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The heart-kidney link

How cardiac diagnostic facilities adversely impact kidney patients

Written by Prathap Kumar | Updated: December 21, 2020 10:26:45 am
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India has been reeling under the burden of cardiovascular diseases (CVDs) for decades. Of all CVDs, coronary artery disease is one of the leading causes of mortality in the country affecting 272 people per 1,00, 000 population, higher than the global average of 235 per 1,00,000. Coronary artery disease develops when coronary arteries that supply blood, oxygen and nutrients to the heart become damaged or diseased due to the build-up of fat, cholesterol, platelets, and calcium. The cholesterol contains deposits called plaque narrow arteries, decreasing blood flow to the heart, causing shortness of breath, chest pain and complete blockage in some cases, leading to a heart attack. As coronary artery disease develops over years, symptoms are not visible in the beginning. In critical cases, early diagnostic and cardiac stents are the most recommended option.

Nowadays, as opposed to the conventional open-heart surgeries, minimally invasive procedures such as percutaneous coronary intervention (PCI), also known as angioplasty, are used in which a stent is placed using a catheter to open up blood vessels in the heart that are narrowed by plaque.
When a person undergoes screening tests such as a CT scan or coronary angiogram for coronary artery disease, a contrast dye is injected. It aids doctors in visualising the exact site of blocked blood vessels and other problems with organs more precisely. The dye is critical for diagnoses as the blockages in the blood vessels can be hard to visualise without it. But in some cases, the dye can have adverse impacts and cause serious problems in the kidneys. Almost one to three per cent people, who receive it during diagnostic tests, develop changes in their kidney function. The condition, known as contrast-induced nephropathy, can affect anyone but those suffering from chronic kidney disease, diabetes, elderly and chronic heart failure are at the greatest risk.

To help people with kidney problems, it is even more important to provide them early and safer alternatives for diagnosis. Here is the good news: With the advancement in technology, we now have diagnostic procedures like Intravascular Ultrasound (IVUS) that use less dye and allow identification of plaque that may be undetectable from angiography alone.

IVUS produces an image of the coronary arteries and its condition by using sound waves (ultrasound), that travel through a tube called a catheter. The pictures are captured from inside the heart rather than through the chest wall. The tube is threaded through the artery into the person’s heart. The diagnostic procedure is not carried out alone; it is done at the time when angioplasty is being performed.

Poor stent positioning is the major cause of blood clot formation as the stent is not expanded to the full width of the artery. This creates a pocket where platelets and other debris get collected causing a blockage. As per research, one of the causes of restenosis or re-narrowing of the arteries is the inadequate expansion of the stent. Technologies like IVUS enable the doctor to see a coronary artery more precisely by generating a real-time picture and providing information. The view can help with stent sizing, in confirming that the stent has been placed correctly and that it is in contact with the vessel wall. IVUS reduces complications and incidence of stent thrombosis and helps in more accurate stent placement.

As IVUS entails a reduced use of contrast dye during PCI, it leaves a minimised impact on the person’s kidney. Further, it provides precise information to the physician, allowing an assessment of the disease and accurate sizing of the stent.

Regardless of any medical intervention, lifestyle and home remedies go a long way in keeping the heart healthy. The following are a few tips and tricks to follow if you are suffering from coronary artery disease or any other cardiac problem.

One, control your blood pressure, cholesterol, and blood sugar level with a healthy diet and regular exercise. Being obese increases the risk of coronary artery disease — therefore, maintaining a healthy weight is a must. One should manage stress with deep breathing and muscle relaxation.

Two, plenty of fruits, vegetables, nuts, and whole grains should be included in the diet. Avoid saturated fats and reduce salt and sugar intake. Omega-3 fatty sources such as fish, flax and flaxseed oil, canola oil, soybeans, and soybean oil reduce inflammation in the body.
Early diagnosis and timely prognosis are the best ways to manage cardiac problems. In times of health crisis, it is imperative to stay connected with one’s doctor through telemedicine to discuss symptoms. However, if the situation is too critical, one should rush to the nearest hospital at the earliest. In the era where technologies have changed the way cardiac diseases are managed, it is crucial to keep yourself abreast of the latest diagnostic and therapeutic options available.

The writer is Chairman & Managing Director and Chief Interventional Cardiologist, Meditrina Group of Hospitals, Kerala

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