Hypertension or high blood pressure develops due to transmission of flawed signals from the brain to the renal nerves. These nerves present in the arteries deliver to the kidneys and play vital role in regulating blood pressure, though it is not completely clear the manner in which they do it.

In nearly ninety-five percent of the situations, there is no lone, specific cause for such flawed signals; however risk factors inclusive of age, binge drinking, inadequate dietetic intake, dearth of physical exercise and being obese are some of the identified aspects.

A normal blood pressure reading is about 120 by 80 and any reading that is 140 by 90 and above is a high reading indicating hypertension. Those suffering from this condition could endure acute headaches.

However, a number of individuals are asymptomatic despite having high blood pressure levels; hence it is a prudent practise to get blood pressure levels evaluated on a regular basis. Treatment of hypertension is also imperative as it is the key risk factor leading to cardiovascular ailments – the heart having to put in greater effort in pumping blood that tends to weaken it. The rising pressure has a damaging effect on the arterial walls that could cause blockages or even brain haemorrhage that are both causal in case of strokes.

Treatment generally initiates with lifestyle alterations like restricting alcohol intake and exercising. In case this does seem to have any effect, then lifelong medications are prescribed that have associated side-effects. These include feeling nauseous, giddiness, lethargy, blurry eyesight, nose bleeding, erratic heart beats or feeling breathless and skin rashes.

Till recent times, all showed to improvement with medicines or those unable to bear the drug side effects were left with no choices but to be hopeful that their situation would not deteriorate. However, renal denervation holds thrilling prospects and a highly commendable development in this field in the past five decades.

During the procedure a fine pliable tube (catheter) is fed via an artery in the groin area in the renal arteries. A line is then passed into the artery and with the assistance of a small electric current the renal nerves situated in the artery wall are ablated. This puts a stop to the flawed signals arising from the brain that tell the nerves to maintain high blood pressure.

The highlight of this procedure is that there is no form of harm done to the renal artery or the kidneys. Though the two renal arteries need this form of treatment, however the surgery merely involves a simple slit on the right side of the groin region with merely a small post-operative mark on the patient’s skin.

Generally, doctors administer 4-6 rounds of electric currents in 120 seconds burst intervals for treating the entire artery.

This procedure appears quite effectual. Though there could be re-growth of the nerves, there is no proof of whether they would re-acquire functionality. There is hardly any risk of blood loss or harm and is risk-free.

Though subsequent to the operation there would not essentially be a complete stoppage of blood pressure drugs though lesser tablets would be needed henceforth and the risk of suffering from heart attack or strokes would be considerably lowered as hypertension is under greater control.

Dilated cardiomyopathy (DCM) is an abnormal  condition of dilatation of the heart muscles with weakened and enlarged  left ventricle,  the heart’s main pumping chamber. This leads to progressive decrease in ejection volume of the  blood pumped out  per heart beat. The left ventricle may fail to relax  preventing its filling  Other chambers of the heart may also be affected.

Symptoms of DCM

Many with DCM lead a normal life without showing any symptoms or only minor ones. With progressive worsening of the heart function  following symptoms are observed.

• Cardiac insufficiency (shortness of breath) due to reduction in ejection volume  of left ventricle upto 30%.
• Swelling of the legs and feet  weight gain , cough congestion due to fluid retention to compensate for the reduced cardiac out put
• Fatigue (feeling overly tired), inability to exercise, or even perform normal activities  due to reduced cardiac function
• Palpitations or fluttering in the chest due to abnormal heart rhythms (arrhythmia)
• Dizziness or lightheadedness  and  Fainting caused by irregular heart rhythms, abnormal responses of the blood vessels during exercise, These  symptoms may be without any apparent cause
• Pulmonary emboli (lungs), renal emboli (kidney) cerebral emboli or stroke (brain)  and peripheral emboli (limbs) due to blood clots as a result of  slow blood flow through the body
• Chest pain or  pressure (occurs usually with exercise or physical activity, but can also occur with rest or after meals).

Causes of DCM

Following are the causes of DCM  except  of   inherited (familial)DCM.  Causes of most cases of DCM  called idiopathic dilated cardiomyopathy or dilated nonischemic cardiomyopathy are unknown

• Severe coronary artery disease
• Alcoholism
• Thyroid disease
• Diabetes
• Viral bacterail, fungal infections
• Heart valve abnormalities
• Drugs that are toxic (or cause damage) to the heart  ( anthracyclins)

It can also occur in women after childbirth(postpartum cardiomyopathy).

