Cardiology Procedure

Heart Failure

HF is the inability of the heart to pump blood effectively to other parts of the body, (Heart failure with reduced Ejection Fraction). The other type of HF is the inability of the Heart to relax properly so that it doesn’t get filled with blood easily, (Heart Failure with preserved Ejection fraction). 

The magnitude of the problem

HF is a growing epidemic in India. The prevalence of HF in India is up to 0.5% of the overall population, i.e. 70 Lakh cases. 20 Lakh cases occur every year.  Indian patients suffer from HF at a younger age (~ 53 years) compared with ~ 70 years in developed countries. Hospitalizations for HF account for a huge healthcare burden in India. As most of the affected individuals are young, the socio-economic impact is unimaginable huge in India. 

What Causes of HF?

HF happens most commonly due to Heart Attacks (Coronary Artery Disease) in India. The typical patient recovers from a heart attack but doesn’t show improvement in heart pumping and develops HF over a period of time. 

Other causes include:

• Untreated or under-treated hypertension
• Diabetes mellitus
• Valvular Heart Diseases
• Cardiomyopathies- diseases of the heart muscle  
• Substance abuse like alcohol
• Infections
• Genetic causes of HF etc.

Symptoms of HF

• Shortness of breath on exertion, 
• Exertional Fatigue, 
• swelling of the legs and body, 
• weight gain due to fluid overload in the body, 
• Nocturnal cough, inability to sleep flat in the bed. 

These are the common symptoms that patients experience due to HF 

Heart Failure

Heart failure is a serious and potentially life-threatening condition that affects millions of people worldwide. It occurs when the heart becomes weakened or damaged, leading to an inability to pump blood efficiently throughout the body. Understanding the causes, symptoms, treatment options, and lifestyle modifications for heart failure is crucial for managing this chronic condition effectively and improving quality of life.

What is Heart Failure?

Heart failure, also known as congestive heart failure, occurs when the heart becomes weakened or damaged, leading to a reduction in its ability to pump blood efficiently. As a result, fluid can build up in the lungs, abdomen, legs, and other tissues, causing symptoms such as shortness of breath, fatigue, and swelling.

Causes of Heart Failure

Heart failure can develop due to various underlying conditions and risk factors, including:

• Coronary artery disease (CAD): Blockages in the coronary arteries can lead to heart muscle damage and weaken the heart's pumping ability.
• Heart attack (myocardial infarction): A heart attack can cause permanent damage to the heart muscle, leading to heart failure.
• High blood pressure (hypertension): Long-term uncontrolled high blood pressure can strain the heart and contribute to heart failure.
• Cardiomyopathy: Diseases of the heart muscle can weaken the heart over time.
• Heart valve disorders: Malfunctioning heart valves can affect blood flow and lead to heart failure.
• Congenital heart defects: Structural heart defects present at birth can contribute to heart failure later in life.

Symptoms of Heart Failure

The symptoms of heart failure can vary depending on the severity of the condition but commonly include:

• Shortness of breath (dyspnea): Especially during physical exertion or when lying flat.
• Fatigue and weakness: Feeling tired or weak, even with minimal activity.
• Swelling (edema): Fluid retention in the legs, ankles, feet, or abdomen.
• Rapid or irregular heartbeat: Palpitations or a sensation of heart racing.
• Persistent cough or wheezing: Especially when lying down due to fluid accumulation in the lungs.
• Decreased exercise tolerance: Inability to perform usual activities without fatigue or shortness of breath.

Diagnosis of Heart Failure

Diagnosis of heart failure typically involves a combination of medical history, physical examination, imaging tests (such as echocardiogram), and laboratory tests (such as blood tests).

Treatment of Heart Failure

Treatment for heart failure aims to improve symptoms, prevent disease progression, and enhance quality of life. Common treatment approaches include:

• Medications: Such as ACE inhibitors, beta-blockers, diuretics, and aldosterone antagonists to reduce strain on the heart and manage fluid retention.
• Lifestyle modifications: Including dietary changes (low-sodium diet), regular exercise within recommended limits, smoking cessation, and limiting alcohol intake.
• Implantable devices: Such as pacemakers or implantable cardioverter-defibrillators (ICDs) to regulate heart rhythm and prevent sudden cardiac arrest.
• Surgical interventions: Such as coronary artery bypass grafting (CABG) or heart valve repair/replacement for selected cases.

Managing Heart Failure through Lifestyle Changes

In addition to medical treatment, lifestyle modifications play a crucial role in managing heart failure and improving outcomes:

• Follow a Heart-Healthy Diet: Emphasize fruits, vegetables, whole grains, lean proteins, and limit saturated fats, cholesterol, and sodium.
• Monitor Fluid Intake: Limit fluid intake to prevent fluid overload and swelling.
• Engage in Regular Physical Activity: Follow an exercise plan tailored to individual abilities and limitations, aiming for a balance of aerobic and strength-training exercises.
• Monitor Weight: Regularly weigh yourself to detect sudden weight gain, which may indicate fluid retention.
• Quit Smoking: Smoking can worsen heart failure symptoms and increase the risk of complications.
• Manage Stress: Practice relaxation techniques such as deep breathing, meditation, or yoga to reduce stress and anxiety.

Conclusion

Heart failure is a complex and chronic condition that requires ongoing management and care. By understanding its causes, recognizing early symptoms, and adopting a comprehensive treatment plan that includes medications, lifestyle modifications, and regular medical follow-up, individuals with heart failure can achieve a better quality of life and reduce the risk of complications.

It's important for patients with heart failure to work closely with their healthcare team to optimize treatment, monitor symptoms, and make informed decisions about their care. With proper management and support, individuals with heart failure can lead fulfilling lives and maintain overall cardiovascular health. Ongoing research and advancements in treatment continue to improve outcomes and offer hope for a better quality of life for those affected by heart failure.

Cardiac Arrest

Cardiac arrest is a sudden and life-threatening emergency that occurs when the heart suddenly stops pumping blood effectively to the rest of the body. It is a critical condition that requires immediate intervention to save a person's life. 

Understanding Cardiac Arrest

Cardiac arrest is different from a heart attack, although the terms are often used interchangeably. A heart attack occurs when blood flow to a part of the heart is blocked, leading to damage to the heart muscle. On the other hand, cardiac arrest happens when the heart's electrical system malfunctions, causing an irregular heartbeat (arrhythmia) that disrupts the heart's pumping action. This leads to an abrupt loss of blood flow to vital organs, including the brain.

Causes of Cardiac Arrest

Several underlying conditions can lead to cardiac arrest, including:

• Coronary Artery Disease (CAD): The most common cause of cardiac arrest is CAD, which occurs due to the buildup of fatty deposits (plaques) in the coronary arteries, reducing blood flow to the heart muscle.
• Heart Attack (Myocardial Infarction): A heart attack can trigger cardiac arrest by causing damage to the heart muscle and disrupting its electrical signals.
• Arrhythmias: Abnormal heart rhythms, such as ventricular fibrillation (rapid and chaotic electrical activity), can cause the heart to stop pumping effectively.
• Electrolyte Imbalances: Disturbances in potassium, magnesium, or calcium levels can affect the heart's electrical activity.
• Heart Valve Disorders: Structural abnormalities in the heart valves can disrupt normal heart function.
• Cardiomyopathy: Conditions that weaken the heart muscle can increase the risk of cardiac arrest.
• Drug Use: Certain medications, recreational drugs, or substances like alcohol can trigger arrhythmias leading to cardiac arrest.
• Electrical Shock: Severe electrical shock can disrupt the heart's electrical system.

Symptoms of Cardiac Arrest

Cardiac arrest often occurs suddenly and without warning. Common symptoms include:

• Sudden loss of responsiveness
• Absence of pulse or breathing
• Unresponsiveness to stimuli
• Sudden collapse

Treatment of Cardiac Arrest

Immediate treatment is crucial to improving the chances of survival in cardiac arrest cases:

• Call Emergency Services: Immediately dial emergency services (e.g., 911) to summon professional medical help.
• Perform CPR (Cardiopulmonary Resuscitation): Begin chest compressions to help maintain blood flow to vital organs. Place the heel of one hand on the center of the person's chest, then place the other hand on top and interlock fingers. Perform chest compressions at a rate of 100-120 compressions per minute.
• Use an Automated External Defibrillator (AED): If available, use an AED to deliver an electrical shock to restore the heart's normal rhythm. Follow the instructions provided with the AED.
• Administer Advanced Life Support: Emergency medical personnel will provide advanced cardiac life support (ACLS) interventions, such as intravenous medications and advanced airway management, upon arrival.

Prevention of Cardiac Arrest

While some risk factors for cardiac arrest, such as age and family history, cannot be changed, there are steps individuals can take to reduce their risk:

• Maintain a Healthy Lifestyle: Adopting a heart-healthy diet, exercising regularly, maintaining a healthy weight, and avoiding smoking can significantly reduce the risk of heart disease and cardiac arrest.
• Manage Underlying Health Conditions: Control high blood pressure, cholesterol levels, diabetes, and other cardiovascular risk factors through medication and lifestyle modifications.
• Seek Regular Medical Care: Attend regular check-ups with a healthcare provider to monitor heart health and detect any underlying conditions early.
• Learn CPR and Basic Life Support (BLS): Being trained in CPR and BLS can enable bystanders to provide immediate assistance in cardiac arrest emergencies, improving outcomes.
• Install AEDs in Public Places: Promote the widespread availability of AEDs in public locations, along with training on their use, to increase survival rates in cardiac arrest cases.

Conclusion

In conclusion, cardiac arrest is a critical medical emergency that requires immediate action and awareness. Understanding its causes, recognizing the symptoms, and knowing how to respond effectively can make a significant difference in saving lives. Prevention efforts focused on adopting a healthy lifestyle, managing underlying health conditions, and improving access to emergency care and interventions are essential in reducing the incidence and impact of cardiac arrest.

Hypertension Diabetes and Heart Disease

In the realm of chronic health conditions, hypertension, diabetes, and heart disease stand out as prevalent and interconnected ailments that significantly impact individuals' well-being and quality of life. Understanding the relationship among these conditions is crucial for effective prevention, management, and treatment strategies. Let's delve into each of these health issues and explore their complex interplay.

Hypertension (High Blood Pressure)

Hypertension, commonly known as high blood pressure, is a condition where the force of blood against the artery walls is consistently too high. This chronic elevation in blood pressure can lead to serious health consequences, including an increased risk of heart disease, stroke, and kidney damage.

Causes of hypertension can vary and may include genetic factors, lifestyle choices such as diet and physical activity levels, stress, and underlying health conditions. Often termed a "silent killer," hypertension can go unnoticed for years without symptoms but still cause damage to blood vessels and organs over time.

Diabetes

Diabetes is a metabolic disorder characterized by elevated blood sugar levels due to either inadequate insulin production (Type 1 diabetes) or the body's ineffective use of insulin (Type 2 diabetes). Prolonged high blood sugar levels can damage blood vessels and nerves, leading to a range of complications affecting the eyes, kidneys, nerves, and heart.

Type 2 diabetes, which is more common, is closely linked to lifestyle factors such as obesity, physical inactivity, and poor diet. The prevalence of diabetes is rising globally, with significant implications for public health systems and individual health outcomes.

Heart Disease

Heart disease encompasses a range of conditions that affect the heart's structure and function, including coronary artery disease, heart attack (myocardial infarction), heart failure, and arrhythmias. Hypertension and diabetes are major risk factors for developing heart disease.

The complex connection among hypertension, diabetes, and heart disease involves multiple interrelated aspects:

• A Vicious Cycle: Hypertension can accelerate the progression of diabetes by damaging blood vessels and impairing insulin sensitivity. Conversely, diabetes contributes to the development of hypertension through mechanisms involving insulin resistance and sodium retention.
• Shared Risk Factors: Obesity, physical inactivity, poor diet (high in salt, sugar, and unhealthy fats), and smoking are common risk factors for both hypertension and diabetes. These lifestyle factors also significantly increase the risk of developing heart disease.
• Target Organ Damage: Chronic hypertension and diabetes can lead to target organ damage, particularly affecting the heart, kidneys, brain, and blood vessels. The cumulative impact of these conditions accelerates atherosclerosis (plaque buildup in arteries), leading to coronary artery disease and increased risk of heart attacks and strokes.

Preventive Strategies and Management

Given the complex interrelation among hypertension, diabetes, and heart disease, a comprehensive approach to prevention and management is essential:

• Lifestyle Modifications: Encouraging a healthy lifestyle comprising regular exercise, a balanced diet rich in fruits, vegetables, and whole grains, weight management, and smoking cessation can significantly reduce the risk of developing these conditions.
• Medication: Medications targeting blood pressure, blood sugar, and cholesterol levels are often prescribed to manage these conditions and mitigate the risk of complications.
• Regular Monitoring and Screening: Routine medical check-ups that include blood pressure measurements, blood glucose tests, and lipid profiles are crucial for early detection and timely intervention.
• Patient Education and Support: Empowering individuals with knowledge about their conditions, including the importance of adherence to treatment plans and lifestyle modifications, is fundamental to successful long-term management.

Conclusion

In conclusion, hypertension, diabetes, and heart disease are intertwined health challenges that require a holistic approach to prevention, management, and treatment. By focusing on factors we can change and using specific strategies, we can reduce the impact of these chronic illnesses and help people to stay healthier.

Heart Attack

A heart attack, also known as a myocardial infarction, is a serious medical emergency that occurs when blood flow to a part of the heart muscle is blocked for an extended period, leading to damage or death of the affected tissue.

What is a Heart Attack?

A heart attack occurs when blood flow to a part of the heart muscle is blocked, causing damage or death to that area of the heart. This blockage is usually due to the buildup of fatty deposits (plaque) in the coronary arteries, which supply blood to the heart.

