Heart disease is now the leading individual cause of disease burden in India.

• Heart disease now is the leading individual cause of disease the burden in India.
• In 2016, there were an estimated 62.5 million years of life lost prematurely due to Cardiovascular Diseases in India.
• 17.5 million people die each year from Cardiovascular diseases, an estimated 31% of all deaths worldwide (WHO).
• Four out of five Cardiovascular deaths are due to heart attacks and strokes (WHO).

WHAT ARE CARDIOVASCULAR DISEASES?

Cardiovascular diseases (CVDs) are disorders of the heart and blood vessels and include coronary heart disease, cerebrovascular disease, rheumatic heart disease, and other conditions. Individuals at risk of CVD may demonstrate raised blood pressure, glucose, and lipids as well as overweight and obesity. Identifying those at the highest risk of CVDs and ensuring they receive appropriate treatment can prevent premature deaths.

SYMPTOMS

• Chest pain, chest tightness, chest pressure and chest discomfort (angina)
• Shortness of breath
• Pain in the neck, jaw, throat, upper abdomen or back
• Pain, numbness, weakness or coldness in your legs or arms if the blood vessels in those parts of your body are narrowed

CAUSES

• Unhealthy diet
• Lack of exercise
• Being overweight
• Smoking

TYPES OF HEART DISEASE

The cardiovascular diseases involving the blood vessels (also known as vascular diseases) are:

• Coronary artery disease
• Peripheral arterial disease
• Cerebrovascular disease (includes stroke)
• Congenital heart disease
• Inflammatory heart disease
• Rheumatic heart disease
• Valvular heart disease
• Hypertensive heart disease
• Heart failure

DIAGNOSIS

• Blood Tests
• EKG/ECG (Electrocardiogram)
• Stress Testing
• Echocardiography
• Coronary Angiography and Cardiac Catheterization
• Electron-Beam Computed Tomography or EBCT
• Chest X-Ray
• Cardiac MRI

TREATMENT

Through Medication:                                                                                 

• Statins - For lowering cholesterol 
• Blood thinners (such as warfarin) - For preventing blood clots
• Beta-blockers - For treating heart attack, heart failure, and high blood pressure
• Angiotensin-converting enzyme (ACE) inhibitors - For heart failure and high blood pressure

Through Intervention:                                                                                 

• Angioplasty -A balloon catheter is inserted to widen narrowed blood vessels that might be restricting blood ow to the heart
• Coronary artery bypass surgery - Allows blood ow to reach a blocked part of the heart in people with blocked arteries
• Surgery -To repair or replace faulty heart valves
• Pacemakers or electronic machines -To regulate heartbeat for people with arrhythmia

PREVENTION

• Quit smoking
• Maintain a healthy body weight
• Monitor your blood sugar regularly
• Keep your cholesterol in check
• Maintain the blood pressure below 120/80 mmHg
• Indulge in moderate exercise
• Consume a healthy diet; cut down on salts, added sugar & saturated fats

Get treated at our Cardiac Sciences Department for any heart related diseases.

400 million people live with Hepatitis. 325 million people are living with chronic viral hepatitis B & C infection worldwide.

• 400 million people live with Hepatitis
• 325 million people are living with chronic viral hepatitis B and C infections worldwide
• 6 -10 million people are newly infected annually
• An estimated 95% of people with hepatitis do not know there are infected

WHAT IS HEPATITIS?

It is an inflammation of the liver, characterized by the presence of inflammatory cells in liver tissue mainly caused by viruses; hence it is also known as Viral Hepatitis. Not all Viral Hepatitis cause long term infections but certain types become chronic, lifelong infections and can lead to serious Liver damage, Cirrhosis and even Liver Cancer.

SYMPTOMS

• Fatigue
• Sudden nausea and vomiting
• Abdominal pain or discomfort on the upper right side
• Clay-colored bowel movements
• Intense itching
• Loss of appetite
• Low-grade fever
• Yellowing of the skin and the whites of your eyes (jaundice)
• Dark urine
• Joint pain

CAUSES

Hepatitis infections are most commonly caused by a group of five known viruses designated A-E.

