Healthy Heart (Vol-6, Issue-72) November, 2015 - Dr. Ajay ... · Happy Diwali and Prosperous New...

Volume-6 | Issue-72 | November 5, 2015

Price : 5/-`

Healthy HeartHonorary Editor : Dr. Ajay Naik

From the Desk of Hon. Editor:

Dear Friends,

Wishing you and your family a Very

Happy Diwali and Prosperous New

Year.

The Arrhythmia and Heart Failure

Management program at CCC,

CIMS has grown from strength to

strength over the past decade. The

entire credit for the same goes to

the faith that you have shown in

our ability and care.

I recently analyzed our procedural

data over past 14 years and am

conveying the same to you for your

perusal.

I am sure that our relationship will

continue to flourish in the future

with the common goal of best

patient care.

- Dr. Ajay Naik

1Care Institute of Medical SciencesCIMS

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Dr. Ajay Naik (M) +91-98250 82666

Dr. Satya Gupta (M) +91-99250 45780

Dr. Vineet Sankhla (M) +91-99250 15056

Dr. Vipul Kapoor (M) +91-98240 99848

Dr. Tejas V. Patel (M) +91-89403 05130

Dr. Gunvant Patel (M) +91-98240 61266

Dr. Dhaval Naik (M) +91-90991 11133

Dr. Manan Desai (M) +91-96385 96669

Dr. Dhiren Shah (M) +91-98255 75933

Dr. Hiren Dholakia (M) +91-95863 75818Dr. Chintan Sheth (M) +91-91732 04454Dr. Niren Bhavsar (M) +91-98795 71917

Dr. Kashyap Sheth (M) +91-99246 12288 Dr. Milan Chag (M) +91-98240 22107

Dr. Divyesh Sadadiwala (M) +91-8238339980

Dr. Amit Chitaliya (M) +91-90999 87400

Dr. Snehal Patel (M) +91-99981 49794

Dr. Ajay Naik (M)

Dr. Vineet Sankhla (M) +91-99250 15056

+91-98250 82666Dr. Shaunak Shah (M) +91-98250 44502

Dr. Keyur Parikh (M) +91-98250 26999

Dr. Milan Chag (M) +91-98240 22107

Dr. Urmil Shah (M) +91-98250 66939

Dr. Hemang Baxi (M) +91-98250 30111

Dr. Anish Chandarana (M) +91-98250 96922

Cardiologists Cardiothoracic & Vascular Surgeons Cardiac Anaesthetists

Neonatologist and Pediatric Intensivist

Pediatric & Structural Heart Surgeons

Congenital & Structural Heart Disease Specialist

Cardiac Electrophysiologist

Dr. Pranav Modi +91-99240 84700(M)

Cardiovascular, Thoracic &Thoracoscopic Surgeon

operator driven EP program over 14 years

at CCC Group, the leading Cardiology

group of Western India.

The operator managed personal database

of EP study and RF ablations over 14 years

from 2001 to October 2015 was studied.

The volume of procedures as well as

Clinical and Interventional management

of arrhythmias is linked to availability of

advanced skills; physician and community

awareness guided by availability of

dedicated Electrophysiologist. The trend

of Electrophysiology study (EPS) and

Radiofrequency ablat ion (RFA)

procedures was studied in a single

Trends of EPRFA therapy for arrhythmias at a single operator large volume center (CCC, CIMS) in Western India

4

49

8375

112105

119132

169161

218 218

204198

213

0

50

100

150

200

250

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Oct-15

Yearly EP procedures 2001 to Oct 2015

www.cims.me Download “CIMS Hospital” Application

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Healthy Heart

Care Institute of Medical SciencesCIMS

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Volume-6 | Issue-72 | November, 2015

and community with availability of higher

skills in the form of Electrophysiologist.

The nature and complexity of arrhythmia

interventions has shown a progressive

rise over the period in the Western India

geographical region.

nature of arrhythmias managed were

analyzed. These represented procedures

performed by a single operator as part of

the CCC group. The procedures had been

performed at 6 hospitals over this period

by the Electrophysiologist, generally

restricted to less than 3 centers at any

given time period.