Signs and Symptoms of a Heart Attack

Recognizing the signs of a heart attack is crucial for prompt intervention. Common symptoms include:

• Chest Pain or Discomfort: This often feels like pressure, tightness, squeezing, or fullness in the center or left side of the chest.
• Pain Radiating to Other Areas: Pain may spread to the arms (often the left arm), back, neck, jaw, or stomach.
• Shortness of Breath: Difficulty breathing may occur with or without chest discomfort.
• Nausea, Indigestion, or Vomiting: Some people may experience gastrointestinal symptoms.
• Cold Sweat, Dizziness, or Lightheadedness: These can occur along with chest discomfort.

Causes of Heart Attacks

The most common cause of heart attacks is coronary artery disease (CAD), where plaque buildup narrows the coronary arteries, reducing blood flow to the heart. Risk factors for CAD and heart attacks include:

• High Blood Pressure (Hypertension)
• High Cholesterol Levels
• Smoking and Tobacco Use
• Diabetes
• Obesity
• Sedentary Lifestyle
• Unhealthy Diet
• Family History of Heart Disease

Prevention of Heart Attacks

While certain risk factors like age and family history cannot be changed, many lifestyle-related risk factors can be modified to prevent heart attacks:

• Quit Smoking: Smoking damages blood vessels and greatly increases the risk of heart attacks.
• Healthy Diet: Eat a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Limit saturated fats, trans fats, cholesterol, and sodium.
• Regular Exercise: Aim for at least 150 minutes of moderate-intensity aerobic exercise per week.
• Maintain a Healthy Weight: Excess weight strains the heart and increases the risk of heart disease.
• Manage Stress: Practice stress-reduction techniques such as meditation, yoga, or deep breathing exercises.
• Control Blood Pressure and Cholesterol: Regular monitoring and appropriate treatment are essential.
• Manage Diabetes: Keep blood sugar levels under control with medication, diet, and exercise.

What to Do During a Heart Attack

If you suspect that you or someone else is having a heart attack, it's crucial to act quickly:

• Call Emergency Services: Dial your local emergency number immediately.
• Chew Aspirin (if recommended): If you have aspirin available and are not allergic, chew and swallow a low-dose aspirin to help reduce blood clotting.
• Stay Calm and Rest: Try to stay calm and keep the person experiencing the heart attack calm and comfortable until help arrives.
• Do Not Delay Seeking Help: Time is of the essence during a heart attack. Quick medical intervention can minimize heart damage and save lives.

Conclusion

Heart attacks are serious medical emergencies that require immediate attention. By understanding the signs, causes, and preventive measures, individuals can take proactive steps to reduce their risk of heart disease and improve heart health. Remember, a heart-healthy lifestyle and early intervention are key to preventing heart attacks and living a longer, healthier life.

Why Replace a Heart Valve When We Can Repair

The human heart is a remarkable organ, tirelessly pumping blood throughout our body. But sometimes, the valves within this vital organ can become damaged, hindering blood flow and causing health problems. When this occurs, doctors may recommend either repairing or replacing the faulty valve. While valve repair sounds like the ideal solution, there are situations where cardiac valve replacement surgery becomes the better choice. Let's delve into the world of heart valve surgery and understand why replacement might be necessary.

Understanding Heart Valves

Our heart has four valves: the aortic, mitral, pulmonary, and tricuspid valves. These valves act as one-way gates, ensuring blood flows in the correct direction within the heart's chambers. When a valve malfunctions, it can become narrowed (stenosis) or leaky (regurgitation). This disrupts blood flow, forcing the heart to work harder and potentially leading to complications like heart failure.

The Importance of Heart Valves

Imagine the heart as a complex pump with four chambers. Blood flows through these chambers in a specific direction, carrying oxygen and nutrients throughout the body. The heart valves act as one-way doors, ensuring blood flows in the right direction. There are four valves:

• Mitral valve: Located between the left atrium and left ventricle, it prevents blood from flowing backward into the atrium.
• Aortic valve: Situated between the left ventricle and aorta, it ensures blood pumps out to the body.
• Tricuspid valve: Placed between the right atrium and right ventricle, it stops blood from flowing back into the atrium.
• Pulmonary valve: Located between the right ventricle and pulmonary artery, it directs blood towards the lungs for oxygenation.
• When a valve malfunctions, it can either become narrowed (stenosis), restricting blood flow, or leaky (regurgitation), allowing blood to flow backward. This disrupts the heart's function, leading to symptoms like fatigue, shortness of breath, chest pain, and even heart failure.

Repair vs. Replacement: Weighing the Options

Doctors will always prioritize valve repair whenever possible. Here's why:

• Preserve Native Tissue: A repaired valve is your own tissue, which generally functions more naturally and offers better long-term durability.
• Lower Risk of Infection: Replacement valves, especially mechanical ones, introduce foreign material into the body, increasing the risk of infection.
• Reduced Medication Needs: Patients with repaired valves often don't require lifelong blood-thinning medications needed with some mechanical replacements.

However, there are times when replacement becomes the more suitable option:

• Severity of Damage:  Extensive damage or a complex tear in the valve may be beyond repair. Surgeons need a good foundation of healthy tissue to perform a successful repair.
• Type of Valve:  The mitral and tricuspid valves are more amenable to repair than the aortic valve. Aortic stenosis, for instance, often required replacement due to the severity of calcification. But with the recent advancements, today, even the aortic valve is amenable to repair or reconstruction.
• Patient Age and Lifestyle:  Younger, active individuals may benefit from the long-term durability of a mechanical valve. Conversely, older patients with a less active lifestyle might opt for a biological valve (made from animal tissue) that requires eventual replacement but avoids lifelong blood thinners.
• Risk of Re-operation:  Sometimes, repairing a severely damaged valve carries a higher risk of future problems requiring another surgery. Replacement might offer a more definitive solution.

Types of Replacement Valves

There are two main types of replacement valves:

• Mechanical Valves: These are incredibly durable, lasting a lifetime in most cases. However, they require lifelong blood-thinning medication to prevent blood clot formation on the valve's surface.
• Biological Valves: These valves are made from animal tissue and don't require blood thinners. However, they degrade over time and eventually need to be replaced, usually after 10-20 years.

Advancements in Heart Valve Repair and Replacement

The field of cardiac surgery is constantly evolving, offering new techniques and technologies for both valve repair and replacement. Here are some exciting developments:

• Minimally invasive valve surgery: This approach involves smaller incisions and faster recovery times compared to traditional open-heart surgery.
• Robotic-assisted valve surgery: Robotics can enhance the surgeon's precision and control during complex valve repair procedures.
• Transcatheter aortic valve replacement (TAVR): This minimally invasive technique uses a catheter-based approach to replace the aortic valve without open-heart surgery.
• Improved valve repair techniques: Surgeons are constantly refining techniques to repair various types of valve damage with greater success rates.
• Next-generation prosthetic valves: Researchers are developing longer-lasting and more biocompatible prosthetic valves, potentially reducing the need for lifelong blood thinners.

These advancements offer hope for better outcomes and improved patient experiences in the future.

Conclusion

While valve repair is always the preferred option when feasible, valve replacement offers a crucial life-saving intervention for patients with severely damaged valves. With advancements in surgical techniques and valve technology, heart valve surgery continues to evolve, providing patients with improved outcomes and better quality of life.

ECMO

In the realm of advanced medical interventions, Extracorporeal Membrane Oxygenation (ECMO) stands as a beacon of hope and a lifeline for patients facing severe respiratory and cardiac challenges. This groundbreaking technology has revolutionized critical care, providing a temporary means of oxygenation and circulation for individuals whose own respiratory and cardiac systems are compromised. 

The Facts Behind ECMO

When the lungs or heart struggle to function adequately, the body's oxygen supply gets compromised. ECMO steps in to bridge this gap. That's how it functions:

• Blood Removal: A thin tube (cannula) is inserted into a large vein, usually in the groin or neck. This cannula removes blood from the body.
• Oxygenation and Removal of Carbon Dioxide: The blood is then pumped through a machine that acts like an artificial lungs. Here, fresh oxygen is added to the blood, and carbon dioxide, a waste product, is removed.
• Blood Return: The oxygen-rich blood is then pumped back into the body through another cannula, usually placed in a major artery.

Who Needs ECMO?

ECMO is a complex and resource-intensive treatment reserved for critically ill patients whose lungs or heart have suffered severe damage. Here are some common scenarios where ECMO might be considered:

• Severe Respiratory Failure: This can be caused by conditions like pneumonia, Acute Respiratory Distress Syndrome (ARDS), or inhalation injuries.
• Cardiogenic Shock: When the heart weakens and fails to pump blood effectively.
• Post-operative Support: Sometimes, ECMO can be used to support patients after heart or lung surgery.

The ECMO Journey

Being on ECMO is a physically and emotionally demanding experience. Here's a glimpse of what a patient might encounter:

• Intensive Care Unit (ICU): ECMO patients require constant monitoring and specialized care, so they reside in the ICU.
• Risks and Complications: While life-saving, ECMO carries risks like bleeding, infection, and blood clots.
• Sedation and Ventilation: Patients are often sedated and may require mechanical ventilation alongside ECMO.
• Recovery and Rehabilitation: The goal is for the patient's own lungs and heart to recover enough to come off ECMO. Depending on the underlying condition, recovery time can vary significantly.

The Future of ECMO

ECMO technology is constantly evolving. Here are some exciting possibilities:

• Minimally Invasive Techniques: Minimally invasive cannulation methods are being explored to reduce complications.
• Portable ECMO Systems: Portable ECMO systems could allow for faster deployment and potentially wider use.
• Long-Term ECMO Support: Advancements might pave the way for ECMO to bridge longer gaps while organs recover.

Conclusion

ECMO is a remarkable medical technology offering a lifeline to critically ill patients. While not a cure, it provides a chance for lungs and hearts to heal. As research continues, ECMO's effectiveness and accessibility are likely to improve, offering hope for a future where more lives can be saved.

Is Heart Failure End of the Story?

A diagnosis of heart failure can be daunting and may initially feel like the end of the story. However, it is crucial to understand that with advancements in medical care, lifestyle modifications, and a positive mindset, life after a heart failure diagnosis is not the conclusion, but rather the beginning of a new chapter. 

Understanding Heart Failure

Heart failure is a chronic condition where the heart struggles to pump blood effectively, leading to a range of symptoms such as fatigue, shortness of breath, and fluid retention. While heart failure is a serious condition, it is not a definitive endpoint; rather, it serves as a call to action for individuals to actively participate in their health management.

Causes

Heart failure often stems from conditions like coronary artery disease, high blood pressure, or lifestyle factors. Recognizing the root cause is the first step toward effective management.

Symptoms

The symptoms of heart failure include, Shortness of breath, fatigue, and swelling are common indicators. Early detection allows for proactive management and an improved prognosis.

Living Well with Heart Failure

Here's how you can take charge:

• Medications: Take your meds as the doctor says. They help your heart do its job better.
• Healthy Diet: Eat lots of fruits, veggies, whole grains, and lean proteins. Cut back on salty and fatty foods to ease the strain on your heart.
• Exercise: Move your body regularly. It helps your heart get stronger, boosts your energy, and improves circulation.
• Weight Management: Shedding some extra weight can really help your symptoms.
• Stress Management: Stress isn't great for your heart, so try things like meditation or deep breathing.
• Regular Doctor Visits: Keep up with your appointments. Your doctor can keep an eye on things and adjust your treatment if needed.
• Good Sleep: Make sure you get enough quality sleep, around 7-8 hours each night.

Medical Interventions

Modern medicine offers a range of interventions to manage heart failure, providing patients with opportunities to lead fulfilling lives.

• Medications: From diuretics to ACE inhibitors and beta-blockers, medications play a crucial role in symptom management, enhancing heart function, and preventing further deterioration.
• Surgical Options: In severe cases, heart transplant or ventricular assist device implantation may be considered. While these are significant steps, they offer hope and a chance at a better quality of life.

Living a Balanced Life

Even with heart failure, life can still be awesome:

• Stay Active: Do stuff you enjoy, whether it's walking, gardening, or hanging out with friends.
• Travel: Don't let heart failure ruin your travel plans. Just talk to your doctor about it first.
• Connect with Others: Having people around is important. Join a group or spend time with friends and family.

Advanced Treatment Options

In some cases, advanced treatment options, such as heart transplants or ventricular assist devices, may be considered. While these interventions are not suitable for everyone, they represent avenues of hope for those facing advanced stages of heart failure. Continued research and advancements in medical science offer new possibilities for improved outcomes and enhanced quality of life.

Conclusion

A diagnosis of heart failure is not the end of the story but rather a call to action for a new beginning. By actively participating in medical management, adopting heart-healthy lifestyles, building a robust support system, and fostering hope and resilience, individuals can navigate life after a heart failure diagnosis with purpose and optimism. Embracing the possibilities that lie ahead, individuals can redefine their narrative and live fulfilling lives despite the challenges posed by heart failure. With continued advancements in cardiovascular care and a holistic approach to well-being, the journey after a heart failure diagnosis can indeed be a story of triumph and resilience.

Aortic Surgeries

The aorta, the largest artery in the human body, serves as the main blood vessel carrying oxygenated blood from the heart to various organs. Aortic pathologies, such as aneurysms, dissections, and aortic valve diseases, can be life-threatening if left untreated. Fortunately, advancements in medical science have led to significant progress in the field of aortic surgeries, offering hope to patients facing these challenging conditions. Here are the different types of aortic surgeries, their significance, and the advancements that have revolutionized the field.

Understanding Aortic Pathologies

Before delving into aortic surgeries, it is crucial to grasp the various aortic pathologies that may necessitate surgical intervention. The three main conditions that require treatment are:

• Aortic Aneurysms: Aortic aneurysms are abnormal bulges or weakening of the aortic wall, which can lead to a life-threatening rupture if left untreated.
• Aortic Dissections: Aortic dissections occur when the inner layer of the aortic wall tears, causing blood to flow between the layers, leading to life-threatening complications.
• Aortic Valve Diseases: These include conditions such as aortic valve stenosis or regurgitation, where the valve fails to function correctly, affecting blood flow from the heart to the aorta.

