Adult cardiology

ECHOCARDIOGRAPHIC HEMODYNAMIC LABORATORY

The heart has a complex, multi-dimensional shape. A proper assessment of the function of its parts requires a multi-dimensional depiction of its structural and functional intricacies. This complex physical relationship can be studied using reflections from high frequency sound waves, called ultrasound, which can give information on blood and heart muscle motion.  

Services offered included in echocardiography:

• Trans-thoracic Echocardiography
• Trans-esophageal Echocardiography
• Tissue Doppler Imaging (tissue velocity and strain imaging)
• 3D Echocardiography
• Contrast Echocardiography
• Pharmacological Stress Echocardiography
• Intra-operative Echocardiography

Five advanced echo labs are in the outpatient department.

Echo machines are also used in the Cath lab, Surgical theaters and ICUs.

MULTI DETECTOR COMPUTED TOMOGRAPHY (MDCT)

For the imaging of cerebrovascular, cardiac, visceral and peripheral vasculatures, CT coronary angiography using a 256 slice CT scanner enables accurate, noninvasive detection of significant coronary artery disease in patients hospitalized for acute chest pain syndrome and negative biomarkers. It is also useful for screening patients with intermediate risk for developing coronary artery disease. It is now the preferred diagnostic modality for evaluating blood clots on arteries supplying lungs (pulmonary embolism).

Diagnosis and treatment planning with nonoperative techniques for aortic aneurysms (thinning and bulging) as well as the dissection of the aorta needs good quality picture generated by MDCT. Occlusion of blood supply to legs, hands and other organs can also be accurately quantified by this technique.

CARDIAC MAGNETIC RESONANCE IMAGING (MRI) 3 TESLA

This imaging is very useful in assessing the damage of heart muscles caused by heart attack, as well as:

• Evaluation of heart failure
• Detection and quantification of heart defects present at birth
• Tumors of the heart
• Pericarditis (inflammation of the sac covering the heart)
• Evaluation of arrhythmogenic RV dysplasia, sarcoidonic and other causes of ventricular arrhythmia and heart failure

NUCLEAR CARDIOLOGY

Using radioisotopes as a diagnostic tool, it is possible to assess the function of the heart and its blood supply. Our sophisticated facility has a Siemens gamma camera to perform the following procedures:

• Thallium and MIBI perfusion studies
• Viability testing
• MUGA (Ventriculogram)
• Ventilation perfusion lung scans
• Renal perfusion scans
• Tc labelled RBC venogram for DVT

POSITRON EMISSION TOMOGRAPHY (PET) MRI

Positron emission tomography, also called PET imaging or a PET scan, is a type of nuclear medicine imaging. Combined with an MRI, it is used to identify patients with damaged heart muscles likely to benefit from angioplasty and bypass surgery. It is also effective in determining the blood flow to the heart as well as infections and cancers.

SYNCOPE (FAINTING) EVALUATION

Holter monitoring and head-up tilt tests with pharmacological challenges are utilized for the evaluation of patients with syncope. Detailed expert clinical assessments and implantation of Loop recorder as well as EP study in selected patients is conducted when necessary. 

Coronary Care Unit (CCU)

The unit is staffed by a specially trained physician and nurses capable of serving patients with heart attack, heart failure and arrhythmias. This 24-bed facility provides care for the sick patients who may require ventilatory support, invasive and noninvasive advanced life support such as emergency pacing (trans-venous and trans-thoracic) and intra-aortic balloon pump support for a failing heart. Hemodynamic monitoring including blood gas analysis enables the management of patients on various therapeutic medications for heart attack and heart failure. CCU protocols help to provide therapies per guidelines and recommendations. Infection control protocols, 1:1 critical care nursing, and the 24x7 availability of a trained physician/cardiologist code blue team have helped in improving outcomes in our CCU, and ensure immediate access to our cathlab.

CARDIAC CATHETERIZATION LABORATORY

The cardiac catheterization lab is equipped with a twin suite Siemens HICOR digital imaging system which is fully networked. The Cath Lab is one of the larger volume centers in India and with the outstanding results achieved so far, the Amrita Cath Lab has played a role in elevating the hospital to national prominence.

The Comprehensive Cardiac Health Checkup identifies high risk individuals and recommends lifestyle modification and drugs for primary prevention of coronary artery disease. Secondary prevention is enabled by risk factor identification, counseling, diet modification and with treatment of associated problems like diabetes mellitus with drugs, during hospitalization.

Remediation offers services including:

• Diagnostic Angiogram
• Intra-vascular Ultrasound
• Fractional Flow Reserve (FFR)
• Angioplasty and Stenting
• Rotablation
• Day care radial route angiogram and angioplasty
• Primary angioplasty program offers 24x7 acute myocardial infarction treatments. In order to facilitate the rapid establishment of blood flow in occluded artery, we bypass the emergency room delay by transporting patients directly to the Cath Lab

• Angioplasty and stenting of blood vessels supplying the brain (carotid artery) to prevent catastrophic stroke in symptomatic patients with blocks
• Renal angioplasty in patients with critically reduced blood flow to kidneys
• Limb saving re-canalization of occluded peripheral vessels
• Aortic angioplasty and stenting for congenital/acquired evaluation/aortoarteritis

• Device closure of heart defects - congenital atrial septal defect and ventricular septal defect
• Post myocardial infarction septal rupture device closure
• Keyhole treatment of valvular heart disease, mitral, aortic, pulmonary and tricuspid balloon valvotomy
• Alcohol ablation of septal myocardium in obstructive hypertrophic cardiomyopathy

• Aortic aneurysm treatment with stent grafts
• Peripheral artery aneurysm-stent grafting

Amrita is one of the few centers in India offering comprehensive cardiac arrhythmia services and has taken the lead in providing the most modern cardiac arrhythmia care by installing a state-of-the-art, 3D mapping system. This system helps in navigating EP catheters in real time as well as for mapping any arrhythmias. The system generates and displays 3D graphical images of cardiac structures. This 3D system helps in offering long lasting cures for complex arrhythmias like post MI scar ventricular tachycardia, atrial fibrillation and focal tachycardia. It also helps improve procedural success and at the same time reduces procedural time and 

X-ray exposures (fluoroscopy) times. The EP team provides:

• Diagnostic electro-physiological study
• Radio-frequency ablation of different arrhythmias in adults and children
• Pacemaker implantation for patients with Brady (slow) arrhythmias
• Cardiac resynchronization (bi-ventricular pacing) in patients with heart failure with expertise in optimization of therapy based on expert ECHO guidance
• Automatic Internal Cardiac Defibrillator (AICD) for patients with potentially lethal heart rhythm abnormalities
• Syncope evaluation including autonomic evaluation, Head-Up Tilt Testing
• Pacemaker – AICD follow up clinic
• Implantation of loop recorders for evaluation of syncope of unknown etiology