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Shoulder Dislocation

Management Team

Shoulder Dislocation

Overview

The shoulder joint is covered by ligaments, a capsule, and a glenoid labrum (bumper of the cup part of the bone), which maintain joint stability. A shoulder joint is said to be dislocated when there is a complete separation of the articulating surface between two bones.

  • While most dislocations can be traumatic (due to injury), some people have generalised laxity, which makes them prone to dislocation.
  • Anterior (ball part coming out in the front) dislocation is more common than posterior dislocation (ball part coming out from the back).
  • Younger age (less than 20 years): The chances of shoulder dislocation decrease with aging. The rate of recurrence after the first episode of dislocation can be more than 90% before 20 years, 50%–60% between 20 and 40 years, and 10%–20% above 40 years of age.

The clinical diagnosis of shoulder dislocation is done with the patient giving a history of arm abduction and performing external rotation and extension (ball throwing position). The orthopaedic surgeon can perform the following examinations to confirm diagnosis:

  • Physical examination:
    • The surgeon can appreciate the loss of normal shoulder contour and complete restriction of movements of the affected shoulder with excruciating pain in an acute (recent) shoulder dislocation.
    • The chronic (old) or recurrent shoulder dislocation patient would demonstrate an apprehension when the arm is moved in abduction, external rotation, and extension (position in which the dislocation occurred).
      • Fracture can be observed along with the dislocation. However, the possibility of neurological association is rare.
  • Imaging studies:
    • X-rays to assess the anterior or posterior dislocation pattern or the presence of a fracture around the shoulder girdle.
    • Magnetic resonance imaging (MRI) to assess soft tissue injuries like a Bankart lesion (tear of the glenoid labrum) or Hill Sach’s lesion (depression in the head part of the ball bone).
    • Computed tomography (CT) for patients with recurrent shoulder dislocation to assess the condition of the glenoid (cup) bone, which can show loss of width, increasing the risk of shoulder dislocation.

Non-surgical treatment

  • Acute shoulder dislocation is usually treated under an emergency procedure, and reduction is performed using various manoeuvres with or without sedation.
  • After the reduction, the arm is immobilised using a sling or immobiliser for at least 3–4 weeks following which the patient undergoes a rehabilitation programme.
  • Physical therapies (like icing) and anti-inflammatories are prescribed for pain management following the reduction manoeuvre.
  • Patients may be referred to the pain management clinic for further management of chronic pain.

Surgical treatment

  • This is advised for patients with associated fractures or in whom closed reduction is not possible.
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Snapping Hip Syndrome

Management Team

Snapping Hip Syndrome

Overview

Snapping hip syndrome (SHS) is a clinical condition characterised by an audible or palpable snapping sensation that is felt or heard in the hip during movement.

Snapping: This can occur in different areas of the hip (the outer part of the hip (internal SHS) or the region where the ball of the thigh bone (femur) connects with the pelvic socket (external SHS)); the tendons or muscles slide over bony areas in the hip, causing a ‘snapping’ or ‘popping’ sensation.

The underlying cause of SHS depends on the type of SHS that patients have. Internal SHS occurs due to one or more of the following causes:

  • The iliopsoas tendon (which connects the muscles in the inner hip to the femur) slides over the pelvic bone.
  • The thigh muscle (quadriceps) slides over the ball of the femur.

External SHS occurs when the band of thick fibrous tissue that traverses the outside of the thigh from the hip down to the knee (the iliotibial band) slides over the top of the femur.

  • Tightness in the muscles and tendons surrounding the hip: This can cause friction, leading to snapping.
  • Sports and/or intense physical activities: Engaging in sports or activities that involve repetitive bending at the hip, such as dancing or cycling, can increase the risk of developing this condition.
  • Trauma to the hip joint/hip joint cartilage injuries.
  • Presence of broken fragments of bones/tissues, which are lodged within the ball-and-socket joint of the hip.