Types of Aortic Surgeries

Aortic surgeries can be broadly classified into two categories: open surgeries and endovascular procedures.

• Open Surgeries: Traditional open aortic surgeries involve making a large incision to access the aorta directly. Surgeons repair or replace the affected portion of the aorta during these procedures. While effective, open surgeries can be invasive and require a more extended recovery period.
• Endovascular Procedures: Endovascular surgery is a minimally invasive approach that involves using catheters and stent grafts to repair the aortic pathology from within. This approach is less invasive, resulting in shorter hospital stays and faster recovery times compared to open surgeries.

Advancements in Aortic Surgeries

Over the years, significant advancements in medical technology and surgical techniques have transformed aortic surgeries, making them safer and more effective.

• Endovascular Aneurysm Repair (EVAR): EVAR has revolutionized the treatment of aortic aneurysms. During this procedure, a stent graft is inserted through small incisions in the groin and guided to the site of the aneurysm. The stent graft reinforces the weakened aortic wall, preventing the risk of rupture. EVAR significantly reduces the chances of complications and has become the preferred method for treating many abdominal and thoracic aortic aneurysms.
• Thoracic Endovascular Aortic Repair (TEVAR): TEVAR (Thoracic Endovascular Aortic Repair) is a specialized form of endovascular surgery designed specifically for thoracic aortic aneurysms. By using stent-grafts, TEVAR provides a less invasive alternative to open surgery for treating these complex conditions. Patients undergoing TEVAR experience reduced blood loss, shorter hospital stays, and faster recovery times. TEVAR has revolutionized the treatment of thoracic aortic aneurysms, offering patients a safer and more efficient option for addressing this critical health concern.
• Hybrid Aortic Procedures: Hybrid aortic procedures combine both open surgery and endovascular techniques. This approach is often utilized for complex aortic pathologies that may require a combination of treatments. Hybrid procedures offer a tailored solution, minimizing the invasiveness of traditional open surgery and capitalizing on the benefits of endovascular techniques.
• Transcatheter Aortic Valve Replacement (TAVR): TAVR is a groundbreaking procedure for patients suffering from aortic valve diseases, particularly those considered high-risk or inoperable for traditional open heart surgery. In TAVR, a prosthetic valve is inserted through a catheter and guided to the site of the diseased valve. This innovative approach reduces the need for sternotomy and results in quicker patient recovery.

Benefits of Aortic Surgeries

Aortic surgeries offer several important benefits:

• Life-saving: Aortic surgeries can prevent life-threatening conditions such as aortic aneurysm rupture or dissection, which can lead to severe internal bleeding and sudden death.
• Improved blood flow: By repairing or replacing damaged portions of the aorta, these surgeries restore normal blood flow, reducing the risk of organ damage and improving overall cardiovascular health.
• Symptom relief: Patients often experience relief from symptoms like chest pain, shortness of breath, and fatigue, which are commonly associated with aortic diseases.
• Enhanced quality of life: Successful aortic surgeries can lead to an improved quality of life, allowing patients to return to their normal activities and routines.
• Long-term benefits: Aortic surgeries have the potential to provide long-term solutions, reducing the need for repeated interventions and ensuring a better prognosis.
• Minimally invasive options: Advancements in technology have led to minimally invasive techniques, resulting in shorter hospital stays, less pain, and faster recovery times.
• Prevention of complications: By addressing aortic issues promptly, surgeries can prevent complications such as stroke, kidney damage, and peripheral artery disease.
• Increased longevity: Aortic surgeries can extend the lifespan of patients with aortic diseases, enabling them to live longer, healthier lives.

Patient Education and Awareness

While medical advancements have revolutionized aortic surgeries, patient education, and awareness are equally crucial. Early detection and intervention play a significant role in successful outcomes. Individuals with a family history of aortic diseases or risk factors like hypertension, smoking, or connective tissue disorders should undergo regular screenings.

Lifestyle modifications, including a heart-healthy diet, regular exercise, and smoking cessation, can significantly reduce the risk of developing aortic diseases. Moreover, recognizing the symptoms of aortic emergencies, such as sudden, severe chest or back pain, requires immediate medical attention.

Conclusion

Aortic surgeries have come a long way in saving lives and improving patient outcomes. The advancements in endovascular procedures, such as EVAR, TEVAR, and TAVR, have made a significant impact on treating aortic pathologies with reduced invasiveness and quicker recovery times. As medical technology continues to progress, we can anticipate even more innovative approaches to managing aortic conditions, enhancing the quality of life for patients worldwide. Remember, early diagnosis and timely intervention are key to successful treatment. Sakra World Hospital offers aortic valve replacement in Bangalore with top-notch care and expertise. Aortic valve replacement is a cutting-edge procedure that can effectively treat aortic valve conditions, providing patients with improved heart function and overall well-being. 

Preventive Tips for Healthy Heart

A healthy heart is essential for a long and vibrant life. Heart disease remains a leading cause of mortality worldwide, making it crucial to adopt preventive measures to protect our cardiovascular health. Fortunately, many heart conditions are preventable through lifestyle changes and proactive habits. 

Here are eight preventive tips for a healthy heart:

Balanced Diet:

A heart-healthy diet plays a pivotal role in preventing cardiovascular diseases. Emphasize a balanced and diverse diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. Minimize the intake of processed foods, sugary snacks, and excessive salt. Opt for foods high in omega-3 fatty acids, such as fatty fish (salmon, mackerel) and flaxseeds, which can lower cholesterol levels and reduce the risk of heart disease.

Regular Physical Activity:

Incorporating regular physical activity into your daily routine is one of the best ways to maintain heart health. Aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous exercise per week. Activities like brisk walking, swimming, cycling, and dancing can improve cardiovascular fitness, lower blood pressure, and reduce the risk of heart disease.

Quit Smoking:

Smoking is a significant risk factor for heart disease and other serious health conditions. It damages blood vessels, increases blood pressure, and reduces the oxygen-carrying capacity of the blood. If you smoke, seek help from a healthcare professional to quit this harmful habit. Quitting smoking can significantly improve heart health and overall well-being.

Manage Stress:

Chronic stress can take a toll on your heart health. Practice stress-reduction techniques like meditation, deep breathing exercises, yoga, or spending time in nature. Engaging in hobbies and maintaining a work-life balance can also be beneficial. By managing stress, you can lower the risk of heart disease and improve your overall quality of life.

Maintain a Healthy Weight:

Excess body weight puts additional strain on the heart and increases the risk of developing heart disease. Achieve and maintain a healthy weight through a combination of a balanced diet and regular physical activity. Focus on losing weight gradually and avoid crash diets, as rapid weight loss can be detrimental to heart health.

Control Blood Pressure and Cholesterol:

High blood pressure and elevated cholesterol levels are significant risk factors for heart disease. Regularly monitor your blood pressure and cholesterol levels, and follow your healthcare provider's advice on managing them. Lifestyle changes, such as a heart-healthy diet, exercise, and, if necessary, medication, can help control these factors and protect your heart.

Limit Alcohol Consumption:

While moderate alcohol consumption may have some cardiovascular benefits, excessive drinking can harm your heart. If you drink alcohol, do so in moderation. For men, this means up to two drinks per day, and for women, one drink per day. However, it's essential to consult with a healthcare professional, as certain individuals should avoid alcohol altogether.

Get Enough Sleep:

Adequate sleep is essential for heart health. Poor sleep quality and insufficient sleep can contribute to hypertension and other cardiovascular issues. Aim for 7-9 hours of quality sleep per night. Establish a consistent sleep schedule and create a relaxing bedtime routine to improve sleep patterns.

Other Important Points

Regular Health Checkups:

Regular health checkups are essential for early detection and prevention of heart disease. Schedule regular visits with your healthcare provider to monitor your blood pressure, cholesterol levels, blood sugar, and other important health indicators. Detecting any potential issues early allows for timely intervention and better management of heart health.

Know Your Family History:

Understanding your family's medical history can provide valuable insights into potential hereditary risk factors for heart disease. If there is a history of heart conditions in your family, be proactive in adopting heart-healthy habits and work closely with your healthcare provider to manage any underlying risks.

Stay Hydrated:

Proper hydration is crucial for heart health. Drinking an adequate amount of water helps maintain blood volume and supports healthy blood circulation. Aim to consume at least eight glasses of water daily and adjust your intake based on your activity level and climate.

Limit Sodium Intake:

Excess sodium can contribute to high blood pressure, a significant risk factor for heart disease. Be mindful of the amount of salt in your diet and opt for low-sodium alternatives when possible. Focus on using herbs and spices to enhance the flavor of your meals instead of relying on excessive salt.

Practice Mindful Eating:

Mindful eating involves paying attention to the taste, texture, and enjoyment of food, as well as recognizing feelings of hunger and fullness. This practice can help prevent overeating, promote healthier food choices, and contribute to maintaining a healthy weight.

5 diet Tips for Better heart health

Here are five dietary tips for improving heart health:

Focus on addition, not subtraction- Rather than eliminating all treats, start by incorporating more fruits and vegetables into your meals. These nutrient-rich options can help reduce blood pressure and cholesterol, while the fiber and crunchiness may satisfy your cravings. Frozen produce is a good alternative to fresh, and it's preferable to canned items.

Switch up your protein sources- Red meat is high in saturated fat, which can raise cholesterol levels. Opt for chicken, fish, or beans instead. If you occasionally consume red meat, choose lean cuts like sirloin.

Make healthier choices at fast-food restaurants- When eating on the go, go for salads or grilled items over fried options. At Mexican chains, try veggie-filled bowls with cauliflower or brown rice rather than tortillas and white rice.

Substitute butter with olive oil for cooking- This simple change retains flavor without increasing cholesterol. Extra virgin olive oil has much lower saturated fat compared to butter.

Swap cold breakfast cereals with oatmeal- Many cold cereals are high in sugar and lacking in nutrients. Oatmeal is a whole grain that can help lower cholesterol and keep you feeling full longer due to its fiber content.

Conclusion:

Prioritizing a healthy heart is essential for a long and vibrant life. By adopting these preventive tips and considering other essential points, you can significantly reduce the risk of heart disease and improve your overall well-being. Remember that small lifestyle changes can make a big difference when it comes to heart health. Consult with your doctor from Bangalore Heart Care Centre at Sakra World Hospital for personalized advice and create a comprehensive plan tailored to your specific needs. Embrace these preventive measures and incorporate them into your daily life to support a healthy heart and a healthier you.

Heart Failure & Transplant LVAD

Understanding Heart Failure

Heart failure is not a singular disease; rather, it is a syndrome caused by various cardiovascular conditions that weaken the heart muscle. The most common causes include coronary artery disease, hypertension, heart valve problems, and cardiomyopathy. As the heart weakens, it struggles to maintain adequate blood flow to meet the body's demands. Consequently, patients may experience symptoms like fatigue, shortness of breath, fluid retention, and reduced exercise tolerance.

How common is heart failure?

• 1-year mortality of untreated pts is 25% and 5 years mortality is 50%.
• Over 3/4th of patients after MI develop heart failure within 5 years.
• 1% of the general population between 55-65 years of age.
• 3% between 65 to 74 years
• 7% from 75 to 84 years
• 20% over 80 years
• Beyond 70 years heart failure is the most common reason for hospitalization.

Heart failure is a serious medical condition in which the heart's ability to pump blood efficiently is compromised, leading to a range of debilitating symptoms and, in severe cases, life-threatening complications. For some patients with end-stage heart failure, a Left Ventricular Assist Device (LVAD) can be a crucial bridge to heart transplantation or even a long-term therapy option. 

Signs and Symptoms of Heart Failure

Common signs and symptoms of heart failure include:

• Shortness of breath, especially during physical activity or while lying down.
• Persistent fatigue and weakness, even with minimal exertion.
• Swelling in the legs, ankles, or abdomen due to fluid retention.
• Rapid or irregular heartbeat (palpitations).
• Persistent coughing or wheezing, accompanied by white or pink phlegm.
• Decreased ability to exercise or engage in physical activities.
• Sudden weight gain caused by fluid buildup.
• Feeling dizzy or lightheaded, especially when standing up.
• Loss of appetite and nausea.
• Difficulty concentrating or feeling confused.
• Chest pain or discomfort in some cases.

Cause of Heart Failure

• May be genetic or acquired Myocarditis, post-MI, Valvular heart disease, etc
• Ischemia is the most common cause in men whereas in women hypertension/DM is the most common cause.

Heart Transplantation: The Ultimate Solution

Heart transplantation is considered the gold standard treatment for end-stage heart failure when all other therapies have failed. A heart transplant involves replacing a failing heart with a healthy heart from a deceased donor. However, the limited availability of donor organs and the complexities of the transplantation process mean that not all eligible patients can receive this life-saving treatment.

Enter LVAD: A Bridge to Transplantation

In situations where a patient is eligible for a heart transplant but no suitable donor heart is immediately available, or in cases where transplantation is not a viable option, LVADs step in as a bridge to either heart transplantation or a long-term solution. An LVAD is a mechanical device that assists the heart in pumping blood effectively, reducing the workload on the weakened heart muscle.

How LVADs Work

LVADs are typically implanted in the patient's chest and connected to the left ventricle and aorta. These devices can either be pulsatile, mimicking the heart's natural pulsations, or continuous flow, providing a constant blood flow. The power source for the LVAD can be external or internal, allowing patients greater mobility and improved quality of life. Advanced LVAD technology has made significant strides in terms of durability and miniaturization, making them more reliable and safer for long-term use.

Benefits of LVAD Therapy

Improved Quality of Life: LVADs can alleviate heart failure symptoms and improve a patient's ability to engage in daily activities and exercise.

Bridge to Transplantation: For patients awaiting a heart transplant, an LVAD can sustain them until a suitable donor heart becomes available.

Destination Therapy: In some cases where transplantation is not feasible, LVADs can serve as a long-term therapy option, allowing patients to lead more fulfilling lives.