Diagnosis of DCM

The diagnosis is based on  personal and familial medical history followed by physical examination and  specific tests like blood tests, electrocardiogram, chest X-ray, echocardiogram, exercise stress test, cardiac cathetirization, CT-scan and MRI.

Myocardial biopsy or heart biopsy where a tissue sample of  the heart is microscopically observed  is another test of detection rarely applied.

Relatives of those with familial DCM should be screened for DCM. by tests mentioned above  In addition a genetic testing may also be done to identify abnormal genes.

Treatment of DCM

Treatment is aimed at  correction of   the causes of DCM. Primary objective is to decrease  the heart size and also to decrease  thequantity of  substances in the bloodstream ,e.g., hormones, which enlarge the heart and aggarvate the symptoms. Several medications are available to the patient  to treat DCM. Physicians recommend  in addition  a variety of lifestyle changes to complement the drug therapy.

Drugs used to treat DCM

Beta-blockers and ACE inhibitors are administered to manage DCM even without onset of symptoms.  On appearance of symptoms or their aggravation, digoxin, diuretics, and aldosterone inhibitors are resorted to. If needed other medications are used by the physician, e.g., use of antiarrhythmics to control heart, use of blood thinners to prevent occurrence of blood clots. Your physician is the best judge for the choice of medication needed by you…

Lifestyle Changes

Diet:

On occurrence of symptoms like shortness of breath or fatigue, a restriction of intake of salt (sodium) to 2,000 to 3,000 mg per day is recommended. Continuation of the same regimen is recommended even on abatement of symptoms. One can adjust to the appropriate quantity by reading the sodium content on the labels of processed foods commonly used nowadays.

Exercice:

Non-competitive aerobic exercises are recommended while avoiding exercises like heavy weight lifting. DCM patients are advised to consult their physician for the appropriate exercise and its intensity.

Surgery for DCM:

One of the following surgery may be needed for severe DCM cases.

Cardiac resynchronization (CRT) by biventricular pacemaker:

Although under optimal therapy , if one still shows symptoms of heart failure and the ECG and Echocardiogram show specific characteristics putting a pace maker  helps to stimulate both right and left ventricles enabling the heart to contract with more force to improve the symptoms and increase physical endurance. Those with a heart block or bradychardia( slow heart rate) also benefit from  pace makers.

Implantable cardioverter defibrillators (ICD):

For patients at risk with life threatening arrythmias or sudden cardiac death ICD is recommended. It constantly monitors heart rhythms and changes  abnormal rhythms to the normal ones with appropriate supply of energy to the heart muscle.

Surgery   is adviced in valve diseases  in thin heart muscle after heart attack, in congenital malformations. Insertion of left ventricular assist device in case of advanced end stage heart failure.

• Aging is known to predictably slacken the heart leading to lowered flexibility that has a major bearing on the transmission of the electrical impulses.
• Individuals with a congenital heart anomaly are at greater risk of getting arrhythmia.
• Those with heart ailments, constricted arteries, those with a history of heart attack, improperly functioning heart valves, past heart surgery and cardiomyopathy are more prone to developing arrhythmia.
• Those with problems of the thyroid gland like hypothyroidism or hyperthyroidism are more prone to developing arrhythmia.
• Certain types of prescription medicines, some OTC medicines intended to treat cough and cold that contain pseudoephedrine might trigger the onset of arrhythmia.
• Those ailing from high blood pressure are more prone to developing CAD or coronary arterial disease and other heart ailments that lead to inadequate transmission of electrical impulses.
• Being overweight or obese has been strongly associated with a wide occurrence of heart ailments inclusive of type 2 diabetes, cancer, cardiovascular disease and arrhythmia.
• An individual with uninhibited diabetes is a major risk of developing arrhythmia than a patient with restrained blood glucose levels or who has been taking adequate treatment.
• Those with disruptive sleep apnea might be prone to bradycardia or atrial fibrillation with greater frequency than other individuals.
• Electrolytes are crucial for the appropriate transmission of electric impulses among cells. An unbalance that could range from soaring to plummeting levels of electrolytes in the heart leads to arrhythmia.
• Those who binge drink on a regular basis are more prone to developing atrial fibrillation.
• Excessive consumption of caffeine or other forms of stimulants could lead to increased heart rate and ultimately leading to arrhythmias.
• Illicit drug abuse like that of amphetamines and cocaine could lead to arrhythmias, particularly ventricular fibrillation.