2060 EP studies were performed, that

included 345 diagnostic procedures and

1 7 1 5 t h e ra p e u t i c R F a b l a t i o n

procedures.

Of the RF ablation procedures, 1604

procedures (93.5%) were performed for

Supraventricular Tachycardia (SVT) and

111 procedures (6.5%) for Ventricular

Tachycardia (VT).

Of the SVT procedures, 1558 were

successful ablations (success rate

97.07 %).

Of the VT procedures, 90 were

successful ablations (success rate

81.08 %).

The number of arrhythmia interventions

increases with increasing awareness,

education and knowledge in physicians

0

20

40

60

80

100

120

140

160

180

2

30

64 60

89 92103 104

116 113

176169

162155

169

SVT EPRFA trends and success rates

SVTprocedures

Successful

0

2

4

6

8

10

12

14

16

18

20

VT EPRFA trends and success rates

VTprocedures

Successful



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Healthy HeartVolume-6 | Issue-72 | November, 2015

8 1 1 p e r m a n e n t p a c e m a k e r

implantations were performed, that

included 373 single chamber and 438

dual chamber pacemaker implants.

Initial years had a majority of single

chamber pacemaker implants, the

crossover to majority dual chamber

pacemakers occurred in 2009.

Single chamber Permanent pacemaker

therapy for symptomatic bradycardia has

been the basic CIED (Cardiovascular

Implantable Electronic Device) implant

performed by Cardiologists. Progression

to Dual chamber pacemakers, ICD and

CRT implantation is usually linked to

availability of advanced skills; Physician

and community awareness, education by

dedicated Electrophysiologists. The

trends of device implant nature and

volumes were studied in a single

operator driven EP program over 14 years

at CCC, CIMS, Ahmedabad.

The operator managed personal

database of CIED implants over 14 years

from 2001 to 2015 was studied. The

volumes of device implants as well as

nature of devices were analyzed. These

represented implants by a single

operator as part of CCC group. The

implants had been performed at 6

hospitals over this period by the

Electrophysiologist, generally restricted

to less than 3 centers at any given time

period.

Electrophysiologist driven CIED (Device) implant trends over 14 years at tertiary care cardiology program (CCC, CIMS) in Western India

0

10

20

30

40

50

60

70

80

90

5

2933

52

44

5154

60

85

55

61

73

89

61 59

Pacemaker Implant procedures

Pacemakers

3

810

17 18 19

2628

48

34 35

41

55

4749

2

2123

35

26

32

28

32

37

21

26

3234

14

10

0

10

20

30

40

50

60

Dual vs. Single Ch Pacemaker implant trends

Dual Ch

Single Ch


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Healthy Heart


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The complexity and number of CIED

implants increases with dissemination of

education, knowledge and awareness in

Physicians ancmunity with availability of

h i g h e r s k i l l s i n t h e f o r m o f

Electrophysiologist. The nature and

volume of CIEDs have shown a

progressive rise over the period in the

Western India geographical region.

247 CRT implants were performed, of

which 170 were CRTP and 77 were CRTD

devices.

163 ICD implants were performed, of

which 120 were single chamber and 43

were dual chamber devices.


0

5

10

15

20

25

30

35

0 01

2

86

1012 12

14

8

25

31

17 17

ICD Implant trends

AICD

0 01 1

8

3

7

9 9

12

6

18

23

8

15

0 0 01

0

3 3 3 32 2

78 8

2

0

5

10

15

20

25

Dual vs. Single Chamber ICD implant trends

Single Ch

Dual Ch

0

5

10

15

20

25

30

35

40

45

1 0

86

3

11

23

11

16

24 25 26

22

44

23

CRT implant trends

CRT

0

5

10

15

20

25

30

10

8

6

3

11

19

10

13

1617

16

13

30

8

0 0 0 0 0 0

4

1

3

8 8

109

1415

CRTP vs. CRTD implant trends

CRTP

CRTD

Connect with us on facebook (www.facebook.com/cimshospitals) to receive regular

informative and interesting updates from CIMS. Also, you can download our application-CIMS