Heart Recovery: In certain instances, LVAD therapy can enable the heart to recover some of its functions, making transplantation unnecessary.

Challenges and Considerations

While LVADs offer hope and promise, they come with their own set of challenges:

Device Complications: LVADs are associated with potential complications such as bleeding, infection, device malfunction, and blood clot formation.

Lifelong Management: LVAD recipients require ongoing medical follow-up, lifestyle adjustments, and strict adherence to medication regimens.

Cost and Accessibility: LVAD therapy can be expensive, and not all healthcare systems have equal access to this advanced technology.

Ethical Considerations: The allocation of LVADs and donor organs raises ethical questions and demands careful consideration.

Conclusion

Heart failure is a debilitating condition that affects millions worldwide, impacting the daily lives of patients and their families. LVADs have emerged as a valuable tool to support those with advanced heart failure, providing relief from symptoms and a renewed sense of hope. However, heart transplantation remains the gold standard for curing end-stage heart failure, offering patients a chance at a new lease on life.

As medical technology advances and research progresses, the future holds promise for even better treatments and outcomes for those facing heart failure. Until then, the tireless efforts of healthcare professionals, coupled with the unwavering spirit of patients, continue to push the boundaries of possibility in the fight against heart failure. A heart transplant in Bangalore at Sakra World Hospital, with its top-notch medical facilities and knowledgeable cardiac surgeons, can provide a ray of hope for patients with advanced heart failure.

Beriberi Disease

Beriberi is also known as thiamine deficiency, caused by a deficiency of vitamin B1. Your body requires thiamin to break down and digest the foods you eat, to maintain a healthy metabolism, and help your muscles and nervous system to perform their work effectively. A severe thiamine deficiency may prevent the body from performing these functions properly and can affect your central nervous system and cardiovascular system.

Beriberi is more common in developing countries among people who eat mostly white rice or highly refined carbohydrates.

There are two types of beriberi disease:

• Wet Beriberi: It mainly affects the cardiovascular system, results in poor circulation and fluid buildup in the tissues.

• Dry Beriberi: It primarily affects the nervous system, causing degeneration of the nerves. Degeneration typically starts in the arms and legs and may lead to muscle atrophy and loss of reflexes.

Who’s most at risk for beriberi?

You won't have to worry about being diagnosed with beriberi if you eat a varied and healthy diet. People who consume a lot of alcohol or struggle with alcohol addiction are more likely to be thiamin deficient. Excess alcohol can make it difficult for the body to absorb thiamin.

Other people at more risk for developing beriberi include:

• Breastfed babies whose mothers are thiamine deficient

• Those who take a high-carbohydrate diet, especially refined carbs

• People who do physical activity or exercise on a regular basis

• Anyone with hyperthyroidism condition, which might prevent thiamin absorption

• People have digestive system issues that can interfere with nutrient absorption, particularly as they age 

• Anyone with high levels of stress

If you're on dialysis or taking diuretics, your risk of beriberi may increase. Doctors typically take steps to observe thiamine levels during these treatments.

What are the symptoms of beriberi?

The symptoms of beriberi may differ depending on its type.

Symptoms of wet beriberi may include:

• Increased heart rate

• Shortness of breath

• Waking during the night due to shortness of breath

• Swelling in the legs and feet

• Severe lack of energy or constant fatigue

Symptoms of dry beriberi may include:

• Vomiting

• Difficulty walking

• Confusion

• General pain and body aches

• Numbness in the hands or feet

• Paralysis in the lower legs

In rare, extreme cases of deficiency, beriberi may cause a condition known as Wernicke-Korsakoff syndrome. This syndrome is a type of brain damage that is caused by severe thiamine deficiency.

A person with Wernicke-Korsakoff  may experience other symptoms, including:

• Memory loss or inability to form new memories

• General confusion

• Rapid eye movement

• Involuntary eye movement

• Blurred or double vision

• Loss of muscle coordination

• Hallucinations

What causes beriberi?

The beriberi is caused due to deficiency of thiamine in the diet. The disease is very rare in areas with access to vitamin-enriched foods like certain breakfast cereals and bread.

According to the National Institutes of Health, beriberi is most common in areas where the diet comprises unenriched, processed white rice, which has only a tenth of the thiamine found in brown rice.

How is beriberi diagnosed?

Your doctor may suggest some medical tests such as blood and urine tests to determine whether you have beriberi. These tests are done to measure the levels of thiamine in a person’s bloodstream to diagnose beriberi.

Doctors will also conduct a neurological exam to check for lack of coordination, droopy eyelids, difficulty walking and weak reflexes. People with later stages of beriberi will show some symptoms like memory loss, confusion, or delusions.

The doctor will also examine a person’s heart rate and breathing rate and check for swelling in the lower limbs or legs, which can indicate heart problems.

How is beriberi treated?

Beriberi can be easily treated with thiamine supplements. Your physician may prescribe a thiamine pill or shot for beriberi treatment and prevention. For severe cases, a healthcare expert will administer intravenous thiamine.

Your progress will be monitored with follow-up blood tests to check how well your body is absorbing the vitamin.

 

New Hope for Patients at Risk of Stroke

Atrial Fibrillation is a condition where the upper chambers of the heartbeat chaotically and the pulse becomes fast and irregular. It is a fairly common heart arrhythmia, seen particularly in the elderly, those with structural heart disease and high blood pressure. The incidence of atrial fibrillation is fairly high. The biggest threat to patients with atrial fibrillation is stroke. A stroke happens due to clot formation in the left upper chamber of the heart and from where it breaks off and migrates into the circulation and most commonly into the brain arteries. The risk of stroke in patients with AF is fivefold higher. In those with valvular heart disease and AF, the stroke risk is even higher. 20 % of all strokes happen due to AF. Traditionally patients with atrial fibrillation have been treated with blood thinners which work very well in preventing stroke. However, blood thinners carry the risk of bleeding and therefore some patients cannot take them. These are people with kidney or liver disease, those with certain haematological disorders like low platelets, and patients already taking other kinds of blood thinners. Similarly, patients who have already bled because of blood thinners cannot continue to take them. This exposes them to the risk of stroke. New hope for these patients is a procedure called “Left atrial appendage device closure”.

In patients with AF, the most common location for clot formation is a small extension of the left atrium called the left atrial appendage. Blood stagnates in the appendage and clot forms. When this clot migrates, it causes a stroke. A novel way of preventing stroke is by plugging this appendage with a device in a procedure called “LAA device closure” which is done under local anaesthesia with mild sedation.

Sakra World Hospitals are regarded as the best cardiac hospital in Bangalore, performing a multitude of treatments and procedures in cardiology and cardiothoracic surgery.

A typical scenario is of Mr. B, an elderly gentleman who was on blood thinners for AF and developed a massive bleed into the brain which left him in the ICU for three weeks. He had to undergo surgery to remove a part of his skull to decompress the brain and subsequently another surgery to reconstruct the skull by Dr. Sreekanth B Shetty, Senior consultant and head of interventional cardiology at Sakra World Hospital. Back on the blood thinner, he bled again, but fortunately without any additional disability. He was obviously not going to be continued on the thinner anymore and to reduce his stroke risk, he underwent “LAA device closure “ and is doing well.

This procedure is also suitable for patients who have had previous stomach or intestinal bleeds and therefore cannot take thinners.

Sakra World Hospitals is a premier heart care centre equipped with state-of-the-art facilities available round-the-clock facilities, renowned cardiothoracic surgeons, intensivists, anesthesiologists and the best cardiac surgeon in Bangalore. Our team of cardiologists and cardiothoracic surgeons are trained at the top institutes in India and abroad and are completely dedicated to atrial fibrillation treatment in India.

For more information, contact Perez Consulting – Sujish@ 9986612170, Jayananda@ 810579431

 

Why Quitting Smoking Is The Hardest Thing To Do

Making resolutions every New Year is like a ritual that brings a sense of optimism and a feeling of control in our minds.  Be it hitting the gym, eating healthy or quitting to smoke, these resolutions are promises to start anew and try to become the better and improved versions of ourselves. However, most of them are difficult to be kept and broken easily. Social science researchers call this the “False Hope Syndrome” where we set high yet unrealistic expectations. According to a study by the United Kingdom’s Royal Society of Public Health, “quitting smoking is the most difficult resolution to keep.” Despite the challenges, promising oneself to quit smoking is one of the most common, difficult and beneficial resolutions. And it’s all in the mind.

India is home to approximately 120 million smokers. Despite the various measures and initiatives taken up by the Ministry of Social Justice and Empowerment of India to reduce drug abuse, the incidence continues to grow. World Health Organization (WHO) stated that tobacco is responsible for an estimated 6 million deaths worldwide each year and out of the 12% of world’s smokers in India, 70% are men, and 13-15% women. It has also been estimated that about 90% of children under 16 years of age have used some form of tobacco in their past, and 70% are still using tobacco products. 

In the wake of the COVID-19 pandemic, leading healthcare experts suggested that smokers are likely to be at increased risk of severe COVID-19, in comparison to non-smokers. Smokers have a history of suffering from severe respiratory illness by causing inflammation in the airways and COVID-19 can make it worse for them, thus suggesting that “now” is a particularly good time to kick the butt. 

Smokers at higher risk of COVID-19 infection

Smokers during the act of smoking use fingers and possibly contaminated cigarettes, which increases the likelihood of transmitting the virus from hand to mouth. They may already be at risk of having reduced lung capacity or may suffer from underlying lung disease, use products such as common vapes or water pipes that can facilitate the transmission of COVID-19 in communal and social settings. COVID-19 is known to directly impact the lungs by reducing its capacity and limiting the intake of oxygen, thus leading to ARDS and pneumonia. Smokers with diabetes or hypertension are also at risk of succumbing to COVID-19, alongside individuals with asthma or wheezing problems. 

Why is it hard to quit smoking?

A single cigarette contains about 10-12 milligrams of nicotine, making you consume about 1.1 to 1,8 mg of nicotine every time you inhale one. Nicotine is a highly addictive substance, similar to cocaine or heroin.  When you smoke, the nicotine is mixed into the blood. When it reaches the brain, it releases dopamine, the feel-good hormone leaving you to feel pleasant, calm and happy. When the dopamine depletes, you are back to your original state and begin to yearn for that fresh flow of nicotine. 

Nicotine acts as a stimulant. People usually smoke to increase concentration. They have trouble focusing when they do not smoke. When you stop smoking for some time, your body starts showing symptoms such as anxiety, frustration, anger, tremors, depression, insomnia, distraction, etc. These unpleasant withdrawal symptoms of nicotine often lead smokers to smoke again. 

Difficult Roads Lead to Beautiful Destinations 

Quitting isn’t easy. People usually turn to smoke as a coping mechanism, especially at stressful times. They usually cut down their intake before attempting to quit it all at once which often fails. During stress, it is better to try and flex other coping muscles. Counselling and medication can help redeem your chances to quit. On average, studies reveal, there are at least 6-11 attempts before they actually succeed. People who quit for even a short duration witness a quick improvement in their lung health. There is a real opportunity to break routines. 

In the current scenario when a looming pandemic is threatening to wipe out human civilization, it is important to take actions that can enforce people to reduce and quit smoking. Heighten all campaigns against smoking and vaping. Recommend complete ban of using shared water pipes in cafes, bars, restaurants, etc. Any enforcement of the ban with adequate fines and penalties might encourage smokers to quit smoking. 

If you are planning to quit smoking, you can follow the following.

1. Fix a date to quit smoking 
2. Go on gradually reducing the number of cigarettes smoked per day and one fine day quit completely 
3. It may take 3-4 attempts to quit smoking and hence don't be discouraged if you fail in one attempt. 
4. Take professional help from a psychiatrist for smoking de-addiction 
5. involve in healthy habits like exercise and yoga/meditation 
6. Try to quit as a group if you smoke with your friends at work
7. Do not restart after quitting.

Nicotine Replacement Therapy – It is a medically approved method to help people quit. They come in the form of gum, lozenges, patches, and inhalers. Studies show that using nicotine replacement doubles your chances of quitting. It also helps reduce craving and withdrawal symptoms. One may consider taking nicotine replacement when you are ready to quit, need help with nicotine cravings or withdrawal symptoms and are not ready to quit the habit but not the substance.

If we negate the several malice of COVID-19, the time of crisis due to the pandemic can be considered as a time of opportunity. If you haven’t been successful in keeping your New Year promises, this is your redemption time. Because if you stretch yourself a bit more, you will treat your community well too.

Smoking: Should I Use Nicotine Replacement to Quit

Smoking: Should I Use Nicotine Replacement to Quit?

Making health decisions is part of our life. These decisions can have a big effect on your health and happiness. Some decisions are suggestive of how good you take care of your health. Others may affect how much it costs. Most people feel better about their health when they are able to take part in these decisions. As you read along, you will understand how your choices affect your health, whether you take part in the decision or ask your doctor to decide. Your decision should ideally be based on both medical facts as well as your own feelings.

Your Choices

1. You can try to quit smoking without using nicotine replacement medicines, such as through nicotine gum, patches, inhalers, or lozenges. 
2. You can use nicotine replacements to help you deal with cravings and withdrawal symptoms, such as getting irritated easily.

Key Points In Making Your Decision

In the past, the only way to quit smoking was to slowly reduce how much you smoked or to quit all at once. Today, you have the choice of using nicotine products or prescription medicines that can make quitting easier. These also work if you smoke cigars or pipes and may work for other tobacco products as well, such as chew or snuff. 

Consider The Following Factors When You Make Your Decision:

1. Studies have shown that using nicotine replacements doubles your chances of quitting smoking. 
2. Withdrawal symptoms and cravings lead to the craving to go back to smoking. Nicotine replacement helps relieve these symptoms. 
3. Your insurance company may pay for all of it or part of it. Even if you require paying for nicotine replacements yourself, consider how much money you will save by not having to buy tobacco anymore. 
4. If you are pregnant, have heart problems, take mental health medicines, or is below the age of 
   18, discuss with your doctor before using nicotine replacements.

