Total Body Reformation

Cardiac Health Management

Comprehensive cardiology services including screening, diagnostic and therapeutic procedures for a wide array of cardiac conditions.

Cardiology

What is CT Coronary Artery Calcium Score?

A CT Coronary Artery Calcium Score is a non-invasive medical test to obtain information on the presence, location and extent of calcified plaque in the coronary arteries. It is measured by taking a special computed tomography (CT) scan of the heart. The scan shows the amount of hardening of the artery wall (the disease that causes this hardening is called atherosclerosis). The results of the scan make it possible to estimate the risk of a heart attack or stroke (brain attack) in the next 5–10 years. The higher the calcium score, the higher the risk of a heart attack or stroke.

A high calcium score does not mean that you will have a heart attack, only that there is a greater likelihood of having one than someone with a low score. Even a person with a score of zero could have a heart attack.

What and who will benefit from the Coronary Artery Calcium Score?

The benefit of this Coronary Artery Calcium Score is to gain better understanding on the relative risk of having a heart attack or stroke in the mere future, and using that information to decide on approaches to reduce the risk.
Your doctor may decide that a second calcium score scan after a few years might be helpful to compare the results with the previous scan.

The calcium score are most informative for women aged between 35 and 70 years and men aged between 40 and 60 years in terms of providing information about cardiovascular risk, or the risk of a heart attack or stroke. Scores in patients outside these age ranges do not have any value in assessing increased risk.

Who will not benefit from a Coronary Artery Calcium Score?

The calcium score is of no benefit to someone who has already had a heart attack, coronary bypass surgery or a coronary artery stent. These events have already indicated a high risk. A calcium score cannot be used to see if any treatment is working or not.

What Is CT Angiography?

CT Angiography is performed using a Toshiba 640-slice 4D CT Scanner Suite as a non-invasive procedure to determine whether either fatty or calcium deposits have built up in your coronary arteries. It is also used to exclude narrowing of the arteries as the cause of chest discomfort and detect other possible causes of symptoms.

It can provide important insights to doctors into the extent and nature of plaque formation with or without any narrowing of your coronary arteries.

After the CT Angiography is completed, you can return to your normal daily activities immediately.

Should I Perform CT Angiography?

We suggest the careful use of CT Coronary Angiography for patients who have:

Intermediate to high-risk profiles for coronary artery disease, but who do not have typical symptoms (especially chest pain, shortness of breath, or fatigue during heavy physical activity)

Unusual symptoms for coronary artery disease (such as chest pain unrelated to physical exertion), but low to intermediate risk profiles for coronary artery disease.

Unclear or inconclusive treadmill stress test.

When there is a blocked or a narrowing in an artery, a balloon is inserted into the blockage and then inflated to widen the area of the blockage. A metal cage called a stent may be inserted to hold the blood vessel open once the balloon is retracted. The procedure does not require open surgery and is performed by Cardiologists.

What Is Angioplasty?

Angioplasty is a procedure performed to open blocked arteries. It is also called PTCA (Percutaneous Transluminal Coronary Angioplasty) or PCI (Percutaneous Coronary Intervention). This procedure is performed under local anaesthesia.

A catheter with a small balloon mounted on the end is passed into the narrowed portion of the coronary artery.

  1. As the balloon inflates, it pushes the plaque against the wall of the coronary artery. This opens the narrowing and improves the blood flow to the heart muscle.
  2. The balloon is then deflated and the balloon catheter is removed from the artery.
  3. In some cases, a tiny wire coil called stent, is inserted with the catheter to support the arterial wall. Stents may not be necessary in some cases.

Coronary Artery Stents

Coronary artery stents are small metallic mesh tubes that are mounted over a balloon catheter and delivered to the narrowed portion of the coronary artery. The balloon is used to expand the stent that presses against the narrowed vessel wall.

Once the balloon has been deflated and withdrawn, the stent stays in place permanently. The inner lining of the artery grows over the surface of the stent incorporating it into the arterial wall permanently. An implanted stent cannot be removed.

2 types Of Stents

  • Drug-coated stents (coated)
  • Bare-metal stents (uncoated)

Both bare-metal and drug-coated stents have been proven to be safe when used in accordance with their prescribed indications.

In fact, both types of stents have a similar low risk of heart attack and death. You should discuss with your doctor on the choice of stents to be used.

