Interventional Cardiology Ecab

Follow-up of patients after surgery is of utmost importance as results of the surgery heavily depend on the treatment of patient in the follow-up period. A good follow-up and proper treatment also provides protection to the patient from various complications and recurrence of the disease. Therapeutic guidelines and algorithms for treatment of the patients after discharge from the hospitals exist for a number of cardiovascular disorders. Still, follow-up and postdischarge treatment is very often found to be inappropriate and incomplete. This results in many avoidable complications for both the patient as well as the treating clinician. This book is designed to update the readers on follow-up regimens for some of the important cardiovascular surgical procedures. Typical supportive case scenarios are included to exemplify and highlight the various points discussed. Thus it provides an excellent opportunity to widen one’s perspective in this area.

Acute coronary syndrome (ACS) is the term for the clinical signs and symptoms of myocardial ischemia: unstable angina, non–ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). Unstable angina and NSTEMI normally result from a partially or intermittently occluded coronary artery, whereas STEMI results from a fully occluded coronary artery. The patients present with a wide arena of signs and symptoms like chest pain, nausea/vomiting, exertional pain, palpitation, shortness of breath, fatigue, etc. Angina, or chest pain, continues to be recognized as the classic symptom of ACS. In unstable angina, chest pain normally occurs either at rest or with exertion and results in limited activity. Chest pain associated with NSTEMI is usually longer in duration and more severe than chest pain associated with unstable angina. The diagnosis of ACS is based on triad of clinical presentation, electrocardiography and cardiac biomarkers. Electrocardiography is the most important initial diagnostic procedure when doctors suspect an acute coronary syndrome. Findings on a 12-lead ECG help the practitioner to differentiate between myocardial ischemia, injury, and infarction, locate the affected area and assess related conduction abnormalities. But at the same front, the definition of unstable angina, NSTEMI and STEMI is based on the levels of cardiac biomarkers too. Acute coronary syndromes are medical emergencies that need prompt action. Half of deaths due to a heart attack occur in the first 3–4 hours after symptoms begin. The sooner treatment begins, the better the chances of survival. Anyone having symptoms that might indicate an acute coronary syndrome should obtain prompt medical attention. Management of ACS involves a spectrum of interventions. It encompasses cardiac monitoring, thrombolysis, antiplatelet therapy, anticoagulant therapy, reperfusion therapy and invasive investigation and revascularization therapy. Reperfusion therapy (percutaneous coronary intervention) mainly holds for the ST-elevation myocardial infarction. Prognosis of the ACS patients depends on the post-myocardial risk stratification. The main highlights of risk stratification are risk stratification scores, assessment of cardiac function and stress testing, and management.

The management of medical disorders in pregnancy has undergone significant changes in the recent years. The pattern of disease has changed with improvements in socio-economic conditions. For example, the incidence of antenatal anemia has decreased progressively in the past few decades, and pulmonary tuberculosis (which used to be prevalent) is now seen only rarely. Chronic rheumatic heart disease has also become less common. On the other hand, gestational diabetes has become more common. This may be due partly to the setting up of screening services for gestational diabetes in many hospitals. The four most common medical disorders complicating pregnancy are anemia, diabetes mellitus, cardiac disease, and thyroid disorders. In addition, because of the improvements in the medical, obstetric, and anesthetic management of pregnancy, many women with medical disorders can go through a pregnancy without major problems. There has also been a progressive decrease in the perinatal mortality associated with some medical disorders, such as diabetes. It is important for all healthcare professionals involved in the management of pregnant women with medical disorders to be conversant with the latest developments in order to provide the best care to these women. The chapters in this issue are certainly helpful in this respect. The eminent authors for the various chapters have discussed the various options available describing in detail their experiences regarding the various aspects of the condition.

Coronary artery disease or CAD is the end result of the process of accumulation of atheromatous plaques within the walls of the arteries supplying the myocardium. Atherosclerosis is a chronic systemic disease process, affecting all the vascular beds in body and many factors responsible for its evolution have been identified. A rising incidence of this disease among people of Indian origin and an emerging role of genetic factors leading to atherosclerosis necessitates modifications in ourstrategies to handle it. The importance of the risk factors in causation of the disease need to be emphasized even more and masses need to be educated about the role of lifestyle modifications in its management. Further, early detection of preclinical or sub-clinical disease would add another dimension to the overall preventive strategy for this condition. This book is designed to update the readers on the evergrowing list of risk factors for CAD and the increasing significance of lifestyle modifications in prevention of the disease. Besides these, the therapeutic approach towards this chronic disease and methods of early detection has also been discussed. Typical supportive case scenarios are also included to exemplify and highlight the various points discussed. Thus, it provides an excellent opportunity to widen one’s perspective in this area.