Types of Nicotine Replacements

Nicotine replacements are in the form of gums, lozenges, patches, and inhalers. Any of these can aid you to quit smoking, but you might prefer one kind over another.

Here Are Some Things To Consider While Making That Choice:

1. Nicotine gums, lozenges, and inhalers can be used to ease sudden urges to smoke. 
2. A nicotine patch may be a good option if you prefer putting on a patch in the morning and forgetting about it until bedtime. 
3. Your doctor could suggest that you use more than one type. For example, if you are using the patch, maybe gum can help you in times when you need extra aid to help you out. 
4. You can get nicotine gum, lozenges, and patches without a prescription. Additionally, the gum and lozenges come in different strengths and flavours. 
5. If you are pregnant or under 18, your doctor may want you to try other ways of quitting before considering a nicotine patch or other products.

You May Want To Consider Nicotine Replacement If Any Of These Apply To You:

1. You are ready to quit. 
2. You need help with nicotine cravings or withdrawal symptoms. 
3. You are not ready to quit nicotine, but you want to quit smoking.

Travelling and Driving After Heart Attack

Traveling And Driving After A Heart Attack And Angioplasty / Bypass Surgery

Traveling after your treatment and discharge for a Heart attack , it is possible to travel by train, tram, car or bus.

If public transport seems stressful, arranging alternatives for the first few weeks in order to avoid peak-hour traffic is an option. Make sure that you find a seat for yourself as well so you do not get tired fast.

Long trips tend to make you feel tired and chances of getting car sick are more than usual. Taking regular breaks can help. If you have had bypass surgery, placing a cushion, pillow or rolled-up towel between your chest and the seat belt may also help to reduce pressure on the wound while it heals.

Flying
checking with your medical expert about the possibility of traveling by plane can be done by even getting a medical certificate form filled by them. Ask the airline about any air travel requirements if you're unsure. 

Travel Insurance
Understanding your heart condition is important to decide your travel insurance for local and overseas trips. Talk to your doctor before buying travel insurance.

You will need to answer a health questionnaire and this may require a medical assessment from a doctor. 

Driving

A Heart Attack and H eart Surgery can affect your ability to drive over a short period of time. 

Talk to your doctor regarding when you can start driving again. You will need their approval in order to do so. It may take longer for those who have undergone heart surgery and you will need to follow specific instructions. This could be within 2 to 4 weeks, depending on the recovery time. 

The following are the possible times you need to wait before you begin driving a private car again:

1. Coronary artery bypass graft (CABG) surgery - at least 4 weeks
2. Heart attack (myocardial infarction) - at least 2 weeks
3. Coronary angioplasty and stent insertion - at least 2 days

If you feel anxious about driving, ease it back slowly. Do not drive alone and take routes you are aware of. Avoid peak hour traffic or long drives. 

Heart Failure

Your chances to drive again after a heart failure depends on the symptoms you experience. If your symptoms are stable and it does not affect you or your ability to drive, then you may continue driving. 

If you have symptoms, you could stop driving for at least one month. If you are unsure, discuss with your doctor for further advice.

You must stop driving for at least one month if your body shows symptoms. If you are not sure, then have a discussion with your doctor regarding the same. You should only start driving again when your doctor tells you it's safe.
 
Pacemaker Implant - Including Box Change 

You can't drive for at least 1 week. You may continue to drive after that as long as you don't have another condition that might disqualify you. 

Implantable Cardioverter-Defibrillator (ICD)

For group car and motorcycle licenses, the following restrictions apply: 

1. You can't drive for one month if you had an ICD fitted, and you didn't have a cardiac arrest
2. If you have an arrhythmia that has caused you to faint, and your ICD appropriately shocks you, and if your treatment is changed by your cardiologist (such as an increase in anti-arrhythmic medications or an ablation) then you must stop driving for 6 months (providing you have no further episodes)
3. If you have an arrhythmia that has caused you to faint, And your ICD appropriately shocks you, but your cardiologist is unable to offer any changes to your treatment to try and prevent it happening again, (such as an increase in anti-arrhythmic medications or an ablation) you must stop driving for 2 years.

Those who have lorries and buses licenses cannot drive with an ICD fitted.

Vehicle Insurance

You may need to inform your insurer about your heart condition to gain coverage. They might not cover you if you start driving sooner than the recommended waiting time. Hence, always check with your insurance company.

Your Licence

By law, you must report a health condition that could affect your driving, including a heart attack. You need to report it as soon as it happens. To check what you need to do, contact the licensing agency in your state or territory.

A heart attack doesn't mean you will be stopped from driving. But the licensing agency may set some conditions or restrictions to make sure you can drive safely. For example, your licence might require that:

1. You obey minimum non-driving advisory periods
2. There is a satisfactory response to treatment
3. There are minimal symptoms that affect driving (chest pain, palpitations, breathlessness)
4. You see your doctor for a periodic review
5. There is minimal pain in your muscles and bones after bypass surgery.

Your doctor can make recommendations about a conditional license, but the transport agency will be making the final decision. It's your responsibility to comply with any conditions on your licence.

There are also different licensing conditions you need to meet. Contact your state or territory office for more information on that. 
 
Driving Commercial Vehicles

If you drive a commercial vehicle (eg a truck or forklift), there are longer waiting times before you drive again. The suggested times are:

1. Coronary artery bypass graft (CABG) surgery - at least three months
2. Heart attack (myocardial infarction) - at least four weeks
3. Coronary angioplasty and stent insertion - at least four weeks
4. There are also different licensing conditions you need to meet. 
5. Contact your state or territory office for more information.

Medicines And Driving

Some medicines can affect your ability to drive. Discuss with your doctor about any side effects of your medicines. This is very important if you drive commercial vehicles. Ask your doctor or pharmacist about how your medications may affect your ability to drive. 

Metabolic Syndrome

Metabolic Syndrome

A metabolic syndrome is a group of health problems that make it more likely for a person to have a heart attack, stroke or develop diabetes. If you are suffering from metabolic syndrome, you have at least  make it more likely you will have at least three of the following:

1. Too much fat around your waist.

2. Borderline or high blood pressure.

3. Borderline or high blood sugar.

4. High triglycerides, a type of fat in your blood.

5. Low “good" HDL cholesterol.

What causes it?

A combination of your family’s history (your genes), as well as an unhealthy lifestyle, can be the cause of the metabolic syndrome. Gaining weight by eating too much and not exercising are the main reasons, especially if you tend to gain weight around your waist.

What are the symptoms?

Metabolic syndrome does not make you feel sick. But if you do suffer from diabetes, heart attacks and strokes, you will develop symptoms of those problems.

What increases your risk?

You are more likely to have metabolic syndrome if:

1. You are older - as you age, your chances rise.

2. You are overweight or obese, especially if you carry a lot of weight around your waist and upper body.

3. Your family members have or had type 2 diabetes and are or were overweight.

4. You have other conditions. For instance, metabolic syndrome is more likely if you have high blood pressure or other problems.

How is it diagnosed?
Your doctor will check your blood pressure, measure your waist, and conduct a fasting blood test. If you have metabolic syndrome, your results may include:

Measurement	Result
Waist size	Men: Greater than 40 inches  Women: Greater than 35 inches
Triglycerides	150 or higher
HDL cholesterol	Men: Less than 40  Women: less than 50
Blood pressure	130/85 or higher
Fasting blood sugar	100 or higher

How is it treated?

Get more exercise

Being more active is one of the best ways to treat metabolic syndrome. Being active help for many reasons:
Helps you lose weight.

1. Lowers blood pressure, triglycerides, and blood sugar.

2. Raises HDL, the “good" cholesterol.

Aim for at least 2½ hours of moderate exercise a week. You could do this brisk walking for 30 minutes a day, at least 5 days a week. You can also be active in blocks of 10 minutes or more throughout your day and week. Moderate exercise is safe for most people, but it's always a good idea to talk to your doctor before starting an exercise program.

Change how you eat

Your doctor may advise you to eat less salt or try the DASH diet to help lower your blood pressure. The DASH diet is low in fat but rich in low-fat dairy foods, fruits, and vegetables.

To get started:

1. Choose low-fat or nonfat cheese, yoghurt, and cottage cheese.

2. Drink skim (nonfat) or 1% milk.

3. Eat lots of fruits and vegetables.

4. Eat more whole grains like brown rice & whole wheat bread.

5. Choose lean meats, chicken without skin, or fish.

6. Eat beans, lentils, and nuts.

7. Limit sodium (salt) to less than 2,300 milligrams (mg)—less than 1 teaspoon—a day.

8. As a rule of thumb, if you limit yourself to 10 calories per pound of your body weight

9. each day and maintain a normal level of activity, you should be able to lose 1 pound per week.

Take medicines if necessary

Lifestyle changes, such as exercise, losing weight, and eating healthier, are usually the first set of approaches for metabolic syndrome. Your doctor may prescribe medicine for your cholesterol, blood sugar, or blood pressure if need be.

Dr Deepak Krishnamurthy MD, DNB
Senior Interventional Cardiologist 

Book an appointment with Dr Deepak Krishnamurthy - https://www.sakraworldhospital.com/doctors

Intravascular Ultrasound (IVUS) for precision angioplasty

Coronary angioplasty has evolved over the last three decades due to improvements in angioplasty hardware such as stents, balloon catheters, wires etc which have made the procedure far easier to perform. Immediate and long-term outcomes and safety of the procedure have markedly improved. Also aiding in ease of performance are advancements in imaging technologies which have made cardiac Cath labs more sophisticated with lower risk of radiation to both patient and operator. There still are limitations in the two-dimensional image that the angiogram generates which make some interpretations inadequate. We do not get enough detail of what’s happening in the blood vessel wall, and the measurements are not precise enough.

This is where Intravascular Ultrasound comes as a boon. Just like how ultrasound imaging of the intra-abdominal organs can be done using an ultrasound probe, the coronary artery can be imaged in detail using a miniature ultrasound catheter which is taken into the coronary artery during an angioplasty.The image generated by this probe gives multiple details such as the size of the blood vessel, length of the segment to be stented, presence of clot or calcium and such other details which are important in planning the procedure. Also, at the end of the procedure,the IVUS tells us if there are any areas of concern that need to be fine-tuned (such as stent under expansion, under-sizing etc.). This gives a sense of objectivity and completeness to the angioplasty procedure which ensures robust long-term outcomes. The IVUS examination is done without too much addition to procedural time and complexity.

Thus, intravascular imaging a very useful adjunct to angioplasty and helps improve long-term results.

Aortic valve Surgery: Types of Repair and Reconstruction

Aortic valve surgery is one of the commonly performed procedures in cardiac surgery across the world. As an alternative to the standard approach of replacement of the aortic valve with the prosthesis, either mechanical of bioprosthetic, interest in aortic valve repair has been there for over 20 years.

There are different kinds of repair for the aortic valve, most being for cases with leaking valves. Very few kinds of repair have been used for valve narrowing or stenosis. A large number of repairs utilized the patient’s own pericardium.

However, the rate of reoperation has been high, making this type of repair less than satisfactory. Its limited durability can be explained by imperfect preparation of the pericardium, the design of the pericardial cusps, and the technical performance of the operation. At the same time, commercially available tissue valves are also imperfect with limited durability and imperfect hemodynamics. The limited durability has become the major issue in younger patients and the imperfect hemodynamics has become the major issue in patients with small aortic roots

Recently, a new technique has become popular as one of the aortic valve reconstruction procedures. The procedure is Professor Ozaki’s work in Japan on an aortic cusp replacement technique using pericardial tissue. The procedure published in the prestigious Journal of Thoracic and Cardiovascular Surgery in 2014 shows very impressive outcomes in 404 consecutive patients with only two patients requiring reoperations because of infective endocarditis. The other 402 patients showed less than mild aortic regurgitation, and no thromboembolic events were recorded after a mean follow-up 23.7 +13.1 months. Freedom from reoperation was 96.2% at 53 months of follow-up. These short and medium-term outcome data are as good as or better than those for standard replacement tissue valves regarding all variables, survival, freedom from reoperation, stroke and endocarditis.

1. Halees ZA, Shahid MA, Sanei AA, Sallehuddin A, Duran C. Up to 16 years follow-up of aortic reconstruction with pericardium: a stentless readily available cheap valve? Eur J Cardiothorac Surg. 2005;28:200-5.

2. Chan KMJ, Rahman-Haley S, Mittal TK, Gavino JA, Dreyfus GD. Truly stentless autologous pericardial aortic valve replacement: an alternative to standard aortic valve replacement. J Thorac Cardiovasc Surg. 2011;141:276-83.

