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The Ramkhamhaeng Heart Center :
 We have the latest  technology for the treatment of heart disease
including PTCA and Cardiac Stents.

At The Heart Clinic our philosophy is to prevent, diagnose and treat patients for  heart disease. The Center's staff is a team of experienced nurses, technicians and physicians who are passionate about their commitment to providing the best preventive care, diagnosis and treatment for cardiovascular disease.

 Modern equipment and technology 

Holter Monitor
Echocardiogram
Cardiac Cath
PTCA
Stents
Cardiac Surgery
Cardiac Rehab

Thailand has gained renown for all forms of  cardiac care, and other types of specialized medicine.  Ramkhamhaeng Hospital has many internationally trained doctors with world-class credentials.  In this era of jet travel, computers, and the Internet, Globalized medicine has arrived. We offer world class healthcare in a beautiful tropical setting at a fraction of the cost of the USA or Europe.  If you are uninsured and/or pay your own medical bills because it is an elective surgery or you don't have or can't get insurance
info@ramhospital.com

Click on the  below for a large image of the heart.

Click on the below for a large image of the heart valves.

Holter Monitor

What is Holter Monitoring?

• Holter monitoring is a continuous, twenty-four hour electrocardiographic (EKG) recording of the heart's rhythm.
• Electrodes are placed on the chest area with the leads attached to a small digital recorder.
• The patient needs to maintain  a 24-hour diary to record daily activities and any symptoms experienced.
• It will take 15 minutes to have the monitor put on.
• The patient will return the next day to have the monitor removed.

Why is Holter Monitoring Done?

• This test will help the doctor evaluate the type and amount of irregular heart beats during regular activities, exercise and sleep.

What Can be Expected After the Monitor is Put on?

• Once the monitor is in place, do not touch or adjust the electrodes or the monitor.
• Do not get the electrodes or the monitor wet.
• Do not have X-rays taken while wearing the holter monitor.
• The patient must record daily activities and any symptoms he experiences in the daily diary provided. This will help the doctor make a more accurate evaluation.

What Preparation is Needed?

• Do not apply creams, oils, or powder to your chest before the test.
• Wear loose, comfortable clothing.
  
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Echocardiogram (ECHO)

What is an Echocardiogram?

• An Echocardiogram is a noninvasive procedure that uses sound waves (ultrasound) to evaluate how well the heart is working.
• Gel is applied to the chest and a transducer (wand-like apparatus) is moved over the chest area to produce an image of the internal structures of the heart.
• The test will take from 30 to 90 minutes depending on the patient's condition and the type of echo needed.
• This test must be ordered by a doctor.
   

Why is an Echocardiogram Done?

Click on the above photo for an enlarged image of an Echocardiogram.

• This test will help the doctor to evaluate:
  • how well the heart is moving
  • how well the valves are working
  • the size of the heart and it's pumping chambers (ventricles).

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Pacemakers

What Is A Pacemaker?

• A pacemaker ia a small electronic device that regulates the heart beat by sending electrical signals to the heart.
• The pacemaker device consists of two parts:
  • The battery unit: a small metal case that contains the power source and regulates how often signals are sent to the heart
  • The wire: carries electrical messages back and forth between the heart and the pacemaker
• The device is much smaller than a deck of cards and weighs a bit more than an ounce.

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Cardio Therapy

Cardiac Catheterization by AXIOM AFC 

Cardiac Catheterization

What Other Terms Are Used To Describe Cardiac Catheterization?

• Heart Cath
• Angiogram

What Is Cardiac Catheterization?

• This procedure is nonsurgical and is performed under X-ray guidance in the Cardiac Catheterization Lab.
• A catheter (a long, thin, flexible tube) is inserted through an artery (blood vessel) in the thigh up into the heart. Occasionally an artery in the arm is used.
• X-rays (pictures) are taken of the heart and coronary arteries.
• The patient is given a mild sedative to help him relax but remains awake during the procedure to allow him to answer questions regarding his comfort level, any chest pain or shortness of breath.
• A small area of the groin or arm is shaved and cleansed where the catheter will be inserted.
• Medication will be used to anesthetize (numb) this area so a small incision can be made where the catheter will be inserted.
• The catheter is inserted through the femoral artery in the groin (or an artery in the arm at the crease of the elbow). X-ray is used to guide the catheter up into the heart.
• A colorless dye is injected through the catheter, and X-ray pictures are taken of the heart and coronary arteries.
• The patient can watch the procedure on the monitor if he wants to.
• The test takes about an hour.
  
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Percutaneous Transluminal Coronary Angioplasty or PTCA & Stent:

Percutaneous Transluminal Coronary Angioplasty (PTCA)

What Other Terms are Used to Describe Percutaneous Transluminal Coronary Angioplasty?

