Cardiology (Cardiovascular Center)

In our department, we perform more than 1,700 cardiac catheterization tests and treatments each year. Among them, we utilize the clinical path for coronary angiography and catheterization for coronary artery disease, allowing patients with busy schedules to perform examinations and treatments in a short period of time. We are working hard to get you treatment. As an example, the following outlines the one-night hospitalization examination and one-day examination in the case of coronary angiography.

cardiac catheterization

1 night 2 days inspection

This is the method currently being used in our hospital.

Flow of inspection for 2 days and 1 night

1. On the day of the examination, please come to the hospital after 8:00 am, and after hearing the explanation of the examination from the doctor and staff, the examination will be performed in the morning.
   • The examination is performed under local anesthesia from the wrist (or elbow in some cases) or thigh blood vessels, and after the examination is completed, you will be asked to stay in the hospital room.
   • If the test is performed from the thigh, it is necessary to lie down and rest in bed for about 4 hours, but if the test is performed from the wrist or arm, you should walk and eat after the test is completed. is possible.
2. After the examination, you will receive an explanation of the results from your doctor in the afternoon or evening.

Day inspection

Cardiac catheterization used to require hospitalization for at least 1 night and 2 days, but we are conducting day-trip examinations on Tuesdays and Fridays only for patients who have undergone catheterization from the wrist or arm in the past. . This system can minimize the disruption to the patient's work and daily life, and can also reduce hospitalization costs.

Day-trip inspection flow

1. On the day of the examination, please come to the hospital after 8:00 am, and after hearing the explanation of the examination from the doctor and staff, the examination will be performed in the morning.
   • The examination is performed under local anesthesia through the blood vessels of the wrist (or elbow in some cases), and after the examination is completed, you will be placed in a waiting room.
   • After the examination, you can walk and eat.
2. After the test, you will receive an explanation of the results from your doctor.
3. Around 16:00 on the same day, after confirming that there is no problem with the wound where the catheter was inserted, I will return home. Please note that these one-night or one-day coronary angiography examinations may not be applicable to patients with renal dysfunction who require hospitalization for several days before and after the examination.
4. Around 9:00 the next morning, after confirming that there was no problem with the wound where the catheter was inserted, the patient was discharged from the hospital.

Echocardiography is a test that uses ultrasound to evaluate the shape and function of the heart. It is an essential test for the evaluation of myocardial infarction and valvular disease, as it enables real-time observation of heart movement. At our hospital, we have several cardiac Ultrasonographer and echocardiography society-doctor technicians.

echocardiography

Echocardiography is a test that uses ultrasound to evaluate the shape and function of the heart. It is an essential test for the evaluation of myocardial infarction and valvular disease, as it enables real-time observation of heart movement. At our hospital, we have several cardiac Ultrasonographer and echocardiography society-doctor technicians.

Inspection equipment

• EPIQ7 (Philips Electronics)
• iE33 (Philips Electronics)
• SC2000 (Siemens Healthcare)
• Artida (Toshiba Medical)
• Aplio (Toshiba Medical)
• Vivid S6 (GE Healthcare Japan)

Transthoracic echocardiography

An ultrasound probe is applied from the chest, and the morphology and function of the heart are evaluated for about 30 to 40 minutes. In addition to screening patients with chest symptoms such as palpitations and shortness of breath and heart murmurs, we mainly focus on cardiovascular diseases such as hypertension, arrhythmia, ischemic heart disease, valvular disease, heart failure, cardiomyopathy, aortic disease, and pulmonary hypertension. as a target. It is also performed before surgery for patients scheduled for surgery on other organs.

transesophageal echocardiography

This is an examination to observe the heart in detail from the esophagus and stomach by swallowing an ultrasound probe that is similar in thickness to a gastroscope. Higher-definition images than transthoracic echocardiograms can be obtained, which is useful for making accurate diagnoses and determining treatment strategies. It is indicated for patients with intracardiac thrombosis and valvular disease before and after surgery, artificial valves, infective endocarditis, embolism, and congenital heart disease (atrial septal defect, etc.).

At our hospital, we use a sedative to ensure that you are asleep during the examination so that you can have the examination safely and comfortably. Although the examination takes only about 10 to 20 minutes, an experienced echocardiologist performs the examination quickly and conducts a detailed evaluation including 3D echo. Safety is our number one priority, and none of the approximately 700 cases performed in our examination and operating rooms in fiscal 2015 resulted in serious complications.

Intraoperative transesophageal echocardiography

Transesophageal echocardiography in the operating room is an important tool for safe cardiac surgery. At our hospital, echocardiologists check newly repaired heart valves in the operating room in valvular disease surgeries such as mitral valvuloplasty and aortic valve replacement, so that safer and more accurate surgeries can be performed. We support this.

stress echocardiography

Patients with angina pectoris, valvular disease, cardiomyopathy, and pulmonary hypertension are subjected to exercise stress using an ergometer (bicycle) or treadmill, and at the same time, transthoracic echocardiography is performed to evaluate cardiac function. and assessment of exercise tolerance.

In our department, we perform approximately 1,400 cardiac CT examinations and approximately 100 cardiac MRI examinations annually.

Cardiac CT examination

For cardiac CT examinations, Toshiba's latest plane detector CT device Aquilion One Genesis edition was introduced in April 2016, so we are using this device for examinations. In this device, 320 rows of detectors are arranged like a plane at intervals of 0.5 mm, and the body trunk can be imaged with a width of 16 cm in 0.275 seconds per rotation. In addition, since it uses an iterative reconstruction method (image processing method after imaging) called FIRST, which has been significantly advanced compared to conventional equipment, it is now possible to obtain clear images with a small amount of exposure. These two features make it possible to obtain extremely high-quality images with low radiation exposure. Cardiac CT is mainly used to evaluate coronary artery lesions, but it is also considered useful for anatomical evaluation of the heart, such as valvular disease and congenital heart disease. In addition to the heart, it is also useful for evaluating aortic and vascular lesions.

Cardiac MRI examination

Cardiac MRI is performed with two devices, 1.5T and 3.0T. Cardiac MRI is useful for evaluation of cardiac function and heart muscle (myocardium). In cine imaging, the movement of the heart can be evaluated in moving images. Cardiac function assessment using this imaging method is considered to be the most accurate among various diagnostic imaging tests. In addition, delayed contrast-enhanced imaging using a gadolinium contrast agent is useful for evaluating the infarct area after myocardial infarction and for diagnosing cardiomyopathy, which is the degeneration of the myocardium.

(Shuichiro Kaji)

MRI machine

Evaluation of myocardial infarction extent by delayed contrast enhancement

Delayed contrast enhancement in cardiomyopathy

Coronary artery imaging at low dose (0.61 mSv)

症状を伴う重症の大動脈弁狭窄症があるけれども、人工心肺を使用する外科手術のリスクが高い患者さんに対する低侵襲治療です。

What is aortic stenosis?

The heart works like a pump to send blood throughout the body. The left ventricle contracts and pumps blood into the aorta, and the aortic valve, which prevents the backflow of blood, is attached to the exit of the left ventricle. Aortic valve stenosis is a pathological condition in which the outlet of the valve is narrowed due to valve degeneration or arteriosclerosis. It can cause shortness of breath and fainting on exertion. Left untreated, severe aortic stenosis can lead to hypertrophy of the heart muscle, heart failure, angina attack, syncope, arrhythmia, and sudden death.

Transcatheter aortic valve implantation (TAVI)

Until now, surgery for aortic stenosis has been performed by opening the chest and implanting an artificial valve under the use of a heart-lung machine. Transcatheter Aortic Valve Implantation (TAVI) is a minimally invasive treatment for patients with severe symptomatic aortic stenosis but who are at high risk for surgery with cardiopulmonary bypass. In Japan, health insurance coverage became available in October 2013. Strict facility standards are stipulated, but since December 2013, our hospital has been the first certified facility in Hyogo Prefecture to obtain approval, we have implanted 72 cases by the end of October 2016.

