure you get timely care and thus, increase your chances for faster recovery.
  • Check the communication style: After everything is sorted, check how effectively your cardiologist communicates with you. Ideally, your heart doctor should make you feel comfortable and listen to your issues attentively. The doctor should consider your treatment preferences, medical history and accordingly offer a treatment plan that best suits your medical condition.

Once you have completed all steps, you will easily know which doctor to consult. So, book an appoint and get the best care for your heart.

Congenital Heart Defects (CDC)

Congenital heart defects or CDCs are medical issues related to the heart, which are present at birth. These problems affect the structure of the baby’s heart and its overall functioning. Further, congenital heart issues also impact the way the blood flows through the heart and ultimately reaches the body. Congenital heart problems can be less complicated like a mild hole or even serious ones like missing or poorly developed parts of the heart. Moreover, congenital heart issues are one of the most common types of birth issues found in kinds.

Reasons for Congenital Heart Defects

The main reason for congenital heart ailments is not known. However, in some cases, children have these problems because of changes in their genes or chromosomes. But in some cases, defects are because of a combination of genes, along with other factors like the environment, the mother’s diet during pregnancy, general health condition of the mother, medications during pregnancy, and smoking during pregnancy. Moreover, in cases, if the mother is obese or obesity or diabetes, a child can have heart issues or defects.

Types of Congenital Heart Defects

Atrial Septal Defect or ASD: Atrial Septal Defect is in the part of the septum, which divides the right and left chambers of the heart. This causes the oxygen-rich blood from the left chamber of the heart, known as an atrium, to go into the right chamber. Instead, the blood from the left chamber should ideally go into the left ventricle as per the normal process. When the direction of blood changes, the oxygen-rich blood flows back into the lungs, instead of going into the body. Typically, ASD can be small or large, depending on the condition of the heart. In most cases, a small ASD is not harmful and does not need any special medical treatment since the hole automatically closes on its own along with the natural growth of the child. In case of a large ASD, there is more leakage of blood, which could be potentially very harmful to the baby. However, if the hole does not fill up on its own, the child will need special care and treatment. That said, the signs of a heart hole do no occur in a child up until the age of 30 years or even later. In all, if a large heart hole is not repaired in time, the child might suffer a heart failure, or irregular heartbeats, stroke, pulmonary hypertension, and several other heart-related complications.

Ventricular Septal Defect or VSD:  A VSD is a kind of defect where the child’s heart has a hole in the opening of the septum, which separates the lower chambers of the heart, known as the ventricles. This defect causes the oxygen-rich blood from the heart’s left ventricle to flow into the right ventricle. The blood eventually mixes up with the oxygen-poor blood, rather than going out of the body through the aorta. In some cases, a child can have more than one VSD. But in most cases, the VSD closes on its own as the child grows in age. Such ailments do not cause any issue. Alternatively, large size VSDs can cause some problems and will need surgery, if they do not eventually close on their own. A large hole can cause heart failure, growth issues, irregular heartbeats, and pulmonary hypertension.

Coarctation of the Aorta: Coarctation is an intense congenital defect, which implies a narrowing of the aorta. Typically, the aorta is a large blood vessel, which stretches from the heart to provide oxygen-rich blood to the entire body. If a child experiences a coarctation of the aorta, the heart is forced to function even harder and pump blood profusely to ensure a smooth flow through the narrowed aorta. This, in turn, impacts the efficiency of the heart and thereby, the general health of the child. This condition is usually present at birth and could be intense or mild, varying from case-to-case. In some instances, the condition can go unnoticed until adulthood. However, this depends on how much the aorta is affected. Coarctation of the aorta can be treated easily and often successfully, but the medical attention is life-long and requires consisted of follow-ups and precautions.

Double-outlet Right Ventricle (DORV): DORV is a serious congenital heart issue, which develops in a child. In this problem, the aorta of the heart, which is generally linked to the left ventricle (the chamber that pumps oxygen-rich blood to the body), is instead by default associated to the right ventricle (the chamber that provides oxygen-poor blood to the lungs). This issue causes both the arteries to automatically flow out of the right ventricle. This leads the oxygen-poor blood to flow to the entire 

D-Transposition of the Great Arteries: This is aserious congenital heart disorder in which the aorta and the pulmonary artery of the heart of the child shift from their normal position. The change in position causes the aorta to flow through the right ventricle and the pulmonary artery to the branch of the left ventricle. This causes the aorta to come off the right ventricle and pulmonary artery to come from the left ventricle. This means that oxygen-rich blood from the lungs flows back to the lungs itself. Instead, the poor-oxygen blood from the body flows back to the system, which should ideally be going to the lungs for the oxygen-enrichment process.