• Balloon Angioplasty
• Angioplasty
• PTCA

Why is an Angioplasty Done?

• A PTCA is a procedure that opens narrowed arteries to increase blood flow.
• A PTCA may be done instead of coronary artery bypass surgery depending upon the type and location of the narrowing, the extent of the disease and the risk involved. 

How is A Balloon Angioplasty Done?

Ramkhamhaeng MD's have the expertise to do Balloon Angioplasty using the artery in the lower arm or wrist which causes less problems than those in the lower leg.  The arm artery will be used in about 90% of all cases.

• This procedure is nonsurgical and is performed under X-ray guidance in the Cardiac catheterization lab.
• A PTCA may be done immediately following a cardiac catherization or sometime later.
• The patient is given a mild sedative to help him relax but remains awake during the procedure to allow him to answer questions regarding his comfort level, any chest pain or shortness of breath.
• A small area of the groin or arm is shaved and cleaned where the catheter is inserted.
• Medication is used to anesthetize (numb) the area so a small incision can be made where the catheter will be inserted.
• A catheter with a deflated balloon on the tip is inserted through the artery in the groin or arm. X-ray is used to guide the catheter up into the heart.
• The catheter is threaded up into the narrowed artery of the heart. The balloon is then inflated and deflated several times to squeeze the plaque deposits against the wall of the artery. 
• The test takes 1-2 hours.
  
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Stents

What is a Stent?

• Stents are tiny mesh-like tubes made from stainless steel. They are placed permanently inside an artery (blood vessel) to hold it open after a balloon angioplasty (PTCA).
• The actual procedure for placement of the stent is the same as an angioplasty with the addition of the stent placement.

Why is a Stent Used?

• A stent may be used to keep an artery open that has closed or partially closed after a previous angioplasty(ies) to improve the flow of blood.
• In some cases, stents are used when blocked bypass vein grafts are opened through angioplasty.

How is a Stent Placed?

• First, an angioplasty is done to open the blockage in the area.
• After the artery is opened, a catheter, which has a stent over a deflated balloon on the tip is reinserted into the artery up to the area previously opened by angioplasty.
• Once in place, the balloon is inflated, expanding the stent and pressing it against the artery wall.
• The balloon is deflated and the catheter and balloon are removed, but the stent remains expanded and in place to help keep the narrowed portion open after angioplasty.
• The stent will remain in the artery permanently.
• The artery will heal around the stent.
• The procedure lasts one to two hours.

What Symptoms May Be Experienced During the Procedure?

• A slight burning or stinging from the medicine used to numb the catheter insertion site
• A slight discomfort or pressure as the catheter is being inserted
• Slight nausea and/or extra heartbeats
• Chest pain may occur as the balloon catheter is being inflated, but it is temporary

 What Happens After the procedure is Completed?

• After X-rays are taken, the balloon and catheter are removed.
• The sheath (IV) is usually left in place in the leg overnight until the blood thinning medications are discontinued and clotting time returns to normal.
• A bandaid or pressure dressing will be placed over the area where the catheter was inserted.
• The patient will be admitted to a special cardiac care unit ( ICU) to be closely observed.
• When the sheath is removed from the groin, (usually the following day), firm pressure is applied to the sheath insertion site for 15-30 minutes until the bleeding stops.
• If an artery in the arm is used, pressure will be applied over sheath insertion site for 15-30 minutes.
• The insertion site will be checked frequently for signs of bleeding.
• Blood pressure and the pulse in the leg (or arm) used will be checked frequently.
• A knot under the skin where the catheter was inserted may occur. This is only temporary.
• Bruising to the leg/groin area may occur where the catheter was inserted. The bruising may spread down the leg and is only temporary.
• Most patients are discharged in eight hours with minimal activity restrictions.

What Precautions Should Be Observed Following the Procedure?

• Avoid bending the leg at the hip (groin area) for six to eight hours after the catheter is removed.
• Hold the bandaid firmly if it is necessary to cough or sneeze.
• Avoid bending or using the arm for six to eight hours if it was used for the insertion of the catheter.

What Signs and Symptoms Should Be Reported Immediately?

• Discomfort or sudden pain at the insertion site
• A warm, moist and sticky feeling, or bleeding
• Any discomfort in chest, neck, jaw, arms or upper back, shortness of breath, weakness or dizziness

Approved by the FDA, a new medicated stent, designed to keep arteries open, is considered by cardiac experts to be the biggest development in coronary care in the past decade. The new stents are coated with medications which prevent recurrent blockages in the arteries. Clinical trials have shown that renarrowing occurs in less than five percent of patients with the medicated stents
 

The combination of PTCA and Medicated Cardiac Stents  makes for a safe and economical method of treatment for Coronary Artery Disease that does not require surgery.

