Holes in the heart are a type of congenital heart disease. Ventricular septal defect (VSD) and atrial septal defect (ASD) are the two most common congenital defects that may affect an individual. These occur due to structural malformation in the walls of the heart when these are developing at the fetal stage. ASD and VSD can be repaired and closed as soon as they are identified or right after birth. ASD is the hole in the septa that divides the two atrium and VSD refers to the hole in the ventricular walls. The holes allow the reverse flow of blood, thus, facilitating the mixing of pure and impure blood.

• To understand the holes in heart we must briefly understand the working of the heart. The heart works like a pump beating on an average of 100,000 times in a day. It has two sides which are divided by a wall called septum. The right side of the valve pumps blood to the lungs and picks up oxygen. The oxygen-rich blood then returns to the left side of the heart from the lungs and then the left side pumps it to the rest of the body.
• These two sides are divided into 4 chambers having four valves connecting them to various blood vessels. For carrying blood from the body to the heart, veins are responsible while arteries carry the blood away from the heart to be circulated to the body. The atria are two upper chambers that collect blood while ventricles are the two lower chambers pumping the blood to the lungs and other parts of the body.
• The valves act like doors allowing a flow of blood through the next chamber to arteries and then they close to keep the blood from again returning back to the previous chamber from where it came. In a systolic contraction, the ventricles pump blood from the heart and in a diastolic contraction, the ventricles relax to receive blood pumped by the atria. The aortic and pulmonary valves close at the beginning of the diastole to prevent the chances of backflow. Thus, the presence of a hole in the septa may lead to mixing of the blood and interfere with the normal flow of blood circulation in the body.
• An ASD is naturally present when the baby is still a fetus. But the hole closes on its own by the time of birth. However, in some cases, it may persist even after birth. An ASD can be of different types, including sinus venosus atrial septal defect, mixed atrial septal defect, ostium secundum atrial septal defect. A VSD, on the other hand, is usually detected in a baby or in an adult when a doctor observes a heart murmur. Certain tests such as an echocardiogram or electrocardiogram are performed to confirm its presence.

Typically, medications are administered to see whether ASD or VSD closes on its own. In case the defect does not close on its own and the individual continues to experience atrial septal defect symptoms such as breathing difficulties, heart murmurs, shortness of breath, and respiratory infections, then a surgery is recommended. The surgical procedure for atrial septal defect repair and ventricular septal defect treatment are almost the same, except the fact that different parts of the heart are targeted during the surgery.

Most physicians advise their patients to undergo the angiogram procedure (also known as angiography and arteriogram) when certain symptoms such as a heart attack or chest pain become a source of worry. A stress test is performed on patients who report chest pain, which is then followed by an angiogram test.

Angiography procedure aims at testing the blockages in the coronary arteries apart from any other cardiovascular-related ailments. Angiography and angiogram procedure can both locate narrowing arteries or blockages that may exist in different parts of the body.

Angiography is recommended for patients with coronary heart diseases (CHD), which can cause the heartbeat to stop suddenly and abruptly. The patient may also suffer from severe chest pain. Angiography can also be performed on patients on an emergency basis when they experience a heart attack. If the blockage is not treated immediately, then healthy tissues around the heart start perishing and turn into scar tissue. It can give rise to several long-lasting problems. Angiography may also be required in the case of a patient with aortic stenosis or those who have had an abnormal heart stress test.

Coronary artery disease (CAD) is one of the most common heart diseases reported across the world. It results due to blood clot formation and plaque accumulation in the major blood vessels of the heart.

Balloon angioplasty is the most common endovascular procedure (procedure performed inside the blood vessel) carried out to treat coronary artery disease. In this procedure, the blood clots in the major arteries of the heart are detected and cleared by inserting a catheter into an artery of the hand (radial artery) or leg (femoral artery). This catheter consists of a balloon at its tip, which dislodges the clot to the periphery of the blood vessel after inflation.

Angioplasty may or may not be followed by coronary stent placement, depending on the angiography findings. This procedure is performed in patients with fewer blood clots in the vessels and those who do not respond to medications. It may also be carried out as an emergency procedure to treat a heart attack.

Signs and symptoms of plaque deposits in the heart

• Fatigue and dizziness due to insufficient blood supply to the tissues and overall decreased efficacy of the heart
• Shortness of breath to compensate for inadequate pumping of the blood
• Compromised blood flow to the heart resulting in heart attack, characterized by pain in the chest, lower jaw, and left arm

Radiofrequency ablation (RFA) is a surgical procedure in which heat generated from medium frequency alternating current is used to ablate a tumour, a part of the electrical conduction system of the heart, or any other dysfunctional areas. The ablation therapy requires local anaesthesia and is done in an outpatient setting.

RFA is a popular treatment for the correction of any abnormality in the electrical system of the heart, which is confirmed during electrophysiology studies (EPS). During this test, the electrophysiology of heart is studied and any abnormalities are noted. The procedure used to correct the identified abnormalities associated with electrophysiology of heart is known as the cardiac ablation procedure.

How does a Pacemaker Implant work?

Pacemaker implantation is a common surgery and it significantly improves the quality of life led by the patient.  The blood-pumping organ, heart, is essentially made of a few groups of muscles. These muscles are controlled by electrical signals to ensure that the heart beats naturally and effectively to circulate blood to all parts of the body. When this electrical signal gets disrupted due to some reason, then an individual may experience tachycardia (where hear beats abnormally slow), heart block, arrhythmia (irregular heartbeat), or a cardiac arrest (abrupt and sudden stopping of the heartbeat).

The contractions happen as a result of triggered electrical pulses generated by sinoatrial node or the SA node. It acts like a pacemaker of the heart. This electrical pulse is then sent to the atrioventricular node or the AV node for relaying the pulse to the ventricles. Pacemaker implantation is suggested when this electrical signaling network is disrupted.The faulty functioning of the natural pacemaker of the heart may lead to the following:

Sick sinus syndrome: It is characterized by a slow heartbeat (bradycardia) or fast heartbeat (tachycardia) or a combination of both. It can happen due to age, a previous history heart attack, and thyroid problem, too much of potassium accumulation in blood, heart surgery, or sleep apnea.

Heart Block

In this case, the impulse is either delayed or absent.

Cardiac arrest

The heart can stop beating. It may result because of the presence of coronary artery disease and muscle problems in the heart, which can happen after the age of 35.

Symptoms

Some of the symptoms observed in patients requiring pacemaker implantation are:

• Bradycardia
• Tachycardia
• Uncontrollable fatigue
• Dizziness experienced throughout the day
• Shortness of breath
• Acute chest pain
• Palpitation and fluttering of the heart (arrhythmia)
  
  

What is a pacemaker implant?

A pacemaker implant is a small device that weighs around 20 g to 50 g and is the size of a matchbox. It has a pulse generator with a battery, a tiny computer circuit and a few wires called pacing leads. This system is attached to the heart and it emits signals through the wires. The pacing rate or the rate of electrical impulses can be adjusted as per the requirement of the body and be accordingly programmed. It can sense if a heartbeat is missed or if the heart is beating too slow. Accordingly, it starts sending a steady signal to normalize the beating of the heart. If the beats are normal, then it simply does not send any signal.