HOSPITAL- on android and ios (apple) phones for further interaction and education.C I M S

android google play storefacebook

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January 8-10, 2016

JICJoint International Conference

2016th12 Annual Scientific Symposiumst21 Year of Academics

In Association with

GMERS Medical College,

Sola, Ahmedabad

Jointly Organized by

CIMSRE

Care Institute

Medical Society

for Research

and Education

Program at a GlanceDay-2, January 9, 2016, Saturday (Satellite Session)

Day-2, January 9, 2016, Saturday - Tracks

Day-3, January 10, 2016, Sunday - Tracks

l Satellite Session-A

l Satellite Session-B

l Satellite Session-C

l Satellite Session-D

l Ahmedabad Heart Failure Conclave (CVTS)

l Do’s & Dont’s in Critical Care Medicine

Workshop

l Sleep Apnea Workshop

l Internal Medicine/Clinical Cardiology

l Critical Care & Pulmonary

l Ahmedabad Heart Failure Conclave (CVTS)

l Trauma Care

Day-1, January 8, 2016, Friday (Main Session)

Day-1, January 8, 2016, Friday (Satellite Session)

Day-2, January 9, 2016, Saturday (Main Session)

l Introduction Session

l Coronary Artery Disease / Acute Coronary

Syndrome

l Interventional Cardiology / Plenary Lectures

l Valvular Heart Disease / Hypertension / Lipids &

Cardiovascular Risk Management

l Plenary Lectures

l Hypertension / Lipids & Cardiovascular Risk

Management

l Pharmacology & Therapeutics – I

l Pharmacology & Therapeutics – II

l Cardiology Guidelines (15 Points to Remember for

Physicians)

l Echo & Cardiac Imaging

l Interactive ECGs / Arrhythmia

l Atrial Fibrillation / Arrhythmia

l Clinical Cases

l JIC Oration

l Structural / Imaging

l Live Case Session - Case Presentation

Visit for online registration www.jicindia.org

Conference Secretariat : CIMS Hospital Nr. Shukan Mall, Off Science City Road, Sola, Ahmedabad-380060

Phone : +91-79-3010 1059 / 1060 Fax : +91-79-2771 2770

Email : Website :[email protected] www.jicindia.org

u

u

u

u

u

u

Prof. Blasé Carabello USA

Dr. Bhavin Dalal USA

Prof. Uri Elkayam USA

Dr. Ramesh Gowda USA

Dr. Ashit Jain USA

Dr. Samir Kapadia USA

u

u

u

u

u

u

Dr. Atul Mehta USA

Dr. Neil Mehta USA

Dr. Navin Nanda USA

Dr. Ravi Ramani USA

Dr. Dipesh Shah USA

Dr. Kris Vijay USA

International Faculty


www.jicindia.org/jic.apk

iOS (apple) application

is available-JIC India 2016

Download JIC

Android Application

on google play store

6

Healthy Heart


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Gift of a Lifetime --- Understanding Brain Dead Organ Donation

Defibrillators used to "shock" a heart may get it functioning

again within the first several minutes after it stops. But

there is no such method to jump-start or revive a brain that

has been deprived of blood and whose cells have died.

How does brain death occur?

When the brain is injured, it responds in much the same

way as an injury like a twisted ankle - it swells. Unlike the

muscles and tissue of the ankle, however, the brain is in a

confined space – the skull – and has no room to swell.

A head trauma, bleeding in the brain from a stroke or

aneurysm, or prolonged cardiac arrest that deprives the

brain of oxygen will cause the brain tissue to swell. The

action of the brain swelling inside a closed space and the

build-up of pressure is what can ultimately lead to brain

death. As the brain swells inside the skull, it pushes

downward toward the brain stem blocking all upward flow

of blood. Depending on the type of injury, this may happen

within minutes or over a period of days. Even while the

heart is still beating and supplying blood to the rest of the

body, blood that carries oxygen cannot reach the brain or

the brain stem, which controls heart rate and breathing.

The result is that the brain and the person dies.