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Cardiac Surgery Department

Coronary Artery Bypass Graft Surgery

What Other Terms are used to Describe Coronary After Bypass Graft Surgery?

• CABG
• Bypass Surgery

What is a CABG?

• CABG is a surgical procedure to treat severe coronary artery disease (heart disease).
• Part of a vein or artery (called a graft) from another part of the body is used to bypass a blockage in one or more of the coronary arteries.
• The type of graft used, a vein from the leg, or an artery from the chest, depends on the number and location of the blockage.
• The graft is attached above & below the blocked area so that blood actually flows around it and to the area of the heart below the blockage.
• Improves blood flow and thereby oxygen and nutrients to the heart muscle itself. Improved blood flow relieves symptoms of angina (chest pain), improves heart function and may prevent a heart attack.

• Off Pump  Typically, when a patient undergoes open-heart surgery, it is necessary to stop the patient's heart and maintain the body's circulation through the use of cardioplumonary bypass (CPB), also called the heart-lung machine. This procedure is commonplace, and quite safe, although there is growing concern about associated risks, such as inflammation, stroke and neurological complications.

  In recent years, an alternative procedure has been developed called off-pump coronary revascularization, or off-pump bypass surgery. In an off-pump bypass, the heart continues to beat and just the portion of the heart being operated on is stabilized during the surgery. Since the heart continues beating, circulation is maintained without the use of the heart-lung machine (therefore - "off-pump").

  At this time, use of the heart-lung machine remains standard procedure, but there is mounting evidence that off-pump bypass surgery may result in fewer complications.

  Compared to traditional CABG, off-pump CABG may reduce some complications and improves outcomes in high risk patients.

  High risk patients who benefit most from off-pump coronary revascularization include people:

  • Who are over 70 years old
  • With kidney disease
  • With risk of stroke or carotid artery disease
  • With lung disease
  • Who should not use a heart-lung machine

• Minimally Invasive Cardiac Surgery is surgery that causes the least  injury to the tissue. It is less painful and only requires a small cut. It leaves only a minimal scar.  This surgery involves a small incision on the left side of your chest as opposed to a full midline incision.  This procedure is used for patients who have disease in their left anterior descending and/or right coronary artery. This approach may also be done for valve surgery.
  
  On the right is an example of minimally invasive incision.
  
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  Heart Valve Disorders
  Click on the below for a large image of the heart valves.
  

  What is the Function of Heart Valves?

  • Heart valves are one-way doors that open to let blood through and close to keep blood from flowing backward. They keep blood flowing in a one-way direction through the heart and lungs.

  • Valves that do not open and close well make it more difficult for blood to flow properly through the heart making the heart pump harder in order to circulate enough blood to the body. Over time, this can weaken the heart.

  What Causes Heart Valve Disease?

  • The following conditions can damage or scar these valves causing improper opening and closing:

    • Birth defects

    • Aging

    • Rheumatic fever

    • Infection

  • Symptoms can range from none to severe.

  What Symptoms May Occur when Valves are Not Working Properly:

  • Palpitations or a "fluttery feeling in the chest"

  • Chest pain which may feel similar to angina

  • A sharp pain-like feeling over the left chest

  • Heavy pressure under the breastbone

  • Pain radiating down the left arm

    • Lasting from a few minutes to hours

    • Appearing when very tired, sick, or under a lot of stress

  • Shortness of breath

  • Dizziness

  • Fatigue

  • Blackouts with advanced disease

   What Treatment Can be Expected?

  • Medications may provide adequate management of the patient's condition in the early stages of heart valve disease.

  • Surgery will be needed to repair defective valves or remove and replace diseased valves when symptoms are severe or patient's health is compromised.

    • The patient's cardiologist and the cardiac surgeon will explain the surgical procedure and what preparation is needed.

  • The doctor will determine which type of valve will be used based on the patient's age and condition.

    • Mechanical valves (artificial)

      • The patient will be on anticoagulation therapy (blood thinners) for life. This will prevent blood clots from forming around the mechanical valve.

      • There will be a noticeable clicking noise from the mechanical valve, similar to a loud watch.

    • Porcine valves (from pigs)

      • With a porcine valve, there is the potential for degeneration or calcification of the valve over a long period of time.

      • A second valve replacement is very likely in younger to middle aged people due to the ten year life span of most valves.

    • Homograft valves (from deceased human donors)

  What Precautions Should be taken When on Anticoagulants (Blood Thinners)?

  • The patient must be careful to take blood thinning medication, Coumadin (Warfarin), as prescribed.

  • Blood will be drawn on a regular basis when on Coumadin in order to monitor blood clotting time and ensure that bleeding problems do not occur.

  • The patient will need to wear an identification bracelet or necklace to identify his use of anticoagulants.

