NEW STENTING TOOL COULD MAKE HEART PROCEDURES CHEAPER AND LESS PAINFUL. March 20, 2017 by Caroline Brogan. New England Journal of Medicine (2017). DOI: 10.1056/NEJMoa1700445 A NEW TOOL for assessing the narrowing of the heart's arteries was FOUND TO BE AS EFFECTIVE AS CURRENT METHODS AND LESS PAINFUL FOR PATIENTS. The tool is similar to current techniques in telling surgeons whether a patient needs a STENT – a type of mesh tube used to hold open clogged arteries and increase blood flow. However, THIS NEW TECHNIQUE, KNOWN AS instantaneous wave-free ratio (iFR), is MUCH MORE PLEASANT FOR the PATIENT, and could be CHEAPER and LESS TIME-CONSUMING for healthcare providers. CORONARY STENOSIS OCCURS WHEN VARIOUS FACTORS CAUSE NARROWING OF THE CORONARY ARTERIES, WHICH DELIVER OXYGEN-RICH BLOOD TO THE MUSCLE OF THE HEART. WHEN THESE blood VESSELS become BLOCKED or are narrowed, this CAN AFFECT how the heart functions, potentially LEADING TO CHEST PAIN, HEART ATTACKS and HEART FAILURE. Now, DR JUSTIN DAVIES and his team from the National Heart and Lung Institute at Imperial College London have DEVELOPED iFR to measure the pressure loss caused by the narrowing in these important blood vessels without the need for drugs with sometimes unpleasant side effects. This novel technology was licensed to Volcano-Philips by Imperial Innovations, the College's technology transfer partner. THE TECHNIQUE RECEIVED FDA APPROVAL IN 2013 and is ALREADY USED IN 4,500 LABS WORLDWIDE, BUT the LATEST STUDY is the biggest yet to PROVE ITS EFFECTIVENESS COMPARED WITH THE CURRENT MOST WIDELY ESTABLISHED TECHNIQUE. "We have already seen iFR ADOPTED INTO THE LATEST 2017 appropriate use criteria (AUC) GUIDELINES and expect this will lead to further changes in guidelines, which would have HUGE IMPLICATIONS FOR CARDIOLOGISTS AND THEIR PATIENTS," said Dr Davies. "iFR technology is already used widely worldwide, and this is the study we've been waiting for to show that our TECHNIQUE IS JUST AS ACCURATE AS OLD ONES, BUT FAR BETTER FOR PATIENTS." DECIDING ON STENTS : Measuring pressure in the coronary artery is important when deciding whether patients need to have a stent fitted – a procedure known as ANGIOPLASTY. This helps to improve the blood supply to the heart muscle by widening the narrowed coronary arteries. However, before patients can undergo angioplasty, CARDIOLOGISTS MUST TEST THE PRESSURE OF THE ARTERY TO MAKE SURE IT IS NARROW ENOUGH FOR A STENT TO BE USEFUL. The first line technique in CURRENT GUIDELINES, known as fractional flow reserve (FFR), requires using powerful drugs such as adenosine to open the blood vessels for easier measurement. However, it can cause severe crushing pain, low blood pressure and breathing difficulties, and adds more time and costs on to the procedure. THE LATEST STUDY HAS SHOWN THAT using the NEW TECHNIQUE (iFR) is just as ACCURATE, causes LESS DISCOMFORT, is LESS TIME-CONSUMING, and might be CHEAPER, than FFR. Click here for a live case demonstration of iFR, courtesy of Imperial College Healthcare NHS Trust. LIKE FFR, iFR measures pressure using a thin wire in the coronary artery, BUT UNLIKE FFR, it uses a mathematical algorithm to take measurements only when the heart is relaxed and the coronary blood flow is high, negating the need for adenosine. IN THIS STUDY, THE RESEARCHERS ENROLLED 2,492 PATIENTS IN 17 COUNTRIES who suffered with chest pain or acute coronary syndrome (heart attack). They RANDOMLY ASSIGNED participants to undergo iFR or FFR, and either inserted a stent or not, depending on the measurements. Patients were followed up for 12 months after the procedure. BY MEASURING subsequent heart attack and mortality after FFR and iFR, the researchers were able to tell whether the type of technique used had any association with higher mortality or other OUTCOMES. Although there were no significant differences in rates of death or subsequent heart attack