Documenting Brain Death

Declaring someone brain dead involves no subjective or

arbitrary judgments. Brain death is a clinical, measurable

condition whose formal definition emerged after the

President's Commission for the Study of Ethical Issues in

Medicine embraced brain death in 1981, when Ronald

Reagan was president.

The electroencephalogram (EEG) of someone who is brain

dead shows no electrical activity, and an injection of mild

radioactive isotopes into the brain reveals the absolute

absence of blood flow. People who are brain dead also have

no gag response. Their pupils do not respond to light and

Understanding Death Before Donation

To understand organ donation and the shortage of organs

for transplants, one needs to have a basic understanding of

how people die and what impact it has on whether they

can, in fact, be donors or not. Of the 2.2 million people who

die in America each year, relatively few die under

circumstances that make them medically eligible to be

either organ donors or tissue donors.

Brain Death and Organ Donation

Most deceased organ donors are brain dead. They have

suffered complete and irreversible loss of all brain function

and are clinically and legally dead. Mechanical ventilation

and medications keeps their heart beating and blood

flowing to their organs.

In the U.S., less than one percent – about 15,000-20,000 –

of all deaths are brain deaths. These are usually patients

who suffer an injury to the brain resulting from a trauma,

stroke or lack of oxygen and are rushed to the hospital,

where doctors aggressively work to save their lives but

cannot.

Brain Dead is Dead. There is No “Recovery”

Brain death can be confusing, particularly for families who

are confronted with the sudden death of someone they

love because a brain dead person on a ventilator can feel

warm to the touch and can look "alive." The heart is still

beating and the ventilator is pushing oxygen and air into the

lungs making the person's chest rise and fall.

Brain death can be confusing for families who are

confronted with the sudden death of someone they love.

When this happens, some families expect that the person

they love can simply be kept on the ventilator in hope that

their condition will improve. But to be brain dead is to be

dead, and no improvement or recovery is possible.



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CIMS Cardiac Surgery Team

Dr. Dhiren Shah+91-98255 75933

Dr. Dhaval Naik +91-90991 11133

Dr. Manan Desai+91-96385 96669

CIMS Cardiac Anaesthetists Team

Dr. Niren Bhavsar +91-98795 71917

Dr. Hiren Dholakia+91-95863 75818

Dr. Chintan Sheth +91-91732 04454

However, in a return to where organ donation began 40

years ago, before the acceptance of brain death, some

patients are becoming organ donors after suffering cardiac

death. The medical community refers to this as "non-heart

beating donation.”

Some people with non-survivable injuries to the brain

never become brain dead because they retain some minor

brain stem function. If such individuals made the decision

to be donors or their families are interested, organ

donation may be an option.

The option of donating organs after cardiac death or "non-

heart beating" donation may be presented to these

families after it is

clear that their

loved one cannot

survive. Donation

i n s u c h c a s e s

entails taking the

patient off the

ventilator, typically

in the operating

room. Once the

pat ient ' s heart

stops beating, the physician declares the patient dead and

organs can be removed.

Today, organ donation after cardiac death has increased the

donation of life-saving organs – mostly kidneys and livers –

by as much as 25 percent in a few areas of the country.

Some experts estimate that it could increase the number of

deceased-donor organs in the U.S. by thirty percent.

they do not blink when a swab is run across their eyeballs.

They do not respond to pain, and in the absence of signals

from the brain, their lungs have stopped working—only the

ventilator keeps them "breathing.”

When the brain is injured, it responds like other injuries—it

swells. However, the brain is confined in the skull and has

no room to swell. This leads to brain death.

To avoid even the smallest chance of mistake, most

hospitals require that two physicians – sometimes hours

apart – each conduct a range of tests in search of even the

slightest indication of brain activity.

None of these physicians can have anything to do with

organ donation and transplantation; they probably do not

even know whether the patient is a would-be donor or how

the family feels about donation. Physicians, however, often

let family members watch as they perform some of these

tests because the tests visually demonstrate that,

appearances notwithstanding, the person they love is

indeed dead.

No One “Pulls the Plug”

Once a person is declared brain dead, families are not asked

to "pull the plug" or to take someone "off of life support"

because such actions would be impossible: the person they

love has already died.

