Adult heart diseases should be examined under 4 main headings.
1- Coronary heart diseases
2- Heart Valve Diseases
3- Congenital heart diseases
4- Rupture (dissection), expansion (aneurysm = ballooning), narrowing in large vessels.
Among these, coronary heart disease is the most common heart disease. Death from this disease, which occurs due to partial or complete narrowing of the coronary arteries that feed the heart, has become the most common cause of death in our country. Approximately 40% of all deaths in our country are caused by heart diseases. Considering that there are an average of 1.5 or 2 million heart patients in our country and that 300,000 people have heart attacks every year and 1/3 of them kill approximately 100,000 people, the social importance of heart diseases can be better understood. Many predisposing factors such as lifestyle, sedentary society, unbalanced and irregular nutrition, rapid urbanization cause this.
Heart diseases manifest themselves as chest pain, shortness of breath, palpitations, nausea and cold sweats, syncope ( It may present with various symptoms such as fainting), swelling in the feet, and cough. Most importantly, having a heart examination every year over the age of 35 can prevent many problems, as it can lead to sudden death without any complaints.
DIAGNOSIS METHODS IN HEART DISEASES
Exertion Test (Stress test)
Exertion test can be applied in two ways
- Exertion ECG (Electrocardiography)
- Stress ECO (Echocardiography) (With exertion or medication)
a. Stress ECG test:
Continuous cardiac electrocardiography of the patient suspected of having stenosis of the heart vessels while walking on the treadmill at a fast pace is called 'exertion test'.
b. Stress Echocardiography:
In some special cases, ultrasonographic examination of the heart (ECHO) is performed immediately before and during the exercise test. By taking it later, the accuracy of the diagnosis of heart disease is increased compared to the normal exercise test.
4 hours of fasting is required for the exercise test. It is beneficial for patients to come with sports shoes and tracksuits if possible.
Echocardiography and Color Doppler
The structure of the human heart, the diameters of its cavities, the functioning of the heart muscle. The technique that converts the capacity and especially the structure and functions of the heart valves into live images using the sound wave method is called echocardiography (ECHO). No preparation or fasting is required for this test and the entire test can be completed in a short time.
Cardiac Catheterization and Coronary Angiography
The structure of the heart, the heart chambers Thanks to cardiac catheterization and coronary angiography, it is possible to precisely observe the pressure values in the blood vessels and large vessels, stenosis and insufficiency in the heart valves, and especially whether there is narrowing or occlusion in the heart vessels. Thanks to this technology, radiological photographs of each of the heart vessels are taken separately from different angles. The procedure time is usually between 10-20 minutes and 4-6 hours of bed rest is required after the procedure. It is performed with the help of a catheter advanced from the groin artery to the heart under local anesthesia. During cardiac catheterization, the pressures inside the heart are measured and at the same time, the contraction function of the heart is examined by injecting 'dyed substance' into the left heart cavity.
Holter Monitor (Heart Rhythm or Blood Pressure Holter)
Heart rhythm is monitored and recorded 24 hours a day with a device called holter. Thanks to this device, heart rhythm disorder can be diagnosed.
Blood pressure holter also records the fluctuation of patients' blood pressure 24 hours a day, during the day, under real life conditions, and blood pressure values during sleep.
Electrophysiological Study
It is the most definitive diagnosis method of heart rhythm disorders. This procedure is performed with the help of a special catheter that is advanced from the groin vein to the heart under local anesthesia. Thanks to the procedure, the locations of rhythm disorders that cause the heart to work too fast (tachycardic) or too slow (bradycardic) are determined with 'millimetric' measurements, and the 'Rhythm Disorder Map' required for definitive treatment is determined. is removed. This method, which requires highly developed knowledge and technology, can be applied in only a few centers in Turkey.
Cardiac MRI
Examination of the pericardium, heart chambers and valves. It is an imaging method that reveals the structure of the heart muscle and the large arteries coming out of the heart and some heart diseases (such as narrowing, expansion, calcification) in an extremely easy and non-harmful way. The procedure time is around 15 minutes and does not require any preliminary preparation.
Nuclear Cardiology
a) Myocardial Perfusion Scintigraphy (Thallium Test): It is a more sensitive method than the exercise test in investigating whether there is any blockage or stenosis in the vessels feeding the heart. Thallium, a radioactive substance administered intravenously, is used to examine the blood flow (or nutrition) of the heart muscle during rest and exertion. The test must be performed while fasting.
b) MUGA: It is the most accurate method for measuring the pumping power of the left ventricle of the heart. Before the procedure, the red blood cells of the blood are marked with a radioactive substance called Technetium. Heart function is measured by imaging simultaneously with ECG recording.
Invasive Cardiological Treatment Methods in Heart Diseases
Significant stenosis and/or stenosis in coronary vessels or when obstruction is observed, balloon angioplasty can be performed in the same session or later, if appropriate. In balloon angioplasty, a specially made balloon is inflated for a short time in the narrow area within the vessel to widen the stenosis. Balloon surgery can be performed to treat multiple stenosis in the same vein or stenosis in more than one vein in the same session or in different sessions. When necessary, in addition to the balloon, a stent (cage) is placed in that area, again with the help of a balloon.
In the balloon procedure, a catheter with an inflatable balloon at the end is placed in the stenosis area (A). After being placed in the stenosis location, the balloon is inflated to open the stenosis (B).
In cases that are not suitable for balloon angioplasty, bypass surgery or drug therapy may be recommended.
Surgical Treatment Methods in Heart Diseases
1- Coronary Bypass Surgery: The word bypass means bridging and it is done with the front of the blocked segment. It is a method of allowing blood to reach the body by bridging it with a side path between the back and the back. Although this procedure is often an open heart surgery performed using a heart-lung machine, different operation techniques have recently been developed, such as heart bypass, small incision bypass, and robotic bypass. For bridging purposes, arteries under the breastbone and vessels such as the right or left internal mammarian artery, radial artery, and saphenous arteries are used for the patient. The purpose of bypass operations is to send the patient back to society as a healthy, active and productive individual.
2- Heart Valve Operations: It is the process of repairing or replacing damaged valves. Here, in addition to the operation with large incisions in the form of an open heart operation, patients can now be provided with a comfortable operation, early discharge and early productivity by using methods that allow discharge within 3 days with small incisions or robotic methods. In addition, valve replacement with completely closed methods has now become a routine treatment option.
3- Aorta and Artery Surgery: The main artery coming out of the heart is called the aorta. The disease that occurs when the aortic vessel tears within its own layers is called dissection. This is an extremely urgent and life-threatening condition that may result in loss of life if it is not treated immediately. In this case, replacing the vein with an artificial vein or placing artificial veins with stents by entering through the vein is life-saving. In addition, implanting endovascular stents, stent grafts or open artificial vessels in all arteries, depending on the occlusion status, were the methods used in vascular surgery. Many surgical treatment methods are applied.
5- Heart Surgery with Small Incision Method
6- Robotic Surgeon rahi
7- Endovascular approaches
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