  • Pain, inflammation, and/or swelling of the hip
  • A sensation of ‘instability’ in the hip joint
  • Weakness in the leg muscles
  • Difficulties in performing regular physical activities that involve the use of the legs

  • Collection of medical history and detailed evaluation of symptoms
  • Physical examinations to ascertain hip mobility
  • Diagnostic imaging tests (X-ray and/or MRI): these tests enable the specialists to get a clear view of the hip joint and help them rule out other hip conditions (hip arthritis/synovitis or tumours)

Non-surgical treatment

  • Rest and ice: Reducing activity and applying ice can help reduce inflammation and pain.
  • NSAIDs: Over-the-counter anti-inflammatory drugs can help manage pain and swelling.
  • Activity modification: Adjusting exercises or sports activities, such as reducing cycling or swimming with only arm movement, can prevent further strain on the hip.

Surgical treatment

  • Hip arthroscopy: A minimally invasive procedure using a camera to remove or repair damaged tissue causing the snapping.
  • Open surgery: If necessary, a more invasive surgery may be done to directly repair the hip joint.

Post-surgical treatment

After the surgery, proper physical therapy for strengthening the hip muscles is usually recommended. It helps enhance mobility, and gradually ease the patients back into their daily activities.

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Scoliosis

Management Team

Scoliosis

Overview

Scoliosis is an abnormal outward deviation of the spine. The most common age group to be affected is the paediatric population. The types of scoliosis include:

  • Congenital scoliosis, which arises soon after birth.
  • Juvenile scoliosis is detected between the ages of 4 and 10 years.
  • Adolescent idiopathic scoliosis (AIS) occurs after 10 years of age.

  • Scoliosis is a painless disorder. It usually does not cause any neurological symptoms.
  • Early onset scoliosis causes underdevelopment of lungs and heart function.
  • Patients with AIS are usually concerned about their appearance with no other significant complaints.

  • A thorough clinical examination to measure the magnitude of deformity, rule out the causes of deformity, and look for clinical signs of nerve tissue involvement.
  • Spine X-ray to demonstrate the apex of deformity and its magnitude and analyse any bony abnormality of the spine.
  • Spinal MRI to determine the status of the neural tissue. Further investigations would vary according to each patient.

Non-surgical treatment

Bracing is recommended for treating scoliosis in children with early-stage disease with mild deformity.

Surgical treatment

This involves correcting the deformity using screws and rods. This is also done as a palliative procedure to decrease the compression on important structures like the lungs.

  • This complex procedure is usually carried out by an expert team, including a spine surgeon, an anaesthetist, a physician, and a physiotherapist.
  • Highly skilled surgeons with extensive experience are needed to achieve favourable outcomes.
  • Rehabilitation post-surgery is crucial to provide excellent results.
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Sciatica

Management Team

Sciatica

Overview

Sciatica is a symptom of pain radiating down from the lower back to buttock, thigh, calf, and foot. It is a sharp shooting pain that is aggravated with activity and relieved with rest.

  • Adult age group
  • Heavy weightlifting
  • Heavy labour activity
  • Obesity
  • Poor posture
  • Trauma

  • Pain radiating down the leg and is associated with tingling and numbness.
  • Some patients may develop weakness in the muscles of their legs.
  • Sometimes severe nerve compression may cause retention of urine and numbness in the perineal region.

  • A thorough clinical examination to rule out all possible causes of sciatica and ensure that the pain is not being referred from any adjacent joint.
  • A comprehensive clinical neurological examination to rule out any pinch on the nerve tissue.
  • X-ray of the lower back to identify abnormal findings. This would also rule out any fractures, malalignment, or abnormal soft tissue shadows.
  • Spinal magnetic resonance imaging (MRI) to locate the site of disc prolapse and confirm the diagnosis.

Non-surgical treatment

  • Most of the patients get relief with analgesics and rest.
  • Some patients may require epidural injections for spine pain management. This is done by the treating physician or a pain management specialist.

Surgical treatment

  • Patients who do not improve or those who present with severe symptoms require surgery.
  • The surgery aims to reduce the compression on the spinal nerves and alleviate patient symptoms.

