Internal-Medicine-and-Cardio-Diabetology

Internal-Medicine-and-Cardio-Diabetology

Under the leadership of Dr. Sunil Bohra, we aim to provide compassionate, comprehensive, coordinated and state of the art patient-centered care to every patient through evidence-based practice.

The department of internal medicine takes care of all the medical needs of the patients admitted for Orthopedic, Spine and Neurologic surgeries. We provide long term comprehensive care for all chronic diseases like Diabetes, Hypertension, Cardiac ailments etc as well as taking appropriate care for all the acute illnesses.

Services Offered:

Out-patient services:

Availability of consultants in the Out Patient Department on all days of the week from Monday to Saturday between 10am and 3pm.

Management of common ailments on an out-patient basis

Management of more complex ailments with the help of laboratory and radiology support on an out-patient basis & considering continuation of care on an in-patient basis when and if need arises

Transition of care to out-patient basis for patients after discharge from the hospital

In-patient services:

Daily rounds are comprehensive, addressing the new problems and the existing co-morbidities with a clinical approach supported by investigations

Day to day monitoring and optimization of medications for all chronic ailments are done.

An electrocardiogram (ECG or EKG) is one of the simplest and fastest procedures used to evaluate the heart. The heart is, in the simplest terms, a pump made up of muscle tissue. The heart's pumping action is regulated by an electrical conduction system that coordinates the contraction of the various chambers of the heart. This electrical activity of the heart is measured by an electrocardiogram. By placing electrodes at specific locations on the body (chest, arms, and legs), a graphic representation or tracing of the electrical activity can be obtained. Changes in an ECG from the normal tracing may indicate one or more of several heart-related conditions.

TMT Test:

Treadmill testing (TMT) or cardiac stress testing is a non-invasive test is performed to assess the heart's response to stress or exercise. The ECG is monitored while a person is exercising on a treadmill. It involves recording the 12-lead ECG before, during, and after exercise on a treadmill for diagnosis of subclinical or latent ischemia (decrease in blood supply to the Heart). The Cardiac stress tests compares the coronary circulation while the patient is at rest with the same patient's circulation observed during maximum physical exertion, showing any abnormal blood flow to the heart's muscle tissue (the myocardium). The results can be interpreted as a reflection on the subject’s general physical condition. This test can be used to diagnose ischemic heart disease, and for evaluating prognosis after a heart attack (myocardial infarction). Reasons for your physician to request an exercise ECG include, but are not limited to, the following:

  • To assess stress or exercise tolerance in patients with known or suspected coronary artery disease (blocked arteries in the heart).
  • To determine limits for safe exercise in patients who are entering a cardiac rehabilitation program and/or those who are recovering from a cardiac event, such as a heart attack (myocardial infarction, or MI) or heart surgery.
  • To assess heart rhythm or electrical activity during exercise.
  • To evaluate heart rate and blood pressure during exercise.
There may be other reasons for your doctor to recommend an exercise ECG.

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Echocardiography
or simply Echo is a painless test that uses sound waves to create pictures of your heart. This test gives your doctor information about the size and shape of your heart and how well your heart's chambers and valves are working. An echocardiogram may be simply performed to assess the heart’s overall function and general structure. There are other reasons for your doctor to recommend an echocardiogram, like: Atherosclerosis, Cardiomyopathy, Congenital heart disease, Ischemic Heart Disease, Congestive Cardiac Failure, Valvular Heart Disease, Aneurysms, Pericarditis and Effusions.

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A dobutamine stress echocardiogram.

is a diagnostic procedure that may be used when a doctor wants to assess the heart muscle under stress. If exercise on a treadmill is not an option due to a person's medical condition, a doctor may use an intravenous medication called dobutamine. Dobutamine causes the heart to beat faster and will mimic the effects of exercise on the heart. Possible indications for a dobutamine stress echocardiogram may include, but are not limited to, the following:

  • To assess the heart's function and structures
  • To assess stress or exercise tolerance in patients with known or suspected coronary artery disease
  • To further assess the degree of known cardiac valve disease
  • To determine limits for safe exercise in patients who are entering a cardiac rehabilitation program and/or those who are recovering from a cardiac event, such as a heart attack (myocardial infarction, or MI) or heart surgery
  • To evaluate the cardiac status of a patient about to undergo surgery
  • There may be other reasons for your doctor to recommend a dobutamine stress echocardiogram. Certain factors or conditions may interfere with a dobutamine stress echocardiogram. These factors include, but are not limited to, the following:
  • Smoking or ingesting caffeine within three hours of the procedure
  • Beta-blocking medications may make it difficult to increase the heart rate to an appropriate level.

A Transesophageal echocardiogram (TEE) is a diagnostic procedure that uses echocardiography to assess the heart’s function. A Transesophageal echocardiogram is performed by inserting a probe with a transducer down the oesophagus rather than placing the transducer on the chest as in a transthoracic echocardiogram. By inserting the transducer in the oesophagus, TEE provides a clearer image of the heart because the sound waves do not have to pass through skin, muscle, or bone tissue. Certain conditions of the heart, such as mitral valve disorders, blood clots or masses inside the heart, dissection (tear) of the lining of the aorta, and implanted prosthetic (artificial) heart valves, are better visualized and assessed with TEE. TEE may be used during surgery to assess the cardiac status of patients with known cardiac disease who are undergoing noncardiac procedures, and during heart surgery to evaluate the effects of surgical intervention to the heart, such as bypass surgery or valve repair or replacement.

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Holter monitor
is a portable device for continuously monitoring the electrical activity of the Heart for at least 24 hours. Simply, it is a continuous digital recording of a patient's ECG for 24 hours. Since it can be worn during the patient's regular daily activities, it helps the physician correlate symptoms of dizziness, palpitations (a sensation of fast or irregular heart rhythm) or black outs. Persons being monitored should not limit normal daily activities, since its purpose is to record how a heart works under various actual conditions over an extended period

Head Up Tilt Table Test (HUTT):
A tilt table procedure is a diagnostic procedure that may be used to evaluate a person who has symptoms of syncope (fainting). This procedure attempts to cause syncope by creating changes in posture from lying to standing. This test is performed by having the patient lie flat on a special bed or table with special safety belts and a footrest while connected to electrocardiogram (ECG) and blood pressure monitors. The bed or table is then elevated to an almost standing position (60 to 80 degree vertical angle) to simulate the patient standing up from a lying position. The blood pressure and ECG are measured during the test to evaluate changes during the position changes. If the test causes an episode of syncope, then the cause of the syncope is vasovagal syncope. The doctor can then prescribe specific treatment for the syncope once the cause is known.

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Ambulatory Blood Pressure Monitoring (ABPM):
Many people have higher blood pressure in the doctor’s office than they have during their regular day. If your doctor suspects white-coat effect, you may need to wear a small, portable, blood pressure monitor to see what your pressure looks like over time during your daily activities. It is normally carried over 24 hours. It uses a small digital blood pressure machine that is attached to a belt around your body and which is connected to a cuff around your upper arm. It is small enough that you can go about your normal daily life and even sleep with it on. ABPM may be done to get a more accurate measurement of your average blood pressure or because you have different readings in the doctor’s office than at home, or for other reasons.