Ptosis correction (drooping eyelid) – Certain cases are so bad that the patient’s vision gets impaired. Patients with drooping eyelids are not encouraged to go for double eyelid surgery straight away as the result will only further highlight the droop down shape of the eye. They are advised to undergo ptosis correction to rectify the droopiness first before considering other cosmetic eye procedure.

Atrial Septal Defect (ASD) and Patent Foramen Ovale (PFO) are the most common holes in the heart that can be detected via Echocardiography.

Percutaneous device closure is an effective, safe, and commonly employed alternative to surgical closure if you are detected with ASD or PFO.

How Is Percutaneous Closure Done?

The device is folded into a special catheter and inserted into a vein in the leg. Using a guide wire, the device is advanced through the atrial septum. When the catheter is in the correct position, the device slowly is pushed out of the catheter until it covers the defect. The device bridges the septal defect. Over time, heart tissue grows over the implant, and it becomes part of the heart, permanently correcting the defect.

What is a pacemaker?

A pacemaker is a device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate or to stimulate the ventricles of your heart.

Your doctor decides what type of pacemaker you need based on your heart condition and also determines the minimum rate (lowest heart rate) to set your pacemaker. When your heart rate drops below the set rate, the pacemaker generates (fires) an impulse that passes through the lead to the heart muscle. This causes the heart muscle to contract, creating a heart beat.

Why do I need a Pacemaker?

If the electrical pathway described above is interrupted for any reason, changes in the heart rate and rhythm occur that make a pacemaker necessary.

Pacemakers are used to treat brady–arrythmias, slow heart rhythms that may occur as a result of disease in your heart’s conduction system (such as the SA node, AV node or His-Purkinje network). Pacemakers are also used to treat syncope (unexplained fainting spells), heart failure and hypertrophic cardiomyopathy.

AICD is a device combining a cardioverter and a defibrillator into one implantable unit. It is thus a small battery-powered electrical impulse generator that is implanted in patients who are at risk of sudden cardiac death due to fast arrhythmias.

The AICD is designed to deliver two levels of electrical energy: a low energy shock that can convert a beating heart that is in an abnormal rhythm back to a normal heartbeat, and a high energy shock that is delivered only if the arrhythmia is so severe that the heart is only quivering instead of beating.

Why do I need an AICD?

AICDs are advised if you are at risk for potentially fatal ventricular arrhythmias (an abnormal rhythm from the lower heart chambers, which can cause your heart to pump less effectively).

Arrhythmias can cause problems with contractions of your heart chambers by:

 Not allowing the chambers to fill with an adequate amount of blood because the electrical signal is causing your heart to pump too fast.

 Not allowing a sufficient amount of blood to be pumped out to your body because the electrical signal is causing your heart to pump too slowly or too irregularly.

Difference between a pacemaker and an AICD?

Pacemaker

If your heart rhythm is too slow and is not treatable with medications, then a pacemaker would be needed. A pacemaker keeps your heart beating at the proper rate and not too slow. However, It is not shocking people all the time as it will only be activated if it is needed.

AICD

This implanted defibrillator is a bigger device. It prevents death from cardiac arrest. The device shocks your heart if needed when it detects a life-threatening rhythm disturbance from the ventricles of your heart. As a pacemaker is built into it, AICD also has the capability of stimulating the heart like a pacemaker.

Cardiothoracic Surgery

Cardiothoracic surgery involves minimally invasive and open heart surgeries for valve repair and replacements, and coronary artery bypasses, and various surgeries for diseases of the lungs, esophagus and chest wall. Conditions treated under cardiothoracic surgery include heart valve disease, coronary artery disease, aortic aneurysm, atrial fibrillation, heart failure, and congenital heart disease.

A Coronary Artery Bypass Graft Surgery (CABG) is a surgery which is performed to bypass blockages and improve blood flow to the heart muscle. A CABG uses a blood vessel (graft) which is taken from the arm, leg or chest to bypass a narrowed or blocked coronary artery.
 

Standard Coronary Artery Bypas Graft Surgery

Standard or Conventional Coronary Artery Bypass Graft surgery (CABG) is done using the heart-lung machine (cardiopulmonary bypass) whereby the machine allows the heart to be stopped. During that period of cardiac inactivity, the machine takes over the function of the heart and lungs. After the heart is temporarily stopped, new blood vessels (grafts) are sewn in place, bypassing the point of narrowing. Upon completion of the grafting, the heart is restarted and the patient is gradually weaned o­ff the heart-lung machine.