  • Avascular necrosis of the femoral head: Decrease in blood supply due to slippage of the head (ball part).
  • Chondrolysis: This is a rare but serious complication where the head of the femur (ball part) is resorbed.
  • Impingement: The hip movements are affected due to abnormal positioning of the femoral head.
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Slipped Capital Femoral Epiphysis

Management Team

Slipped Capital Femoral Epiphysis

Overview

Slipped capital femoral epiphysis (SCFE) is a condition primarily affecting adolescents in whom the femoral head (ball part of the hip bone) moves in a backward direction relative to the neck of the femur (thigh bone) because of the damage in the growth plate.

SCFE can be stable (the child can walk with or without crutches) or unstable (the child cannot put the body weight on the affected side).

  • Obesity and male sex (commonly observed in obese male teens).
  • Hormonal issues (such as thyroid disorders) and kidney disease.
  • Use of steroids.

  • Stable SCFE:
    • Difficulty in walking (the patient walks with toes pointing outwards).
    • Associated intermittent pain in the hip/groin or even in the knee of the affected side, which especially increases after walking/exertion.
  • Unstable SCFE: This is a more severe form of disease in which there is:
    • Sudden onset of pain after an episode of a recent fall.
    • The child is not able to walk without support.
    • The leg is externally (outwards) rotated.
    • There is a limb length discrepancy (the affected leg is shorter than the unaffected leg).
    • Occasionally, there could be bilateral (both sides) involvement in different stages.

  • Clinical tests may reveal pain around the hip region and limitation of the internal (inner) rotation of the hip.
  • X-rays are usually taken from two different angles and are sufficient to diagnose SCFE.
  • Magnetic resonance imaging (MRI) is beneficial in early cases when the X-rays cannot diagnose the disease.

Non-surgical treatment

This is usually helpful during the initial phase of the disease. This comprises:

  • Strict non-weight bearing on the affected side and rest.
  • Obesity treatment for children, if needed.
  • In fewer cases, the application of a hip spica cast (plaster) to immobilise the hip joint.

Surgery

This is advised when the non-surgical treatment fails and is usually done under general or spinal anaesthesia based on the general condition of the patients and their preferences.

  • In-situ fixation: The physician inserts 1–2 screws to prevent further slippage. Sometimes, the surgery is advisable on the opposite side as a prophylactic measure.
  • Open reduction: This is usually required for patients with a severe form of the disease (unstable SCFE) when closed reduction and screw fixation are not possible.

After surgery

To regain paediatric bone health, the patient is allowed weight bearing on the affected side after a couple of weeks and return to sports is permitted after 4–6 months depending on the recovery.

  • Avascular necrosis of the femoral head: Decrease in blood supply due to slippage of the head (ball part).
  • Chondrolysis: This is a rare but serious complication where the head of the femur (ball part) is resorbed.
  • Impingement: The hip movements are affected due to abnormal positioning of the femoral head.
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Rotator Cuff Tear (RCT)

Management Team

Rotator Cuff Tear (RCT)

Overview

The shoulder joint is surrounded by four groups of muscles called rotator cuff muscles, which arise from the shoulder blade bone (scapula). These muscles can partially or completely undergo tearing depending on the underlying cause.

  • Age above 40 years
  • Trauma (secondary to any injury) or degeneration (age-related wear and tear)
  • Smoking  
  • Overuse of the shoulder
  • Orthopaedic sports injuries (weightlifting or overhead sports)

  • The diagnosis is primarily based on history (injury or non-injury), symptoms (pain and/or weakness in the affected shoulder affecting daily activities), and clinical examination (specific tests related to the rotator cuff muscle function), which are performed by the shoulder surgeon.
  • The diagnosis is further confirmed by performing ultrasonography or magnetic resonance imaging.

The treatment is based on a variety of factors, such as age, general health condition, duration and type of tear, and activity level.

  • Conservative management usually comprises rest, non-steroidal anti-inflammatory medicines, physical therapy (targeting specific muscles), or even steroid injections (primarily advised for pain management).
  • Surgical management can include a rotator cuff repair (arthroscopic or open), muscle transfers (in patients with massive irreparable tears), or even joint replacement surgery (reverse shoulder replacement).
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Patellar Tendonitis

Management Team

Patellar Tendonitis

Overview

The patellar tendon (patellar ligament) connects the knee cap (patella) to the top of the shin bone (tibia), along with the muscles at the front of the thigh. This tendon is responsible for knee extension. An injury or sprain to this tendon is known as patellar tendonitis. This condition is particularly prevalent among athletes engaged in sports that require frequent, intense physical activities; however, patellar tendonitis can also affect individuals who do not participate in sports. This disease has been reported to be more common among men than among women.

