Invasive Cardiology Sector - european quality

The cardiovascular diseases are the main factor, which causes high mortality-rate, disablement and temporary inability to work both worldwide and in Bulgaria.

More than half of the deaths in Europe are caused by cardiovascular diseases. Although there is a recent tendency for decrease of the number of cardiac incidents in Europe, the number of those who are afflicted with cardiovascular diseases is increasing. The inauspicious statistics for the countries of Central and Eastern Europe, as well as for Bulgaria increases in all indices.

The cardiovascular diseases are the reason, which stands first for the deaths among the population of Europe, as stated in the European Charter for cardiac health. They compose the half of all the cases of death in Europe, causing the death of more than 4.35 million people in 52 countries members of the European region of the World Health Organization and more than 1.9 million people in the countries of the European Union.

According to the World Health Organization in the world:

“Approximately 12 million people die every year from cardiovascular disorders but half of them could be saved if are applied better prophylactic programs”.

These cases of death destroy not only the separate persons but also deprive the families of the ones they love. The heart diseases are the main factor for disablement of the population and diminution of the quality of life.

The best thing you could do is to take the care of your own health in your hands. The undertaking of responsibility will help you to live a healthy and salutary life. Life means not only to be alive but to be healthy.

Professor Alexander Chirkov
Dr. Al Samra
Dr. Akif Ali Shaban
Dr. Dragnev
Chief nurse Violeta Stamatova

The cardiovascular diseases take the first place as per frequency of diseases with fatal outcome. They are before the total number of oncological diseases. Women become more frequently victims of fatal outcome caused by cardiovascular problem – 55% of the total number of deaths, compared to men – 43%. The cardiovascular diseases are of even higher percentage for people with low social economic status. That fact explains to a certain extent the tendency for increase of the mortality-rate due to cardiovascular incident in the countries of Central and Eastern Europe, while in North, South and West Europe the opposite tendency is being noted.

Although the cases of death in West Europe decrease, the number of the persons who are afflicted with cardiovascular diseases continues to increase, according to the data of the World Health Organization. According to the opinion of experts in that area, in order to be avoided a cardiac incident is necessary to be taken adequate measures for lowering the blood pressure, the serum cholesterol, to be held prophylaxis and fight against obesity and misuse of tobacco products. The measures on the part of the state should be directed to the population as a whole, personally to each one human being and to be bestowed special cares and attention to the groups in high risk. Factors for fatal event can be the presence of sugar diabetes, misuse of alcohol and stress.

The motive activity – 30 minutes per day five times a week, the correct alimentary regime, blood pressure below 140/90, the keeping of the serum cholesterol under 5 mmol/l (190mg/dl), the normal glucose metabolism, the evasion of excessive stress protect the heart from fatal incidents. Bulgaria is on the last place in Europe per quality of cardiological cares (only Ukraine is after us). 64.7% of the Bulgarians die from cardiovascular diseases (according to the National Statistics Institute for the year 2008). Statistics: 30% of the Bulgarians are afflicted with heart diseases, more than two million persons have high blood pressure, 500 thousand have ischemic heart disease, and 50 thousand annually die from infarct and 20 thousand from sudden cardiac death.

According to data from the World Health Organization 75 percent of the diseases are caused by unhealthy way of living, i.e. the person himself “elaborates” his disease through the way he lives and not due to his age and his sex.

The general risk factors for cardiovascular and brain-vascular diseases are known: high blood pressure, excess weight, decreased physical activity, sugar diabetes, tobacco smoking, alcohol…

Everything begins with the irrational nutrition and mainly with the excess use of salt, high caloric foods or foods with high cholesterol content.

The risk factors – they represent habits or features, which increase the probability for a given individual to develop a coronary disease.