  • The patient must be careful not to cut himself because he will bleed longer than normal. Direct pressure should be applied for five to ten minutes in the event of a cut.

 Rehabilitation 

The Heart Disease Recovery
& Prevention Program
Our comprehensive heart program includes Cardiac Rehabilitation, a recovery program designed for people who have coronary disease, electrical disorders or have had a heart attack, heart surgery or balloon angioplasty.

What is Cardiac Rehabilitation?

Our healthcare professionals work as a team with both the patient and the physician to help achieve the highest possible level of recovery. This is achieved through a medically supervised program of exercise therapy, risk factor intervention, education and emotional support.

How Can Cardiac Rehabilitation Benefit the Patient or Someone They Love?

• Help ease the recovery period for the patient and family
• Provide a safe environment during the recovery phase
• Provide emotional support from experienced and caring healthcare professionals as well as other cardiac patients.
• Identify and help modify risk factors that contribute to Heart Disease
• Aid in the return to a healthy and enjoyable style of living.

While still in the Hospital (Phase 1), our Cardiac Rehabilitation nurse will work with the patient to gradually and safely increase activity levels, provide information about the patient's disease and treatment, answer questions, address concerns and give the patient and family guidelines and instructions for going home.

Cardiac Rehabilitation continues after the patient goes home (Phase 2). The patient returns to the hospital three times a week on an outpatient basis for telemetry monitored exercise therapy, education and dietary counseling. At this level the patient will have the opportunity to interact with other individuals who have also experienced a cardiac event.

A maintenance program (Phase 3) provides the patient with the opportunity to continue an exercise program in a structured, medically supervised environment as long as it is beneficial.

What Kind of Education about Heart Disease is Provided?

A comprehensive educational manual, lectures and video library provide information for the patient and family on the following topics:

• The heart and how it works
• Coronary artery disease
• Identifying and modifying risk factors
• Nutrition and food management
• Cholesterol and fats
• The recommended diet
• Medications
• Principles of exercise
• Stress
• Coping with heart disease: the effect of
  heart disease on the patient and family

Follow your Doctors advice on medication and required appointments.

Risk Factors for Heart Disease
Heredity : A tendency toward atherosclerosis and heart disease appears to run in families.

Race : Compared to Caucasians, African-Americans are three times more likely to have severe high blood pressure, which increases the possibility of heart disease.

Male gender : Although heart attacks kill nearly as many women as men in the United States, they tend to strike men earlier in life.

Age : Risk increase with age. Only 5 percent of heart attacks occur in people younger than 40.

Tobacco smoking : The more you smoke, the greater the risk to the heart. On average, smokers are twice as likely as nonsmokers to have a heart attack and two to four times more likely to suffer sudden cardiac death.

High blood cholesterol : The higher the blood cholesterol level, the greater the risk for coronary heart disease. Total blood cholesterol levels below 200 mg/dl are associated with relatively low rates of coronary heart disease.

High blood pressure : Risk of coronary heart disease is lowest among people with an average systolic blood pressure of less than 120, and an average diastolic blood pressure of less than 80.

Physical inactivity : Everything else being equal, coronary heart disease is 1.9 times more likely to develop among physically inactive people than among active people.
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info@ramhospital.com

Ramkhamhaeng (pronounced ram-cam-hang)  Hospital sits at the center of one of Thailand’s largest and most respected hospital groups. With 485 beds and twenty-four sister hospitals Ramkhamhaeng has the resources, experience and expertise to provide international quality health care at very competitive prices. This combined with a long tradition of Thai hospitality has earned Ramkhamhaeng Hospital the confidence of the people of Thailand, the Region, and the World.

Thailand has gained renown for all forms of cosmetic surgery, cardiac care, and other types of specialized medicine.  Ramkhamhaeng Hospital has many internationally trained doctors with world-class credentials.  In this era of jet travel, computers, and the Internet, Globalized medicine has arrived. We offer world class healthcare in a beautiful tropical setting at a fraction of the cost of the USA or Europe.  If you pay your own medical bills because it is an elective surgery or you are uninsured and don't have or can't get insurance info@ramhospital.com

We have the latest medical equipment, such as
Cardiac Cath, MRI (Magnetic Resonance Imaging), Spiral CT Scan (Spiral Computerized Tomography Scan) and Ultrasound to support our medical staff in the fast and accurate diagnosis and treatment of disease.

The hospital also has a long history of providing quality specialty clinics like Plastic Surgery, Cardiac Rehabilitation, In Vitro Fertilization + Embryo Transfer, and The Test Tube Baby Clinic.

The hospital specializes in personalized services for all our international visitors.  We will meet you at the airport and escort you to the hospital, walk you through the hospital stay and then escort you back to the airport for your departure.

info@ramhospital.com