  • Intense physical activity: Such activities may stress the patellar tendon, causing this condition.
  • Tightness in leg muscles: Tightness of the quadriceps (thigh muscles) and hamstrings can increase the strain on the patellar tendon.
  • Muscle imbalances: Some muscles on the legs may be stronger than others, due to which the pull on the patellar tendon is uneven; this may result in patellar tendonitis.
  • Chronic health conditions: Kidney failure, certain metabolic conditions (diabetes), and/or autoimmune conditions (such as rheumatoid arthritis) may cause the blood flow to the knee to be impaired, weaking the patellar tendon.

  • Participation in professional sporting activities: These require the intense use of the knee joint (e.g., jumping, quick changes in direction, and sprinting)
  • Risky occupations: Physically demanding professions may increase the likelihood of developing this condition.
  • Ageing: Wear and tear of the knee joint with age may lead to this condition.

  • Discomfort, pain, tenderness, and swelling in the anterior (front) region of the knee, especially when climbing stairs or rising from a chair.
  • Occasional redness around the knee joint.

  • X-ray imaging: This is utilised to rule out other bone-related issues that could lead to knee pain.
  • Ultrasound: This can help orthopaedic doctors detect tears or bruises in the patellar tendon.
  • Magnetic resonance imaging (MRI): This can help accurately diagnose any continuity issues (such as tears in the tendon and injuries to adjacent structures).

Various treatment interventions for patellar tendonitis include:  

  • Stretching routines and sports physiotherapy
  • Muscle-strengthening exercises
  • Use of a patellar tendon support strap
  • Corticosteroid injections
  • Platelet-rich plasma (PRP therapy)
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Neck Pain

Management Team

Neck Pain

Overview

Neck pain may present as mild discomfort, which improves with gentle stretching, while some patients may experience severe pain that may not respond to simple analgesics. Although this condition is self-limiting, patients may seek medical advice for rapid rehabilitation.

  • This condition may arise in all age groups. Although unusual in the paediatric age group, children require medical attention for further evaluation.  
  • Adults may experience neck pain, which might be related to poor posture, excessive screen time, long duration of desk work, or sometimes without any predisposing cause.  
  • Older individuals may experience neck pain because of spinal degeneration.

  • Patients complain of pain in the neck. Sometimes this pain may radiate to the shoulders or arms.  
  • Some patients may experience tingling and numbness in the upper limb or weakness of muscles.  
  • Some patients may complain of severe nagging pain, which may not be relieved even after rest and medications.

  • A thorough clinical examination to rule out that the pain is not being referred from any adjacent joint.  
  • A comprehensive clinical neurological examination to rule out any pinch on the nerve tissue.
  • X-ray of the neck to look for degenerative changes and rule out any fractures, malalignment, or abnormal soft tissue shadows.

  • A short course of anti-inflammatories, analgesics, and muscle relaxants.
  • Local cold fomentation may help in relieving pain and improve rehabilitation.
  • Once the pain reduces, advanced physiotherapy should improve the range of motion, and the strengthening of muscles may be started.
  • Correction of posture and lifestyle modifications are an integral part of treatment.
  • Severe cases may require cervical discectomy.
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Lumbar Pain

Management Team

Lumbar Pain

Overview

Lumbar pain is a discomfort or pain in the lower half of the back. It is caused by many conditions (like muscular spasms and ligament strain), spinal conditions (like compression and narrowing of the spinal canal), facet joint arthritis, instability, disc degeneration or infection, fracture of lumbar vertebrae, scoliosis, pain at the back of the abdomen, and tumour of lumbar spine.