Possible Complications:

• Stroke – When the heart is undergoing fibrillation or quivering, it is an implication of its improper pumping mechanism. This could lead to blood accumulating in clusters that eventually leads to clot formation. A probable dislodgement of any one of the clots could travel to a brain artery, creating a blockage and thus leading to a stroke. Stroke would cause damage to the brain and could lead to fatality.
• Heart Attack – Protracted tachycardia or bradycardia would lead to the heart inadequately pumping blood to the body and other vital organs that could lead to a cardiac failure. Treatment could normally aid in improving this situation.
• Alzheimer’s disease – According to the studies conducted by the scientists at Intermountain Medical Center, Salt Lake City, there has been lucid association noted between atrial fibrillation and the development of Alzheimer’s disease.

Bradycardia treatment (sluggish heartbeats): If the underlying issue is a hypo-active thyroid gland or a drug-associated side effect, then that problem would need prompt treatment. If there is no primary problem detected, then the doctor might recommend a pacemaker implantation.

Pacemaker – This small device inserted just beneath the skin of the chest or the abdomen reinstates the function of the atrioventricular node. It aids in controlling anomalous heart rhythms by sending electrical pulses to stimulate the heart into beating at a normal rate.

Tachycardia Treatment (rapid heartbeats):

• Vagal maneuvers – Particular maneuvers could be done by the patient that could aid in stopping arrhythmia that commences above the SVY or the lower half section of the heart. During the maneuver, the patient would be required to control breath, following which the patient would need to strain, cough or immerse the face in chilled water. There might be other forms of maneuvers that might be medically advised. The vagal nerves get affected during maneuvering that lead to the heart rate slowing down.
• Medicines - Though, these medications provide no cure, they are normally effectual in lowering occurrences of tachycardia alongside lowering down he heart rate when they happen. Such medications require proper administration for optimal outcome and to avert complications. In certain situations, the heart rate might plummet to precarious levels due to these medications, following which the patient might require to have a pacemaker.
• Cardioversion – When the tachycardia commences in the upper half of the heart or the atria and involves atrial fibrillation, then the doctor might administer a jolt of electric shock for resetting the heart back to normal rhythm – this procedure is known as cardioversion. This non-invasive, painless procedure is conducted externally under the influence of a drug relaxant.
• Ablation Therapy – This disease-elimination technique employs the use of one and at times, two catheters being introduced via the blood vessels into the inner part of the heart in locations that are deemed as the origin points of the arrhythmia. The electrodes located at the tip of the catheters are heated up or conversely chilled in order to freeze up the problem tissue. An infinitesimal part of the cardiac tissue is annihilated that leads to the creation of an electrical block along the conduit that is causing the arrhythmia.
• Implantable cardioverter- defibrillator or ICD – An ICD is implanted when the patient has a high likelihood of developing hasty or fibrillating ventricular heartbeat. The atrial (upper half of the heart) defibrillation or quivering is also treated with ICD. The ICD is inserted close to the left collarbone. The electrodes are located at the end of the wires that go via veins to the heart. The ICD examines the heart rhythm and causes the heart to pace much alike a pacemaker no sooner has it spotted an irregular sluggish rhythm. Specialists vouch for ICD’s to be better at majorly lowering the chances of a fatality due to arrhythmia as compared to medications.
• Maze Procedure- During the procedure a sequence of surgical slits are done in the upper half of the heart or atria. After they undergo healing, they transform into scars that become frontiers which ascertain proper flow of the electrical impulses that aid in effectually maintaining steady heart beats. This is an invasive, open-heart surgical intervention with high success rate and is usually the option carried out for those that have shown little improvement after trying other treatments.
• Ventricular aneurysm surgery – When the presence of a lump or aneurysm in the blood vessel that leads to the heart is the reason behind arrhythmia, and none of the treatments are proving beneficial, then the aneurysm could be surgically removed. The surgery has a high success rate – though at times it is employed when the inserted ICD or catheter ablation does not function properly.
• Coronary Bypass Surgery – Coronary bypass surgery is conducted on those patients with severe case of coronary heart disease along with recurrent ventricular tachycardia. A grafting is done wherein the arteries or veins from other parts of the body are implanted to the coronary arteries for bypassing atherosderotic constriction and improving blood supply to the heart muscle or myocardium.

