Sinus Bradycardia Bilateral Ventricula Hypertrophy Valve Replacement Surgery CRTD Pacemaker Implantation

Case study of 66-year-old gentleman from Tanzania with Sinus Bradycardia, Bilateral Ventricular Hypertrophy, Valve Replacement Surgery suggested for CRTD Pacemaker Implantation

Diagnosis – This is medical condition of 80-year-old gentleman in which, an electrocardiogram (ECG) report is noting sinus bradycardia of 56 bpm with bilateral ventricular hypertrophy (means your heart is beating slightly slower than the standard average), and the electrical signals suggest thickening or enlargement in both the lower left and lower right chambers of your heart.

While the mild heart rate of 56 bpm alone is often completely harmless, the presence of bilateral (biventricular) hypertrophy is a structural finding that requires a formal medical follow-up to identify the underlying cause and protect long-term heart function.

Sinus Bradycardia (56 bpm): This indicates that your heart’s natural pacemaker (the sinus node) is controlling your rhythm but firing at 56 beats per minute.

Bilateral Ventricular Hypertrophy: Also known as biventricular hypertrophy, this indicates that the muscle walls of both the left ventricle (which pumps blood to the body) and the right ventricle (which pumps blood to the lungs) appear thickened on the EKG.

We will need to find out the underlying cause and then treat the same. To do this, we will need to do some investigations. –

Investigations Needed – ECHO, ECG, Coronary angiography and other routine tests including blood work.

Possible line of treatment – The line of treatment will largely depend on what is causing the condition – Likely causes and treatment are –

1.Uncontrolled Hypertension – This will need medical management urgently as not only it will worsen the heart condition, it may also be a potential threat for Neurological stroke.
2.Valvular Heart Disease: Conditions like aortic stenosis (narrowing of the main heart valve) or problems with the pulmonary valve force the ventricles to exert extra pressure to push blood out. – In this case, we will need to find out which Valve is not functioning properly and accordingly change that Valve – A Valve Replacement Surgery.
3.Cardiomyopathy or Infiltrative Disorders: Certain structural heart conditions, such as hypertrophic cardiomyopathy, cause genetic thickening of the heart walls. Sometimes, specific proteins or substances deposit in the heart muscle (such as in amyloidosis or Fabry disease), which can simultaneously cause wall thickening and slow down the sinus node. This may require a CRT-D pacemaker implantation.

A CRT-D (Cardiac Resynchronization Therapy with Defibrillator) is an implanted medical device for advanced heart conditions, combining a biventricular pacemaker and an implantable cardioverter-defibrillator (ICD). Permanent pacemaker implantation is generally required for true Tri fascicular block to prevent sudden death due to high risk of complete heart block. It is considered a lifesaving, necessary intervention.

Heart valve replacement is a medical procedure to swap a damaged heart valve with a biological or mechanical prosthetic. The primary methods used are traditional open-heart surgery, minimally invasive surgery.

Kindly Note: The advised plan is solely based on the reports shared with us. The final line of treatment will be decided post the physical and clinical evaluations of the patient on arrival only.

We will recommend the following Doctors and Hospitals for the patient:

1.Amrita Hospitals // Dr. Sameer Bhate
Kindly take a virtual tour of the hospital via link – https://pin.it/6VWWsyyzq
2.Fortis Healthcare Limited-Gurgaon // Dr. (Col) Manjinder Sandhu 
Kindly check the hospital gallery via link – https://pin.it/2EBKE74Va
3.Artemis Hospital, Gurgaon // Dr. Amit Kumar Chaurasia
Kindly take a virtual tour of the hospital via link – https://pin.it/1bs51UAGE
4.BLK-MAX Super Specialty Hospital // Dr. Subhash Chandra
Kindly take a virtual tour of the hospital via link – https://pin.it/1Ji84QapI
5.Sarvodaya Healthcare, Faridabad // Dr. Jay Relan
Kindly take a virtual tour of the hospital via link – https://pin.it/57aR7umFf

We will recommend the following Doctors and Hospitals for the patient:

1.Amrita Hospitals // Dr. Sameer Bhate
Kindly take a virtual tour of the hospital via link – https://pin.it/6VWWsyyzq
2.Fortis Healthcare Limited-Gurgaon // Dr. (Col) Manjinder Sandhu 
Kindly check the hospital gallery via link – https://pin.it/2EBKE74Va
3.Artemis Hospital, Gurgaon // Dr. Amit Kumar Chaurasia
Kindly take a virtual tour of the hospital via link – https://pin.it/1bs51UAGE
4.BLK-MAX Super Specialty Hospital // Dr. Subhash Chandra
Kindly take a virtual tour of the hospital via link – https://pin.it/1Ji84QapI
5.Sarvodaya Healthcare, Faridabad // Dr. Jay Relan
Kindly take a virtual tour of the hospital via link – https://pin.it/57aR7umFfWe will recommend the following Doctors and Hospitals for the patient:

1.Amrita Hospitals // Dr. Sameer Bhate
Kindly take a virtual tour of the hospital via link – https://pin.it/6VWWsyyzq
2.Fortis Healthcare Limited-Gurgaon // Dr. (Col) Manjinder Sandhu 
Kindly check the hospital gallery via link – https://pin.it/2EBKE74Va
3.Artemis Hospital, Gurgaon // Dr. Amit Kumar Chaurasia
Kindly take a virtual tour of the hospital via link – https://pin.it/1bs51UAGE
4.BLK-MAX Super Specialty Hospital // Dr. Subhash Chandra
Kindly take a virtual tour of the hospital via link – https://pin.it/1Ji84QapI
5.Sarvodaya Healthcare, Faridabad // Dr. Jay Relan
Kindly take a virtual tour of the hospital via link – https://pin.it/57aR7umFf

Estimated cost:

The estimated cost of evaluations will be approx. USD 800-900 on OPD basis.

The Estimated cost of Valve Replacement to CRTD with Biventricular Pacemaker Implantation at the various hospital will be approx.: 

These are 2 different procedures and as don’t know which procedure will be done, we have given you a range to cover both procedures.

Stay in India: The patient will require 2-3 days for initial evaluations on an OPD basis. The patient will require a total of 5-7 days of hospitalization for the procedure. The post-discharge of the patient may require 15 days to follow up on an OPD basis. Total Length Stay in India will be approx. 2-3 weeks.

Inclusions:

1. The cost of all investigations related to the procedure.
2.The cost of the treatment.
3.The doctor’s fee and surgery charges.
4.Domestic Indian stents will be used. 
5.The stay of the patient and 1 attendant during hospital admission.
6.All meals for the patient and the attendant as per the available menu while in hospital.
7.Medical Consumables and Medicines while in hospital.
8.The fee for dietician and nursing while in hospital.
9.It also includes complimentary Airport Transfers, Forex Services, and assistance.

Exclusions:

1. Any consultation other than in discussion
2.Extended stay.

On Arrival: The patient and her attendant will be received at the airport by our Representative. Apart from the medical and nursing team, one Case Manager will take care of all the needs. We shall also assist them with reasonably charged accommodation near the hospital. They may prepare USD 30-50 per day towards accommodation in the guest house after being discharged from the hospital.

Hope I have been able to give you a satisfactory answer to the query. Do kindly ask for any clarifications needed. I will be happy to answer & shall look forward to assisting your patient in India.

Regards,
Abhik.