  • Pain
  • Stiffness
  • Muscle spasm
  • Decreased mobility
  • Radiating pain to both lower limbs

  • Palpation of lower back, assessment of movements, and neurological examination.
  • X-rays to diagnose degenerative changes, fractures, or muscle spasm.
  • Spinal magnetic resonance imaging (MRI) to obtain details of soft tissue spinal cord and nerve roots and disc.
  • Computed tomography CT to determine occult fractures.
  • Nerve conduction studies for the assessment of nerve roots.

Non-surgical treatment

  • Pain medication  
  • Rest
  • Ice pack application
  • Epidural steroid injection, facet joint injection, or nerve root injection

Surgical treatment

  • Decompression through laminectomy and lumbar discectomy with or without spinal fusion
  • Fracture fixation
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Heart Transplant

Management Team

Heart Transplant

Overview

Heart transplant is a surgical treatment through which a surgeon replaces a diseased, failing heart with a healthier donor heart. Heart transplant is a major operation, but your chance of survival is good with appropriate follow-up care.

Not everyone is a good candidate for a heart transplant. A heart transplant may not be suitable for you if you:

  • are of an advanced age that would hinder your ability to recover from a heart transplant operation
  • have another medical condition that could impact the length of your life, even if you receive a new heart, such as a serious kidney, liver, or lung disease
  • have a recent personal medical history of cancer
  • have an active infection
  • are unwilling or incapable of making lifestyle changes required to keep the new heart healthy, for example, abstinence from drinking alcohol or smoking

  • Risks of open-heart surgery include bleeding, infection and blood clots
  • The donor heart may be rejected by your body
    • Your immune system may perceive the transplanted heart as a foreign entity. This could cause the immune system to reject the heart. Every patient who receives a heart transplant is also prescribed immunosuppressant medications to help prevent rejection.
    • To help avoid the transplanted heart from being rejected, it is crucial to always take your prescribed medications and attend all your follow-up appointments with your doctor.
  • Often, the transplanted heart can be rejected without you experiencing any symptoms. Frequent heart biopsies will be performed for the first year after your heart transplant to check if your body is rejecting the donor heart. After the first year, you may no longer need frequent biopsies.
  • During the biopsy procedure, a tube is passed through to the heart via the veins using a small incision in the neck or groin. A biopsy device is then run through this tube. The device obtains a small tissue sample from the heart, which is then studied in a lab.
  • Primary graft failure: This occurs when the donor heart does not function as expected. Primary graft failure is a common cause for death in the first few months following a heart transplant.
  • Problems relating to the arteries: It is possible that you may develop a condition called cardiac allograft vasculopathy after your transplant. In this condition, the walls of the arteries in the transplanted heart thicken and harden, making blood flow through the heart difficult. This can lead to heart attack, heart failure, arrythmias (abnormal heart beat), or sudden cardiac death.
  • Side effects of medications: The life-long immunosuppressant medications that you will be prescribed after the heart transplant could contribute to severe damage to the kidneys or other problems.
  • Cancer: People who take immunosuppressant medication are also at an increased risk of developing cancer, particularly skin and lip cancers, as well as non-Hodgkin’s lymphoma.
  • Infection: Immunosuppressant medications reduce the ability to fight infections. It is common for people who have received heart transplants to develop infections that require hospital admission within the first year of transplantation.

Frequently, the preparations to receive a donor heart will begin weeks or months before the transplant operation.

The first step:

If your doctor has recommended that you undergo a heart transplant, then you will be referred for an evaluation to a heart transplant centre. You can also consult a transplant centre of your own choice. If you have health insurance, then your provider may have their own list of approved transplant centres.

The important criteria to consider for a heart transplant centre are the number of heart transplants performed at the centre each year and the survival rates of the patients who have undergone transplantation there. There are websites where transplant centre statistics can be compared, such as the National Organ and Tissue Transplant Organisation and the Indian Transplant Registry.

It is also worthwhile for you to check if a transplant centre offers other services, such as assistance with travel arrangements, coordination with support groups, local housing assistance for the duration of your recovery (if needed), or information on other organisations that can help you with these issues.