After general anesthesia, a long, thin tube called a catheter is inserted into an artery in the groin. If it is not possible to approach from the legs because the blood vessels in the legs are not in good condition, a few centimeters of incision is made in the chest wall between the ribs and a catheter is inserted directly into the heart, or a catheter is inserted from the subclavian artery or ascending aorta. insert. A folded prosthetic valve is brought to the heart via a catheter and implanted at the aortic valve. As of October 2016, two types of valves manufactured by Edwards Lifesciences and Medtronic can be used.

implantable prosthetic valve

Treatment from leg vessels

Treatment from the chest wall

Immediate after implantation of artificial valve (red arrow)

heart team

Multidisciplinary staff such as cardiologists, Cardiology Cardiovascular Surgery, Anesthesiology, diagnostic imaging specialists, nurses, radiological technologists, and clinical engineers bring together the knowledge and skills of each specialized field for TAVI treatment. It is possible only by selecting the most suitable treatment method for the patient and performing the treatment. The group responsible for this TAVI treatment is called the “Heart Team”. At our clinic, we have established a heart team system consisting of experts in each field.

Who are the target patients for TAVI?

have severe symptomatic aortic stenosis,

1. Elderly (generally over 80 years old)
2. Those who have had open heart surgery such as bypass surgery in the past
3. People with respiratory diseases such as emphysema
4. Those with liver disease such as cirrhosis
5. Patients with comorbidity with malignant disease (expected to have a prognosis of 1 year or longer)
6. Those who have received radiotherapy to the chest
7. Those with severe aortic arteriosclerosis

For these reasons, TAVI is indicated for patients who are at high risk for surgery. However, those who are judged to have low risk and safe surgical procedures and dialysis patients are not eligible for TAVI.

hybrid operating room

A hybrid operating room is required to become a TAVI accredited facility. A hybrid operating room is a treatment room that combines an operating table and cardiac/cerebrovascular X-ray equipment, enabling endovascular treatment using a catheter in an environment with the same level of air cleanliness as an operating room. Our hospital introduced a hybrid operating room in July 2011 when we moved to a new hospital. It is used not only for TAVI, but also for biventricular pacemaker surgery, aortic stent graft surgery, etc.

To patients and medical professionals who wish to have TAVI

Whether TAVI is indicated or not should be determined by performing a detailed preoperative examination (coronary angiography, transesophageal echography, coronary angiography, pulmonary function test, etc.). First of all, please bring a letter of introduction from your primary care doctor and visit our outpatient clinic.

Percutaneous mitral valve clipping (MitraClip®)

Mitral regurgitation (regurgitation) and heart failure

The heart has four chambers (Fig. 1). The upper two are called the left atrium and right atrium, and the lower two are called the left ventricle and right ventricle. The repeated beats of these four chambers enable the heart to pump blood efficiently. Oxygenated blood in the lungs is sent to the left atrium and then to the left ventricle through the mitral valve between the left atrium and left ventricle. The left ventricle works as a pump for the heart, and the blood ejected from the left ventricle is sent to the whole body through the aorta through the aortic valve. Between the left atrium and the left ventricle is the mitral valve, which prevents the backflow of blood from the left ventricle into the left atrium.

Mitral regurgitation (regurgitation) is a disease in which the mitral valve does not close completely due to various causes (Fig. 2), and blood flows backward from the left ventricle to the left atrium when the left ventricle contracts. . In severe cases, symptoms of heart failure such as shortness of breath and swelling may appear, which may be life-threatening.

What is percutaneous mitral valve clipping (MitraClip®)?

Severe mitral regurgitation can cause palpitations, shortness of breath, fatigue, and heart failure requiring hospitalization. Until now, surgery (valve replacement/valvuloplasty) using an incision in the chest and a heart-lung machine has been the fundamental treatment. However, there were quite a few patients who gave up on surgery or were unable to actively recommend surgery because of poor heart function, other illnesses, or advanced age.

Transcatheter mitral valve clipping using the MitraClip® system is safer than surgery and can be performed even in patients with high surgical risk (Fig. 3). Since it is less invasive than surgery, it is now possible to treat patients who had difficulty undergoing surgery. It started in Europe in 2003 and started to be covered by health insurance in Japan in April 2018.

Indications for MitraClip®

MitraClip® is indicated when the risk of surgical valve replacement/plasty is high or judged impossible. Specifically, they are elderly, have a history of heart surgery, have a weak heart, have malignant tumors, are immunocompromised, and are frail. However, due to the nature of closing the mitral valve with a clip, MitraClip® may be difficult to treat depending on the morphology of the mitral valve. In addition to evaluating the general condition, the mitral valve was evaluated using cardiac ultrasound images, etc., and a multidisciplinary heart team consisting of cardiologists, Cardiology Cardiovascular Surgery, Anesthesiology, etc. Decide on a course of treatment.

inquiry

If you have any questions or concerns regarding MitraClip®, please consult with your primary care physician and then contact the Department of Cardiology at our hospital.

Consultation window

Cardiology Natsuhiko Ehara (Tuesday), Go Kitai (Monday)

What is Atrial Septal Defect

The heart has four chambers (Fig. 1). The upper two are called the left atrium and right atrium, and the lower two are called the left ventricle and right ventricle. The repeated beats of these four chambers enable the heart to pump blood efficiently. Oxygenated blood in the lungs is sent to the left atrium, through the mitral valve between the left atrium and the left ventricle, to the left ventricle. The left ventricle works as a pump for the heart, and the blood ejected from the left ventricle is sent to the whole body through the aorta through the aortic valve.

The atrial septum is the wall (septum) that separates the right atrium from the left atrium. If there is a hole in the interatrial septum due to various causes, the blood returning to the left atrium will flow into the right atrium, increasing blood flow from the right ventricle to the lungs. As a result, the load on the right atrium and right ventricle (right heart load) increases, which can lead to symptoms of heart failure. In addition, when pressure is applied to the body, for example, due to strong straining, blood flow may flow from the right atrium to the left atrium. If there is a blood clot in the right atrium, it may cause embolism such as cerebral infarction.

Closure of the atrial septal defect is effective in preventing and progressing symptoms when right heart overload or embolism is observed. Spontaneous closure of the perforation after childhood is rare, and closure of the perforation with a catheter or surgery is an option.

Occlusion plug used for catheter treatment

Catheter closure plugs are shaped like two discs. It is formed by knitting wires made of nitinol, a shape memory alloy, and the mesh of the wires is covered with a non-woven fabric. The obturator plug is soft and can be stretched and stored inside the catheter. A disk is pulled out one by one from the catheter, and the atrial septal defect is sandwiched between two disks from both sides to close the hole.

Actual flow of transcatheter atrial septal defect closure

General anesthesia or local anesthesia is administered to prepare for treatment. The state of the hole is observed by ultrasonography from inside the esophagus or blood vessel. Next, a vein is punctured from the base of the leg and a sheath is inserted. A guide wire is advanced through the sheath into the vessel, through the right atrium, interatrial septum, left atrium, and into the pulmonary veins. In that state, the wire is used as a guide to advance the delivery sheath (catheter that carries the closure plug) into the left atrium (①). Deploy the obturator plug from the tip of the delivery sheath (②), confirm that the defect is tightly closed with the disc on the left atrium side and the disk on the right atrium side (③ to ⑤), and attach the occluder plug to the delivery system. (6). In this state, the remaining shunt blood flow and the indwelling state of the occlusive plug are evaluated using ultrasound images. If the indwelling situation is unfavorable, the occlusive plug may be retrieved and placed again, or the treatment may be abandoned. Depending on the condition of the hole, multiple occlusive plugs may be used for treatment. After reconfirming that the occlusive plug is firmly fixed and the blood short-circuit has been properly improved, the delivery sheath is removed, and the base of the thigh is compressed or sutured to stop the bleeding, and the operation is completed. Surgery takes about 2-3 hours, including pre- and post-procedure preparation.

After the operation, you will wake up from the anesthesia, and if there is no problem in stopping the bleeding at the base of your leg, you will be able to stand up and walk. Also, after treatment, there may be sore throat due to the effects of anesthesia and transesophageal ultrasonography, but in most cases it will be relieved in a few days. You will be discharged from the hospital after checking your progress for several days to make sure there is no occluded plug.

Catheter-based atrial septal defect closure is considered to be a less invasive and safer treatment, but surgery may be a better option depending on the shape of the hole and other comorbidities. . At our hospital, a heart team consisting of cardiology Cardiology and Cardiovascular Surgery departments consults and considers treatment policies tailored to each patient. Atrial septal defect closure surgery using a catheter has been performed in Japan since 2005, and many people have been treated. Although there are a limited number of facilities that can perform this procedure in Japan, our hospital is accredited by the Japanese Association for Interventional Cardiovascular Interventions and the Japanese Association for Interventional Heart Diseases.

inquiry

If you have any questions or concerns regarding atrial septal defect closure, please consult with your primary care physician and then contact the Department of Cardiology at our hospital.

