Treatment Options

Chest pain and shortness of breath during physical exertion are the most critical symptoms in the cardiovascular field, often caused by arteriosclerosis of the coronary arteries, known as angina or myocardial infarction. Our hospital operates a 24-hour system to respond to acute myocardial infarction. Upon confirming a diagnosis of acute myocardial infarction, we immediately perform coronary angiography. If a lesion is found in the coronary artery, we proceed with catheter interventions such as stent placement (PCI). For angina, characterized by chest pain during exertion, we actively evaluate using coronary CTA to obtain precise information about coronary artery lesions and devise the most appropriate treatment plan.

Surgical Techniques

At our hospital, coronary angiography is primarily performed via the radial artery in the wrist, aiming for the least invasive method. Typically, this involves a one-night stay, with the patient arriving, undergoing examination and treatment on the same day, and being discharged the next day. Experienced and skilled cardiologists are always on hand for catheter treatments, including emergency situations. Additionally, the physicians, nurses, and technicians involved in the examinations receive specialized training in catheter tests and treatments, ensuring comprehensive care. Alongside coronary CTA, we also use various tests such as nuclear medicine tests, exercise stress tests, cardiac ultrasound, and peripheral vascular ultrasound to diagnose and treat ischemic heart disease and arteriosclerosis. We also actively accept cardiovascular emergency cases in chronic dialysis patients.

The Hidden Danger of Leg Arteriosclerosi

Arteriosclerosis can also affect the arteries flowing to the legs. The main issue with leg arteriosclerosis is a disease called peripheral artery disease (PAD). When arteriosclerosis affects the leg arteries, it often coexists with arteriosclerosis in the heart and brain vessels. Early symptoms include heaviness and pain in the calves while walking, which subsides after resting for a few minutes (intermittent claudication). It is crucial to detect and treat this condition early, as it is often overlooked as mere muscle pain. The dangerous aspect of this disease is the occurrence of severe ischemic limb, where the toes suddenly turn black (gangrene), leading to bacterial infection, non-healing wounds, and eventually limb amputation. This condition is known to occur frequently in patients with diabetes or those undergoing dialysis.

Comprehensive Same-Day Diagnosis

At our hospital, we have established a system for diagnosing on the same day of the visit using ABI and vascular ultrasound to measure blood pressure in the upper and lower limbs. Our hospital is also renowned nationwide for catheter treatments, being one of the leading facilities in the country.

Understanding Arrhythmia

The sinoatrial node at the top of the heart generates electrical impulses, which travel through conduction pathways to the entire heart muscle. If the sinoatrial node fails to generate electrical impulses or if there is an issue in the conduction pathways, the electrical signals from the sinoatrial node do not properly reach the heart muscle, causing irregular heart rhythm or rate. Symptoms of arrhythmia include chest pain or discomfort, palpitations, shortness of breath, dizziness, and fainting. Tachycardia (rapid heartbeat) can cause palpitations, shortness of breath, dizziness, and fainting, while bradycardia (slow heartbeat) can cause shortness of breath and loss of consciousness. Fainting or near-fainting symptoms are particularly dangerous, as they may indicate a life-threatening arrhythmia.

Treatment Options

An electrophysiological study (EPS) is conducted to diagnose arrhythmia. This involves inserting several thin electrode catheters through veins in the groin or neck into the heart. The metal tips (electrodes) on the catheters contact the inner heart wall, allowing detailed monitoring of the heart’s electrical activity. EPS is a crucial and effective test for diagnosing arrhythmias.

Treatment for bradycardia involves the use of a pacemaker, which delivers electrical impulses to the heart muscle to maintain necessary heart contractions. For tachycardia, catheter ablation surgery is performed, where a thin tube (catheter) is inserted into the blood vessel and high-frequency energy is used to burn and block the arrhythmia-causing circuit in the heart muscle. In addition to traditional ablation, atrial fibrillation treatment involves using a cryoablation balloon to isolate the pulmonary veins. This newer method shortens treatment time and improves outcomes.

Implantable cardioverter-defibrillators (ICDs) are used to continuously monitor heart rate and stop dangerous arrhythmias, preventing cardiac arrest. Additionally, biventricular pacemakers are implanted for cardiac resynchronization therapy in patients with severe heart muscle damage causing heart failure.

Understanding Aortic stenosis

Aortic stenosis is a condition where the valve between the left ventricle and the aorta does not open properly, often due to calcification with aging. Symptoms include shortness of breath, palpitations, and chest pain during physical activity, and in severe cases, fainting or sudden death. Medication is limited in effectiveness, and valve replacement surgery is necessary. Many elderly patients hesitate to undergo surgery due to the risks involved.

Treatment Options

Transcatheter Aortic Valve Implantation (TAVI) is a newer treatment for this condition. A folded artificial valve, about the thickness of a pencil, is placed over a balloon and advanced to the narrowed aortic valve. The balloon is inflated to deploy the artificial valve, which begins functioning immediately. Although TAVI has been in use for only about 10 years and its long-term safety is not fully established, it is an option for patients over 80 or those with high surgical risk due to previous heart surgery.

Treatment Options

Mild cases are treated with medication, while severe cases require surgery.

Our hospital began performing TAVI in August 2015, with 84 cases conducted in 2018. Percutaneous mitral valve repair (MitraClip) is a new treatment for elderly patients with mitral regurgitation who cannot undergo open-heart surgery. This involves using a catheter to clip the mitral valve leaflets, reducing regurgitation. Since insurance approval in April 2018, we have performed 14 successful MitraClip procedures over nine months. This treatment is expected to improve symptoms and outcomes in elderly patients with mitral regurgitation who have difficulty managing heart failure with medication.