between the two techniques, PATIENT EXPERIENCE WAS MUCH IMPROVED WITH THE iFR TECHNIQUE. The researchers found that ADVERSE EVENTS occurred in 31 PER CENT OF FFR patients AND THREE PER CENT OF iFR PATIENTS OVERALL. FFR was also associated with a HIGHER RATE OF SHORTNESS OF BREATH (reported in one per cent of iFR patients and 20 per cent of FFR patients); CHEST PAIN (nearly two percent in iFR and seven per cent in FFR); HEART RHYTHM disturbances (nearly ZERO per cent in iFR and nearly five per cent in FFR); ABNORMALLY LOW BLOOD PRESSURE (nearly zero per cent in iFR and one per cent in FFR); and SERIOUS ADVERSE EVENTS, which included severe shortness of breath or disturbance of normal heart rhythm (nearly zero per cent in iFR and nearly one per cent in FFR). They also found that iFR reduced the overall length of the PROCEDURE, from an average of 45 MINUTES FOR FFR to 40 MINUTES FOR iFR. The results from this trial, known as DEFINE-FLAIR, are published in the New England Journal of Medicine, and are presented today at the American College of Cardiology's 66th Annual Scientific Session in Washington. LEAD AUTHOR DR DAVIES SAID: "As our technique ELIMINATES the NEED FOR ADENOSINE and REDUCES the LENGTH OF the PROCEDURE, it could mean that iFR SAVES HEALTHCARE PROVIDERS MONEY. The study also provides a very good, REAL-WORLD SNAPSHOT OF THE TIME it takes to actually get a patient in, do the physiological assessment, do the stenting if necessary, and finish." CO-AUTHOR of the study, Dr Sayan Sen, SAID: "'CARDIOLOGISTS HAVE BEEN WAITING FOR SOMEONE TO PROVE THAT THIS NEW TECHNIQUE IS JUST AS EFFECTIVE AS THE CURRENT ONE." "Many of our physician colleagues have been waiting for these results, and for them to be incorporated fully into the guidelines they use. DEFINE-FLAIR gives guideline makers the evidence they need to go ahead and suggest the technique that's BETTER TOLERATED BY PATIENTS, and MORE COST EFFECTIVE for the health service." Next, Dr Davies and co-investigator Professor Javier Escaned will further analyse this data to fully compare the costs of iFR and FFR. They will also work to combine data from another study testing iFR outcomes, SWEDEHEART, with their own. The two groups of researchers will work together to conduct a follow-up analysis combining the data from the two studies in a META-ANALYSIS of primary outcomes that will include approximately 4,500 patients. $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ £££££££££££££££££££££££££££££££££££££££££££££ MORE INFORMATION: Justin E. Davies et al. Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI, New England Journal of Medicine (2017). DOI: 10.1056/NEJMoa1700445 _______________________________________ PROVIDED BY: Imperial College London. _______________________________________ IMAGE : A STENT HOLDING OPEN A CLOGGED ARTERY. ====================×========================
Useful n informative
Nice way of treating blocked arteries.There was a video showing the mechanism . Thanks for sharing.
Stunts for dilating the cardiovascular vessels to over come ischemic effect . The etherosclerotic plaque may obstruct the flow of blood supply to most vital organ cause angina and may Leeds to ischemic heart disease .
Very useful information.
Very nice update for patients as well as doctors.
Great information! Thank you
nice
Very nice update, thanks for sharing
Nice update
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45m diabetic on OHA,controlled,bp normal rarely upto140/90 has no any complaints ecg after 5killometer walking routine checkup…… plz expert opinion if there is any future warning…………… history only genetical diabetics
Dr. Dinesh2 Likes27 Answers - Login to View the image
53/M c/o Severe chest pain (squeezing in nature) radiating to left arm and upper back a/w profuse sweating since 1 hr. k/c/o T2DM x 3 yrs on RX k/c/o smoker - 20 beedi / day x 25 yrs ECG taken Diagnosis and treatment??
