The Hindu : Tamil Nadu News : Experts call for use of ECG to detect failing hearts

Online edition of India's National Newspaper
Tuesday, Apr 26, 2005

Tamil Nadu

Tamil Nadu

Experts call for use of ECG to detect failing hearts

M. Dinesh Varma

The logistics and high costs involved in heart transplants have prompted cardiac specialists to look for innovative techniques

CHENNAI: Cardiac specialists will look for newer parameters with the Electrocardiogram (ECG) equipment in a bid to detect incipient congestive heart failure, or the condition where the heart is unable to pump enough oxygen to other organs.

With early diagnosis of congestive heart failure an important determinant of the quality of treatment outcomes, experts who attended a symposium at the Madras Medical Mission on Sunday have called for using the ECG to evaluate the heart mass that works in disharmony as well as the site of the trouble.

The key to early diagnosis could well lie in detecting the subtle differences between a normal and abnormal heart, experts felt.

Experts in the fields of echocardiography, clinical and surgical cardiology and cardiac electrophysiology attended the one-day event that focussed on current techniques and limitations regarding detection of heart failure and also treatment modalities.

The symposium organised by MMM's Institute of Cardiovascular Diseases under the auspices of the Indian Academy of Echocardiography attracted around 300 specialists from across the country.

The event was held against the backdrop of the increasing burden of congestive heart failure, making it imperative for specialists to detect heart failure at an early stage through newer techniques and also identify patients who might require advanced treatments in the form of cardiac pacing and stem cell and gene therapy.

It is estimated that one in 1,000 adults will have some symptom of heart failure. Of these, between 50 and 100 patients would require some medical intervention.

Paradoxically, the growing demand for cardiac care has stemmed from the advancements in treatment, which have increased the numbers of survivors with unhealthy hearts.

Though heart transplants represent the gold standard for end-stage heart failure, the logistics and high costs involved in transplants have prompted cardiac specialists to look for innovative techniques.

"We are searching for ways to reduce the cost of pacing therapy, which involves insertion of electrical leads to bring about electromechanical synchrony between the chambers of the heart," said Ulhas Pandurangi, MMM cardiologist and organising secretary of the symposium. In fact, by making slight programming adjustments on the pacing device, it is possible to reduce the cost of pacing therapy by Rs. 1 lakh (at present, the therapy costs around Rs. 3 lakhs).

Dr. Ulhas was part of the MMM team which had, in October 2004, carried out an innovative hybrid therapy on a 45-year-old patient with severely impaired heart function, a technique which was held out as a viable alternative to heart transplantation for patients with end-stage heart failure.

While blocks to the blood supply to the heart was removed by a coronary bypass surgery, the surgeons resorted to artificial mitral valve replacement for the leaking valve and insertion of electrical leads to restore electromechanical synchrony between the chambers of the heart, a technique called biventricular pacing.

Amit Vora, cardiac electrophysiologist from Mumbai, felt that it was as important to identify the right patient for pacing therapy as it was to make an early diagnosis to obtain the best treatment results.

It is estimated that the therapy works effectively in around 85 per cent of heart failure patients.

T. S. Kler, Director, Department of Cardiology, Escorts Heart Institute, New Delhi, focused on identifying responders to cardiac resynchronisation therapy. K. K. Kapoor, consultant cardiologist, Apollo Indraprastha Hospitals, New Delhi, outlined the newer techniques of electrocardiography.

R. Alagesan and S. Shanmugasundaram of Madras Medical College, Mullasari Ajit, head of cardiology, MMM and G. Vijayaraghavan, Director, Kerala Institute of Medical Sciences, Thiruvananthapuram, were among the experts who attended.

Participants also stressed the need for launching more training programmes in advanced therapeutics for heart failure in the light of paucity of skilled personnel and tertiary care centres.

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