• Blood and Urine Analysis – These tests are conducted for checking the blood count and the functioning of the liver, thyroid and kidney. The blood is additionally checked for the presence of particular chemical markers that are indicators of heart malfunction like BNP or brain natriuretic peptide – a kind of hormone whose secretion by the heart increases during injury or overstrain, though it is initially recognized by the brain. The sodium and potassium levels are evaluated for testing serum electrolytes.
• ECG or Electrocardiogram – The electrical and rhythmic activities are recorded by the ECG via electrodes affixed on to the skin’s surface. The impulses generated are recorded in a form of waves and the output being viewed on a display unit or the printout on paper. The test could also spot any heart damage that could have occurred due to heart attack.
• Holter Monitor – The convenient worn device that measures all data regarding the electrical activity of the heart beats. The device is internally donned by the patient for a period of nearly two days with a button-like device that could be pushed in case of symptoms being experienced. This helps the doctor to observe the condition of the heart rhythms during that particular period.
• Event Monitor or Recorder – This device is quite alike the Holter monitor except that it doesn’t record the heart beats. There are two forms of event monitors – one that employs a phone for signal transmission from the recorder during symptomatic periods. The second type of diagnostic device is ideal for detecting sporadic rhythmic distortions and has to be worn at all times for longer periods of time lasting up to a month except while bathing.
• Echocardiogram – This ultrasound scan test is employed to for checking the heart’s pumping mechanism. This scan aid in differentiating systolic heart malfunction from diastolic heart malfunction –the heart showing stiffness and not appropriately filling. The video images of the heart are created with the aid of sound waves that aid in diagnosing the heart’s pumping efficiency. Ejection fraction is a vital measurement carried out to determine in each heartbeat the proportion of blood being ejected out from the left ventricle –the chief pumping chamber. A normally functioning heart pumps out nearly sixty percent of the blood that flows into the ventricle during every heart beat.
• Chest X-ray – The images generated during X-ray assist in determining the functioning of the heart and the lungs. The presence of any form of congenital heart anomaly is also detected in a chest X-ray. Other underling conditions that might elucidate the appearance of the symptoms are also diagnosed through this procedure.
• Tilt-table Test – A tilt-table test is conducted when ECG or the Holter methods could not corroborate the reasons behind recurrent episodes of fainting, giddiness or wooziness. The table gauges the blood pressure, heart’s rhythms and rate in varying positions ranging from lying down to erect for detecting if there is an appropriate blood supply to the brain, a dearth of which leads to episodes of fainting.
• EP or Electrophysiological Testing – A minimally-invasive, rather painless, non-surgical intervention testing aids in analyzing the arrhythmia form, cause and probable reaction to the treatment. The test is conducted in an electrophysiology lab under the guidance of an electrophysiologist that aids in replicating the offending arrhythmias in a controlled environment. The EP study is conducted in the following steps:
• Under the influence of local anesthesia, a preliminary perforation is made through which an introducer sheath is introduced into a blood vessel that acts as a conduit for the catheter that is lined up the blood vessel via the body reaching into the right cardiac chambers.
• The movement of the catheter is monitored by the electrophysiologist. While lodged within the heart, the catheter detects and records the origin of the irregular impulses, their rate and which normal conduit paths they evade. Treatments are employed to determine if they halt the arrhythmia.
• The catheter and introducer sheaths are then gently taken out, and the puncture site is sealed by either application of pressure to the location or by suturing it.

Those in good health would barely ever ail from long-lasting arrhythmia only if the person is exposed to an external triggering factor like drug misuse or an electric shock. Due to an underlying problem, the electrical impulses might not be able to suitably pass through to the heart, thus raising the chances of arrhythmia.

• Binge drinking.
• Being diabetic.
• Drug misuse.
• Over-intake of coffee.
• Heart ailment.
• Soaring blood pressure or hypertension.
• A hyperactive thyroid gland or hyperthyroidism.
• Mental strain.
• Heart scarring due to heart attack.
• Smoking.
• Certain dietetic supplements, herbal medications or other medicines.
• Reduced blood supply or a damage or death to the cells and tissues of the heart could modify the heart’s capacity for conducting electrical impulses leading to the development of arrhythmia.
• Variation in the heart structure could be due to:

Coronary arterial disease or CAD: could cause the constriction of the heart’s arteries, mostly leading to a heart attack that scars the heart tissue leading to interference in the correct movement of the electrical impulses that cause the heart beat. This leads to the heart beating either faster (ventricular tachycardia) or erratically (ventricular fibrillation).