Consultation window

Cardiology Natsuhiko Ehara (Tuesday), Toshiaki Toyoda (Friday)

What is patent foramen ovale

The heart has four chambers (Fig. 1). The upper two are called the left atrium and right atrium, and the lower two are called the left ventricle and right ventricle. The repeated beats of these four chambers enable the heart to pump blood efficiently. Oxygenated blood in the lungs is sent to the left atrium, through the mitral valve between the left atrium and the left ventricle, to the left ventricle. The left ventricle works as a pump for the heart, and the blood ejected from the left ventricle is sent to the whole body through the aorta through the aortic valve.

The foramen ovale is a hole in the wall (atrial septum) that separates the right atrium and the left atrium, and it is there to circulate blood from the placenta throughout the fetus during fetus (Fig. 1). It usually closes spontaneously within a few months after birth, but it may remain open as it grows. This condition is called Persistent Foramen Ovale (PFO), and is said to occur in about one in four healthy adults. Blood can flow through this hole, but it is usually asymptomatic and does not require treatment. However, when venous pressure increases due to exercise or coughing, blood may flow from the right atrium to the left atrium through the foramen ovale. At that time, blood clots may pass through the foramen ovale, flow from the right atrium to the left atrium, arterial blood vessels, and reach the brain, resulting in cerebral infarction. If a patent foramen ovale is thought to be the cause of a stroke, the treatment option is to close the foramen.

About the treatment of patent foramen ovale

Whether a patent foramen ovale needs treatment depends on whether it is causing a stroke, the size of the hole, the amount of blood shunting (the amount of blood flowing through the hole), and complications such as heart failure and embolism. determined by the presence or absence of disease.
Catheter treatment for patent foramen ovale has become possible in Japan since 2019 with the Amplatzer PFO occluder. It is

Occlusion plug used for catheter treatment

Catheter closure plugs are shaped like two discs. It is formed by knitting wires made of nitinol, a shape memory alloy, and the mesh of the wires is covered with a non-woven cloth. The obturator plug is soft and can be stretched and stored inside the catheter. A disk is pulled out one by one from the catheter, and the foramen ovale is sandwiched between two disks from both sides to close the hole.

Actual flow of transcatheter patent foramen ovale closure

General anesthesia or local anesthesia is administered to prepare for treatment. The state of the hole is observed by ultrasonography from inside the esophagus or blood vessel. Next, a vein is punctured from the base of the leg and a sheath is inserted. A guide wire is advanced through the sheath into the vessel, through the right atrium, foramen ovale, and into the left atrium and pulmonary veins. Using the wire as a guide, the delivery sheath (catheter that carries the closure plug) is advanced into the left atrium. When the delivery sheath passes through the foramen ovale, the obturator plug connected to the cable is deployed from the tip (①), and it is confirmed that the hole is tightly closed with the disc on the left and right atrial sides ( ②), and remove the closure plug from the cable (③). In this state, the remaining shunt blood flow and the indwelling state of the occlusive plug are evaluated using ultrasound images. If the indwelling situation is unfavorable, the occlusion plug may be retrieved and placed again, or the treatment may be abandoned. Depending on the condition of the hole, multiple occlusive plugs may be used for treatment. After confirming once again that the occlusion plug is firmly fixed and the blood short-circuit has been properly improved, the delivery sheath is removed and the base of the thigh is compressed or sutured to stop the bleeding, and the operation is completed. Surgery takes about 1-2 hours, including pre- and post-procedure preparation. After the operation, you will wake up from the anesthesia, and if there is no problem in stopping the bleeding at the base of your leg, you will be able to stand up and walk. Also, after treatment, there may be sore throat due to the effects of anesthesia and transesophageal ultrasound, but in most cases it will be relieved in a few days. You will be discharged from the hospital after checking your progress for several days to make sure there is no occluded plug.

Closure of patent foramen ovale using a catheter is considered to be a highly safe treatment with little burden on the body, but its main purpose is to prevent recurrence of cerebral infarction due to patent foramen ovale. At our hospital, the brain-heart team consisting of Cardiology and Neurology consults and considers treatment policies tailored to each individual patient.
Patent foramen ovale closure surgery using a catheter has been performed in Japan since 2019, and many people are being treated. Although there are a limited number of facilities that can perform this procedure in Japan, our hospital is accredited by the Japanese Association for Interventional Cardiovascular Interventions and the Japanese Association for Interventional Heart Diseases.

inquiry

If you have any questions or concerns about patent foramen ovale closure surgery, please consult with your primary care doctor and then contact the Department of Cardiology at our hospital.

Consultation window

Cardiology Natsuhiko Ehara (Tuesday), Toshiaki Toyoda (Friday)

We perform stent graft treatment to prevent rupture of aortic aneurysms and catheter treatment to improve blood flow in the lower extremities.

Stent graft treatment for aortic aneurysm

What is an aortic aneurysm

An aneurysm is a dilated part of a blood vessel that is 1.5 times or more the diameter of the normal artery. An aneurysm in the abdominal aorta is called an abdominal aortic aneurysm, and an aneurysm in the thoracic aorta is called a thoracic aortic aneurysm. Most of them are caused by atherosclerosis and are asymptomatic.

Aortic aneurysms with a size (diameter) of 50 mm or more in the abdomen and 60 mm or more in the chest are said to be prone to rupture and should be treated. Even if the aneurysm is less than these sizes, it may be indicated for treatment depending on the shape of the aneurysm, which is prone to rupture, or the speed of expansion of the aneurysm.

What is stent graft treatment?

A stent graft is a combination of an artificial blood vessel and a stent (a metal mesh, like a spring). Stent graft treatment prevents aortic aneurysm rupture by inserting it from the femoral artery (artery at the base of the leg) and expanding it at the affected area to block blood flow to the aneurysm.

This treatment method has the advantage of being less stressful on the body than the conventional thoracotomy or laparotomy artificial blood vessel replacement. However, depending on the anatomical conditions of the blood vessel (the degree of tortuousness of the blood vessel, the distance between the branch from the aorta and the aortic aneurysm, etc.), stent graft surgery may be difficult. comprehensively assess the condition of the patient and select a treatment method.

In addition, leaks (leakage of blood flow) may occur in the future as a problem specific to stent graft treatment. Therefore, after stent graft treatment, it is necessary to have regular examinations such as CT scans.

Catheterization for peripheral arterial disease

In recent years, the number of arteriosclerotic diseases is on the rise due to the aging of the population and the westernization of dietary habits.

Arteriosclerosis obliterans is a disease that causes ischemic symptoms in the lower extremities mainly due to stenosis or blockage of arteries in the lower extremities. Symptoms range from intermittent claudication (pain in the legs when walking) to severe pain in the legs at rest, ischemic ulcers, and gangrene.

An upper extremity index (ABI) test can be used to screen for lower extremity ischemia. If lower extremity ischemia is suspected, vascular echo examination, CT examination, skin perfusion pressure test (SPP), etc. are performed in order to more accurately examine the stenosis, occlusion site, and blood flow. When finally considering revascularization treatment, angiography (catheterization) is often performed.

Revascularization treatment (catheterization or bypass surgery) is considered for the purpose of improving symptoms, or when ulcers are intractable due to severe lower extremity ischemia. Which treatment is better depends on the site and morphology of the lesion, so it is necessary to consider for each patient.

Catheterization is usually performed by inserting a tube from the femoral artery (artery at the base of the leg), checking for stenosis or blockage with a contrast medium, expanding it with a balloon, and placing a stent if necessary. With this treatment, even if the treatment is successful, reocclusion or restenosis may occur 6 months to 1 year later. After surgery, oral antiplatelet agents are required.

Catheter ablation is a treatment that burns (burns the heart wall) a portion of the heart muscle that causes tachyarrhythmia. The official name in Japanese is percutaneous catheter myocardial ablation (K-5951, K-5952), which has been rapidly progressing and becoming widely performed since the 1980s.

catheter ablation

Catheter ablation is a treatment that burns (burns the heart wall) part of the heart muscle that causes tachyarrhythmia. The official name in Japanese is percutaneous catheter myocardial ablation (K-5951, K-5952), which has been rapidly progressing and becoming widely performed since the 1980s. First, after local anesthesia, multiple electrode catheters (electrical cord-like devices with a diameter of 3 mm and a length of about 1 m) are inserted from the base of the foot (mainly the right hip joint), the right neck, and the shoulder.