 

Are There Side Effects?

Although it is a safe procedure, there are some side effects such as personality changes, mental deterioration as well as damages to the kidneys and lungs due to being hooked up on the heart-lung machine.These complications, which can affect the lives of patients and their families have led surgeons to look for different options. One of the best options is the a technique called the Off-Pump Coronary Bypass Graft Surgery (OPCAB)
 

Off-Pump Coronary Artery Bypass Graft (OPCAB) Surgery

OPCAB is also famously known as Beating Heart Coronary Artery Bypass Graft Surgery
 
This is a technique whereby the CABG is done in the usual manner, but without connecting the patient to the heart-lung machine and not stopping the heart (thus called o­ff-pump). Parts of the heart where the necessary sewing takes place are stabilized using a specially designed apparatus called stabilizer. This manoeuvre allows the sewing of blood vessels to be done safely and accurately without having to stop the heart. Indeed, it is as if the patient is undergoing any other major operation where the circulation continues in the physiological manner and not artificially as with the use of the heart-lung machine.
 

The Advantages Of OPCAB Include:

Earlier recovery
shorter stay in the hospital and may be able to return to normal activities.

Less complications. Lower risk of complications associated with the heart-lung machine such as stroke, lung and kidney problems.

Less bleeding. requires fewer blood transfusions.

Less brain complications
less problems with mental clarity and memory.

What is Heart Valve Surgery? 

Heart Valve Surgery is an operation to fix a damaged or faulty heart valve. This is required when the valve is hardened or calcified (in which it prevents the blood from moving forward) or too loose (in which the blood tends to flow backwards).

To Repair or Replace? 

Valve Repair Surgery

When possible, it is often preferable to surgically repair your heart valve rather than to replace it with a prosthetic device. Valve repair surgery usually involves the surgeon modifying the tissue or underlying structures your valve and implanting an annuloplasty ring or band.

Valve Replacement Surgery

 If the diseased native heart valve cannot be repaired, the surgeon may choose to replace it. The first step is to remove the diseased valve and then implant a prosthetic valve in its place.

There are two main types of prosthetic heart valves:

Tissue (bioprosthetic) valves

Created from animal donors’ valves that is strong and flexible. Tissue valves can last 10-20 years, and usually do not require the long-term use of blood thinning medication.

Mechanical valves

Made of strong and durable materials,  the mechanical valves will last throughout the remainder of the patients’ lifetime. Blood thinning medication would be required for the remainder of the patient’s life to prevent blood clots from forming on the synthetic materials.

Often times, Heart Valve Surgery may be combined with other procedures (such as more than one valve procedure or bypass surgery) to fully treat the heart disease.

 

Less Invasive Heart Valve Surgery

A less invasive heart valve operation is performed through smaller incision using specialised surgical instruments. The incision is normally around 2 to 4 inches as compared to traditional operation that may be as long as 6 to 8 inches.

iHeal Medical Centre is also dedicated to the prevention, early diagnosis and treatment of diseases of the chest. We continue to expand treatment options for patients, utilizing minimally invasive procedures such as video-assisted thoracic surgery (VATS).

Below are parts of the common thoracic diseases treated:

  • Lung cancer
  • Pleural diseases (including Pneumothorax, Pleural effusion and Lung empyema)
  • Gastroesophageal reflux
  • Chest wall tumors
  • Lung volume reduction surgery for emphysema
  • Mediastinal tumours and diseases
  • Sympathicotomy for hyperhidrosis (excessive sweating)
  • Benign diseases and tumors of the lung

Pectus excavatum (sunken chest) is a condition in which a person’s breastbone is sunken into his or her chest. In severe cases, it can look as if the centre of the chest has been scooped out, leaving a deep dent, eventually interfere with the function of the heart and lungs. Mild cases of pectus excavatum can cause self-image problems. Some patients with this condition often avoid activities such as swimming that make hiding the condition difficult.

A concave stainless steel bar that is slipped under the sternum with the assistance of a small camera using two small incisions on each side of the chest. The bar is then flipped, and the sternum moves to the proper position. A second bar may be attached perpendicular to the first for better results in more severe cases. To support the bar and keep it in place, a metal plate called a stabilizer is inserted on both sides of the chest. The stabilizer fits around the bar and into the ribcage where it is secured in place. This technique requires no cutting or removal of cartilage or bone and it takes only 1 to 2 hours.

