keralaayurvedashram

AYURVEDIC TREATMENT of Heart Disease


Heart of matter: For some, exercise better than angioplasty

Barcelona: Working up a sweat may be even better than angiolplasty for some heart blocks for heart patients, experts say. Studies have shown heart patients benefit from exercise, and some have even shown it works better than surgical procedures. At a meeting of the European Society of Cardiology on Sunday, several experts said doctors should focus more on persuading their patients who have heart block symptoms to exercise rather than simply doing angio plasties. Angioplasty is the top treatment for people having a heart attack ,heart block or hospitalized with worsening heart block symptoms. It involves using a tiny balloon to flatten a blockage and propping the heart artery ope with a mesh tube called a stent. Most angioplaties are done on a nonemergency basis, to relieve chest pain caused by clogged arteries cutting off the heart's blood supply.

Heart Block "It's difficult to convince people with heart block to exercise instead of having an angioplasty, but it works,"said Rainer Hambrecht of Klinikum Links der Weser in Bremen, Germany. Hambrecht published a study in 2004 that found that nearly 90% of heart block patients who rode bikes regularly were free of heart blockage problems one year after they started their exercise regimen. Among patients who had an angioplasty insted, only 60% were problem-free after a year. Hambrecht is now conducting a similar trial, which he expects to confirm his initial findings: that for some heart blockage patients, exercise is more effective than a surgical procedure. Other experts agreed that would likely be the case.

An angioplasty "only opens up one vessel blockage," said Christopher Cannon, an associate professor of medicine at Harvard University and spokesman for the American College of Cardiology. He was not linked to Hambrech't research. "Exercise does a lot more than fixing one little problem." Among other benefits, exercise lowers bad cholesterol while raising good cholesterol, helps the body process sugar better, improves the lining of the blood vessels and gets rid of waste material faster. Exercise also lowers blood pressure and prevents plaque buildup in the arteries. Previous research has estimated one third of heart blockage disease and stroke could be prevented if patients did two-and-a half hours of brisk walking every week. In this US, that would mean 280,000 fewer heart-related deaths every year. Still, doctors admitted that persuading patients for complete heart block treatment to exercise instead of going in for an angioplasty, which can take less than a day, would be a tough sell.

HEART DISEASE

It's Not Fifties Any Longer, Study Finds The Disease Now Strikes People In Their Thirties With Men At Greater Risk. 50% Indians prone to heat dieses. When it comes to heart diesease, the thirties, it seems, are the new fifties. If the typical heart attack patient until five years back was in his mid-fifties, doctors say this no longer holds true. Now, the man with blockages in his heart is most probably in the 30-39 age group and with another health complication such as diabetes or hypertension.

The Saffola life Study 2009, covering 8,469 people, found that 49.1% Indians were at high risk for developing heart attack/heart blockage diseases. On the eve of World Heart Day, the multi-city survey found that this bunch's vital heart statistic-the ratio (called HDL) - is too high at 4.5 to be termed healthy. The American Heart Association holds the ideal ratio between total cholesterol and HDL is 3.3. The survey also found most men in the 30-39 age group fell in the heart attack/heart blockage disease high risk category.

Men from Mumbai and Chennai were worst off (with a high risk ratio of 49.6% and 53.8% respectively)as compared to men in Kolkata and Delhi (32% and 29.7% respectively). The survey attributed the difference in the risk rates for Mumbai's men to longer commuting time, long working hours, unhealthy eating habits, lack of physical activity and erratic eating schedules. Others had better lifestyle habits. According to Dr. Shashank Joshi, endocrinologist with Lilavati Hospital in Bandra, who was associated with the survey, "The survey only underlines what we are seeing now- abnormal cholestral and trigylcerides in the younger age group. In fact, the 20-40 age group is the new vulnerable group as far as heart disease goes". He blames the high levels of stress and disrupted sleep patterns for the development. Dr. N .O .Bansal, who heads the cardiology department of J J Hospital in Byculla, says, " There is no more denying the fact that as compared to a Caucasian youngster, the Indian youngster is more prone to heart diseases". It is a combination of genetic and lifestyle factors, he says. Stating that the "younger phase" of heart diseases was apparent about five years back, he says his department a referral centre for the entire state-gets men under 30 as well. Cardiologist Dr. Manjeet Juneja, who consults at Wockhardt Hospital, Mulund, says heart diseases are happening 15 years too early for most people because of " preventable causes". He recallsa 23-year-old brought to the hospital from Nashik. "The boy was tense about admission to an MBA course and smoked a cigarette 30 minutes before collapsing," says Dr Juneja. He was managed with medicines alone. Moderate physical activity, like a 35-40 min brisk walk per day, is associated with a 55% lower risk! Make exercise a part of your routine will control the heart diseases. Green And Lean Have low-saturated-fat, trans fat-free, low-cholesterol foods like fruits & vegetables; whole grain products like whole wheat bread; whole grain creal; brown rice & whole wheat pasta; fat-free & low-fat milk products; lean meats & poultry without skin; fatty fish baked or grilled; beans and peas;nuts and seeds in limited amounts; skimmed milk & fat-free cheese. STRIKING AT THE CORE
India Affected (2003 figures) Ideally Risk Factor