Risk Factors, Which We Cannot Control

Hereditary defective – the coronary disease develops in certain families. Some people derive genes, which influence the way their organism synthesizes and uses the cholesterol.
Age – in the course of ageing the arteries, which normally are elastic, harden and loose their elasticity. With the time fatty deposits are stratifying on the internal surface of the arteries.
Sex – men are more pervious to fall ill from coronary disease in an earlier age, in comparison to women (before the age of 60 years). But the risk for women equalizes with those for men after the menopause or after surgical removal of ovaries and especially if there are other risk factors.
Tobacco smoking – it increases the content of adrenaline in the blood, as well as the content of other substances, which harm the walls of the blood vessels and the myocardium. The nicotine provokes spasms of the arteries and exercises unfavorable influence on the walls of the vessels. After getting into the blood it activates the thrombocytes (potential risk of formation of thrombi. About 30% of the deaths caused by cardiovascular diseases are consequence of tobacco smoking. About one of each five cases of death caused by cardiovascular diseases is related to the tobacco smoking (an average of about 10 000 people annually die from tobacco smoking). The good news is that those who stop smoking can diminish that risk with more than 75% within five years.
High level of fats in the blood – although the organism itself could synthesize too much cholesterol, for the most of us the high cholesterol is due to nutrition with food rich of fats. In order to diminish the level of the cholesterol you should consume more whole grain foods, fruits, haricot beans, fish and chicken or turkey meat without the skin. Avoid eating of meat products rich of fats, like beef, pork, lamb, mussels, animal organs, as well as egg yolk and dairy products with high content of oils.
High blood pressure – the excess pressure on the arterial wall causes roughening of the coverage on the internal sides of the arteries, which facilitates the sticking of fats that the blood contains to the walls of the arteries. In order to control your blood pressure you should stop tobacco smoking, you should diminish your weight, to take less salt, to increase the motions and to diminish the quantity of alcohol, which you drink.
Excess weight – it impedes the work of your heart. Your aim is to achieve healthy weight and to maintain it. Get an advice from your doctor before commencing a program for loosing weight.
Lack of motion – the lack of or limited motions combined with the other risk factors could contribute for the development of coronary disease. The regular motions support the pumping function of the heart, support the control of the body weight and lower the cholesterol and the blood pressure.
High level of stress – being under stress your organism produces chemical substances, which make your heart to work more intensively. The excess emotional stress for a long period could cause increase of the blood pressure.
Diabetes – the hardening of the arteries is much more frequent at diabetes. If you are afflicted with this disease you can diminish the risk of cardiovascular diseases by learning to control the diabetes. Keep your blood sugar within the recommended limits. Make physical exercises on a regular basis, keep healthy body weight and take the prescribed medicines in the exact way specified by your doctor.
The above mentioned risk factors are the reasons also for the appearance and the development of the so called ischemia (coronary) disease of the heart. Its nature expresses in the following: the normal blood irrigation of the heart muscle is being disturbed and oxygen hunger appears due to changes of the blood vessels of the heart, the so called coronary vessels. At that disease there is a discrepancy between the necessity of the heart muscle of blood (respectively of oxygen) and the ability for its provision.
Within the notion “ischemia” disease of the heart are included several disease units, among which the most frequent are the stenocardia (also known as angina pectoris or breast-pang) and the cardiac (myocardium) infarct, which leads to occlusion of coronary vessel and certain death of millions of heart cells within the damaged zone of the heart. The development of these diseases is almost always accompanied by the presence of a main symptom – pain, which is usually localized in the front part of the chest behind the sternum but can be diffused also to the hand, even to the back of the neck and to the teeth. It is with different duration and intensity, not infrequently combined with the so called vegetative manifestations like general weakness, sometimes with nausea and/or vomiting and often with drop of the blood pressure. These manifestations are expressed in different levels of intensity at the stenocardia and at the cardiac infarct but in all cases a sign for a quick reaction
The diagnosis is determined on the basis of the combination of the three main indicators – characteristic of the pain, changes in the electric cardiogram and changes in the laboratory examination results among which main significance have the changes in the so called cardiac enzymes. The determination of correct diagnosis conditions the further treatment of such patients. The first step is treatment with medicines in order to overcome the main symptoms of the patients through the application of combination of medicines (the mortality-rate is 21-15%). The second step is invasive examination also known as coronarography. By means of it is ascertained the place and also the level of narrowing of the blood vessels of the heart and is determined the necessity of execution of procedures for their widening in order to be improved the feeding of the cardiac muscle.
These procedures are performed in specialized departments in the most contemporary and qualified approach to such cases. Through the coronarography can be made widening (dilatation) of the blood vessels – with or without insertion of the so called stents (small plates, which are inserted into the coronary vessel aiming to widen the narrowed section and to improve the blood delivery of the cardiac muscle). In the invasive cardiology is established the term “the golden hour” – the first hour from the appearance of the pain, i.e. if the examination is being performed up to the sixth hour, it is quite possible to be avoided any consequences of the infarct (the mortality- rate drops to 2%). The stents have been introduced into the clinical practice more than 20 years ago and they divide into two types. The first type is of metal and the other, the most contemporary for the time being, medicine-secreting.
The medicine secreting stents are recommended to patients suffering from diabetes because they give better results. Of course it cannot be ignored that they are several times more expensive than the metal ones, and while the Health Fund covers entirely the expenses on them, for a single medicine-secreting stent the patient is to pay between 1500 and 3500 BGL.
Notwithstanding the success reached regarding the treatment, the prophylactic of the ischemia through maximum efforts for overcoming the risk factors remains a main issue, as their presence is a prerequisite for its appearance and development. That is why it is necessary to be improved the health culture of the population, to be performed on a regular basis clinical observations and screening of those groups of people who are in danger of developing ischemia.

In this department most frequently are received patients with the following acute disturbances of the blood circulation and of the rhythm and capacity:
Acute myocardial infarct, Unstable stenocardy, Stable stenocardy, Acute cardiovascular insufficiency, Acute rhythm and capacity disturbances with chemo-dynamic disorders.