Debates about whether to "pull the plug" or discontinue

support on someone who is in a coma or in a persistent

vegetative state have nothing to do with organ donation;

such people still have brain function, and are not dead.

Organ and Tissue Donation after Cardiac Death

Typically when a person suffers a cardiac death, the heart

stops beating. The vital organs quickly become unusable for

transplantation. But their tissues – such as bone, skin, heart

valves and corneas – can be donated within the first 24

hours of death.


Printed, Published and Edited by Dr. Keyur Parikh on behalf of the CIMS HospitalPrinted at Hari Om Printery, 15/1, Nagori Estate, Opp. E.S.I. Dispensary, Dudheshwar Road, Ahmedabad-380004.

Published from CIMS Hospital, Nr. Shukan Mall, Off Science City Road, Sola, Ahmedabad-380060.

If undelivered Please Return to :

CIMS Hospital, Nr. Shukan Mall,

Off Science City Road, Sola, Ahmedabad-380060.

Ph. :

Fax:

Mobile : +91-98250 66664, 98250 66668

+91-79-2771 2771-75 (5 lines)

+91-79-2771 2770

Subscribe “Healthy Heart” : Get your “Healthy Heart”, the information of the latest medical updates only ` 60/- for one year. To subscribe pay ` 60/- in cash or cheque/DD at CIMS Hospital Pvt. Ltd. Nr. Shukan Mall, Off Science City Road, Sola,

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Healthy Heart

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Healthy Heart Registered under thPublished on 5 of every month

th thPermitted to post at PSO, Ahmedabad-380002 on the 12 to 17 of every month under

stPostal Registration No. issued by SSP Ahmedabad valid upto 31 December, 2017stLicence to Post Without Prepayment No. valid upto 31 December, 2017

RNI No. GUJENG/2008/28043

GAMC-1725/2015-2017CPMG/GJ/97/2014-15

CIMS Hospital : Regd Office: Plot No.67/1, Opp. Panchamrut Bunglows, Nr. Shukan Mall, Off Science City Road, Sola, Ahmedabad - 380060.

Ph. : Fax:

CIMS Hospital Pvt. Ltd. | CIN : U85110GJ2001PTC039962 | |

+91-79-2771 2771-75 (5 lines) +91-79-2771 2770.

[email protected] www.cims.me

PATIENTS WHO ARE ELIGIBLE

Endovascular Workshop Peripheral

Dr. Ashit Jain, Washington Hospital, USADr. Ramesh Gowda, Mount Sinai Beth Israel & Brooklyn hospital, USA

l l l

l l l l

l l l l

l l l

l l

l l

l l

Carotid Artery Stenosis Renal Artery Stenosis Acute Limb Ischemia Critical Limb Ischemia

Varicose Veins Dialysis Access Procedures Pulmonary Embolism Thoracic Outlet Syndrome

Uterine Fibroids Vascular Malformations Venous Insufficiency and Venous Ulcers Claudication

Femoropopliteal Disease Brachiocephalic Arterial Disease Venous Thromboembolic Disease

Thoracic Abdominal Aortic Aneurysms Mesenteric Disease

Catheter-Based Interventions for Failing Hemodialysis Accesses Infrapopliteal Peripheral Arterial Disease

Intracranial Arterial Stenotic Disease Vertebral Arterial Disease

l

Organized by


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CIMS Hospital, Nr. Shukan Mall, Off Science City Road, Sola,Ahmedabad-380060. Phone : +91-79-2771 2771-75 (5 lines) For appointment call : +91-79-3010 1200, 3010 1008 (9 am-5 pm)Mobile : +91-98250 66661 or email onemail : web :

[email protected]@cims.me www.cims.me

January 7, 2016, Thursday

Kindly refer your PVD, AAA patients for

consultation (complimentary) and intervention.

Please contact any

CIMS Cardiologist listed on front page


with


Healthy Heart (Vol-6, Issue-72) November, 2015 - Dr. Ajay ... · Happy Diwali and Prosperous New...

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