29.8 mn affected by Coronary Heart Disease (CHD) in rural & urban areas

LDL≤100

TOT CHOL ≤200

HDL ≥60

TOT CHOL:HDL=3.3

risk factor

 

14.1 million in urban areas

15.7 million in rural areas

How They Fare

how they fare?

  • In Mumbai, men aged 30-39 are at highest risk of CHD
  • Reasons are long commuting times, long working hours, bad eating habits.
  1. LDL or low-density lipo-protein and HDL or high-density lipo-protein carry cholesterol from one cell to another
  2. Cholesterol is a soft waxy matter in cells
  3. TGL or triglycerides are common fats


Maximum City Is At Maximum Risk





  MUMBAI CHENNAI DELHI BANGALORE KOLKATA
BASE (2008) 1,799 421 1,747 778 253
LDL≥130 & TGL≥150 &HDL≤ 30 1.1% 1.1% 0.3% 0.3% 0.3%
LDL≥130 &HDL≤30 2.0% 1.1% 0.3% 0.3% 0.3%
TOT CHOL : HDL≥ 4.5 49.6% 53.8% 28.6% 41.2% 32%
LDL ≤100 & HDL≥35& TGL ≤150 18.3% 16.4% 29.7% 24.5% 38%


Net population at high risk in the country is 49.1%.

Silent killer takes a heavy toll at work The World Heart Federation has found that over 17.2 million people die each year from cardivascular diseases, making it the leading cause of death worldwide. Almost half of those who die are in their productive years and hence economic consequences are dramatic.

In 2003, a comprehensive study focusing on the economic returns of workplace health promotion concluded that (congenital heart block treatment) such programmes can achieve a 25-30% reduction in medical and absenteeism costs in an average period of about 3.6 years. "Most of us spend 50% of our time at the workplace. We are so engrossed in doing our job well, we often forget that in order to be healthy it is essential that we should stay fit. The most common excuse I hear from patients is 'I am so busy that there is no time for fitness'. The point to note is that even while working , we can get this opportunity," points our Dr Sundhir Vaishnav, cardiologist with Asian Heart Hospital, Bandra Kurla Complex. Vishanav has some simple tips on how to stay fit on heart disease even when one has little time for exercise.

WALK THE TALK While travelling to work, walk to the staion or bus stop. If you travel in a chauffer-driven car, get down from the car at least a couple of kms away from the office/home and walk. Even 30 minutes of walking every day goes a long way in significantly reducing the incidence of heart disease.

STAIRS FIRST It is advisable to use the stairs than the lift. At least climb three floors. Do the same on your way downstairs.

STRETCH IT

While seated for long hours at the desk hunched on your computers, do some neck, shoulder and leg stretches every few hours. Take a few deep breaths.

SMOKED OUT Keep your work environment smoke-free. Passive smoking is as harmful as active smoking.

SOUP IT At the office cafeteria, take generous helpings of soup, salad and fruits Avoid eating processed food as they have a high salt content.

TAKE THE TREADMILL Visit the gym in the office regularly.

HEALTH CHECK-UP Last but not the least, go for a health check-up once a year. This is important for people in their for people in their forties and fifties. It helps in detecting silent diseases like BP, high sugar and high cholesterol.