The stainless steel bars are typically removed about two years after the initial surgery. By then, correction is expected to be permanent.

Details coming soon

Heart Related Specialities

Sleep, Allergy and Sinus & ENT Clinic is a unique practice dedicated to the treatment of snoring, sleep apnea, allergy, and sinus related disorders utilizing the latest methods from minimally invasive in-office techniques to more advanced surgical procedures.

  1. a)  General Ear, Nose and Throat (ENT) Diagnosis and Care
  2. b) Diagnosis Skin Prick Allergy Test and Blood RAST Allergy Testing
  3. c) Evaluation and Treatment of Sleep Disorders
  4. Sleep Studies investigation and Treatment of Snoring and Obstructive Sleep Apnea (OSA)
  5. Continuous positive airway pressure (CPAP)
  6. d) Surgery for snoring and Obstructive Sleep Apnea (OSA)
  7. Radiofrequency Inferior Turbinates
  8. Radiofrequency of Soft Palate
  9. Radiofrequency of Tongue Base
  10. Anterior Palatoplasty – The Palatal Lift Operation
  11. e) Audiology Hearing and Middle Ear Pressure Testing
  12. f) Diving related ENT disorders
  13. g) Minimally Invasive (Keyhole) Sinus Surgery, Minimally Invasive Endoscopic Septoplasty
  14. h) Radiofrequency (minimal bleeding surgery) of nose, tongue base and tonsils

What is Obstructive Sleep Apnea (Snoring)?

Also called Obstructive Sleep Apnea Syndrome occurs when there are repeated episodes of complete or partial blockage of the upper airway during sleep. During a sleep apnea episode, the diaphragm and chest muscles work harder to open the obstructed airway and pull air into the lungs. Breathing usually resumes with a loud gasp, snort or body jerk. These episodes can interfere with sound sleep. They can also reduce the flow of oxygen to vital organs and cause irregular heart rhythms.

Causes of Obstructive Sleep Apnea:

Excess Weight (Obesity)

Associated with soft tissue of the mouth and throat. During sleep, when throat and tongue muscles are more relaxed, this soft tissue can cause the airway to become blocked. But many other factors are also associated with the condition in adults.

  • Structural abnormalities
  • Jutting lower jaw (retrognathia)
  • Undersized or receding lower jaw or chin (micrognathia)
  • Narrow upper jaw
  • Enlarged tongue
  • Enlarged tonsils

Are you having this problem? We have the solution for you.

Anterior Palatoplasty – The Palatal Lift Operation

This procedure involves an anterior soft palatal advancement technique with or without removal of the tonsils. The procedure is done under general or local anesthesia. The patient will be seated on an examination chair with the mouth open.

Benefits of Anterior Paloplasty

  • Snoring intensity reduced by >70%
  • Can be done under local anesthesia
  • AHI index reduced by more than half
  • Less extensive than UPPP
  • Not a single case of long-term nasal reflux
  • Reshape the soft palate – lifts it up via a mucosal cut and absorbable sutures

Nephrology is a branch of medicine concerning the diagnosis and treatment of kidney diseases. Rising rates of non-communicable diseases such as hypertension, heart disease and diabetes often bring about other complications such as kidney disease. As malfunctioning kidneys spells long-term care and management, our dedicated kidney care team will help you look at holistic ways to arrest your kidney failure and allow you a good quality of life. Using a well-established multi-disciplinary approach, we ensure you are properly educated on kidney disease and how to care for yourself with minimal disruption to your daily routine.

Endocrinology is a speciality of internal medicine that deals with the diagnosis and treatment of diseases related to hormones, such as diabetes and thyroid disorders. This branch of medicine covers human functions including the coordination of metabolism, respiration, reproduction, sensory perception and movement. Endocrinology also focuses on the endocrine glands and tissues that secrete hormones.

Urology is the specialty that focuses on the urinary tracts of males and females, and on the reproductive system of males. Urologists diagnose, treat, and manage patients with urological disorders such as benign prostatic hyperplasia (BPH), cancer of the bladder or prostate, erectile dysfunction, haematuria (blood in the urine), kidney stones, prostate disease, urinary tract infections and vesicoureteral reflux.

OGDS or Endoscopy is an examination of the upper part of the gastrointestinal tract to the duodenum and large bowel and the distal part of the small bowel. It is a procedure that uses a lighted, flexible endoscope to examine the inside of the stomach and colon. It is commonly used to diagnose conditions such as ulcers, cancer and internal bleeding in the stomach and colon.