3. Shigeyuki Ozaki, Isamu Kawase, Hiromasa Yamashita, Shin Uchida, Yukinari Nozawa, Mikio Takatoh, So Hagiwara. A total of 404 cases of aortic valve reconstruction with glutaraldehyde-treated autologous pericardium. J Thorac Cardiovasc Surg 2014;147:301-6

4. Shigeyuki Ozaki, Isamu Kawase, Hiromasa Yamashita, Shin Uchida, Yukinari Nozawa, Mikio Takatoo, So Hagiwara, Nagaki Kiyohara. Aortic Valve Reconstruction using Autologous Pericardium for Infective Endocarditis with Root Abscess. Toho University, Tokyo, Japan. AATS abstract 2015

5. Shigeyuki Ozaki, Isamu Kawase, Hiromasa Yamashita, Shin Uchida, Yukinari Nozawa, Mikio Takatoh, So Hagiwara and Nagaki Kiyohara. Aortic valve reconstruction using autologous pericardium for ages over 80 years. Asian Cardiovascular & Thoracic Annals 2014;22: 903–908

6. Hiromasa Yamashita, Shigeyuki Ozaki, Kiyotaka Iwasaki, Isamu Kawase, Yukinari Nozawa, and Mitsuo Umezu. Tensile Strength of Human Pericardium Treated with Glutaraldehyde. Ann Thorac Cardiovasc Surg 2012; 18: 434–437

7. Shigeyuki Ozaki, Isamu Kawase, Hiromasa Yamashita, Shin Uchida, Yukinari Nozawa, Mikio Takatoh, So Hagiwara, Nagaki Kiyohara. Reconstruction of Bicuspid Aortic Valve With Autologous Pericardium – Usefulness of Tricuspidization. Circ J 2014;78:1144 – 1151

8. Shigeyuki Ozaki, Isamu Kawase, Hiromasa Yamashita, Shin Uchida, Yukinari Nozawa, Takayoshi Matsuyama, Mikio Takatoh, So Hagiwara. Aortic valve reconstruction using self-developed aortic valve plasty system in aortic valve disease. Interactive CardioVascular and Thoracic Surgery 2011;12:550–553 (2011 Published by European
Association for Cardio-Thoracic Surgery Institutional report – Valves)

9. Isamu Kawase, Shigeyuki Ozaki, Hiromasa Yamashita, Shin Uchida, Yukinari Nozawa, Takayoshi Matsuyama, Mikio Takatoh, So Hagiwara. Aortic valve reconstruction with autologous pericardium for dialysis Patients. Interactive CardioVascular and Thoracic Surgery 2013;16:738–742

10. https://www.rbhh-specialistcare.co.uk/

11. https://publicdocuments.sth.nhs.uk/pil3800.pdf

Other Kinds of repair

Dr. Adil Sadiq attended training by Dr. Ozaki at Tokyo, Japan, in OCT 2017, followed by certification

Link to the lecture program is given below

http://www.ikou-commons.com/

Dr Adil Sadiq has been invited to represent India at the Upcoming world webinar conference on Ozaki Aortic valve reconstruction. Nov 2018

A link of the proposed program is given below

http://www.temdec.med.kyushu-u.ac.jp/

What You Should Know About Coronary Angiography

What is Coronary Angiography?

Coronary angiography is a procedure in which a special X-ray of the heart’s arteries (the coronary arteries) is taken to see if they are narrowed or blocked. It is an important test, used when the doctor suspects a coronary heart disease. The procedure is performed under a local anesthetic and a catheter (a long thin tube) is put into an artery in the groin, or at the inside of the elbow or near the wrist. The catheter is moved up the inside of the artery until it reaches the heart. A special dye is then injected into the coronary arteries and X-rays are taken. The X-ray image (a ‘coronary angiogram’) gives detailed information about the state of the heart and coronary arteries.

When is a Coronary Angiography needed?

Coronary angiography is considered as the gold standard investigation for detecting coronary artery disease and is done under different circumstances:

1. Sometimes it is done in patients who present with a heart attack, 

2. or in those who have a positive treadmill, 

3. or in patients who present with either chest pain or breathlessness during exercise,

4. or if the patient is suspected to have coronary heart disease. 

The doctor may recommend the test if the patient has chest pain that is suspected to be caused by narrowed coronary arteries, or if the doctor wants to assess the degree of narrowing in the coronary arteries. 

Coronary Angioplasty will further help to see if the patient can benefit from a procedure such as angioplasty or bypass surgery, to relieve the symptoms and reduce the risk of further heart problems like a heart attack. 

Are there any risks involved?

As with many medical tests, there are some risks involved, rarely any serious problems develop. Most people have no trouble, and the benefits usually far outweigh the risks. The patient can always discuss with the doctor any questions or concerns they may have about coronary angiography.

Earlier Coronary angiography was done through the groin route, whereas nowadays it is done through the wrist route. When doing it through the groin route, the major complication is primarily related to the access site bleeding. Because it is a large artery in the groin, the bleeding complications can sometimes be quite nasty, often necessitating blood transfusions or surgical procedures to close the hole or the bleed in the artery. Sometimes because of the clotting in the leg artery, the patient may also require blood thinners or procedures to remove the clot. 

These complications related to the access site have now been substantially reduced by now doing the coronary angiography through the wrist route. Because it is a small artery, very easily accessible and present against the bone. The bleeding complications are eliminated and there is no risk of losing the pulse because there are 2 parallel arteries running in the wrist that take care of the circulation to the hand. Therefore in going through the wrist artery, there is no risk of losing the wrist artery. 

Coronary angiography can rarely induce any heart-related complications like heart rhythm disorders or heart attacks. Also, there is a very rare possibility of a stroke because we are catheterizing the aorta from where some plaque might get disturbed and go into the brain artery and cause strokes. Fortunately, these complications are very rare. 

Other complications are related to the use of the contrast medium which is used to opacify the artery during Coronary angiography. These are iodinated contrasts but sometimes may cause some mild allergies like itching or wheals or rashes etc. Very rarely serious allergic reactions like bronchospasm or severe anaphylactic reactions which are life-threatening can occur but are very uncommon. And whenever such reactions occur, they occur in the Cath Lab, thus can be easily managed because all the emergency equipment is available. 

The other important complication that one needs to be very careful is in the very elderly and in those who have preexisting kidney diseases, where the radiographic contrasts can cause contrast-induced nephropathy leading to the deterioration of the kidney function. Therefore, these complications can be avoided by limiting the amount of contrast and aggressively hydrating the patient after the procedure, choosing a kidney safe contrast along with careful patient selection. 

So when we chose a Coronary angiography in the right way for the right reasons and perform it safely, it is a very safe procedure.  However, one should always be aware of the possible complications and be ready to manage them.

How is a Coronary Angiography performed?

Coronary angiography is done in special laboratories (‘cath-labs’) that look like operating theatres. The patient is taken there on a trolley, or in a wheelchair, and asked to lie on a narrow table, which will be moved from side to side during the test. The patient is connected to a machine that will monitor the heartbeat continuously. Many people have a small needle put into a vein in the back of one hand to allow medicines to be given during the test.

The doctor will inject a local anesthetic into the groin, arm or wrist (where the catheter is to be inserted) and if the arm is used, a small cut will be made. The catheter will be inserted into the main artery at that point.

The catheter is moved through the main blood vessel of the body (the aorta), to the beginning of the coronary arteries of the heart. Its progress is watched via X-rays shown on a monitor. Most people will not feel any pain or sensation during the test. As there are no nerves inside the arteries, the patient will not feel the movement of catheters through the body.
When the catheter is in place, a small amount of X-ray dye will be injected into it. X-rays will be taken as the dye travels through the coronary arteries. These X-rays will be shown on a monitor and recorded on a computer. Different catheters are needed to study the various arteries. One will be removed and the next introduced through the same place in the groin or arm.

Some people have nausea or chest discomfort when the dye is injected, but this does not last long. A larger injection of dye is given if the heart muscle is to be examined. This may give a warm feeling in the upper chest first, then over the rest of the body. The feeling may last for about 10 to 15 seconds.

The test will take about 30 to 40 minutes. When the test has been completed, the catheter will be removed and pressure is applied to the area where it was inserted. Patients can be then shifted to the ward or recovery area to rest in bed for at least four hours. In most circumstances, the patient will be allowed to go home after four to six hours. Some people may need to stay in the hospital longer so that their symptoms can be monitored further. The X-ray dye passes through the kidneys and is excreted in the urine.

Heart Attack: Causes, Risk Factors, Symptoms, Diagnosis and Treatment

What is a Heart Attack?

Our heart muscles need oxygen to survive. A heart attack occurs when the blood flow that brings oxygen to the heart muscles is severely reduced or cut off completely. This happens because coronary arteries that supply the heart muscle with the blood flow can slowly become narrow from a buildup of fat, cholesterol and other substances together known as plaque. This slow process is known as atherosclerosis. When a plaque in a heart artery breaks, a blood clot forms around the plaque. This blood clot can block the blood flow through the heart muscle. When the heart muscle is starved for oxygen and nutrients, it is called ischemia. When damage or death of part of the heart muscle occurs as a result of ischemia, it is called a heart attack or myocardial infarction (MI). 

What are the causes and risk factors of a Heart Attack?

A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol – deposition of plaques (known as atherosclerosis). The process itself does not present with any symptoms and the condition is known as coronary artery disease, which is generally the cause of most heart attacks.

During a heart attack, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can completely block the flow of blood through the coronary artery.

Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Use of tobacco and of illicit drugs, such as cocaine, can cause a life-threatening spasm. A heart attack can also occur due to a tear in the heart artery (spontaneous coronary artery dissection).

Sometimes a coronary artery temporarily contracts or goes into spasm. When this happens the artery narrows and blood flow to part of the heart muscle decreases or stops. Though is it not sure what causes the spasm, but it can occur even in normal-appearing blood vessels as well as in vessels partly blocked by atherosclerosis. One such severe spasm can cause a heart attack.

What are the classical symptoms of a Heart Attack?

Common heart attack signs and symptoms include:

1. Pressure, tightness, pain, or a squeezing or aching sensation in the chest or arms that may spread to the neck, jaw or back

2. Nausea, indigestion, heartburn or abdominal pain

3. Shortness of breath

4. Fatigue

5. Lightheadedness or sudden dizziness

Heart attacks can manifest with different complaints in different patients. The classical symptom is a severe chest pain in the center of the chest, or maybe a little to the right or left, often described as a heaviness similar to a weight or a tight band around the chest and it may also radiate to the inside of the left arm or both the shoulders or even to the jaw or the upper back or upper abdomen. This may be associated with breathlessness, sweating, and sometimes loss of consciousness. These are some of the classic signs of a heart attack. 

However, Bruising is not a manifestation of a heart attack. Bruising may be due to blood thinners that are used to treat heart attacks. But we should always remember that a heart attack does not always present with these kinds of symptoms. Patients may be having a heart attack even with symptoms like minor heartburn or excessive fatigability or only left arm pain and jaw pain particularly when they have coronary risk factors like smoking, blood pressure, diabetes, family history or age. So when these risk factors are there, the complaints can be a little different. So one should always be alert to the possibility of a heart attack in the presence of such different symptoms.

How can a Heart Attack be diagnosed and treated?

Ideally, screening should be done during regular physical examinations especially for patients who are at an increased risk of having a heart attack.
In an emergency situation for a patient presenting symptoms of a heart attack, it is essential to understand the exact symptoms and history of the patient and check the blood pressure, pulse and temperature. The patient might need to be hooked up to a heart monitor and will almost immediately need certain tests to be performed.

Tests that help check if the signs and symptoms, such as chest pain, indicate a heart attack or another condition. These tests include:

    1. Electrocardiogram (ECG) – to record the abnormal electrical activity of the heart in case of a heart attack.
    2. Blood tests – especially for certain cardiac enzymes that leak into the blood during damage to the heart muscles as occurs during a heart attack.
    3. Additional tests that may be required are:
    4. Chest X-ray 
    5. Echocardiogram
    6. Coronary catheterization (angiogram) 
    7. Exercise stress test 
    8. Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI)

Unstable Angina: Causes, Symptoms and Prevention

What is Unstable Angina? 

Unstable angina is a situation where the coronary blockages have progressed to a point where the blood supply is critically reduced to the heart. So the person experiences symptoms either at minimal physical activity or even at rest. Sometimes a patient with unstable angina may not manifests with chest pain, and rather present symptoms like breathlessness, pain in the left arm, or jaw pain. So chest pain is not always a manifestation of unstable angina.

What causes Unstable Angina?

If fat-containing deposits (plaques) in a blood vessel rupture and blood clots are formed, it can quickly block or reduce the flow through a narrowed artery, suddenly and severely decreasing blood flow to the heart muscle. Unstable angina can also be caused by blood clots that block or partially block the heart's blood vessels.

What are the characteristic symptoms of Unstable Angina?

Characteristics of unstable angina (a medical emergency) include:

1. Can occur even at rest

2. There is a change in the usual pattern of angina

3. Is often unexpected

4. Is usually more severe and lasts longer than stable angina, maybe as long as 30 minutes

5.  May not disappear with rest or use of angina medication

6. Might signal a heart attack

How can Unstable Angina be diagnosed and managed?

Unstable angina worsens and is often not relieved by rest or usual angina medications. If the blood flow doesn't improve, the heart muscle deprived of oxygen dies — a heart attack. Unstable angina is dangerous and requires emergency treatment.

If a patient with Unstable angina has no ECG changes and the cardiac enzymes particularly troponin are negative on multiple occasions when tested 6 hours apart – then it may be considered as a low risk Unstable angina. Such patients may be subjected to a stress test. However, if a patient with unstable angina has dynamic ECG changes, blood pressure fluctuations and elevated cardiac enzymes, then such patients should not be subjected to stress tests because this can precipitate a heart attack. Such patients should be advised a cardiac catheterization or coronary angiography for assessment.

Angina: Causes, Symptoms and Prevention

What is Angina?

Angina is the discomfort that one experiences when there is a narrowing of the heart’s artery, or when the heart does not receive enough blood supply, particularly while exercising because during exercise or any strenuous activity, the heat rate and blood pressure goes up and the heart needs more blood supply.

Angina is a symptom of coronary artery disease and is typically described as squeezing, pressure, heaviness, tightness or pain in your chest. Also known as angina pectoris, can be a recurring problem or a sudden, acute health concern.

Angina is relatively common but can be hard to distinguish from other types of chest pain, such as the pain or discomfort due to indigestion. Therefore in case of unexplained chest pain, one should seek immediate medical attention.

What causes Angina?

Angina is caused by reduced blood flow to the muscles of the heart. Our blood carries oxygen, which is necessary for the heart muscle to survive. When the heart muscle isn't getting enough oxygen, it causes a condition called ischemia.

The most common cause of reduced blood flow to the heart muscle is coronary artery disease (CAD). The heart (coronary) arteries can become narrowed by deposits called plaques. This is called atherosclerosis.

This reduced blood flow is a supply problem — due to which the heart does not get enough oxygen-rich blood. So, during times of low oxygen demand, eg. while resting the heart muscle may be able to get by on the reduced amount of blood flow without triggering angina symptoms. But when there is an increased demand for oxygen, such as during exercise, this can cause angina.