These electrode catheters are placed inside the heart to monitor for arrhythmias (cardiac electrophysiology). Once the type and cause of the arrhythmia are identified, immediate treatment (ablation) is performed. A high-frequency current is applied from the tip of the catheter for about one minute to the myocardium involved in abnormal electrical signals. Myocardium to which an electric current is applied generates heat of 50-60°C, causing cells to collapse and harden (protein denaturation and coagulative necrosis). The congealed heart muscle can no longer generate abnormal signals or make abnormal electrical circuits. In other words, the cause of the arrhythmia disappears and the patient is completely cured.

Length of hospital stay and costs

To date, almost all tachyarrhythmias can be cured by catheter ablation. General ablation treatment at our hospital requires hospitalization for 2 nights and 3 days. Arrhythmias that can be performed on a 2-night, 3-day schedule include paroxysmal supraventricular tachycardia (WPW syndrome, atrioventricular nodal reentrant tachycardia, atrial tachycardia), atrial flutter, ventricular extrasystole, (idiopathic Gender) ventricular tachycardia. Atrial fibrillation and (organic) ventricular tachycardia have hospitalization schedules of 4 days 3 nights to 6 days 5 nights (see below).

Arrhythmia ablation is covered by health insurance, and many life and medical insurance policies cover surgery benefits. The cost of hospitalization is about 100,000 yen.

About complications

It is a treatment that is expected to please many people, freeing them from the anxiety of palpitations and the curse of lifelong drugs. The main ones are rebleeding and hematoma at the catheter insertion site, vascular injury and cardiac tamponade (lowering blood pressure due to bleeding from the heart), embolism (cerebral infarction and pulmonary embolism), infection, and new diseases such as atrioventricular block. arrhythmia, etc. At our hospital, we make every effort to ensure that all patients undergoing ablation treatment are fully informed of the possibility of these complications, as well as preventive measures.

atrial fibrillation ablation

Catheter ablation requires specialized knowledge and skill, so it can only be performed at a hospital with an Arrhythmia Specialist. Above all, ablation treatment for atrial fibrillation requires advanced technology, but we are actively treating it at our hospital.

Atrial fibrillation is divided into paroxysmal atrial fibrillation in which arrhythmia attacks occur occasionally, persistent atrial fibrillation in which arrhythmia persists for one week or longer, and long-lasting (chronic) atrial fibrillation in which arrhythmia persists for one year or longer. increase. In paroxysmal atrial fibrillation, it has been found that many of the abnormal signals that trigger tachycardia attacks are expressed from around the pulmonary veins (blood vessels that return blood cleaned in the lungs to the left atrium). In order to prevent this abnormal signal from being transmitted to the atrium, electricity is applied to the junction of the pulmonary vein and the left atrium to create a circumferential ablation line. The basic atrial fibrillation ablation is the ablation method (pulmonary vein isolation) that confines the abnormal signal in the pulmonary vein. At our hospital, we perform a method (enlarged ipsilateral pulmonary vein isolation) that further enhances effectiveness by isolating the four pulmonary veins on the left, right, top and bottom all at once, two each on the top and bottom. For early onset (paroxysmal) atrial fibrillation, 80% of patients respond with one treatment with this method. Furthermore, multiple treatments are effective in 93% of patients.

With a long history of atrial fibrillation, the condition progresses gradually and the arrhythmia persists. For such persistent and chronic atrial fibrillation, in addition to the enlarged ipsilateral pulmonary vein isolation described above, options include superior vena cava isolation, left atrium linear ablation, and fibrillation matrix ablation. We are also doing a combination of treatment methods. With these methods, 60% of sustained atrial fibrillation are successful with one treatment.

Among those who are suffering from atrial fibrillation, if "palpitations do not subside even with drug treatment" or if you want to "reduce the risk of developing cerebral infarction", this atrial fibrillation is recommended. Ablation seems to be a good treatment. Atrial fibrillation ablation is performed on a hospitalization schedule of 3 nights and 4 days to 5 nights and 6 days.

Advances in ablation treatment technology

Catheter ablation is a treatment method with a history of only about 20 years, but it is progressing at a rapid pace. At our hospital, we actively introduce useful new treatment devices and use them to improve treatment results.

CARTO

The "CARTO" system can search for the cause of arrhythmia in detail and three-dimensionally based on the navigation function based on magnetic field information, and can create a three-dimensional arrhythmia map by combining CT images and intracardiac ultrasound images.

EnSite Array

The "EnSite" system can capture instantaneous changes in arrhythmia and display those movements in three dimensions.

contact force catheter

By sensing the pressure at the tip of the ablation catheter, the "Contact Force Catheter" offers even greater therapeutic efficacy and safety.

New atrial fibrillation ablation treatment method

In addition, we have introduced new atrial fibrillation ablation treatment methods such as “cryocoagulation balloon ablation” and “hot balloon ablation” from Japan.

Appropriate use of these latest devices has been effective in treating more people suffering from arrhythmia than ever before.

Treatment results

Annual number of ablation treatment cases

Treatment results

In paroxysmal atrial fibrillation, which is an early-onset type, the treatment results are generally good, but the longer the duration of the arrhythmia, the less effective the treatment. As shown below, the results of treatment at our hospital (normal pulse maintenance effect) show a similar trend. Early detection and early treatment of atrial fibrillation are important.

inquiry

Patients who have problems with palpitations, irregular pulse, etc., or who wish to undergo catheter ablation treatment, please consult with their family doctor and visit the Cardiology Arrhythmia Outpatient Department (Wednesday: Kobori, Friday: Sasaki). .

If you have any questions about arrhythmia in general, please contact us by e-mail (mail mark). Please feel free to use it.

Treatment with a pacemaker or implantable cardioverter-defibrillator for bradyarrhythmia or tachyarrhythmia.

Device therapy for arrhythmia

pacemaker treatment

The heart is divided into four chambers (left and right atria, left and right ventricles) by muscular walls (myocardium). The four chambers regularly contract and expand about 100,000 times a day, acting as a pump to send blood throughout the body. The regular beating of the heart (heart movement) is controlled by stimulation of "electrical signals" that flow through the myocardium. The "electrical signals" that move this heart are made in the heart's power station (sinus node) and are regularly transmitted at a rate of 60-100 times per minute. It flows in one direction along the wall of the heart from the top (atrium) to the bottom (ventricle), stimulating and contracting the myocardium in a regular manner.

A heart disease that requires a pacemaker is called "bradyarrhythmia," which is a condition in which the heart beats abnormally slow due to an arrhythmia. Typical examples include sinus insufficiency syndrome (a condition in which the function of the sinus node, which emits heartbeat signals, is impaired), and atrioventricular block (the heartbeat signal emitted from the sinus node is blocked in the middle and is not successfully transmitted to the ventricles). state). A bradyarrhythmia prevents the brain and body from getting enough blood, and may cause temporary loss of consciousness or dizziness.

A pacemaker constantly monitors the patient's own pulse and electrical signals and provides electrical stimulation to the heart to prevent it from becoming too slow. If the patient's own pulse is well maintained, electrical stimulation is not given. A pacemaker consists of a body consisting of an electrical circuit and a battery, and wires (leads) that transmit electrical signals to the heart. The size of the main body is about 5 cm in width, and the heat is about 8 mm.

The pacemaker body is implanted under the skin through an incision of several centimeters in the skin slightly below the collarbone. One or two wires are implanted through blood vessels deep in the clavicle to reach the heart. The surgery is performed under local anesthesia and takes about 1 to 2 hours. After surgery, if the progress is good, hospitalization for about a week is necessary.

After you leave the hospital, you can live the same life as before the pacemaker was implanted. However, there are a small number of electrical appliances in the home and some that require attention when inspected by medical equipment in hospitals.