Other possible causes include:

• Excessive consumption of alcohol
• In some cases, immune system identifies the liver as a foreign object and begins to attack and causes inflammation
• Metabolic disorders

TYPES OF HEPATITIS:

There are three major types of Hepatitis. The symptoms seen for the Hepatitis are similar but the treatment options are determined based on the type of the virus and whether it is acute or chronic.

• Hepatitis A (HAV) - is caused by the Hepatitis A virus and is one of the major causes of food-related infections and illnesses. It appears as an acute infection and doesn't cause chronic liver diseases. Vaccination is available and usually resolved within 2 months of infection.
• Hepatitis B (HBV) - is a chronic Liver inflammation caused by the Hepatitis B virus. It is potentially life-threatening infection leading to severe Liver conditions like Cirrhosis and Liver cancer. Vaccination is available for Hepatitis B.
• Hepatitis C (HCV) - is a long term infection caused by the Hepatitis C virus. People become infected with the Hepatitis C virus by sharing needles or other equipment to inject drugs. There is no vaccination available for Hepatitis C.

Other Less common types of Hepatitis are:

• Hepatitis D - is caused by the Hepatitis D virus and occurs when a person is infected with Hepatitis B.
• Hepatitis E - is self-limiting liver inflammation caused by the Hepatitis E virus and usually associated with water contamination.
• Autoimmune Hepatitis - is a chronic, autoimmune disease of the Liver that occurs when the body's immune system attacks Liver cells causing the liver to be inflamed. Treatment of Autoimmune Hepatitis involves the prescription of immunosuppressive glucocorticoids.

DIAGNOSIS:

Common tests that help diagnose Hepatitis are:

• Liver function tests (AST and ALT elevated out of proportion to alkaline phosphatase, usually with hyperbilirubinemia)
• Viral serologic testing
• PT/INR measurement
• Ultrasound
• Liver biopsy

TREATMENT
Treatment for Hepatitis is determined based on the type and stage of the viral infection:

• Interferon injections – Most common treatment to manage and slow diseases progression
• Anti-viral Drugs – Early treatment can stop the chronic infection and prevent Liver Cirrhosis
• Liver transplant – If the liver is severely damaged, a liver transplant may be an option

COMPLICATIONS OF HEPATITIS

Hepatitis can progress to further complicated diseases. Some of the most common complications of Chronic Hepatitis are:

• Fibrosis
• Cirrhosis
• Liver cancer
• Liver failure

PREVENTION

Viral Hepatitis can be prevented through hygienic lifestyle and other precautionary measures like:

• Getting Vaccinated
• Safe Blood transfusion
• Safe Injection
• Don't share or re-use sharp objects or syringes

Liver transplantation is a life-saving surgical procedure performed to replace a diseased or failing liver with a healthy one from a donor. This complex procedure offers hope to individuals with end-stage liver disease, liver cancer, or acute liver failure, providing them with a chance at renewed health and longevity. In this comprehensive guide, we'll explore everything you need to know about liver transplantation, from the indications and evaluation process to the surgical procedure and post-transplant care. 

Dr Suresh Raghavaiah, HOD & Sr Consultant - HPB & GI Surgery, & Multi-organ (Liver, Pancreas, Small Intestine) Transplant Surgery, emphasizes the transformative impact of liver transplantation, stating, "Liver transplantation offers a second chance at life for individuals battling end-stage liver disease. It not only saves lives but restores hope and vitality to patients and their families."

Understanding Liver Transplantation:

Liver transplantation is typically recommended for individuals with advanced liver disease that cannot be effectively managed with medical therapy or other interventions. Common indications for liver transplantation include cirrhosis, chronic hepatitis, alcoholic liver disease, autoimmune liver disease, primary biliary cholangitis, and liver cancer (hepatocellular carcinoma). Additionally, acute liver failure resulting from viral hepatitis, drug toxicity, or other causes may also necessitate urgent transplantation.

When do you require Liver Transplantation: 

• Liver transplantation is indicated when the liver reaches a point of irreversible damage or dysfunction, compromising its ability to perform essential functions.
• End-stage liver disease, characterized by extensive scarring and impaired liver function, is a primary indication for transplantation.
• Liver cancer, particularly hepatocellular carcinoma, may require transplantation when conventional treatments such as chemotherapy or surgery are not viable options.
• Acute liver failure, resulting from viral hepatitis, drug toxicity, or other causes, may necessitate urgent transplantation to prevent life-threatening complications.
• Certain metabolic disorders, such as Wilson's disease, hemochromatosis, and alpha-1 antitrypsin deficiency, may progress to a stage where liver transplantation is the only treatment option to prevent organ failure and associated complications.
• In some cases, liver transplantation may be considered for autoimmune liver diseases, primary biliary cholangitis, primary sclerosing cholangitis, and other chronic liver conditions that do not respond to medical therapy or other interventions.