What are the symptoms of Angina?

Symptoms associated with angina include:

    1. Chest pain or discomfort
    2. Pain in the arms, neck, jaw, shoulder or back accompanying chest pain
    3. Nausea
    4. Fatigue
    5. Shortness of breath
    6. Sweating
    7. Dizziness

Chest tightness, breathlessness and fatigue after any kind of exertion, whether it is swimming or cycling or running or even walking up a few stairs or slope, could be an indication of Angina.

The severity, duration and type of angina can vary. It's important to recognize if there is any new or changing chest discomfort. New or different symptoms may signal a more dangerous form of angina (unstable angina) or a heart attack.

How can Angina be diagnosed and managed?

If the chest pain lasts longer than a few minutes and doesn't go away even after rest or taking angina medications, it may be a sign of a heart attack. Call for emergency medical help immediately.

To diagnose angina, the doctor will start by doing a physical exam and by understanding the symptoms. Risk factors, including family history of heart disease are important. There are several tests your doctor might recommend in order to confirm angina, like:

    1. Electrocardiogram (ECG)
    2. Stress test/Treadmill test
    3. Echocardiogram 
    4. Chest X-ray 
    5. Coronary angiography
    6. Cardiac computerized tomography (CT) scan

If there are any blockages, one may experience these kind of symptoms, so these tests play a very important role to ascertain if there is any problem in any of the heart’s arteries. 

Even if a blockage is ruled out is advised to improve the fitness levels, reduce excess weight and continue a good exercise regime. 

There are many options for angina treatment, including lifestyle changes, medications, angioplasty and stenting, or coronary bypass surgery. The goals of treatment are to reduce the frequency and severity of the symptoms and to lower the risk of heart attack and death.

Lifestyle changes and medications are frequently used to treat stable angina. But surgical procedures, such as angioplasty, stenting and coronary artery bypass surgery, may also be required sometimes to treat angina. 

Successful Knee Replacement Surgery on a High-Risk Cardiac Patient

Dr. Jagdish from Bhopal, aged 70 years, was suffering from pain in both his knees for the past 6 years and in the last 3 years, the pain aggravated to unbearable levels. Being a doctor himself, he feared undergoing knee replacement surgery and kept postponing the surgery. Having previously undergone a cardiac bypass (open heart) surgery and angioplasty, he was all the more terrified trying to take a decision on knee replacement.  When the pain became unbearable, he made up his mind to undergo the surgery.

Both his knees needed to be replaced and therefore he wondered if it had to be done in two different sittings or in one go. Although every doctor he met recommended two separate sittings, he decided otherwise. The rationale behind the decision was in fact simple; two sittings would mean double rehabilitation. The advantage of a single sitting is that the post-surgery recovery period is significantly reduced and also avoids the psychological distress of getting admitted twice.

He met many specialists and hospitals across the country to settle with the most adept hands to replace his knees. After through research, he finalized on Dr. Chandrashekar P of Sakra World Hospital, who is a pioneer in “MINIMALLY INVASIVE COMPUTER ASSISTED KNEE REPLACEMENT”.

After a through clinical analysis, Dr. Chandrashekar referred him to a cardiologist for their opinion on his heart’s condition. Taking a look at his reports and consulting with the cardiologist, Dr. Chandrashekar P. said with a broad smile, “Don’t worry doctor saheb. We’ll replace both knees at once.”

Dr. Jagdish is now completely recovered and happy that he took this life-changing decision. “If in future my wife has to under a knee surgery, it would be only under the care of Dr. Chandrashekar” Says Dr. Jagdish jokingly.

Trans fat is double trouble for your heart health

Trans fat raises your LDL ("bad") cholesterol and lowers your HDL ("good") (HDL)cholesterol.

Find out more about trans fat and how to avoid it.

Trans fat is considered by many doctors to be the worst type of fat you can eat. Unlike other dietary fats, trans fat — also called trans-fatty acids — both raises your LDL ("bad") cholesterol and lowers your HDL ("good") cholesterol.

A high LDL cholesterol level in combination with a low HDL cholesterol level increases your risk of heart disease, the leading killer of men and women. Here's some information about trans fat and how to avoid it.

What is trans fat?

Some meat and dairy products contain small amounts of naturally occurring trans fat.But most trans fat is formed through an industrial process that adds hydrogen to vegetable oil, which causes the oil to become solid at room temperature.

This partially hydrogenated oil is less likely to spoil, so foods made with it have a longer shelf life. Some restaurants use partially hydrogenated vegetable oil in their deep fryers,because it doesn't have to be changed as often as do other oils.

Trans fat in your food

The manufactured form of trans fat, known as partially hydrogenated oil, is found in a variety of food products, including:

• Baked goods. Most cakes, cookies, pie crusts and crackers contain shortening, which is usually made from partially hydrogenated vegetable oil. Ready-made frosting is another source of trans fat.

• Snacks. Potato, corn and tortilla chips often contain trans fat. And while popcorn can be a healthy snack, many types of packaged or microwave popcorn use trans fat to help cook or flavor the popcorn.

• Fried food. Foods that require deep frying — french fries, doughnuts and fried chicken — can contain trans fat from the oil used in the cooking process.

• Refrigerator dough. Products such as canned biscuits and cinnamon rolls often contain trans fat, as do frozen pizza crusts.

• Creamer and margarine. Nondairy coffee creamer and stick margarines also may contain partially hydrogenated vegetable oils.

Reading food labels

If a food has less than 0.5 grams of trans fat in a serving, which is regarded as safe level, the food label can read 0 grams trans fat. This hidden trans fat can add up quickly, especially if you eat several servings of multiple foods containing less than 0.5 grams a serving.

When you check the food label for trans fat, also check the food's ingredient list for partially hydrogenated vegetable oil — which indicates that the food contains some trans fat, even if the amount is below 0.5 grams.

How low should you go?

Trans fat, particularly the manufactured variety found in partially hydrogenated vegetable oil, appears to have no known health benefit. It is recommended that the  intake of trans fat be kept as low as possible.

The Food and Drug Administration (FDA) has determined that partially hydrogenated vegetable oil is no longer "generally recognized as safe" and should be phased out of the production of food over the next several years.

How trans fat harms you

Doctors worry about trans fat because of its unhealthy effect on your cholesterol levels — increasing your LDL and decreasing your HDL cholesterol. There are two main types of cholesterol:

• Low-density lipoprotein (LDL). LDL, or "bad," cholesterol can build up in the walls of your arteries, making them hard and narrow.

• High-density lipoprotein (HDL). HDL, or "good," cholesterol picks up excess cholesterol and takes it back to your liver.

If the fatty deposits within your arteries tear or rupture, a blood clot may form and block blood flow to a part of your heart, causing a heart attack, or to a part of your brain,causing a stroke.

What should you eat?

Don't think a food that is free of trans fat is automatically good for you. Food manufacturers have begun substituting other ingredients for trans fat. Some of these ingredients, such as tropical oils — coconut, palm kernel and palm oils — contain a lot of saturated fat. Saturated fat raises your LDL cholesterol. 

In a healthy diet, 25 to 35 percent of your total daily calories can come from fat — but saturated fat should account for less than 10 percent of your total daily calories.

Monounsaturated fat — found in olive, peanut and canola oils — is a healthier option than is saturated fat. Nuts, fish and other foods containing unsaturated omega-3 fatty acids are other good choices of foods with monounsaturated fats.

Heart attack: The Golden Hour

The first hour after the onset of a heart attack is called the golden hour. Appropriate action within the first 60 minutes of a heart attack can reverse its effects.

This concept is extremely important to understand because most deaths and cardiac arrests occur during this period. However, if the person reaches the hospital and gets treated within this period s/he can expect near-complete recovery.

Window of opportunity:

The Golden Hour is a window of opportunity that impacts a patient’s survival and quality of life following a heart attack. It is a critical time and time, is a muscle. This is because the heart muscle starts to die within 80-90 minutes after it stops getting blood, and within six hours, almost all the affected parts of the heart could be irreversibly damaged. So, the faster normal blood flow is re-established, the lesser would be the damage to the heart.

To reduce the damage, it is important to get to the hospital as soon as possible. Other than the consequences of a damaged heart muscle, the most common killer in the early period are abnormal heart rhythms called ventricular tachycardia and ventricular fibrillation where the heart muscles contract at a rapid rate, but no effective pumping of blood from the heart takes place. This is why once the person reaches a medical facility (ambulance or hospital), they are immediately put on an ECG monitor to assess the heart rhythm so that they can be given prompt treatment in case of an abnormal rhythm, which could be delivering a shock (Cardioversion) or administering certain medication. 

Steps to be taken:

• Recognize the symptoms

• Call for help immediately

• Reach the hospital promptly.

Watch out for these signs: 

• Heaviness or pressure or burning sensation over the chest while at rest or minimal exertion, associated with restlessness, perspiration, radiation of pain to jaw, back, left arm.

• Breathlessness without any chest discomfort, especially in diabetics.

• Abdominal pain and bloating are usually acidity-related problems, but if the symptoms are more than usual in severity or are associated with other symptoms, take them seriously.

What’s wrong and how to fix it?

Heart attack is caused when a clot completely blocks a blood vessel in the heart. The primary aim is to get rid of this clot as soon as possible; otherwise, that part of the heart dies.Even if there is a slight suspicion that the symptoms could be of a heart attack, chew a 300/325mg of aspirin tablet immediately; it helps dissolve the clot. Once you are at the hospital, the doctors will try to get rid of the clot, either with the help of a very powerful clot buster medicine [thrombolytic medicines] or with a procedure called primary angioplasty.Although both modalities have advantages and disadvantages, primary angioplasty is the preferred therapy in most scenarios. In primary angioplasty, a diagnostic coronary angiogram is performed immediately to identify the site of blockage and angioplasty is performed and a stent (metallic scaffold) is deployed in the artery to open up the blood flow. 

The only prerequisite is that it can be done only in hospitals where a cardiac catheterization laboratory and doctors well versed with this procedure are available. Apart from this, other supportive therapy also gets initiated simultaneously.

Be prepared:

• Always keep the contact numbers of ambulances and nearby hospitals stored in your cell phone, so that you can call them in case of need. 

• Try to reach the nearest hospital which has cardiac care facilities…as early as possible. 

• Try to go by ambulance.

• Do not drive yourself as you could harm yourself as well as others. 

• Call the hospital helpline; so that the system can be activated even before the patient reaches the hospital.

Prevent the attack:

It’s always best to prevent such an event from happening. For that, leading a heart-healthy lifestyle is important. All the risk factors for heart disease like high blood pressure, diabetes, high cholesterol, obesity, sedentary lifestyle, smoking, are silent killers as they do not produce uncomfortable symptoms and are hence neglected by most of us. Getting yourself checked by an expert cardiologist at regular intervals is critical.

What to do if a person suddenly collapses?

Follow these pointers diligently:

• Make the patient lie down on his/her back immediately

• Listen to the heartbeat by keeping your ear over the chest

• Check if the person is breathing by keeping your finger near the persons’ nose to feel their breath. If the patient is not breathing, start giving chest compression and intermittent mouth-to-mouth respiration if possible.

• Call for an ambulance and shift the patient to a nearby hospital.

Preventing heart disease and strokes never too early

Protecting your heart as you age depends on making healthy choices when you are younger. Adopting healthy lifestyles at a young age prevents lifestyle diseases like obesity, diabetes, high blood pressure and high cholesterol which eventually lead to heart diseases.

Childhood obesity increases chances of obesity later in life .Therefore children should be encouraged to have more outdoor physical activities and should avoid junk food. Teenagers should inculcate a regular exercise regimen and they should be educated about the ills of smoking and alcohol.

20s are the age in which one should have the baseline health parameters like blood sugar, blood pressure and cholesterol checked, particularly if there is family history of heart diseases. If one has picked up smoking as a teenager, it is time to quit. Regular exercises should continue.

The 30s are about juggling family life and career .This leaves many adults with little time to worry about their hearts. Make an effort to balance all three.

• Make heart-healthy living a family affair. Create and sustain heart-healthy habits in your kids and you’ll reap the benefits, too. Spend less time on the couch and more time on the move. Explore a nearby park on foot or bike. Take your pet for a walk. Plant a vegetable and fruit garden if you have space, and invite your kids into the kitchen to help cook.

• Know your family history.  Having a relative with heart disease increases your risk, and more so if the relative is a parent or sibling.That means you need to focus on risk factors you can control by maintaining a healthy weight, exercising regularly, not smoking and eating right. Also, keep your doctor informed about any heart problems you learn about in your family.

• Tame your stress. Long-term stress causes an increase in heart rate and blood pressure that may damage the artery walls. Learning stress management techniques not only benefits your body, but also your quality of life. Try deep breathing exercises and yoga and find time each day to do something you enjoy.
  Volunteering and working for community causes also does wonders reducing stress.

In the 40s body metabolism begins to slow down. In India we need to make heart health a priority from a very early age , because we are prone for premature atherosclerosis. Healthy choices you make now can strengthen your heart for the long haul. Understand why you need to make a lifestyle change and have the confidence to make it.

• Watch your weight. But you can avoid weight gain by following a heart-healthy diet and getting plenty of exercise. The trick is to find a workout routine you enjoy.
  If you need motivation to get moving, find a workout buddy. 

• Have your blood sugar level checked regularly . In addition to blood pressure checks and other heart-health screenings, you should have a fasting blood glucose test.
  You should have every three years. Testing may be done earlier or more often if you are overweight, diabetic or at risk for becoming diabetic. 

• Don’t ignore snoring. Listen to your sleeping partner’s complaints about your snoring and get yourself tested for sleep apnoea.
  One in five adults has at least mild sleep apnea, a condition that causes pauses in breathing during sleep. If not properly treated, sleep apnea can contribute to high blood pressure, heart disease and stroke. 