Implantable defibrillator, fully subcutaneous implantable defibrillator, wearable defibrillator

An implantable cardioverter defibrillator (ICD), which stands for Implantable Cardioverter Defibrillator, prevents sudden death from life-threatening severe arrhythmias (ventricular fibrillation and ventricular tachycardia). It is an implantable therapeutic device for

In a healthy heart, electrical impulses are produced in the upper part of the right atrium called the sinus node, and the impulses pass through the atrium, through the center of the heart called the atrioventricular node, to the ventricles, and then into the ventricles. muscles contract. As a result, blood is pumped throughout the body (brain, stomach, intestines, kidneys, muscles, etc.) to sustain life. However, when some kind of disorder occurs in the heart, the ventricular muscles suddenly become excited on their own, causing abnormally rapid contractions and irregular tremors. This condition is called ventricular tachycardia or ventricular fibrillation. In ventricular tachycardia or ventricular fibrillation, sufficient blood cannot be pumped throughout the body, causing fainting or sudden death.

When an implantable cardioverter-defibrillator is implanted in the body, it automatically detects such sudden and life-threatening arrhythmias (ventricular tachycardia or ventricular fibrillation) and provides immediate electrical therapy to Arrhythmia can be stopped. An implantable cardioverter-defibrillator consists of a metal "main body" that contains a battery and a microcomputer, and "leads" that are placed in the heart through blood vessels and transmit electrical information from the heart to the main body. increase. Generally, the body is implanted between the skin and muscle on either side of the chest (slightly below the collarbone). One lead wire is placed in the heart chamber called the right ventricle from the subclavian vein, which is a large vein that leads to the heart, and if necessary, another lead wire is placed in the heart chamber called the right atrium. In the absence of an arrhythmia, the implantable cardioverter-defibrillator only monitors for arrhythmias. An implantable cardioverter-defibrillator also has the function of a pacemaker, so it is possible to compensate for the heart rate by pacing people who have a slow pulse (called bradycardia). If an arrhythmia occurs, lead wires placed in the heart transmit electrical signals to the body. If the main unit determines that the arrhythmia requires treatment, it will be treated. There are two main types of treatment: "anti-tachycardia pacing," which uses rapid pacemaker-like stimulation to stop arrhythmias, and "cardioversion," which is called "defibrillation." , which gives an electrical shock to the heart to stop the arrhythmia. Arrhythmia detection judgments and electrical therapy methods are programmed into the main unit in advance to suit each patient's disease.

During surgery, a local anesthetic is injected about 3 cm below the collarbone. Local anesthesia is usually used to keep you conscious during the procedure, but a sedative may be used to make you feel more comfortable. After the anesthesia has taken effect, a few centimeters of skin is cut about three centimeters below the collarbone to create a small pocket under the skin for the implantable cardioverter-defibrillator. Insert one or two wires (leads) connecting the main body of the implantable cardioverter defibrillator and the heart into the large vein that runs under the collarbone (subclavian vein), and ensure that the leads are properly inserted into the desired location in the heart. Check with X-ray fluoroscopy. The leads are attached to the body of the implantable cardioverter-defibrillator, tucked under the skin, and the incision is sutured. After that, depending on the case, we may actually induce a ventricular arrhythmia and confirm that it works properly after an anesthetic is dripped intravenously and the patient is asleep. Surgery time is about 2 to 3 hours. After the surgery, you will only need to rest for a few hours, and you will be able to leave the hospital and return to your daily life in about a week.

Until now, only implantable cardioverter-defibrillators of the type in which wires are placed in the heart through blood vessels were available, but since 2016, the main body implanted under the armpit and one subcutaneously placed defibrillator have been available. Total subcutaneous implantable cardioverter-defibrillators (S-ICDs), which use leads to deliver shock therapy, are now available. In this system, the main body and wires do not touch the heart or blood vessels, so there is a possibility of complications not only during implantation surgery, but also when the lead or main body is infected with bacteria and the lead must be removed. is expected to decrease. Implantation is usually performed under general anesthesia. In addition, it may not be used depending on the patient's arrhythmia type and heart condition.

In addition, if it is unclear whether the patient needs to be implanted with an implantable cardioverter-defibrillator or if the patient's condition makes it impossible to implant an implantable cardioverter-defibrillator immediately, it may be worn for a limited period of time. An automatic defibrillator may also be used.

Implantable electrocardiograph (implantable loop recorder)

Fainting can have many causes, some of which are caused by an arrhythmia. The most reliable way to diagnose whether syncope is caused by an arrhythmia is to check the electrocardiogram at the time of syncope. For this reason, a 24-hour electrocardiogram recording called Holter ECG is often performed, but since it is not possible to know when an arrhythmia will occur, the possibility of an arrhythmia that causes fainting during Holter ECG recording is very low. Not expensive. Therefore, an implantable electrocardiograph may be used to clarify the cause in patients with unexplained fainting. Implantable electrocardiographs can record electrocardiograms for a long period of time (up to about 3 years).

An implantable electrocardiograph is a very small device that is implanted under the skin in the left chest. The operation takes about 30 minutes under local anesthesia. Once the wound has healed, you can resume normal activities such as bathing and exercising.

pacemaker outpatient

Patients with a pacemaker or implanted cardioverter-defibrillator should visit the pacemaker outpatient clinic regularly to check for battery exhaustion and lead problems, whether the settings are appropriate, and whether there is no arrhythmia requiring treatment. etc. In addition, we are available to answer questions and concerns about daily life related to pacemakers, etc., and help you lead a more comfortable life.

Recently, we are also conducting management through remote monitoring. If a transmitter is installed in the home of a patient with a pacemaker or an implanted cardioverter-defibrillator, the same information as the checkup performed at the pacemaker outpatient clinic will be automatically reflected on the website via the telephone line. Our clinical engineers and doctor can obtain this information through the Internet. As a result, it is possible to safely reduce the frequency of outpatient visits to pacemaker outpatient clinics, and to enable early detection of abnormalities in the lead and body, as well as arrhythmias that require treatment.

A new treatment for heart failure, "cardiac resynchronization therapy," uses a pacemaker to improve the pumping function of the heart.

What is Cardiac Resynchronization Therapy?

A new treatment for heart failure, "cardiac resynchronization therapy," uses a pacemaker to improve the pumping function of the heart.

The heart has four chambers (right atrium, right ventricle, left atrium, left ventricle). The blood that has returned from the whole body passes through the right atrium and right ventricle, goes to the lungs, receives oxygen in the lungs, and then flows through the left atrium and left ventricle to the whole body. The heart works by sending electrical signals through its four chambers. In a healthy heart, these electrical signals travel in an orderly manner. However, when some kind of disorder occurs in the heart, the order in which electrical signals are transmitted in the heart may be shifted. If the electrical signal of the ventricle, which should be transmitted to the entire ventricle almost at the same time, is not transmitted quickly and slowly, the heart will also move erratically (ventricular dyssynchrony). . Ventricular dyssynchrony in a weakened heart can further weaken the heart and cause an inadequate pumping of blood, leading to heart failure.

In such cases, a device (pacemaker) that artificially emits electrical signals to create a regular rhythm sends electricity to two separate locations in the left ventricle to arrange the sequence of electrical signals transmitted to the heart (resynchronization). Treatment to improve heart function is sometimes given and is called cardiac resynchronization therapy. Of the four chambers of the heart, the left ventricle plays the most important role. It can also improve the contraction gap between the left ventricle and the right ventricle. A pacemaker must be implanted under the skin in the chest to keep electrical signals flowing to the heart.

Cardiac resynchronization therapy is indicated for patients who meet the following conditions:

• People with moderate to severe heart failure, such as shortness of breath even with light exertion
• Patients with "ventricular dyssynchrony," in which the ventricles do not contract well due to abnormalities in the way electrical signals are transmitted in electrocardiograms and echocardiograms.
• Patients with very poor cardiac function (left ventricular ejection fraction of 35% or less [normal value: 55% or more])
• Those who are treated with various medicines but do not improve their symptoms

In principle, this treatment can be performed at hospitals that meet the “Facility Standards for Biventricular Pacemaker Implantation” established by the Ministry of Health, Labor and ministry of Health, Labor and Welfare notation, and performed by a Certified Physician for this surgery. Our hospital has been performing cardiac resynchronization therapy since 2004. By September 2008, 31 patients had undergone de novo implant surgery. Although there were no serious complications such as death or cardiac rupture due to the operation, there was one case in which the lead was detached after the operation and reoperation was required. Unlike general pacemaker treatment for arrhythmia, cardiac resynchronization therapy is intended for patients with severe heart failure, so it is reported that there is a 30% chance that symptoms will not improve even after surgery. Results at our hospital showed that 65% of patients were treated effectively (improved left ventricular ejection fraction by 5% or more). For people at high risk of developing a life-threatening arrhythmia, a biventricular pacemaker may be implanted to defibrillate the heart by delivering an electrical shock to the heart to stop the arrhythmia.