Indications for Liver Transplant: 

The indications for liver transplantation vary depending on the underlying liver disease or condition. Common indications include cirrhosis, chronic hepatitis, alcoholic liver disease, autoimmune liver disease, primary biliary cholangitis, and hepatocellular carcinoma (liver cancer). Acute liver failure resulting from viral hepatitis, drug toxicity, or other causes may also necessitate urgent transplantation.

Types of Liver Transplant: 

Liver transplantation involves two primary types, each with its own unique process and considerations:

Deceased Donor Liver Transplantation:

• In this type of transplantation, the liver is obtained from a deceased donor who has previously consented to organ donation.
• The donor liver is carefully procured and matched with a suitable recipient based on factors such as blood type, body size, and medical urgency.
• Deceased donor liver transplantation offers the advantage of utilizing a whole liver, which can be particularly beneficial for recipients with extensive liver disease.

Living Donor Liver Transplantation:

• Living donor liver transplantation involves the surgical removal of a segment of the liver from a healthy living donor.
•  The donor liver segment is then transplanted into the recipient, where it gradually regenerates and assumes full functionality.
•   Living donor liver transplantation offers the advantage of reducing wait times for transplantation and may be particularly beneficial for recipients with urgent medical needs or incompatible blood types with deceased donors.

Eligibility and Evaluation:

Before undergoing liver transplantation, candidates undergo a comprehensive evaluation to assess their overall health and suitability for the procedure. This evaluation includes medical history assessment, physical examination, laboratory tests, imaging studies (such as ultrasound, CT scan, or MRI), and specialized liver function tests. Additionally, candidates undergo psychosocial assessments to ensure adequate support and compliance with post-transplant care requirements.

Transplant Procedure: 

During the liver transplantation surgery, the diseased liver (recipient liver) is surgically removed, and the healthy donor liver is implanted in its place. The transplant team meticulously connects the donor liver to the recipient's blood vessels and bile ducts, ensuring proper blood flow and bile drainage. The surgical procedure may take several hours to complete, depending on the complexity of the case.

Surgical Procedure:

Liver transplantation involves the surgical removal of the diseased liver (recipient liver) and its replacement with a healthy liver from a deceased or living donor. The procedure may be performed using either a whole liver from a deceased donor or a segment of the liver from a living donor (living donor liver transplantation). During the surgery, the donor liver is meticulously connected to the recipient's blood vessels and bile ducts, ensuring proper blood flow and bile drainage.

Post-Transplant Care: 

Following liver transplantation, recipients require lifelong medical supervision and adherence to a comprehensive care plan. This includes immunosuppressive medications to prevent rejection of the transplanted liver, regular monitoring of liver function and drug levels, vaccination against infections, and lifestyle modifications to promote overall health and well-being. Recipients also undergo regular follow-up appointments with their transplant team to monitor graft function, manage complications, and address any concerns.

Outcomes and Prognosis: 

Liver transplantation offers excellent long-term survival and quality of life for eligible candidates, with the majority of recipients experiencing significant improvement in symptoms and overall health. However, the success of liver transplantation depends on various factors, including the underlying liver disease, the presence of comorbidities, surgical technique, post-transplant care, and adherence to medical therapy. With advancements in surgical techniques, immunosuppressive medications, and transplant protocols, the outcomes of liver transplantation continue to improve, offering hope to countless individuals worldwide.

Conclusion: 

Liver transplantation represents a remarkable achievement in modern medicine, providing a lifeline to individuals with end-stage liver disease and liver failure. By understanding the indications, evaluation process, surgical procedure, and post-transplant care involved in liver transplantation, patients, caregivers, and healthcare providers can navigate this complex journey with knowledge and confidence. Through ongoing research, innovation, and collaboration, the field of liver transplantation continues to evolve, offering hope and renewed vitality to those in need of a secon