Ebstein Anomaly: This is a rare congenital issue where the child’s heart valve, located between the right atrium and the right ventricle of the heart, sits in the wrong position. The leaflets of the valve are not of the right shape. This causes the value to malfunction and ultimately lead to leakage of the blood back to the valve and then finally to the right atrium.

Hypoplastic Left Heart SyndromeThis is one of the most severe types of the heart defect. This syndrome occurswhen the child’s left side of the heart does not develop properly during the pregnancy term. This makes the left-side of the heart unable of pump oxygen-rich blood to the rest of the body efficiently. In this syndrome, surgery or other medical treatment is required. However, as soon as the baby is born and displays any symptoms of the disorder, urgent medical attention is required:

Symptoms of Congenital Heart Defects

Symptoms of heart defects in children vary by the type of ailment. In some cases, there may be no signs at all. However, some common signs include:

  • Blue-tinted nails
  • Blue lips
  • Tiredness when feeding
  • Sleepiness

Most of the congenital heart issues are detected during pregnancy. However, some other health concerns can also be diagnosed during post-birth and later like. 

Chest Pain – Symptoms and Causes

Chest pain can be described as piercing pain or a minor steady ache, which often makes people uncomfortable and restless. In some cases, chest pain can also give a burning or crushing sensation, which lasts for a specific period. However, the intensity of chest pain depends on the underlying medical condition. In some cases, chest pain could also be an indication of a heart attack or a heart ailment. In other situations, chest pain could be a small non-harmful issue.

But irrespective of the intensity, chest pain and more importantly, recurrent chest pain should be given immediate medical attention to. Moreover, it is critical to consult a specialist to know the underlying cause and treat the same. 

Heart-related causes of chest pain

If the chest pain is due to an underlying condition of the heart, a person will also experience additional symptoms like shortness of breath, vertigo and heart tremors. A few heart-related conditions that can cause chest pain include:

Angina: Angina is a feeling of pressure or squeezing of the heart, which leads to intense pain and dizziness. Angina is a very common heart issue and usually occurs because of the minimum supply of blood to the muscle of the heart. A person experiencing angina can often mistake it for a heart attack. However, angina is not a very condition and does not lead to any permanent damage to the heart tissue. That said, angina experienced during physical activity is not a matter of concern but angina while sitting or in a relaxing mode is a very serious issue and will need immediate attentive medical care.

Heart attack: In some cases, people experience intense chest pain that travels further to the left arm or the jaw is often due to a heart attack. A person experiencing a heart attack is likely to get a feeling of sharp chest pain, along with tightness and stabbing feeling in the heart.Chest pain caused because of a heart attack indicates that there is a blockage in one or more arteries that is eventually resulting in lack of blood supply to the heart. Moreover, a person experiencing chest pain because of heart attack can also have symptoms like shortness of breath, extreme sweating, nausea, uneven pulse, feeling of choking, extreme weakness and numbness.

Myocarditis: Myocarditis is a medical condition where the heart muscle is swollen because of multiple causes including fever. Myocarditis causes mild pain or pressure in the heart, which can often appear as chest pain. Pain in the heart is also accompanied byshortness of breath, swollen legs, palpitations, etc.Myocarditis is not a seriously alarming condition but in case, there are severe symptoms, medical attention is required.

Pericarditis: Pericarditis is another common heart issue, which is often confused with a heart attack. This condition happens when there is swelling in the watery sac covering the heart. The chest pain caused because of pericarditis can be sharp or dull. It usually begins in the centre of the heart and then radiates to the left side of the heart. A person experiencing this medical issue might also have other symptoms like fatigue, muscle ache and mild fever. The swelling or inflammation can happen because of an existing infection or even due to previous heart surgery. The symptoms of pericarditis usually fade away in a week or so but in case, the signs last longer than this period, medical help is necessary.

Valve Disease: Pain in the chest which occurs because of any exertion can indicate a potential problem in the heart valve.Some other symptoms of valve disease are murmur, breathlessness and fatigue.