After you select a transplant centre, you will be evaluated to determine if you are eligible for a heart transplant and check if you:

  • have a heart condition or disease that could improve after a transplant
  • could see improvement by undergoing other, less aggressive treatments instead of a transplant
  • are of adequate health to go through surgery and post-transplant treatments
  • will give up smoking, if you are a smoker
  • are ready to and capable of following the medical program that the transplant team will outline
  • are emotionally prepared to undergo the waiting period for a donor heart
  • have a suitable network of family and friends that can help and support you during this stressful period

  • There is a four-hour window after the removal of a donor heart during which the heart transplant needs to take place. Due to the length of the window, hearts are typically offered first to a nearby transplant centre and then to centres that are within a specific distance of the donor hospital.
  • The transplant centre will notify you when a potential heart is available. You must keep your mobile phone charged and turned on at all times.
  • Once you are notified, you and your transplant team have limited time to accept the donation. You will have to go to the transplant centre immediately after being notified.
  • As much as possible, make travel plans ahead of time. Some heart transplant centres provide private air transportation or other travel arrangements.
  • Have a suitcase packed with everything you will need for your hospital stay, as well as an extra 24-hour supply of your medications.
  • Once you arrive at the hospital, your doctors and transplant team will conduct a final evaluation to determine if the donor heart is suitable for you and if you are ready for surgery.
  • If your doctors and transplant team decide that either the donor heart or surgery is not appropriate for you, you might not be able to have the transplant.

  • Heart transplant surgery is an open-heart procedure that takes several hours. If you have had previous heart surgeries, the surgery is more complicated and will take longer.
  • You will receive medication that causes you to sleep (general anaesthetic) before the procedure.
  • Your surgeons will connect you to a heart-lung bypass machine to keep oxygen-rich blood flowing throughout your body.
  • Your surgeon will make an incision in your chest. Your surgeon will separate your chest bone and open your rib cage to give access to your heart. After this, your surgeon will remove the diseased heart. They will then sew the donor heart into place and attach the major blood vessels to the donor heart.
  • Your donor heart usually begins beating after restoration of blood flow. Occasionally, an electric shock may be required to ensure proper beating of the donor heart.
  • You will be prescribed medication after the surgery to help you manage pain.
  • A ventilator will be used to help you breathe after the surgery. You will also have tubes in your chest to help drain fluids from around the heart and lungs.
  • You will also be given fluids and medications intravenously after the surgery.

  • For the first few days after your transplant, you will have to remain in the intensive care unit (ICU). After this, you will be moved to a regular hospital room. Typically, you will stay in the hospital for one or two weeks. The length of ICU stay is different for each person.
  • After discharge from the hospital, the transplant team will check your progress at an outpatient transplant centre. Many people choose to stay in proximity to the transplant centre for the first three months post-surgery, because of the frequency and intensity of monitoring. The follow-up appointments after this period are less frequent, making travel easier.
  • Your transplant team will keep a careful eye out for any signs and symptoms that your body is rejecting the heart. These include shortness of breath, fever, fatigue, weight gain, or if you are not passing urine often enough. If you observe any of the signs and symptoms of rejection or infection, then you must let your transplant team know immediately.
  • Frequent heart biopsies will be performed for the first year after your heart transplant to check if your body is rejecting the donor heart. Rejection is most common in the first year after transplantation. After the first year, you may no longer need frequent biopsies.

After your heart transplant, many long-term changes need to be incorporated into your lifestyle, including:

  1. Taking immunosuppressants
    • Immunosuppressant medications reduce the activity of your immune system, thereby preventing it from targeting your donor heart and rejecting it. Some of these immunosuppressants will have to be taken life-long.
    • These medications increase your risk of getting an infection. As a result, your doctor might also prescribe antibacterial, antiviral, and antifungal medications to you.
    • Immunosuppressants can also worsen—or increase the risk of developing—certain conditions, including high blood pressure, high cholesterol, diabetes, or cancer.
    • The doses and number of immunosuppressants that you take can be reduced over time, as the risk of rejection decreases.
  2. Managing your medications, treatments, and developing a lifelong care plan
    • After receiving a donor heart, it is crucial for you to adhere to all your doctor’s instructions, take all the medications, and stick to a lifelong care plan.
    • You may be given instructions about your lifestyle, such as ensuring to use a sunscreen, avoiding tobacco products, taking regular exercise, following a healthy diet, and taking precautions to reduce your infection risk.
    • Make sure to adhere to your doctor’s instructions, show up for your follow-up appointments, and get in touch with your transplant team immediately if you experience any signs of infection or rejection.
    • Establish a daily routine for your timely medications, to avoid forgetfulness in taking them.
    • Always carry a list of your medications, in case of emergency medical care. Make sure to tell each of your doctors about your current medications every time they prescribe you a new one.
  3. Cardiac rehabilitation