In the department are applied all the contemporary methods of treatment:
Primary angioplasty (PCI) at acute myocardial infarct with persisting CT
segment elevation
Intraaortic balloon pump, chemofiltration, temporary transvenous electric cardiostimulation, apparatus ventilation, invasive control of the chemo-dynamic electric cardioversion with biphasic impulses
Treatment with GP II v/III a venous blockers of the thrombocytes aggregation
In the department for invasive cardiology at Multi-profiled Hospital for Active Medical Treatment “Hadji Dimitar” – Sliven are preformed diagnostic and interventional medical procedures in planned and urgent order.
The department has the disposal of high qualified team of specialists, which execute:
Diagnostic procedures, including left and right cardiac catheterization, coronary angiographies, aortographies, carotidographies, left and right ventriculographies, interventional procedures:
Coronary angioplasty combined with intracoronary stenting, angioplasty of peripheral vessels
mitral valvuloplasty
The department has the disposal of one catheterizing room equipped with the necessary appliances.
In addition to giving a precise diagnostic of the heart disease, the coronarographies ensure quality and modern medical treatment and multiply the chances for good prognosis and high-grade life after the manipulations.

Functional sector

It is performed by highly specialized research work EKG test - a stationary bike or jogging path, Holter ECG monitoring, 24 hour monitoring of blood pressure, Doppler sonography of the brain, kidney and peripheral arteries, venous Doppler of lower limbs, echocardiography, including transesophageal. Cabinets have ultrasound machines last generation with unique diagnostic capabilities for Bulgaria.

Angiographic Sector

Here are executed all high-specialized invasive cardiological and vessel examinations and therapeutic procedures:
Hearth catheterization
Angiography of coronary, brain, periphery, carotidal and visceral arteries
Selective pulmonary angiography
Intravascular ultrasound (IVUS)
Percutaneous coronary interventions
The sector provides through its ambulatory units and hospital base complex consultancy-diagnostic and curative activity using the most contemporary methods and means of the cardiological science and art.
In the hospital units, which are situated in the consultancy-diagnostic sector of the hospital are provided:
A. Diagnostic-consultative medical examinations and clinical observation.
B. Functional-diagnostic examinations:
Electric cardiography;
Transtoracal echo cardiography;
Transesophagial echo cardiography;
ECG stress-test;
24-hours ECG-Holter
In the hospital base are performed:
A. Invasive diagnostic jointly with the department of graphic diagnostic, including:
Right cardiac catheterization;
Pulmonary angiography;
Left cardiac catheterization;
Left ventriculography;
Selective coronary angiography;
Periphery angiography
B. Invasive cardiological curative procedures jointly with the department of graphic diagnostic, as follows:
Implantation of intracoronary stent;
Carotidal angioplasty;
Rhinal angioplasty;
Periphery angioplasty;
Angioplasty of venous grafts;
Mitral, aorta-pulmonary and tricuspidal valvuloplasty;
Pericardial puncture;
Implantation of cava filter;
Implantation of temporary and permanent pacemakers;
Implantation of automatic cardioverter (defibrillator);
Insertion of intraaortic counterpulser.
The specified functional-diagnostic and invasive-diagnostic examinations, intensive medical treatment and interventional cardiological curative procedures are performed in accordance with the requirements of the agreed “clinical pathways” with the National Health Insurance Fund and the elaborated own clinical protocols (therapeutic algorithms).
The condition of each newly received patient is discussed thoroughly by a consilium of doctors led by the principal of the clinic, in order to be determined the most effective and curative strategy.
By means of the implemented system for monitoring and internal estimation of the quality of diagnostic-curative activities and the medical nursing cares, within the context of the main principle “motion in favor of the effect of the medical treatment” has been reached:
Strict observation and adhesion to the specific for the hospital medical standards;
High quality provision of the general and specific general nursing cares.
The periphery angioplasty has been initiated by Dotter and Judkins in 1964.
After an occasional passing through an occluded iliac segment with guide and catheter during a diagnostic angiography, Charles Dotter for the first time popularizes the idea for possible percutaneous treatment of the occlusive arterial disease in 1963. In 1964 he uses a series of polyethylene catheters with increasing diameter for recovery of the perfusion of lower limb of an elder woman who had refused amputation.
In the year 1980 Gruentzig, with the support of prof.Al.Chirkov performs the last of five in number demonstrative courses (together with Sons, Judkins and Dotter) for execution of coronary angioplasty. During the same year has been registered case No 1000 of coronary angioplasty. Gruentzig starts the method with balloon catheters made by himself and his girlfriend in the kitchen of their lodging. With the years the materials and the methodology for execution of percutaneous vascular interventions have become improved and developed incredibly fast.