Cardiac resynchronization therapy is performed to supplement drug therapy, and you will continue to take the drug as before, so please follow your doctor's instructions. You should also have your pacemaker checked regularly.

Surgery for cardiac resynchronization therapy

The surgery involves inserting a pacemaker under the skin of the chest. A local anesthetic is injected about 3 cm below the collarbone. Local anesthesia is usually given so that you remain conscious during the procedure. When implanting a biventricular pacemaker with a defibrillation function, it may be performed under general anesthesia.

After the anesthetic has taken effect, a few centimeters of skin is cut to create a small pocket under the skin where the pacemaker will fit. Insert 3 wires (leads) connecting the pacemaker body and the heart (2 wires in the case of atrial fibrillation) into the thick vein running under the clavicle, and make sure the leads are properly inserted into the desired location in the heart. Check with X-ray fluoroscopy. The lead is attached to the body of the pacemaker, tucked under the skin, and closed by suturing the incision. After surgery, the implanted skin may swell slightly.

Cardiac rehabilitation is designed to help patients with heart disease lead a safe and comfortable life after discharge from the hospital.

Efforts in Cardiac Rehabilitation

Cardiac rehabilitation is designed to help patients with heart disease lead a safe and comfortable life after discharge from the hospital. Cardiac rehabilitation focuses on exercise therapy, but also includes education and counseling to prevent future cardiovascular disease. Cardiac rehabilitation is said to be effective in improving exercise capacity, symptoms, arteriosclerosis risk factors, and psychological status in patients with heart disease, and is also said to reduce mortality. Surgery and medicine alone are not enough to treat heart disease. Cardiac rehabilitation is the way to compensate for the maximum therapeutic effect.

In the past, cardiac rehabilitation was mainly considered as exercise therapy aimed at recovery from muscle weakness resulting from long-term bed rest due to illness. It has come to be called comprehensive cardiac rehabilitation, which includes many elements such as education and enlightenment about diseases for family members, dietary guidance, smoking cessation guidance, and lifestyle guidance such as stress management. doctor and nurses alone are not enough to perform comprehensive cardiac rehabilitation. At our hospital, many occupations such as physiotherapists, nutritionists, pharmacists, and clinical psychologists participate to practice team medicine. We strive to help our patients in many ways.

Target diseases of cardiac rehabilitation

1. acute myocardial infarction
2. after heart surgery
3. angina pectoris
4. Macrovascular disease (aortic dissection, aortic aneurysm, post-aortic surgery)
5. chronic heart failure
6. Lower extremity arteriosclerosis obliterans

Effects of cardiac rehabilitation

Cardiac rehabilitation consists mainly of exercise therapy, lectures on heart disease and its prevention, and multidisciplinary counseling. Here, we will explain what kind of positive effects can be obtained by doing exercise therapy for people with heart disease.

Around 1940, patients with acute myocardial infarction were forced to undergo absolute bed rest for a period of time for treatment. However, after that, problems such as muscle weakness due to prolonged absolute rest began to be pointed out, and in the 1970s, exercise therapy after myocardial infarction began to be widely performed. Similarly, until around 1980, patients with chronic heart failure were treated with rest and activity restrictions. However, the exercise tolerance (how hard you can exercise) in patients with chronic heart failure has little to do with heart function, but rather muscle mass and vascular endothelium (the inner wall of blood vessels). It has been found that the functions of certain cells, which play an important role in dilating blood vessels, are important. For this reason, exercise therapy is now being performed even in patients with chronic heart failure.

From now on, we will take a closer look at how exercise therapy specifically brings about changes in the body and mind.

Effects of cardiac rehabilitation

Cardiac rehabilitation consists mainly of exercise therapy, lectures on heart disease and its prevention, and multidisciplinary counseling. Here, we will explain what kind of positive effects can be obtained by doing exercise therapy for people with heart disease.

Around 1940, patients with acute myocardial infarction were forced to undergo absolute bed rest for a period of time for treatment. However, after that, problems such as muscle weakness due to prolonged absolute rest began to be pointed out, and in the 1970s, exercise therapy after myocardial infarction began to be widely performed. Similarly, until around 1980, patients with chronic heart failure were treated with rest and activity restrictions. However, the exercise tolerance (how hard you can exercise) in patients with chronic heart failure has little to do with heart function, but rather muscle mass and vascular endothelium (the inner wall of blood vessels). It has been found that the functions of certain cells, which play an important role in dilating blood vessels, are important. For this reason, exercise therapy is now being performed even in patients with chronic heart failure.

From now on, we will take a closer look at how exercise therapy specifically brings about changes in the body and mind.

(1) Improvement of exercise tolerance

Exercise increases muscle mass and increases the number of capillaries in the muscles, allowing the body to take in more oxygen and improving exercise tolerance. It is said that people with better exercise tolerance (those who can perform more intense exercise with less symptoms) are less likely to die from heart disease, so it is expected that exercise therapy will extend the lifespan of heart disease patients. I can do it.

(2) Improvement of heart function

It is said that exercise therapy improves the diastolic function of the heart, lowers blood pressure, and increases the volume of blood pumped from the heart. In the past, there was a time when exercise therapy was thought to cause the heart to grow in size and its function to decline, but we now know that there is no such concern.

(3) Improvement of blood vessel function

The walls of blood vessels are lined with cells called endothelial cells. These cells produce substances that dilate blood vessels, such as nitric oxide (NO), and play a very important role in regulating the expansion and contraction of blood vessels as needed. It is said that exercise therapy improves the function of these vascular endothelial cells, making it easier for the heart and muscles to dilate during exercise, increasing blood flow and improving symptoms.

(4) Improving muscle mass and quality

Physical therapy improves muscle mass and quality. In addition, it is said that the amount of blood pumped out of the heart also increases because it becomes easier for blood to return from the veins to the heart by increasing the muscle mass and contractile force.

(5) Improving balance of autonomic nerves

The autonomic nervous system consists of the sympathetic nervous system (activated during intense activity) and the parasympathetic nervous system (activated during relaxation). In patients with heart disease, the sympathetic nervous system is always dominant, and the parasympathetic nervous system tends to be weakened. When the sympathetic nervous system becomes dominant unnecessarily, the heart rate increases even at rest, arrhythmia is likely to occur, and palpitations may occur. Conversely, when exercising, the heart rate does not rise properly and excessive breathing occurs, making it easier to get tired. Exercise therapy can improve the balance between the sympathetic and parasympathetic nerves, so these symptoms can be expected to improve. In addition, it is said that the stronger the sympathetic nerve activity, the shorter the life expectancy of heart disease patients.

(6) Psychological effect

Patients with heart disease have symptoms such as palpitations, shortness of breath, fatigue, and chest pain that limit their daily activities. If such a state continues, it will become easy to become depressed mentally. Exercise is thought to have a positive effect on the mind, as it improves mood and can be expected to improve symptoms through exercise therapy.

As described above, exercise therapy has various effects, and one study reported that exercise therapy was able to reduce the risk of death and hospitalization due to heart disease.

Cardiac rehabilitation is not just exercise therapy. Since various occupations (doctor, nurses, physical therapists, pharmacists, nutritionists, etc.) are comprehensively involved in the treatment of one patient, various things such as precautions in daily life, diet and oral medicine can learn.

Be aware of the following symptoms in your daily life.

What is Cardiac Rehabilitation?

lifestyle guidance

The purpose of cardiac rehabilitation is not only to recover the physical strength that has temporarily decreased due to illness and to aim for social reintegration. The goal is to help patients stay healthy and maintain a high quality of life after discharge from the hospital. For that reason, patients themselves need to acquire correct knowledge and continue to practice healthy behaviors based on that knowledge.

lifestyle guidance

The purpose of cardiac rehabilitation is not only to recover the physical strength that has temporarily decreased due to illness and to aim for social reintegration. The goal is to help patients stay healthy and maintain a high quality of life after discharge from the hospital. For that reason, patients themselves need to acquire correct knowledge and continue to practice healthy behaviors based on that knowledge.