Colonoscopy is a test that allows the doctor to look at the inner lining of your large intestine (rectum and colon). A colonoscopy can detect inflamed tissue, ulcers and abnormal growths. The procedure is used to look for early signs of colorectal cancer and can help doctors diagnose unexplained changes in bowel habits, abdominal pain, bleeding from the anus, and weight loss.

At what age should routine colonoscopy begin?

Routine colonoscopy to look for early signs of cancer should begin at age 50 for most people—earlier if there is a family history of colorectal cancer, a personal history of inflammatory bowel disease, or other risk factors. The doctor can advise patients about how often to get a colonoscopy.

How to Prepare for Colonoscopy?

The doctor usually provides written instructions about how to prepare for colonoscopy. The process is called bowel prep. Generally, all solids must be emptied from the gastrointestinal tract before the procedure. Patients should not drink beverages containing red or purple dye a day before the procedure. Iron supplements should be discontinued 2 weeks before the procedure.

Patients should inform the doctor of all medical conditions and any medications, vitamins, or supplements taken regularly, including:

  • Aspirin
  • Arthritis medications
  • Blood thinners
  • Diabetes medications
  • Vitamins that contain iron

Anaesthesiology is the medical speciality concerned with the use of drugs or other agents that blocks or temporarily takes away the body’s sensation (including the feeling of pain). It is a pharmacologically induced and reversible state of amnesia, analgesia, loss of responsiveness, loss of skeletal muscle reflexes, decreased stress response, or all of these simultaneously. Anaesthesiology is the continuity of patient care involving preoperative evaluation, intraoperative and postoperative care. There are many sub-specialties covered within anaesthesiology including cardiac anaesthesiology.

Radiology provides clinical services in diagnostic radiology, interventional radiology, and ultrasound and cross sectional imaging. The department provides the scanning of images of the body for the diagnosis of disease with or without the use of radiation.considering other cosmetic eye procedure.

Hepatobiliary Surgery is a respective surgery which is done to treat chronic diseases of pancreas and liver. This surgical treatment is often performed for benign and malignant diseases of the liver, pancreas, gallbladder, and bile ducts.

Get To Know Your Digestive System

Conditions like jaundice, fatty liver associated with obesity, high alcohol consumption and metabolic conditions like high cholesterol and diabetes, to liver cirrhosis and cancer can all cause damage to the body’s Hepoto-Pancreato-Biliary (HPB) system – yet few understand its importance.

Made up of the liver, pancreas, bile ducts and gallbladder, each organ is intrinsically related, and they are all essential to the body’s digestive system. Together, they are responsible for over 3600 functions in the body, including processing food, absorbing nutrition and disposing off toxins and waste. Taking care of the HPB system through early detection is vital for patient’s overall health and to empower them to seek the right care.

HPB System – The Liver

The liver is a vital organ, without which the tissues of the body would quickly die from lack of energy and nutrients. It performs many essential functions related to digestion, metabolism, immunity, and the storage of nutrients within the body. It is also the only organ in the body that has an incredible capacity for regeneration of dead or damaged tissues and it is capable of growing quickly to restore its normal size and function.

HPB System – The Pancreas 

The pancreas is a gland located at the upper back of the abdomen below and behind the stomach. It contains exocrine cells, which produce enzymes for digestion of food, and endocrine cells, which produce hormones for regulation of blood sugar levels. The pancreas has three main parts; head, body and tail. The head of the pancreas is next to the common bile duct (which drains bile from the liver) and duodenum (the first part of the intestine).

HPB System – The Biliary Tract

The biliary tract is made up of the gallbladder and bile ducts. The gallbladder is a pouch that connects to the mid-portion of the main bile duct, acting as a reservoir for bile while it is not being used for digestion. The main function of the bile duct is to transport bile, a liquid produced by the liver to the intestine where it helps with the digestion of food.

Respiratory Medicine is concerned with the treatment of lung diseases that can be due to a wide spectrum of conditions. The nature of these conditions can be inherited, congenital, infective, inflammatory, vascular, malignant, allergic, sleep-related, neuromuscular, or airway-related. Services provided include patient assessment and evaluation, diagnostic services such as pulmonary function testing and blood analysis, cardiopulmonary resuscitation, ventilator management, and oxygen therapy.

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