Cardiomyopathy: Cardiomyopathy is a medical condition that occurs because of thickening or thinning of heart muscles. The issue in the heart muscle disturbs the normal pumping action of the heart and causes chest pain. This chest pain usually occurs post eating or exercising. Other accompanying symptoms include swollen legs and ankles, heart tremors, and uneven heart rhythm. A patient with cardiomyopathy will require medical care immediately.

Aortic Rupture: Pain in the chest accompanied by a sharp pain in the upper back could likely be a sign of aortic rupture. This aortic rupture happens because of ablood leakage due to a tear within the aortic walls of the heart.

Respiratory causes of chest pain

In other cases, chest pain could also be an indication of a potential issue with the respiratory system of the body. Some respiratory problems that can cause chest pain include:

Pneumonia: If a person experiences chest pain along with strong, stabbing pain, the kind which gets intense with each breath, is more likely because of pneumonia.Some of the other signs that occur along with the chest pain in pneumonia are fever, chills and severe cough, with phlegm. In case a patient has any of these issues or even such mild symptoms, call emergency help.

Asthma: Asthma causes swelling the airways and leads to tightness and pain in the chest of the patient. However, asthma can be easily managed provided it is diagnosed and treated in time and effectively.

Chronic Obstructive Lung Disease (COPD): COPD is a disease, which blocks the inflow and outflow of air via the lungs due to swelling or inflammation. A chest ache that worsens with the rise in physical activity or exertion could be due to COPD.

Pulmonary Embolism: Chest pain can also occur because of a pulmonary embolism, which happens when a blood clot forms in one of the arteries of the lungs. This blockage makes it difficult to breathe and can feel similar to that of a heart attack.

Collapsed Lung: In some instances, the patient might feel a tingling sensation or pain in the chest while breathing. This could indicate a collapsed lung where the air gets trapped between the walls of the chest and the lungs. Thus, in turn, pressurises the lungs and makes it problematic for the lungs to expand upon inhaling of air.

Other respiratory issues that cause chest pain could include pleurisy, lung cancer and pulmonary hypertension. That said, the chest pain in these health issues is more recurrent in nature. 

Digestive causes of chest pain

Digestive issues that cause chest pain happens because of a malfunction of the digestive system and the connected esophagus. Chest pain caused because of digestive concerns worsens at the time of lying down and improves with movement, exertion or any physical activity. Such chest pain is a likely indication of one of the below digestive problems:

  • Gastroesophageal Reflux Disease (GERD) – acid reflux ailment causing a burning sensation in the chest
  • Esophagitis – fiery sensation and chest ache while swallowing
  • Esophageal Rupture
  • Dysphagia – discomfort and pain while swallowing
  • Gallstones
  • Pancreatitis
  • Hiatal Hernia

Some other causes of chest pain

Apart from the heart, respiratory and digestive causes of chest pain, the below issues can also lead to acute pain in the chest

  • Extreme anxiety 
  • Panic attack
  • Muscle strain
  • Injured rib
  • Costochondritis, which is swelling of the rib cartilage

Diagnosis of Chest Pain

To know the actual reason for chest pain, the doctor will conduct diagnostic tests. Some of the tests useful for this purpose are:

  • An electrocardiogram (ECG or EKG) to check the electrical activity of the heart
  • A blood test to assess the enzyme level in the body
  • Chest X-ray to evaluate the condition of the heart, lungs and blood vessels
  • An Echocardiogram to obtain the moving images of the heart
  • An MRI to measure the existing damage to the aorta or the heart muscle
  • Stress test
  • An Angiogram to assess any blockage in arteries

Treatment of Chest Pain

To treat chest pain in patients, it is critical to understand the underlying cause and the intensity of the issue. The treatment of chest pain can include medications, non-invasive procedures, surgery or a combination of these.

The below methods can be used to cure heart-related chest pain: 

  • Medicines
  • Cardiac catheterization, which includes the usage of balloons or placement of stents to open the narrowed or blocked arteries of the heart
  • Coronary artery bypass grafting or bypass surgery that surgically repairs the injured or compromised arteries

The methods below can treat chest pain caused because of other issues:

  • Lung re-inflation for patients where the chest pain is because of a collapsed lung
  • Antacids or other medical procedures for patients that experience acid reflux and heartburn, along with their signs
  • Anti-anxiety medicines to treat patients that have chest pain due to panic attacks

Overall, it is advisable to not ignore chest pains or take them lightly. It is good to consult a doctor upon any troubling symptoms and eliminate any chances of a serious underlying condition. Timely help is always beneficial.

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