Purpose of lifestyle guidance

Many heart diseases are said to be caused by unhealthy lifestyles. Also, heart disease is a recurring disease. Unhealthy lifestyles are often cited as a factor in relapses of diseases that have once recovered. The purpose of lifestyle guidance is for patients to review their past lifestyle habits after being hospitalized, specifically think about new lifestyle habits after discharge, and to be able to continue to do so for a long period of time.

What to Do in Cardiac Rehabilitation

Nurses are mainly in charge of lifestyle guidance. Together with the patient, the nurse reviews the lifestyle before hospitalization. Together with the patient, I think about life after discharge and help them to carry out healthy behaviors that are more individualized. We also support you to maintain good health for a long time after you leave the hospital. We provide opportunities for individual health consultations with patients not only during hospitalization, but also during outpatient cardiac rehabilitation and regular outpatient visits.

How to cope with heart disease

1. Observe your physical condition

It is the most important item for physical condition management. If you can monitor your weight, blood pressure, pulse, and whether you have subjective symptoms, it will be easier to manage your physical condition. In addition, problems can be detected early, leading to early consultation with a medical institution. As a result, the damage to the body can be kept to a minimum even if it deviates from health. In order for the patient to be able to monitor their own physical condition, we will work with nurses to confirm methods for measuring weight, blood pressure, and pulse, as well as methods for observing subjective symptoms.

2. Salt reduction and water management

It is an unavoidable item to deal with heart disease. Excess salt increases blood pressure. Salt also causes the body to retain water, which can lead to overhydration and heart failure. A registered Registered Dietitian explains in detail about a diet for heart disease (low-salt diet), but we spend a lot of time devising dietary habits during lifestyle guidance.

3.Establishment of exercise habits

Exercise therapy has a very positive effect on heart disease. Patients who have established exercise habits are expected to not only stabilize their blood pressure, blood sugar levels, and cholesterol levels, prevent recurrence of heart disease, but also prolong their life and health prognosis. However, excessive exercise puts a strain on the heart, exacerbates medical conditions, and may even trigger seizures. Appropriate exercise intensity varies from person to person, but in cardiac rehabilitation, exercise therapy is carried out by selecting the exercise intensity that suits each individual. In addition, physical therapists play a central role in providing individual guidance on exercise therapy so that even after discharge from the hospital, exercise therapy can be performed at the same intensity.

4. Prevention of stress on the heart in daily life

Excessive strain on the heart is dangerous not only during exercise but also in everyday life. For example, taking a bath immediately after eating, doing housework continuously, and exercising without taking internal medicine. Inadvertent actions can cause excessive strain on the heart, so through lifestyle guidance, we explain how to prevent stress on the heart in daily life.

In this way, there are many items that must be known in order to successfully deal with heart disease. Furthermore, performing these procedures continuously over a long period of time requires a great deal of effort, and performing them all places a heavy burden on the patient. Therefore, in the lifestyle guidance we provide, we try to suggest actions that patients should continue to take in order to maintain their health in a way that is less burdensome. Please take advantage of cardiac rehabilitation to maintain your own health and continue a higher quality of life.

General exercise program

Appropriate selection and continuation of exercise is important to lead a comfortable daily life.

Appropriate selection and continuation of exercise is important to lead a comfortable daily life.

Step1 Let's improve physical strength

type of exercise

aerobic exercise

Exercise that takes in enough oxygen in the body

• Walking, bicycling, swimming (underwater walking), etc.

anaerobic exercise

exercise performed in conditions where oxygen is scarce

Sprinting, pull-ups, push-ups, weightlifting, etc.

People with heart disease are recommended to do "aerobic exercise" at light to moderate intensity without putting a strain on the heart. Gradually increase the pace during the first 3 minutes as a warm-up, and gradually decrease the pace during the final 3 minutes as a cool-down. This will also help prevent injuries.

exercise intensity

pulse rate

Aim for a heart rate that does not strain the heart.

Subjective symptoms

Perceived exercise intensity (Borg index) is used.

Exercise using 11 (easy) to 13 (somewhat hard) as a guideline. It is an exercise that makes you sweat lightly or you can have a conversation while exercising.

exercise time

Start with a comfortable time and extend it little by little. A typical goal is 30-40 minutes.

exercise frequency

If possible, every day is good, but 3 to 5 times a week is fine.

Step2 Strengthen your muscles

resistance training

weight training

effect

Improving muscle strength, muscle mass, muscle endurance, improving basal metabolism

Method

* Don't hold your breath, don't recoil

number of times

More reps with lighter weights

frequency

2-3 times a week

Precautions for exercise therapy

1. Avoid strenuous exercises that compete with others.
2. Avoid extremely cold days and driving in hot weather.
3. After heart surgery, avoid extreme movements such as arching your chest, twisting your body, and lifting heavy objects.
4. Sweating increases the viscosity of blood, making it easier for blood vessels to clog. Hydrate before and after exercising.

How much can I actually move?

In order to know this, "lower extremity muscle strength measurement" and "cardiopulmonary exercise test (CPX)" are necessary.

Lower extremity strength measurement

Lower extremity muscle strength is important for exercise tolerance and daily living. It is also believed to be associated with survival. Assess leg muscle strength objectively.

cardiopulmonary exercise test

CPx can be used to understand how much movement is possible in daily life, and can be used for lifestyle guidance.

diet remedy

About meals and nutrition

Group nutrition class
Cardiovascular diseases include hypertension, angina pectoris, myocardial infarction, heart failure, arteriosclerosis, etc. In order to prevent and treat these diseases, it is necessary to acquire good eating habits and lifestyle habits for the body. . In the classroom, we mainly talk about the rhythm of meals, the appropriate weight, the amount of salt and the quality of fat. Let's think together about what we should be careful about in our normal eating habits. We will also explain the points of how to reduce salt in your daily diet and other cooking methods.

Individual nutrition consultation
For those who have taken a group nutrition class, registered Registered Dietitian use food models etc. to provide more specific dietary therapy that suits each patient's life so that it will lead to life after discharge. I will talk to

materials to actually use

drug therapy

group classroom

There are various types of drugs used for cardiovascular disease, but I will talk about the drugs that are commonly used. It is very important to understand exactly what the medicine is prescribed for. Your medication may change depending on your condition. If you know what kind of medicines are available other than the medicines you are taking now, it will be useful for future reference, so let's study together.

Individual explanation

We'll talk more about individual medications.

Frequently Asked Questions

Q1: When do you take 1 "about 30 minutes after meals", 2 "just before meals", and 3 "immediately after meals"?

(1) within 30 minutes after finishing a meal, (2) 10 minutes before a meal, and (3) 10 minutes after a meal.

Q2: Is it okay to take medicines "after meals" without eating?

In general, there are many medicines that can be taken without food without any problem, but depending on the type, there are cases where it is preferable to take food with food from the viewpoint of side effect prevention, there are cases where it is necessary to take food with food from the viewpoint of efficacy, and there are cases where it is necessary to take food with food. Some medicines must be taken on an empty stomach, so be sure to consult a pharmacist.

Q3: I don't know how to take too many medicines! The tablets are big and hard to swallow! Is there a better way?

It is possible to package each dose in a single bag, or to powder it by crushing it into powder. However, there are some medicines whose quality deteriorates when packed or powdered, so be sure to consult your doctor or pharmacist.

Q4: Can I stop taking the medicine when the symptoms disappear?

Discontinuing the medicine at your own discretion may worsen the condition, so be sure to follow your doctor's instructions regarding dosage and administration. Let's solve other things that are in trouble and doubts together! !

psychotherapy

Lecture on stress

In everyday life, it seems that various hardships and tensions have an effect on the mind and body. Modern people call these “various things” “stress,” and they are working hard not to be defeated by it. I want to take the attitude of not taking it lightly, but not fearing it. I wish I could tell you a little bit of the contents.

psychology test

The inherent uniqueness of a person is difficult to express in numbers or diagrams. Acknowledging these limitations, psychological tests are a tool to roughly understand one's personality and state of mind. Please contact us if you are interested.

self-reliance training

I find myself annoyed. Even when it's okay to relax, the tension doesn't go away. The self-reliance training method is a procedure to calm yourself down in such a case. I will explain how to proceed with practice for those who want to practice and wear it.

Cardiac rehabilitation scene

Voices of patients who participated in cardiac rehabilitation

Q: What made you decide to participate in outpatient cardiac rehabilitation?