Dr. Nelson Jd51 Likes251 Answers - Login to View the image
Heart attack: A heart attack occurs when the flow of blood to the heart is blocked. The blockage is most often a buildup of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries). The plaque eventually breaks away and forms a clot. The interrupted blood flow can damage or destroy part of the heart muscles A heart attack, also called a myocardial infarction, can be fatal, but treatment has improved dramatically over the years. It's crucial to call ambulance or emergency medical help if you think you might be having a heart attack. Symptoms Common heart attack signs and symptoms include: Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back Nausea, indigestion, heartburn or abdominal pain Shortness of breath Cold sweat Fatigue Lightheadedness or sudden dizziness Heart attack symptoms vary Not all people who have heart attacks have the same symptoms or have the same severity of symptoms. Some people have mild pain; others have more severe pain. Some people have no symptoms; for others, the first sign may be sudden cardiac arrest. However, the more signs and symptoms you have, the greater the likelihood you're having a heart attack. Some heart attacks strike suddenly, but many people have warning signs and symptoms hours, days or weeks in advance. The earliest warning might be recurrent chest pain or pressure (angina) that's triggered by exertion and relieved by rest. Angina is caused by a temporary decrease in blood flow to the heart. When to see a doctor Act immediately. Some people wait too long because they don't recognize the important signs and symptoms. Take these steps: Call for emergency medical help. If you suspect you're having a heart attack, don't hesitate. Immediately call ambulance or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only if there are no other options. Because your condition can worsen, driving yourself puts you and others at risk. What to do if you see someone who might be having a heart attack If you see someone who's unconscious and you believe is having a heart attack, first call for emergency medical help. Then check if the person is breathing and has a pulse. If the person isn't breathing or you don't find a pulse, only then should you begin CPR to keep blood flowing. Push hard and fast on the person's chest in a fairly rapid rhythm — about 100 to 120 compressions a minute. If you haven't been trained in CPR, doctors recommend performing only chest compressions. If you have been trained in CPR, you can go on to opening the airway and rescue breathing. Causes A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol (atherosclerosis). This condition, known as coronary artery disease, causes most heart attacks. During a heart attack, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can block the flow of blood through the coronary artery, starving the heart muscle of oxygen and nutrients (ischemia). You might have a complete blockage or partial. A complete blockage means you've had an ST elevation myocardial infarction (STEMI). A partial blockage means you've had a non-ST elevation myocardial infarction (NSTEMI). Diagnostic steps and treatment might be different depending on which you've had. Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Using tobacco and illicit drugs, such as cocaine, can cause a life-threatening spasm. Risk factors Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body. You can improve or eliminate many of these risk factors to reduce your chances of having a first or another heart attack. Heart attack risk factors include: Age. Men age 45 or older and women age 55 or older are more likely to have a heart attack than are younger men and women. Tobacco. This includes smoking and long-term exposure to secondhand smoke. High blood pressure. Over time, high blood pressure can damage arteries that feed your heart. High blood pressure that occurs with other conditions, such as obesity, high cholesterol or diabetes, increases your risk even more. High blood cholesterol or triglyceride levels. A high level of low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol) is most likely to narrow arteries. A high level of triglycerides, a type of blood fat related to your diet, also ups your risk of heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol (the "good" cholesterol) lowers your risk of heart attack. Obesity. Obesity is associated with high blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes. Losing just 10 percent of your body weight can lower this risk, however. Diabetes. Not producing enough of a hormone secreted by your pancreas (insulin) or not responding to insulin properly causes your body's blood sugar levels to rise, increasing your risk of heart attack. Metabolic syndrome. This occurs when you have obesity, high blood pressure and high blood sugar. Having metabolic syndrome makes you twice as likely to develop heart disease than if you don't have it. Family history of heart attack. If your siblings, parents or grandparents have had early heart attacks (by age 55 for male relatives and by age 65 for female relatives), you might be at increased risk. Lack of physical activity. Being inactive contributes to high blood cholesterol levels and obesity. People who exercise regularly have better cardiovascular fitness, including lower high blood pressure. Stress. You might respond to stress in ways that can increase your risk of a heart attack. Illicit drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack. A history of preeclampsia. This condition causes high blood pressure during pregnancy and increases the lifetime risk of heart disease. An autoimmune condition. Having a condition such as rheumatoid arthritis or lupus can increase your risk of heart attack. Complications Complications are often related to the damage done to your heart during an attack, which can lead to: Abnormal heart rhythms (arrhythmias).Electrical "short circuits" can develop, resulting in abnormal heart rhythms, some of which can be serious, even fatal. Heart failure. An attack might damage so much heart tissue that the remaining heart muscle can't pump enough blood out of your