Table of Content

• Heart blocks / Atrioventricular (AV) blocks

• Risks

• Symptoms of Heart Block

• 7 Symptoms of a Second-Degree Heart Block

• 5 Symptoms of a Third-Degree Heart Block

• What is Angiography?

• What is Angioplasty?

• Distinguishing between Angiography and Angioplasty

• The Procedure of Balloon Angioplasty

• Aftercare

Introduction

• According to the World Health Organization's latest analysis, it is estimated that we lose almost 17.9 million lives to heart disease each year. It ranks as the number one cause of death globally. Our heart is saddled with the duty of pumping blood to the rest of our organs. It makes sure that we receive nutrition and oxygen to function normally. But within the last decade or so, heart diseases have elevated to new heights. 

• Epidemiology suggests that ischemic heart disease, when presented in tandem with stroke, indicates failing heart health in the Indian population. Over the last decade, heart disease in India has increased by 59%, in pure metrics. 23.2 million people suffered from heart-related ailments in 1990, and in the 2010s, it grew to around 37 million. It is estimated that as opposed to the global average, we have higher cardiovascular-related deaths with 272 per 100 000 population in comparison to 235 per 100 000 population.   

• A heart attack is a widespread phenomenon with the current population; everyone knows someone who has been at the other end of a heart-related crisis. Over the decades, the prevalence has increased manifold. The current generation of people lives in a fast-paced world with unhealthy lifestyles, making them susceptible to heart diseases. When facing any ailment, it is essential to know what it entails, especially when it involves a vital organ such as the heart.

Heart blocks / Atrioventricular (AV) blocks

• The heart exhibits abnormal heart rhythm (also called arrhythmia) with irregular electric signals. This can be due to underlying blocks in the vessels that pump blood. These blocks are plaques that are caused by the buildup of fat molecules in the bloodstream. 

• A block is based on the extent of obstruction present in blood supply between the upper and lower chambers of the heart, the atria, and the ventricles, respectively. Heart blocks are categorized into three types.

1. First-degree heart block: It is a common type of obstruction and does not require treatment or targeted medication. It shows little to no symptoms and is common in athletes who go through rigorous training. In this heart block, the electric signals slow down and pass through the heart to the ventricle without significant impairment. 

2. Second-degree heart block: Here, there is a delay with the heartbeat to reach the ventricle due to slowing electric impulses.  

There are two types of second-degree heart block they are 

1. Mobitz type I 

2. Mobitz type II

• During the former type of block, the patient experiences a drop in heartbeat, and the former has more chance to progress to a third-degree heart block, and the electrical signal is carried to the ventricle sometimes.

3. Third-degree heart block: This type of heart block is also called complete heart block. It is the most severe, and the electric signals between the upper and lower chambers are completely impaired during this condition. When a patient is affected with this type of block, they need immediate emergency care and treatment. 

Risks

Many patients are at higher risk of having blocks in the heart and may require a combination of Angiography and Angioplasty to correct the condition. 

• They include patients who suffer from the following conditions:

• Congenital Malformations(defects during childbirth or in premature babies)

• Old age (patients above the age of 65)

• Cardiomyopathy (heart muscle disease)

• Heart Attack

• Severe Hypothyroidism

• After open-heart surgery

• Lyme disease

• Ingesting certain medication that slows the heart rate

• Sarcoidosis

• High potassium levels

Symptoms of Heart Block

Based on the severity, we can further classify the symptoms accordingly.

7 Symptoms of a Second-Degree Heart Block

A Second-degree heart block will make the patient exhibit symptoms like

1. Dizziness

2. Loss of consciousness 

3. Irregular heartbeats that make your heart skip/pause

4. Chest pain

5. Labored breathing

6. Nausea

7. Queasiness

5 Symptoms of a Third-Degree Heart Block

A Third-degree heart block will make the patient exhibit symptoms like:

1. Intense fatigue

2. Arrhythmia(Irregular heartbeats)

3. Dizziness

4. Fainting

5. Cardiac arrest

If this condition is not immediately treated, it could be fatal for the patient. 

What is Angiography?

• In the simplest terms, Angiography is an imaging test. It evaluates the blocks, narrowing, malformation, or enlarging of vessels, i.e., the arteries or veins present in our heart. This is done using a contrast liquid dye and a thin, flexible tube termed as a catheter. 

• We learn the extent and severity of heart disease by this procedure. An angiogram is an image taken with the catheter and can be done with the access point from the groin or arm. 

What is Angioplasty?

An angioplasty is a minimally invasive procedure meant to remove plaque buildup in the walls of the arteries. Plaque buildup happens when cholesterol is collected in the blood. It widens the obstructed blood vessel and enables smoother blood flow. Angioplasty is also called percutaneous coronary intervention (PCI). There are different types of angioplasty, such as Angioplasty balloon procedure, Atherectomy of the artery, Stent placement surgery, Rotablation procedure, and Cutting Balloon Angioplasty.

Distinguishing between Angiography and Angioplasty

• 'Angio' from greek refers to vessels that carry blood. Both Angiography and Angioplasty are procedures that are meant for the discovery and treatment of blocks in our body, primarily the heart. 

• Distinguishing the two is not easy as they involve most of the same equipment like the catheter, and both are performed under general anesthetic and are minimally invasive. But the important fact is that one is exploratory and the other is surgical. Around 90% of patients who undergo an angioplasty procedure survive it. 

The Procedure of Balloon Angioplasty

• A patient undergoes Chest X-Ray, Electrocardiogram, and all blood workup before the angioplasty procedure. Angiography is performed for imaging analysis, and the prognosis for the procedure is decided based on that. Patients are advised to stop ingesting aspirin, steroids, or blood thinner-containing medications. And are also not allowed to eat or drink 8 hours before the procedure.

• Balloon angioplasty is a popular procedure for removing blocks in the heart. It involves using a catheter with a balloon tip to be inserted through an artery and enlarging a narrowing artery. After inflation, it is passed through the block to widen the artery and normalize blood flow. Then the tip is deflated and slowly removed. Angiography is constantly done to examine the area for normal heart function.  

• The procedure gives the patient an option to avoid complicated surgery like an open-heart coronary artery bypass graft (CABG), minimizes a chance for heart attack, improves good outcomes when a patient presents with unstable angina. 

Aftercare

• An Angioplasty is a long and complicated procedure. It is very successful and requires little to no recovery time for the patients. All patients can function normally within a few days or a week. But patients need to be careful of certain symptoms that can present after the procedure. Rigorous physical activity for a certain period is not allowed for the patient. Some physical signs should also be looked into, like bruising in the surgical area, excessive tiredness, or lacking energy. Also, sudden onset of other symptoms like painful chest pains occurring after the procedure, fever, or swelling at the site where the catheter was inserted should be monitored. 

• Angiography and angioplasty are two sides of the same coin; they are both used in the diagnostic and treatment methods of the heart and are essential in making it possible to function normally. They are both of paramount importance in helping patients gain a healthy heart.