Do you sometimes find it difficult to breathe when you are a little tired, or when you climb a flight of stairs? Do you feel a heaviness in your chest, like a suffocation? Although there are many causes for these symptoms, there may be a reason you don't think about. That is an unnecessary thickening of a part of the heart muscle. Today we are talking about Alcohol Septal Ablation, a very effective treatment that is not a major open surgery and is used to treat this condition.
What is Alcohol Septal Ablation?
Simply put, this is a minimally invasive procedure used to treat a heart condition called Hypertrophic Cardiomyopathy (HCM) . Imagine, there is a wall in our heart that separates two chambers. We call this the septum. In a person with HCM, this wall becomes unnecessarily thick and stiff.
When the wall thickens in this way, the path through which blood is pumped from the heart to the body becomes blocked. Just like a large vehicle stuck in a narrow road creates traffic. This prevents the heart from pumping blood properly. That's when symptoms like shortness of breath and fatigue appear.
Alcohol Septal Ablation (ASA) involves inserting a thin, flexible tube, called a catheter , into the small blood vessel that supplies blood to the thickened muscle. Then, a very small amount of alcohol is injected through it. The alcohol destroys the cells that have thickened unnecessarily and causes the area to shrink. The blocked blood flow is then re-opened, and blood flow is restored.
Why is this treatment done and who is it best for?
This treatment is mainly used for the condition we discussed earlier , hypertrophic cardiomyopathy (HCM) . This is usually a genetic condition that is passed down from generation to generation.
Cardiologists recommend this treatment for people who have symptoms such as shortness of breath and fatigue that cannot be controlled with medication.
The other main treatment for HCM is an open-heart surgery called a septal myectomy . In this, the chest is opened and the thickened muscle is cut out and removed. However, not everyone can undergo major surgery. The risks of open surgery are especially high for older people or those with other medical conditions.
For those who cannot tolerate such open heart surgery, Alcohol Septal Ablation (ASA) is a very good and safe alternative.
| Feature | Alcohol Septal Ablation (ASA) | Septal myectomy (open surgery) |
|---|---|---|
| Treatment method | Minimally invasive (via a catheter) | Open heart surgery (opening the chest) |
| Recovery time | Short term (about a week) | Long term (several weeks or months) |
| Who is best suited for? | For those who cannot tolerate open surgery, are elderly, or have other illnesses | For generally healthy, young people who can tolerate surgery |
What should I do before treatment?
Your doctor will give you all the advice you need before this treatment.
- You may be asked to stop taking some medications a few days before treatment.
- You will need to fast (abstain from eating and drinking) for several hours before the treatment.
- You can also have several tests done to check your health:
- Echocardiogram: A scan that looks at the function and structure of the heart.
- Electrocardiogram (EKG): A test that looks at the electrical activity of the heart.
- Complete Blood Count (CBC): A complete blood count.
- Chest X-ray: An X-ray examination of the chest.
What happens during treatment?
This is a procedure done in the hospital and takes about an hour or two. You will be conscious, but the medical team will give you medication to keep you calm and relaxed.
1. Numbness: First, the area where the catheter will be inserted (usually the upper arm or wrist) is numbed.
2. Inserting the catheter:Then, the thin tube (catheter) is inserted into a blood vessel and guided to the correct location in the heart using X-ray images.
3. Alcohol injection: Once the appropriate blood vessel is identified, a small amount of highly purified alcohol (`isopropyl alcohol`) is injected through it. You may feel a slight discomfort in your chest at this time.
4. Temporary Pacemaker: During this procedure, a temporary pacemaker wire is inserted into your heart through a vein in your neck. This is done to monitor your heart rate for 2-3 days after treatment.
5. Finishing: When the work is finished, the catheter is removed and a bandage is placed over the insertion site.
What happens after treatment?
After the treatment, you will need to stay in the hospital for two or three days. During this time, the medical team will continue to monitor your health and heart rate. If you are in pain, you will be given painkillers.
It is important to continue monitoring your heart rate during your hospital stay after treatment, as a very small number of people may develop irregular heartbeats as a side effect of this treatment and may need to have a permanent pacemaker implanted.
If the treatment was done through a vein, you will be asked to lie in bed with your legs spread for a few hours to prevent bleeding. If it was done through a wrist splint, you usually don't need to lie in bed like that.
What are the risks of this treatment?
As with any medical procedure, there are some minor risks, but complications are very rare.
- Bleeding or infection at the catheter insertion site.
- Formation of blood clots in blood vessels.
- Minor damage to the walls of the heart (may need to be repaired surgically).
- Heart Block: A disruption in the heart's electrical signals. This can cause the heart to beat too slowly or too fast. If this happens, a permanent pacemaker may be needed.
- Pericardial Effusion: Accumulation of fluid in the sac around the heart.
Don't worry about this. Your doctor will explain these risks to you thoroughly.
| If you have these symptoms after treatment, see a doctor immediately! | |
|---|---|
| * Chest pain | * Difficulty breathing or shortness of breath (dyspnea) |
| * Dizziness or feeling faint | * Abnormal heartbeat or chest tightness |
| * Excessive fatigue | * Redness, swelling, bleeding, or fever where the catheter was inserted |
| * Nausea and vomiting | |
Most people can return to normal activities within a week of treatment, and symptoms usually improve quickly.
Take-Home Message
- Alcohol Septal Ablation (ASA) is a highly successful non-surgical treatment for HCM, a thickening of the heart muscle.
- This is a great option, especially for the elderly or those with other illnesses who would find it difficult to tolerate open heart surgery.
- Although this treatment results in a faster recovery, there are minor risks, such as heart block, which may require a permanent pacemaker.
- Discuss and understand all the details with your cardiologist before and after treatment.
- If any unusual symptoms occur after treatment, seek medical advice immediately.
👩🏽⚕️ Additional questions (FAQs)
💬 Is wheezing/asthma just a lung disease? Can wheezing occur with an enlarged heart?
Many people think that wheezing only occurs in 'Asthma'. But that is completely wrong! 'Cardiomyopathy / Heart Failure' When the heart fails, the lungs fill with fluid (blood), making it difficult for the patient to breathe and 'wheezing' can occur. This is called 'Cardiac Asthma' in medical science. In this case, the chest does not open even when using inhalers!
💬 How do I know if my wheezing is normal asthma or heart failure?
A normal asthma attack occurs when there is dirt/dust, or when there is a cold. But when it comes to 'heart problems', 1) When you lie down/flatten in bed at night and try to sleep, you suddenly feel short of breath and wake up screaming (Orthopnea). 2) Along with that, your legs/ankles swell abnormally (Edema). 3) If your chest feels tighter than usual when you climb stairs, it is definitely a heart disease!
💬 When you have a stroke, you should call an ambulance immediately, without staying at home, using an inhaler. What are the fatal/emergency situations?
The biggest danger is a complete cardiac arrest! If, along with the heart attack, 1) there is an unbearable pain in the middle of the chest, as if there was a stone (Chest Pain / Heart attack), 2) if the pain spreads down the left arm to under the jaw, 3) if the patient sweats profusely as if he was taking a bath, his face turns black/blue, and he becomes dizzy and loses consciousness, the patient can die in seconds! You should go to the hospital's emergency department immediately!
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