heart. Heart failure can be temporary, or it can be a chronic condition resulting from extensive and permanent damage to your heart. Sudden cardiac arrest. Without warning, your heart stops due to an electrical disturbance that causes an arrhythmia. Heart attacks increase the risk of sudden cardiac arrest, which can be fatal without immediate treatment. Prevention It's never too late to take steps to prevent a heart attack — even if you've already had one. Here are ways to prevent a heart attack. Medications. Taking medications can reduce your risk of a subsequent heart attack and help your damaged heart function better. Continue to take what your doctor prescribes, and ask your doctor how often you need to be monitored. Lifestyle factors. You know the drill: Maintain a healthy weight with a heart-healthy diet, don't smoke, exercise regularly, manage stress and control conditions that can lead to heart attack, such as high blood pressure, high cholesterol and diabetes. Some common homoeopathic remedies that can prevent and treat heart attacks are: Arnica: One of the first symptoms of a heart attack is radiating pain from the chest to the left arm. The moment a person experiences such a symptom, he or she should be given arnica. Arnica helps calm the mind and treats the physical and mental shock of this experience. Arnica can also stem the internal bleeding and reduce internal bruising. Aconite: Sudden chest pain and a high heart rate are other common symptoms of a heart attack. As soon as such symptoms are experienced, aconite should be given to the patient. This treats the anxiety and mental anguish being experienced and lowers the heart rate. Aconite should ideally be given along with arnica. Nux Vomica: Nux vomica is often prescribed in cases where the patient complains of fatigue, chest pain and heaviness in the chest. This is often experienced after eating a heavy meal or triggered by exposure to stress. Stimulants such as coffee, alcohol and drugs can also stimulate such symptoms. Arsenicum: Arsenicum may be used to treat burning, chest pain that worsens at night. The patient may also complain of suffocation that worsens when lying on his back and may feel excessively thirsty. However, because of the chest pain, he may not be able to drink enough water to satiate his thirst. Arsenicum also helps calm restlessness and anxiety.
Dr. Anu Radha5 Likes5 Answers - Login to View the image
Hypertension & Diabetes - What’s The Big Deal? The worst attack you’ll ever face will be the one that catches you unguarded. It’s very evident that both diabetes and hypertension are silent killers. What does that mean? They basically don’t show any symptoms in the initial stages and so a person suffering from this deadly dual disease is often caught off guard when he reaches a point where attention (not prevention) becomes the only criterion. It is not surprising that the number of people suffering from hypertension is just increasing. What was once thought as an old man’s ailments – diabetes, hypertension, kidney diseases – are now being called lifestyle diseases as it is claiming its victims among the young and the able. When someone with diabetes is diagnosed, they are often cautioned that this disease doesn’t come alone, it brings with it other diseases too. Usually, diabetes and hypertension are interlinked. Diabetes is a disease that affects the arterial and venous system of the body. It increases the chances of suffering from atherosclerosis or blockages in the heart. If a person is also suffering from hypertension or high blood pressure which increases the blood pressure in the arteries and keeps the arterial walls elevated all the time, this increases one’s chances of suffering from cardiovascular complications like ischemic heart disease, coronary artery disease, risk of heart attack and heart failure. But why is this such a BIG DEAL? Because in good old days, for people suffering from diabetes, having a blood pressure of less than 140/90 was also considered normal, but recently the guidelines have changed. According to the new guidelines, the systolic pressure should be less than 130 and diastolic pressure should be less than 80. So it is important to maintain the number at 130/80. It is thus very important to keep your blood pressure in check if you are suffering from diabetes. Hypertension is also known to affect the other organs of the body. In hypertension, the blood vessels throughout the body remain dilated and the force of the blood against the artery walls is too high. This damages small capillaries and veins in every organ. If you have diabetes too, the intensity at which the damage can happen will only accelerate. Hypertension first affects the arteries of the heart which increases the risk of heart failure, heart attack and other cardiovascular damages. Next, it impacts the kidneys, eyes, brain and other organs too all of which could lead to life-threatening conditions like renal failure, blindness or even stroke respectively. When the sugar levels remain high it creates more pressure in the arteries. This is why maintaining proper blood pressure, especially when you have diabetes becomes crucial. Chances of organ damage increases when one suffers from uncontrolled hypertension and diabetes together than suffering from diabetes with the blood pressure being in control. While treating diabetes it is also important to select drugs which can have a protective effect on the heart and kidneys. ARB drugs and ace inhibitors are better suited in this aspect. The right medication along with lifestyle changes, cholesterol management and corrective eating habits go a long way in keeping diabetes in check and lowering hypertension. The bonus is the major organs are even taken care off in the process. Hope this article is alarming enough for you to get off the couch, take a run or relook at your diet, especially if you have diabetes.
Dr. Pradeep Gadge, Diabetologist3 Likes3 Answers - Login to View the image
pt came with Left leg cellulitis..pt has no other specific complaints related to CVS..k/C/of Hypertension ..BP 140/90..
Dr. Praveen Kumar15 Likes41 Answers
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