Adult heart diseases should be examined under 4 main headings.
1- Coronary heart diseases
2- Heart Valve Diseases
3- Congenital heart diseases
4- Large vessels rupture (dissection), dilation (aneurysm = ballooning), narrowing.
Among these, coronary heart disease is the most common heart disease. Death from this disease caused by partial or complete narrowing of the coronary artery vessels that nourish the heart has become the most common cause of death in our country. Deaths due to heart diseases constitute about 40% of all deaths in our country. Considering that there are 1.5 or 2 million heart diseases in our country and 300.000 people have a heart attack every year and 1/3 of them approximately 100.000 people die, the social importance of heart diseases is better understood.
Many preparatory factors such as rapidly increasing cigarette consumption, stressful life, inactivated society, unbalanced and irregular recession, rapid urbanization cause this.
Adult Heart diseases can manifest with different symptoms such as chest pain, shortness of breath, palpitations, nausea and cold sweats, syncope (fainting), swelling of the feet, and cough. Most importantly, having a heart examination every year above the age of 35 can prevent many problems, since it will have consequences that go up to sudden death without any complaints.
DIAGNOSIS METHODS IN Adult HEART DISEASES
Stress Test (Stress test)
Effort test can be applied in two ways
Stress ECG (Electrocardiography)
Stress ECHO (Echocardiography) (With effort or medication)
a. Stress ECG test:
Continuous electrocardiography of the patient, who is suspected of stenosis of the heart vessels, while walking on the treadmill at a fast pace is called an “effort test”.
b. Stress Echocardiography:
In some special cases, the ultrasonographic examination (ECO) of the heart is taken just before and immediately after the effort test, making the accuracy of the diagnosis of heart disease even greater than the normal effort test.
4 hours of fasting is required for the stress test. It is beneficial for the patients to come with sports shoes and tracksuits, if possible.
Echocardiography and Color Doppler
The technique that transforms the structure of the human heart, the diameters of its cavities, the working capacity of the heart muscle, and especially the structure and functions of the heart valves, into a live image with the sound wave method is called echocardiography (ECO). No preparation or hunger is required for this test, and the entire test can be completed in a short time.
Heart Catheterization and Coronary Angiography
It is possible to observe the structure of the heart, pressure values in the heart chambers and great vessels, stenosis and insufficiencies in the heart valves, and especially whether there is a narrowing or obstruction in the heart vessels, thanks to cardiac catheterization and coronary angiography. Thanks to this technology, radiological photographs of each of the heart vessels are taken 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 that is advanced from the inguinal artery to the heart under local anesthesia. During the cardiac catheter, the pressures in the heart are measured and at the same time, the contractile function of the heart is examined by giving a “dyed substance” to the left heart cavity.
Holter Monitor (Heart Rhythm or Blood Pressure Holter)
The heart rhythm is monitored and recorded for 24 hours with a device called Holter. Thanks to this device, heart rhythm disorder can be diagnosed.
The blood pressure Holter also records the fluctuation of the patients’ blood pressure for 24 hours, during the day, under real-life conditions, and the blood pressure values during sleep.
It is the most accurate diagnostic method for heart rhythm disorders. Thanks to this procedure, which is performed with the help of a special catheter that is advanced from the inguinal vein to the heart under local anesthesia, the locations of rhythm disorders that cause the heart to work too fast (tachycardia) or too slow (bradycardia) are determined with ‘millimetric’ measurements, the ‘Rhythm Disorder Map’ required for definitive treatment. ‘is removed. With extremely advanced knowledge and technology, this method requires Turkey ‘can be applied in only a few centers.
It is an imaging method that reveals the structure of the pericardium, heart chambers and valves, heart muscle and large arteries emerging from the heart, and some heart diseases (such as constriction, dilation, calcification) in an extremely easy and non-harmful way. The processing time is around 15 minutes and does not require any preparation.
a) Myocardial Perfusion Scintigraphy (Thallium Test): It is a more sensitive method than effort test in investigating whether there is any obstruction or stenosis in the vessels feeding the heart. The blood supply (or nutrition) of the heart muscle is examined during rest and during exercise with Thallium, a radioactive substance administered intravenously. The test should be done hungry.
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. Simultaneous imaging with ECG recording is performed to measure heart function.
Invasive Cardiological Treatment Methods in Adult Heart Diseases
Balloon angioplasty can be performed in the same session or later, if appropriate when significant stenosis and/or occlusion in the coronary vessels. In balloon angioplasty, a specially made balloon is inflated for a short time in the narrow area inside the vessel and the stenosis is expanded. The balloon can be applied to more than one stenosis in the same vein or to 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 with the help of a balloon.
In the balloon procedure, a catheter with an inflatable balloon is placed at the end of the stenosis area (A). After the stenosis is placed, the stenosis is opened by inflating (B).
In cases that are not suitable for balloon angioplasty, bypass surgery or drug therapy may be recommended.
Surgical Treatment Methods in Heart Disease
1- Coronary Bypass Surgery: Bypass literally means bridging, it is a method of providing blood to reach the obstructed segment by bridging it with a lateral path between the front and the back. Although this procedure is mostly an open heart surgery procedure performed using a heart-lung machine, different operation techniques such as bypass in the working heart, bypass with small incision method and robotic bypass have been developed recently. For the purpose of bridging, arteries under the breastbone, right or left internal mammalian artery, radial artery, saphenous veins are used. The purpose of bypass operations is to send the patient back to society as a healthy, active, productive individual.
2- Heart Valve Operations: It is the process of repairing or replacing damaged valves. Here, in addition to the large incisions made in the form of open-heart surgery, methods that allow patients to be discharged within 3 days with small incisions or robotic methods can be used to provide comfortable operation, early discharge, and early productivity. Also, valve changes with completely closed methods are now among the treatment options that are also used routinely.
3-Aortic and Arterial Surgery: The main artery originating from the heart is called the aorta. Dissection is a disease caused by a rupture of the aortic vessel within its own layers. This is an extremely urgent and vital situation that results in loss of life if not treated urgently. In this case, replacing the vein with an artificial vein or inserting stented artificial veins by entering through the vein is life-saving. Also, implantation of endovascular stents, stent-grafts, or open artificial vessels were the methods used in vascular surgery, depending on the occlusion of all arteries.
4- Treatment of Venous (Venous) Varices and Thrombosis: Many open and closed surgical treatment methods are used here.
5- Cardiac Surgery with Small Incision Method
6- Robotic Surgery
7- Endovascular approaches