Unlike the emergence of wrinkles and gray hair, what you can’t see as you get older is the impact aging has on your heart. So starting in the 50s, you need to take extra steps. 

• Eat a healthy diet.  It’s easy to slip into some unhealthy eating habits, so refresh your eating habits by eating plenty of fruits and vegetables, fiber-rich whole grains, fish (preferably oily fish-at least twice per week), nuts, legumes and seeds and try eating some meals without meat. 

• Learn the warning signs of a heart attack and stroke. Now is the time to get savvy about symptoms. Not everyone experiences sudden numbness with a stroke or severe chest pain with a heart attack. And heart attack symptoms in women can be different than men. 

• Follow your treatment plan. By now, you may have been diagnosed with high blood pressure, high cholesterol, diabetes or other conditions that increase your risk for heart disease or stroke. Lower your risk by following your prescribed treatment plan, including medications and lifestyle and diet changes. 

With age comes an increased risk for heart disease. Your blood pressure, cholesterol and other heart-related numbers tend to rise. Watching your numbers closely and managing any health problems that arise — along with the requisite healthy eating and exercise — can help you live longer and better. 

• Have an ankle-brachial index test. Starting in your 60s, it's a good idea to get an ankle-brachial index test as part of a physical exam.
  
  The test assesses the pulses in the feet to help diagnose peripheral artery disease (PAD), a lesser-known cardiovascular disease in which plaque builds up in the leg arteries. 

• Watch your weight. Your body needs fewer calories as you get older. Excess weight causes your heart to work harder and increases the risk for heart disease, high blood pressure, diabetes and high cholesterol. Exercising regularly and eating smaller portions of nutrient-rich foods may help you maintain a healthy weight. 

• Learn the warning signs of a heart attack and stroke. Heart attack symptoms in women can be different than men. Knowing when you’re having a heart attack or stroke means you’re more likely to get immediate help. Quick treatment can save your life and prevent serious disability.

Chronic Total Occlusion Angioplasty

Are you suffering from complex heart blockage?

Is quality of your life getting limited by chronic total blockage in one of your arteries?

If you have been diagnosed with chronic total occlusion in one artery, bypass surgery is not the only solution.

Chronic Total Occlusion (CTO) is build-up of complex total blockage with fatty deposits inside the walls of coronary artery for more than 3 months. It causes chest pain and breathlessness. Due to improved results of CTO angioplasty, patient with one coronary artery total blockage would not require bypass surgery.

This technique is currently infrequently performed owing to high technical difficulty and perceived risk of complications. However, with the advent of advanced technology and innovative percutaneous techniques, interventional cardiologists have improved the outcomes of percutaneous coronary intervention, making it a viable option for some patients who are experiencing symptoms related to their CTO.

Interventional cardiologists now are able to gently steer special guide wires and catheters across the blockages. In the last few years, the success rate of the approach has increased from about 60 percent to 90 percent. This is in comparison to the success rate of about 98 percent for angioplasty of non-total blockages.

Successful CTO–angioplasty performed by team of skilled interventional cardiologists can significantly improve a patient's quality of life, improve left heart function, reduce the need for subsequent bypass surgery, and possibly improve long-term survival. A number of factors must be taken into account for the selection of patients for CTO–angioplasty, including the extent of muscle supplied by that artery, the level of muscle viability, location of the CTO, and probability of procedural success.

Life Changing Cardiac LIS

Gone are the days when a dreaded heart operation entailed cracking open your breastbone, and ensuing recovery took months.  Minimally invasive Cardiac surgery has changed all that.

Pioneering current day practice is Cardiac Least Invasive Surgery, or simply Cardiac LIS- the most advanced form of minimally invasive cardiac surgery, where not just the incision size small, but also the pain, blood loss, hospital stay and requirement for strong antibiotics, the least! All these added benefits lead to a recovery period, almost seven times faster compared to conventional heart surgery, and return to home as-early-as three days.

The ‘Key-hole’ access to the heart is facilitated by video-endoscopes, specialized instrumentation, three-dimensional projections, minimal tissue disruption and negligent blood loss. The cornerstone of success is a specially trained surgeon, skilled in robotic and least invasive surgery, andthe harmony that he shares with his equally skilled support team of doctors, nurses and technicians.

Housing the only Biplane Hybrid Catheterization Lab in the country, Sakra World Hospital, Bangalore, has the most advanced operating suite for all Cardiac LIS procedures, including multi-vessel Beating Heart Bypass surgery, Aortic valve replacements, Mitral and Tricuspid valve repairs or replacements, Closure of holes in the heart, Single-sitting combined angioplasty and surgical procedures.

Cardiac LIS has its limitations. Just like it cannot be done at all hospitals or by all surgeons, it is not applicable universally. Still almost 70% of all conventional cardiac operations can be done by the Cardiac LIS technique.

Twenty years ago, everybody was skeptical about a laparoscopic abdominal operation, when today it has become the rule. Cardiac LIS is at that same crossroad. It is the future of cardiac surgery, being performed in our hospital today!

Heart Attacks A heart stopping tale

We’ve all heard it, feared it and panicked over it whenever there was even a little pain in our left arm, but heart attacks aren’t the end of the world. In fact, when treated with proper caution and care, heart attacks can be fully recovered from. We at Sakra World Hospital always encourage our patients to make well-informed choices. To understand how to shed blind fear of heart attacks, we must try to understand what a heart attack is, its causes, emergency treatment and rehabilitation. Read on to get to the heart of the matter.

What is a heart attack?

In simple words, a heart attack occurs when the blood flow to your heart is suddenly reduced or cut off. During a heart attack, your heart muscles don't get the oxygen they need & without it, the heart muscles get damaged or destroyed.

What causes a heart attack?

A gradual buildup of cholesterol and a fatty material called plaque in your artery walls usually causes a heart attack. A heart attack occurs when the plaque breaks off your artery wall which then results in a blood clot forming around the broken-off plaque, blocking the artery.

What are the symptoms?

Men and women have different symptoms, but both may have pain, pressure, or discomfort in the chest. Other symptoms include shortness of breath, sweating, fainting, and nausea. Men are more likely to break out in a cold sweat and feel pain move down the left arm during a heart attack.

Women are more likely than men to have back or neck pain, heartburn, shortness of breath, nausea, vomiting, and indigestion. They may also feel extremely tired, light-headed, or dizzy. Flu-like symptoms and sleep problems may also occur 2 weeks before a heart attack.

What should I do in case of a heart attack?

If you or someone you’re with is experiencing the symptoms of a heart attack, the chances of survival are much higher with emergency medical treatment within 90 minutes. Sakra World Hospital has a dedicated cardiac team that is well trained and equipped with the latest technology to treat you in case of a heart attack.

While waiting for emergency treatment, the person with heart attack symptoms should chew and swallow an aspirin to lower the risk of a blood clot (unless they're allergic). If the person is unconscious, hands-only CPR can double his/her chances of survival.

Am I at risk?

Smoking can raise your risk of a heart attack. So can having high blood pressure, high cholesterol levels, diabetes, and being obese. Your odds of having a heart attack go up with age, and men have a greater risk than women. A family history of heart disease could also increase your risk.

Other things that can raise your risk of a heart attack are a lack of exercise, depression, and stress.

Can I prevent heart attacks?

If you smoke, stop. It will immediately cut your chances of a heart attack by a third. Get exercise and eat plenty of fruits, veggies, and whole grains to keep your arteries healthy.

Will a heart attack treatment affect my daily life too?

If you're in the hospital for a heart attack, you may come home in just a few days. You can resume your normal activities after a few weeks. The Sakra World Hospital offers various cardiac rehab therapies that can help you recover. You'll get a fitness program that's made just for you, and learn how to keep up a heart-healthy lifestyle. Our counselors are always here for your support if you're depressed or worried about getting a second heart attack.

A healthy lifestyle and an active physique go a long way when it comes to heart health. However, a lot of other factors like hereditary risks and diabetes can make your heart health deteriorate. To prevent any such unseen factors from taking a toll on your heart, book a heart check-up with our highly experienced cardiac team at bit.ly/cardiacsciences. Our team of specialized doctors ensures that your heart stays healthy and you stay happy.

Sakra Cardiac Sciences for Complex Angioplasty

The Center of excellence with Best skills & Best Technology : World renowned Cardiologist Dr. Nakamura's visit to Sakra World Hospital, Bangalore

Coronary artery chronic total occlusion (CTO) is complete or almost complete blockage of a coronary artery for 30 or more days. Coronary CTO is caused by a heavy build-up of atherosclerotic plaque within the artery.

Traditionally, most patients with CTO required coronary artery bypass graft (CABG) surgery to clear the blockage. In the past, total blockages of the coronary artery have been difficult to clear with interventional procedures.

However, with the advent of advanced technology and innovative percutaneous techniques, interventional cardiologists are improving the outcomes of percutaneous coronary intervention, making it a viable option for some patients who are experiencing symptoms related to their CTO.

Interventional cardiologists now are able to gently steer special guide wires and catheters across the blockages. New technology makes fine movement of the guide wire tip much easier to control than in the past.

In the last few years, the success rate of the combined percutaneous approach has increased from about 60 percent to 80 to 85 percent. This is in comparison to the success rate of about 98 percent for percutaneous treatment of non-total blockages. Although the percutaneous approach has potential complications, the complication rate is comparable to that of standard angioplasty (about 1 percent).

Japanese interventional cardiologists have contributed immensely to the development of techniques and devices for successful recanalisation of CTOs. One such pioneering interventional cardiologist is Dr Sunao Nakamura.

Sakra world Hospital has the unique advantage of Japanese collaboration which allows mutual exchange of knowledge between medical ,nursing and management teams of Sakra and it's sister hospitals in Japan.

On 4th May 2014  Dr Sunao Nakamura , chief of Cardiovascular Sciences and President of New Tokyo Hospital , Chibi, Japan had visited Sakra world hospital. He is known world over for his pioneering techniques and skills in the area of coronary interventions. He is also closely involved with the development of new devices which have significantly improved the success rates of re-canalization of chronic total occlusions. CTO angioplasty is considered the final frontier in interventional cardiology . Dr Nakamura had very fruitful discussions with staff of the Department of Cardiac sciences at Sakra and shared his experience. We also conducted a CME where he addressed Physicians and Cardiologists from all over Bangalore. Dr Sreekanth Shetty, Senior interventional Cardiologist at Sakra , who is an expert in complex angioplasties performed angioplasty of a Chronic Total Occlusion of a right coronary artery , which was technically very challenging . It was an honor for the Staff of Cardiac Sciences to be appreciated by Dr Nakamura over the successful conduct of the difficult procedure . We are certain that this collaborative effort of Sakra and new Tokyo Hospital will go a long way in addressing the challenges of complex coronary interventions."

Heart attacks can strike the young too- healthy lifestyle for a healthy heart

Metabolic Syndrome

A metabolic syndrome is a group of health problems that make it more likely for a person to have a heart attack, stroke or develop diabetes. If you are suffering from metabolic syndrome, you have at least  make it more likely you will have at least three of the following:

1. Too much fat around your waist.

2. Borderline or high blood pressure.

3. Borderline or high blood sugar.

4. High triglycerides, a type of fat in your blood.

5. Low “good" HDL cholesterol.

What causes it?

A combination of your family’s history (your genes), as well as an unhealthy lifestyle, can be the cause of the metabolic syndrome. Gaining weight by eating too much and not exercising are the main reasons, especially if you tend to gain weight around your waist.

What are the symptoms?

Metabolic syndrome does not make you feel sick. But if you do suffer from diabetes, heart attacks and strokes, you will develop symptoms of those problems.

What increases your risk?

You are more likely to have metabolic syndrome if:

1. You are older - as you age, your chances rise.

2. You are overweight or obese, especially if you carry a lot of weight around your waist and upper body.

3. Your family members have or had type 2 diabetes and are or were overweight.

4. You have other conditions. For instance, metabolic syndrome is more likely if you have high blood pressure or other problems.

How is it diagnosed?
Your doctor will check your blood pressure, measure your waist, and conduct a fasting blood test. If you have metabolic syndrome, your results may include:

Measurement	Result
Waist size	Men: Greater than 40 inches  Women: Greater than 35 inches
Triglycerides	150 or higher
HDL cholesterol	Men: Less than 40  Women: less than 50
Blood pressure	130/85 or higher
Fasting blood sugar	100 or higher

How is it treated?

Get more exercise

Being more active is one of the best ways to treat metabolic syndrome. Being active help for many reasons:
Helps you lose weight.

1. Lowers blood pressure, triglycerides, and blood sugar.

2. Raises HDL, the “good" cholesterol.

Aim for at least 2½ hours of moderate exercise a week. You could do this brisk walking for 30 minutes a day, at least 5 days a week. You can also be active in blocks of 10 minutes or more throughout your day and week. Moderate exercise is safe for most people, but it's always a good idea to talk to your doctor before starting an exercise program.

Change how you eat

Your doctor may advise you to eat less salt or try the DASH diet to help lower your blood pressure. The DASH diet is low in fat but rich in low-fat dairy foods, fruits, and vegetables.

To get started:

1. Choose low-fat or nonfat cheese, yoghurt, and cottage cheese.

2. Drink skim (nonfat) or 1% milk.

3. Eat lots of fruits and vegetables.

4. Eat more whole grains like brown rice & whole wheat bread.

5. Choose lean meats, chicken without skin, or fish.

6. Eat beans, lentils, and nuts.

7. Limit sodium (salt) to less than 2,300 milligrams (mg)—less than 1 teaspoon—a day.

8. As a rule of thumb, if you limit yourself to 10 calories per pound of your body weight

9. each day and maintain a normal level of activity, you should be able to lose 1 pound per week.

Take medicines if necessary

Lifestyle changes, such as exercise, losing weight, and eating healthier, are usually the first set of approaches for metabolic syndrome. Your doctor may prescribe medicine for your cholesterol, blood sugar, or blood pressure if need be.

Dr Deepak Krishnamurthy MD, DNB
Senior Interventional Cardiologist