KEEPING UP THE PACE

Discussion in 'Health and medical' started by Dr. Jai Maharaj, Jun 24, 2003.

  1. Keeping up the pace

    By Aparna Kher
    The Pioneer
    Wednesday, September 27, 2000

    About 22.5 million patients worldwide suffer from
    congestive heart failure, a condition where the heart
    loses it's pumping action. Around a million new patients
    are added to this growing list of patients each year.

    Heart failure patients can be classified into four
    categories depending on the symptoms. The first category
    patients, also known as Class I patients, complain of
    breathlessness while doing regular exercises. Class II
    patients experience breathlessness during any physical
    activity other than routine while Class III patients may
    suffer from breathlessness while performing minor routine
    activities like changing clothes, walking in the house.
    Patients in the last stage experience shortness of breath
    even while doing nothing. These patients are also known
    as refractory heart patients.

    While patients in the class I and II category can be
    operated upon successfully, the only logical long-term
    solution for class III and IV patients is a heart
    transplant. Though heart transplants in foreign countries
    have been carried out successfully, such transplants in
    India are as of yet a theoretical possibility. The
    infrastructure and the kind of expertise needed to carry
    out such operations is lacking, says Dr Tarlochan Singh
    Kler, senior consultant cardiologist and head of
    department of electrophysiology and cardiac pacing at the
    escorts heart institute and research centre.

    Even in advanced countries , 90 per cent of heart
    patients die waiting for a donor heart. After a
    transplant, there are high chances of infection and the
    receiver s body rejecting the donor heart. This can prove
    fatal.

    Until very recently, Class III and IV patients or End
    Stage Heart Disease (ESHD) patients were doomed. Not
    anymore. Research in several countries has come up with a
    special kind of pacemaker, also known as a bi-ventricular
    pacemaker or a heart failure device.

    How is it different from a normal pacemaker? A bi-
    ventricular pacemaker has an extra lead while the former
    has only two.

    Patients with ECG abnormalities will benefit most from
    this path-breaking technology. In such cases, the left
    and the right ventricles contract at different times as
    opposed to a normal heart where they do so
    simultaneously. In worst cases, the delay in contraction
    between the upper and lower chambers of the heart
    increases. Estimates show that roughly 40 per cent of
    heart failure patients suffer from ECG abnormalities.

    The bi-ventricular pacemaker is introduced in much the
    same manner as the normal pacemaker. The third and extra
    lead of the new pacemaker is introduced in the left
    ventricle so that the normal physiology of the heart is
    restored.

    Studies have shown that 30 to 40 per cent of discomfort
    was reduced after the introduction of the bi-ventricular
    pacemaker.

    This new pacemaker was implanted for the first time in
    South Asia at the Escorts Heart Institute and Research
    Centre by Dr Kler. So far only six patients have
    benefitted by the procedure which costs around Rs 3 lakh.

    A normal pacemaker costs around Rs 1.5 to 2.5 lakh over
    and above the cost of operation and medical care. A bi-
    ventricular pacemaker costs around Rs 3 lakh over and
    above the cost of operation.

    Heart patients, who cannot afford, can look out for
    pacemaker donations. Often pacemakers in working
    condition are taken off the dead, sterilised and re-used.
    The leads of the pacemaker are changed. This procedure is
    carried out on a voluntary basis and the pacemaker
    company does not provide any warranty to the second
    receiver of the pacemaker.

    The incidence of infection is also high as compared to
    that of a normal pacemaker. Such a process is, however,
    illegal in foreign countries. The operation is simple and
    similar to that of implanting an ordinary pacemaker. The
    patient is given local anesthesia. The batteries of the
    pacemaker work for five to seven years.

    The bi-ventricular pacemaker may just be in it s infancy,
    but it may just be the answer to hundreds, whose hopes
    had died an untimely death.

    Read the complete news at:
    http://www.dailypioneer.com

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