Cardiomyopathy – a diseased myocardium – a heart muscle leads to the ventricular walls stretching, or the left ventride wall might narrow thus gravely affecting the heart’s blood-siphoning efficacy mostly leading to heart tissue damage.

Valvular heart disease – The narrowing or leakage of the heart valves leads to the stretching or thickening of the heart muscles that could raise the chances of developing arrhythmia.

Tachycardia affecting the atria leads to:

• Atrial fibrillation – This is a widely prevalent form of arrhythmia chiefly affecting the older age bracket causes erratically faster beating of the atrial chambers, the risk being higher due to hypertension or some other heart ailment. Rather than the normal production of a singly strong contraction, the chamber palpitates or quivers leading to the heat beats soaring to350 beats/minute and even touching 500-600 in some individuals. Long lasting atrial fibrillation could lead to stroke alongside some other grave complications.
• Atrial fluttering – The atrial flutter is ordered in nature while atrial fibrillation is transient. Atrial fluttering is a grave condition which classically leads to soaring heart beats reaching 250-350 beats/minute.
• Supraventricular tachycardia (SVT) – SVT is caused due to regularly-paced, abnormal heart beats due to swift emission of electrical impulses that originate above the atrio-ventricular node. These spurts mostly happen when the electrical impulses from a heart beat begins to circle via the additional path, usually leading to raised heart beats of 160-200 beats/minute. SVT could be because of an underlying heart ailment. Youngsters with normally functioning hearts could have SVT or racy hearts – though it might be uncomfortable, but not of any serious consequence.
• Wolff-Parkinson-White or (WPW) syndrome – In this rather uncommon though potentially life-ominous syndrome, there is an additional electrical link within the heart that operates as a short route, leading to an unnaturally quicker heart beat (at times, erratic).

Tachycardia affecting the ventricles leads to:

• Ventricular tachycardia (VT) – irregular electrical impulses that originate in the ventricles leading to irregularly rapid heart beats. In general, the heart would bear the scarring due to a former heart attack that compels the electrical signal to take a trip around it. By and large, the ventricular contractions would race past two hundred times per minute.

Ventricular tachycardia is known to affect individuals with heart-associated ailments, like scarring or ventricle muscle marring due to arterial disease or a heart attack. There are two forms of VT, namely:

Unsustained VT – This continues for a period of nearly half a minute and is normally not of any grave consequence. Though, there is imminent likelihood of long-standing VT.

Sustained VT – This is longer-enduring form of VT and is deemed as a medical emergency.

• Ventricular Fibrillation: Anomalous heart rhythm comprising of very fast, unsynchronized quivering contractions of the ventricles. The ventricles fail to adequately impel blood and keep needlessly quivering. There is drastic drop in blood pressure leading to major organs like the brain being deprived of crucial blood supply. Many patients become unconscious rather fast and need urgent medical aid inclusive of CPR or cardiopulmonary resuscitation.

Patients with are administered CPR till their heart can be jolted back into normal functioning employing a defibrillator have improved survival rates. Fatality is mostly the consequence if the patient is not promptly administered CPR in a matter of crucial few minutes. Ventricular fibrillation is normally related to some form of heart ailment and mostly elicited by a heart attack.

• Long QT syndrome – A disorderly heart rhythm that might at times lead to quick, unsynchronized heartbeats. The syndrome name is derived from the QT segment noted in the tracing derived from the electrocardiogram that endures little longer in the syndrome than usual. Fainting could happen when heartbeats hasten that might be a threat to life. In extreme situations, the heart rhythm might turn out to be so frenzied that it could lead to abrupt death. Few individuals genetically bear an anomalous gene that raises the chances of contracting Long QT syndrome. Several medicines are also known to lead to Long QT syndrome.