“While I was in the hospital, I felt that my rehabilitation was not sufficient, and I was very anxious about leaving the hospital. Also, when I thought about what to do after discharge, I felt that I had little exercise habits, so I decided to participate. 』(Male in his 60s)

Q: Were there any good things about participating in outpatient cardiac rehabilitation?

“By coming to rehab, I was able to have my physical condition checked by a nurse and to ask about my concerns. I'm trying to improve my physical condition with the goal of coming to rehabilitation, and I'm glad I participated because I can feel that my physical strength has recovered. 』(Female in her 80s)

List of Cardiac Rehabilitation Instructor Qualifications

• doctor Yutaka Furukawa
• doctor Takeshi Kitai
• doctor Takafumi Yamane
• doctor Kim Kite-tae
• doctor Ryosuke Murai
• Yumiko Ogura Nurse
• Naoko Nakamura Nurse
• Masashi Namazuya Nurse
• Misa Tagashira Nurse
• Kentaro Kentaro Iwata Physical therapist
• Kiyohiko Kado Physical therapist
• Takayuki Shimogai Physical therapist
• Miyako Tauchi Physical therapist
• Kosuke Sasaki Physical therapist
• Kyosuke Wakata Physical therapist
• Yusuke Takahashi Physical therapist

*This content is intended for doctor and is intended to deepen the understanding of this medical institution, and is not intended for publicity or advertising for the general public.

Hello, I am Yutaka Yutaka Furukawa Director of Cardiology Department Kobe City Medical Center General Hospital.
Our hospital is working every day to provide medical care in order to fulfill our role as an advanced medical institution and critical care center that is trusted by patients and primary care doctors in Kobe City and its suburbs. In the field of cardiovascular medicine, new treatments are being developed and improved one after another. In our department, we always try to incorporate advanced treatments and carefully judge the indications of these treatments. In addition, since prompt treatment is required for emergency patients with cardiovascular diseases such as ST elevation myocardial infarction and acute aortic dissection, we have established the necessary systems and equipment to provide medical care.
As an example of the former, we will introduce catheter treatment for structural heart disease such as valvular disease, and as an example of the latter, we will introduce our department's efforts in the acute phase treatment of ST-segment elevation myocardial infarction. We hope that you will read it and use it as a reference when referring patients.

Yutaka Furukawa
Cardiology Director

Catheterization of structural heart disease

Structural heart disease is a translation of Structural Heart Disease (SHD), and refers to a group of diseases in which abnormalities are observed in the structure of the heart, such as valvular disease and congenital heart disease. Surgery was the only radical treatment option for many of the diseases in this area. Catheter therapy is being introduced one after another. I feel that TAVI has become well established in the clinical setting, and I think many people are familiar with it.

At our hospital, we created the TAVI Heart Team in collaboration with our department, Cardiovascular Surgery, and other departments within the hospital, and started treatment in February 2014 as the first facility in Hyogo Prefecture. Since then, the number of cases has increased year by year, and by the time the article was published in December 2020, a total of 283 patients with aortic valve stenosis had undergone TAVI.

As the results of new clinical trials become clearer, the indications for TAVI, which were initially limited to surgical contraindications and high-risk patients, are expanding to include lower-risk and younger patients. On the other hand, there are concerns about the long-term durability of TAVI valves compared to tissue valves used in surgical operations, and some lesions are structurally unsuitable for Cardiovascular Surgery doctor, we carefully determine whether surgery, TAVI, or medical observation is best for each patient. There have been no 30-day deaths so far, and the overall results at our hospital are very good. In addition, from March 2019, as a treatment started at our hospital, there is a percutaneous mitral valve coaptation repair (MitraClip) for mitral valve regurgitation.

This treatment consisted of clipping the cusps at the regurgitant orifice of the mitral valve to control regurgitation. There was also a surgical procedure based on it (Alfieri method). In rare cases, a congenital anomaly called a double mitral valve orifice, in which the normally one mitral valve orifice is congenitally separated into two, is seen, but if there are no other coexisting anomalies, the mitral valve is not necessarily a mitral valve. Abnormalities such as stenosis and regurgitation do not necessarily occur in the function of the caprular valve. For this reason, If the pretreatment mitral valve orifice is large enough, the MitraClip can be performed without mitral stenosis after treatment. Mitral valve plasty and replacement are effective as fundamental treatments for mitral valve regurgitation. MitraClip is used for minimally invasive treatment for cases where surgery is impossible or at high risk due to the patient's age or complications. As for the MitraClip, the heart team is examining whether it is appropriate or not. If you have a patient with mitral regurgitation who you think may need treatment, please refer them to our clinic, which has both options.

In addition, in addition to catheter closure for atrial septal defect, which has been performed in Japan for a long time, percutaneous patent foramen ovale closure, which is an extension of that, has recently become available under health insurance. .

At our hospital, when treating these structural heart diseases, we strive to provide each patient with the most appropriate treatment that is necessary, but not excessive, while fully considering past evidence and recommendations from guidelines. We will be responsible for everything from the judgment of treatment indications to implementation, so please do not hesitate to introduce us, including cases that are difficult to refer. 

cardiology emergency medicine

Our hospital was relocated to the current location about 9 years ago, but when designing the current hospital, we repeatedly considered how to functionally fulfill our role of providing emergency medical care and advanced medical care in this medical area. overlapped. For emergency cardiology, an angiography room for emergency catheterization and PCI is located adjacent to the emergency department on the first floor so that critically ill emergency patients can be treated quickly. As a result, we were able to shorten the time from patient arrival to treatment.
Due to this and the increased awareness of all the medical staff involved, the "Door to Balloon" time from the arrival of a patient with ST elevation acute myocardial infarction to the treatment of coronary artery lesions has been shortened, and now all ST elevation Achieved “Door to Balloon” time within 90 minutes for acute myocardial infarction.

In addition, we perform extracorporeal cardiopulmonary resuscitation (ECPR) in cooperation with the emergency department for cardiopulmonary arrest cases due to cardiovascular diseases such as acute myocardial infarction. ECPR is invasive cardiopulmonary resuscitation using a percutaneous cardiopulmonary support (PCPS or Veno-Arterial Extracorporeal Membrane Oxygenation: VA-ECMO) inserted through the femoral vein into the right atrium. Venous blood is removed from blood vessels by a centrifugal pump installed in a closed circuit outside the body, the blood is oxygenated by a membrane oxygenator in the same circuit, and blood is sent to the patient's systemic circulation through a blood vessel inserted from the femoral artery. During treatment, the cardiopulmonary function is temporarily replaced to maintain the function of the vital organs of the whole body, while the primary disease is treated and the patient's own circulatory function is restored.
In order to implement this, teamwork is required between the emergency physician who first examines the case of cardiopulmonary arrest at the time of hospital visit, and the Cardiology who performs the subsequent treatment such as PCI and the management of PCPS. increase. In order to be indicated for treatment, it is necessary not only to expect recovery of circulatory function, but also to expect recovery of brain function. Of course, patients who have a sudden change in the hospital will also be indicated for the same treatment depending on the code for dealing with sudden changes.
Our hospital's response to cardiopulmonary arrest cases on arrival may be difficult for family doctors to see directly, so we would like to take this opportunity to introduce our hospital's efforts.

message to teachers

We introduced the current situation and efforts of our department in acute care for cardiovascular diseases from two aspects: recently introduced treatment and emergency care.
In addition to structural heart disease such as valvular disease and coronary artery disease that appeared in this article, catheter ablation treatment for tachyarrhythmia and various myocardial diseases, which are recognized by many doctors, etc. Our hospital provides acute care that covers a wide range of cardiovascular diseases.

Our hospital is also a base hospital for COVID-19 treatment, and I think that doctors may be worried about the current hospital functions, and this may lead to patients refraining from seeing a doctor. Medical treatment for severe COVID-19 requires a large amount of human resources, and it is true that our hospital is facing various difficulties in providing acute medical care compared to "before COVID-19". am. In such a situation, our hospital will take advantage of the lessons learned from the first wave of COVID-19, and in order to fulfill its original role as an advanced medical institution and critical care center, we will provide acute care and treatment for severe patients other than COVID-19. We are striving to balance medical care for severe COVID-19 patients. We hope that this article will help doctors who are contributing to community medicine in Kobe City and its neighboring medical areas to deepen their understanding of our department, and help them introduce their important patients with peace of mind. I would appreciate it if you could be.