Cardiac rehabilitation programs incorporate exercise and education to help you improve your health and recover after a heart transplant. These programs might start before you are discharged from the hospital and can help you regain your strength and improve your quality of life.

Most people who receive a heart transplant enjoy a good quality of life.

  • Depending on your condition, you may be able to resume many of your daily life activities, such as returning to work, participating in hobbies and sports, and exercising. Discuss with your doctor what activities are appropriate for you.
  • Women who have had heart transplants can become pregnant. Talk to your doctor if you are considering having children after your transplant. You will likely need medication adjustments before becoming pregnant, as some medications can cause pregnancy complications.
  • Survival rates after heart transplantation vary based on several factors. Survival rates continue to improve despite an increase in older and higher risk heart transplant recipients. Worldwide, the overall survival rate for adults is more than 85% after one year and about 69% after five years.

Heart transplants are not successful for everyone. Your new heart can fail for a number of reasons.

  • In such cases, your doctor might recommend adjusting your medications or, in more extreme cases, having another heart transplant.
  • If additional treatment options are limited, you might choose to stop treatment.
  • Discussions with your heart transplant team, doctor and family should address your expectations and preferences for treatment, emergency care and end-of-life care.

It is normal to feel anxious or overwhelmed while waiting for a transplant or to have fears about rejection, returning to work or other issues after a transplant. The support of friends and family members can help you cope during this stressful time.

  • Joining a support group for transplant recipients: Talking with others who share your experience can ease fears and anxiety.
  • Setting realistic goals and expectations: Recognise that life after transplant might not be the same as life before transplant.
  • Having realistic expectations about results and recovery time can help reduce stress.
  • Educating yourself: Read as much as you can about your procedure and ask questions about things you do not understand.

You may need to modify your diet after your heart transplant surgery to make sure that your new heart is healthy and functions well. A good diet and regular exercise to maintain a healthy weight can help you avoid complications like high blood pressure, diabetes, and heart disease.

A specialist in nutrition, such as a dietitian can help you understand your nutrition and dietary requirements after a transplant. They can also answer any questions you may have. A dietitian will also give you healthy food options and ideas that you can add to your diet plan. These may include:

  • A daily intake of fresh fruits and vegetables
  • Switching to whole-grain breads, multi-grain foods and cereals
  • Consuming fat-free or low-fat dairy products, such as milk, to regulate the calcium levels in your body
  • Eating lean meats, such as poultry or fish
  • Keeping a low-sodium (low-salt) diet
  • Staying away from unhealthy fats (saturated and trans fats)
  • Staying away from grapefruit and grapefruit juice because it can affect specific immunosuppressant medications (calcineurin inhibitors)
  • Limiting your alcohol intake
  • Drinking enough water and other fluids every day to stay hydrated
  • Adhering to food safety guidelines to decrease your chances of contracting an infection

  • Your doctors and care team may suggest that you partake in regular exercise and physical activity after your transplant. This can help you improve your physical and mental health.
  • Regular exercise can help regulate blood pressure, reduce stress, maintain weight, strengthen bones, and enhance overall physical function.
  • A personalised exercise regimen will be developed by your doctors or care team.
  • Your exercise regimen may include warm-up exercises such as slow-walking or stretching, as well as physical activities including cycling, walking, and strength training.
  • Cool down exercises, such as slow walking, are also likely to be included in your exercise regimen.
  • Make sure to have a conversation with your care team about what physical activities may be suitable for you.
  • If you feel tired, then take a break from exercising. If you experience shortness of breath, nausea, irregular heartbeats, or dizziness, then stop exercising. Get in touch with your doctor immediately if your symptoms persist.
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