Bradycardia (Irregularly slow heart rhythms) – A sluggish heartbeat (less than sixty beats per minute) doesn’t essentially imply a reason for concern. A fit individual having a healthy heart might have a lower resting heart rate than could be lesser than sixty beats per minute, and still be hail and hearty. Bradycardia is an issue when there is a fault in the heart that leads to improper pumping of blood. Instances comprise of the following:

• Sickly sinus – When the sinus node that is the heart’s innate pacemaker, poses a problem due to improper functioning, the patient’s resting heart rate might plummet to unnaturally low levels (bradycardia). Sickly sinus might be caused due to scars occurring close to the sinus node that destabilizes the movement of the electrical impulses.
• Conduction block - A hindrance in the electrical pathways of the heart could happen in or close to the atrioventricular node situated on the path lying in-between the atria and the ventricles. The blockage might be noted along the other conduits to each ventricle. There could be slowdown or impediment in the transmission of the electrical impulses between the upper and lower parts of the heart that is dependent on the kind of blockage and its location. If there is complete blockage of the signal, few cells present in the atrioventricular node or ventricles could cause a steady though sluggish heartbeat. The person could feel missed heart beats or bradycardia – while at times some persons are asymptomatic.

Early or premature heart beats – An untimely heartbeat transpires in-between two normally occurring heartbeats. This takes place in the ventricles and occurs prior to the ventricles having any time to be inundated with blood subsequent to a normal heartbeat. The patient might experience a skip in heartbeats. In majority of the situations, an infrequent untimely beat is not bee fretted about. Though, it could activate a longer-standing arrhythmia that is particularly the situation when the person has a heart ailment.

Arrhythmias are basically problems associated with the heart’s rhythms that transpire when the electrical impulses traveling to the heart which are responsible for co-ordination of the heart beats do not aptly function, leading to the heart beating unnaturally faster, slower or patchily.

Accelerated or sluggish heart beats don’t necessarily imply the presence of heart disease. Heart rates could normally rise during the course of exercising. Some highly fit athletes has a heart rate of lesser than 60 beats per minute when resting.

Several heart arrhythmias are inconsequential that feel like the heart is racing or quivering. However, at times arrhythmias, particularly the faster than normal kinds or the outcome of a weak or damaged heart, might lead to bothersome and even potentially lethal signs.

Arrhythmia Symptoms:

Certain patients could be asymptomatic and the problem could be discerned only during the time of a regular exam by the doctor. Despite the fact that the patient does perceive the presence of symptoms, it doesn’t essentially translate into a grave matter. Incongruously, a number of patients with perilous arrhythmias might be asymptomatic, while others showing symptoms might not have any severe issues.

Tachycardia symptoms comprise of:

• Breathing distress.
• Giddiness.
• Feeling washed out, fainting or almost fainting – syncope.
• Sense of flutter felt in the chest.
• Wooziness.
• Abrupt sense of feeling weak.

Bradycardia symptoms comprise of:

• Pain in the chest or angina.
• Difficulty in concentration.
• Feeling befuddled.
• Trouble experienced while doing exercises.
• Faintness.
• Exhaustion and weariness.
• Wooziness.
• Palpitations.
• Shortened breaths.
• Syncope sensations of fainting or nearly fainting.

Atrial fibrillation symptoms comprise of:

• Throbbing chest pain (Angina).
• Feeling out of breath.
• Giddiness.
• Palpitations.
• Syncope – sense of fainting or nearly fainting.
• Feeling weak.

In the latest landmark Gracia II trial that is available in the European Heart Journal, sheds light on some intriguing concepts. A comparison was drawn regarding the post tenecteplase angioplasty that could be performed a couple of hours I.V. bolus of tenecteplase with PAMI. The trial revealed that primary and secondary end points were analogous in both. The novel terminology pharmaco invasive treatment is employed that has the benefits of drug and perfunctory intercession. Comparable findings were cited in both the trials namely TRANSFER-AMI and FAST-MI.

In conclusion, it emerges that the Tenecteplase injection is the idyllic therapy in patients ailing from ST elevation acute myocardial infarction especially in third world countries.

In few hours following administration of Tenecteplase, coronary angiography and angioplasty are generally carried out on all patients. This method is safe and leads to lesser complications in stabilized patients.

During angioplasty, stents are normally employed that comprise of two forms, namely drug-covered and non-drug or bare metal. There has been credible progress in drug eluting stents noted from first to second generation with long-standing drug release close to six months time period, eco-friendly stents and better outcomes. Drug-eluting balloons are novel concepts in intercession and appear to be quite promising. These stents help in averting the arterial collapse with drug-eluting ones performing even better.

Nowadays, coronary angiography and angioplasty could be performed either through the wrist region also known as Radial Intervention or through the groin area –Femoral Intervention. Both the approaches have satisfactory results and are conducted at the prudence of the operator. Atypically, the ulnar artery could also be used during the method.

Prior to hospitalization, thrombolysis has been a commonly sought endeavour by doctors that has proven to exhibit exceptional outcome and lowers fatality rates by seven percent. Also, C.T. Angiography is not a substitute to Coronary Angiography in heart attacks.

Those patients that complain of chest pain must be promptly given Sorbitrate. Heart patients must always carry some sorbitrate that could be a crucial life-saver during heart attacks.

Hyper acute emergency – crisis management strategies

Reperfusion of the heart muscle done by opening the obstructed artery by either Primary angioplasty or by clot-absolving medicine is the decisive treatment that is successfully employed.

Elaxim –Tenecteplase justly earns the accolades for being a life-giving drug. Its clot-busting properties have the potential to terminate a heart attack. Injections could be administered IV bolus either at the patient’s home, in the ambulance or Intensive Care Cardiac Unit.

Administering these injections on time could make a major distinction between being alive and fatality. In the global setting noted since 2000, elaxim is the swiftest delivery clot buster. If the injection is promptly delivered within six hours of the commencement of chest discomfort and pain, it could cause a positive change in the end result of heart attack cases. It releases the blockage in the artery in nearly 85% of heart attack cases and normalised TIMI III flow is attained. Prompt treatment guarantees favourable results with negligible complications.

Elaxim has been proven to have better efficiency as compared to earlier clot-busting medicines such as streptokinase and urokinase, as it could be administered I.V.bolus, is clot or fibrin specific, is non-allergic and leads to lesser extent of bleeding.

PAMI or Primary Angiography is deemed the gold standard for treating heart attacks. However, the procedure must be conducted in a Cath Lab in a hospital within a time span of ninety minutes from the commencement of chest pain. This critical time factor is quiet difficult to achieve. Statistics reveal that merely 4.2% patients in the United States and six percent in Europe are lucky enough to receive the treatment within the ninety minute time limit.

In several countries, even this is tricky and rather unfeasible to attain. This reveals that the so-professed gold-standard is a mirage for many, though PAMI does have its own standing. PAMI has to be carried out by proficient, adroit surgeons with state-of-the-art facilities, high volume centre with door to balloon period not crossing over ninety minutes.

A 52-year old man of Indian origin was lately discharged from a hospital facility after having hoodwinked death. He was ailing from an atypical heart complication that had been repaired in a similarly unique procedure.

In an attempt to save his life, the surgeons placed him into an indeterminate state of suspended sentient, wherein he was not demonstrably animate according to the high-tech screening devices in the operating room. Providentially, the man did not face any neurological impediment due to the apparently radical procedure.

His ailment was atypical, but the doctors employed a one-off strategy for curing him. The patient concerned had been on hypertension medication for nearly a decade, never doubted that his aorta – the highly significant artery in the human body – was beginning to develop a rip or would split open along its inner wall that leads to the blood oozing out into and along the aortic wall. This condition is dubbed ‘Aortic dissection’. The blood pressure in such cases is known to soar in nearly 62-78% of the cases.

Subsequent to this condition occurring, the person developed abrupt and extreme chest pain. Following a doctor’s visit, he was advised to go in for this unusual form of bypass surgery that had a lesser than one percent risk factor, whereas treating this complication had a risk factor of nearly 25%.

However, the key concerns of the surgeons were not merely limited to the replacement of the seeping valve or the sickly section of the aorta. The surgeons had to be extra-vigilant regarding the carotid artery that transports blood to the brain and originates from the aortic arch that was being replaced.

Till the year 1950, aortic dissection was majorly an autopsy analysis. Hence, was the reason behind the resolution for employing ‘suspended animation’. The plan was to lower brain activity to a level wherein the surgeons got an opportunity for removing the unhealthy section of the aorta and fix a synthetic one in its place.

Suspended animation has been used since the past three decades, with doctors hailing from the New York Presbyterian Hospital employing it for treating brain aneurysm in 1990.

During this operative procedure, the surgeons initially replaced the man’s leaking aortic valve. The patient’s body temperature was lowered from his former temperature of 36.4 degrees celcius to 18 degrees celcius by passing his blood via a heart lung machine.

The patient was administered a jab of sodium pentothal or truth serum to lower brain activity to nil. The patient was gradually brought into a state of suspended animation.

In close to an hour’s time, without being perilous, his dissected aortic arch was swapped with a synthetic version.