The truth about heart attacks Doctors fight the popular misconceptions about the causes of heart disease. When Dr. Peter Libby, chief of cardiovascular medicine at Brigham and Women's Hospital in Boston, talks to his patients about heart disease, he often has to start by disabusing them of a popular misconception. Most think cholesterol silts into arteries, blocking them like a clogged pipe. When, one day, an artery gets completely blocked, a heart attack occurs-no blood is getting through to the heart. But the plumbing image is not only mistaken, cardiologists say. It can also lead patients to make disastrous errors in trying to protect themselves from a heart attack. Plaque is actually a pimple-like growth inside an artery wall. The pimples, stuffed with what Libby describes as a "kind of chronic pus," usually grow outward so they do not obstruct the blood vessel for many years. But once plaque gets started it covers the walls of the arteries. Arteries removed during autopsies of heart attack patients tell the story. "There are all kind of plaques," Libby says. There is the large, ugly yellow plaque that leads to the heart attack. It pops open, attracting red blood cells that form a clot on its surface, blocking the artery. There also are grayish-white plaques, old ulcerated plaques that became calcified. There is so-called vulnerable plaque, the pustules that are ready to burst. And there are yellowish streaks, thought to be plaques starting to develop. Patients typically have dozens of vulnerable plaques, and it is impossible to know which will burst and which of those will result in a blood clot that blocks an artery. The only thing proven to reduce the risk of a heart attak in someone with vulnerable plaque is the same thing that works to prevent vulnerable plaque from developing in the first place-controlling cholesterol levels, blood pressure and blood sugar and not smoking. Excess cholesterol gets stuck in artery walls. The wall becomes inflamed with white blood cells of the immune system. Those white blood cells in turn spew out highly active molecules that change the biology of the artery wall, leading to plaque. And it turns out that controlling these humdrum risk factors can nearly prevent heart attacks , said Dr.Daniel Levy, director of the Framingham Study. As for LDL cholesterol, the dangerous form, Libby said, "If we applied lifestyles and the drugs we have consistently, LDL is a done deal." Levy thinks he understands why these prevention strategies are given such short shrift. Prevention, he says,"does not have a face". There are no personal stories, no individuals who can be pointed as the success of prevention. It is just statistics.

Heart disese is now believed to occur when excess cholesterol inside an artery's walls incites inflammation and the growth of plaque

  • LDL cholesterol particles are absorbed by the artery wall, prompting cells in the wall to summon the immune system.
  • White blood cells of the immune system squeeze into the artery wall.
  • The white blood cells send out chemical signals that cause inflammation.
  • The white blood cells grow and start to ingest the LDL cholesterol particles. This is the start of plaque, pimple-like growths.
  • The plaque enlarges and gets covered with a cap of smooth muscle cells.
  • The cap ruptures, forming an open wound that attracts red blood cells. They form a clot to seal the surface of the plaque, but the clot can grow, blocking the artery and causing a heart attack.

Source: Peter Libby, Brigham and Women's Hospital, Harvard Medical School. Keyhole heart op to bypass EXPENSIVE ROBOTICS Mumbai: Cardiac surgeon Dr Ranjit Deshpande says he shows his innovation to medical practies in India. "I worked with Dr Nitu Mandke at Hinduja Hospital when beating heart surgery was still new. Before that, I worked at Tata Memorial Hospital where video-assisted thoracic surgery was common," he says. It is this experience on the video-assisted surgery (now an LCD TV monitor)that Despande now draws to perform perform his ninimally invasive cardiac surgery. It is the workmanship he picked up as Manke's team member that helps him in drawing out the internal mammary artery through a 3mm-hole.

There is another India angle that Deshpande is proud of. "When most centres across the world are investing in buying expensive infrastructure used for robotic surgeries, my method is relatively cheaper." The commonplace video-as against the exotic Da Vinci robotic arm-is suited for Indian budgets, he says. "In fact, the procedure's USP is that it doesn't require costly equipment like a surgical robot. In the UK, the cost of this robot is 1.5 million pounds. But my technique requires an initial set-up cost of 50,000 ponds," he adds. At present, Deshpande uses the technique only for persons with single-vessel or double-vessel problems. "When I get back to London,I plan to use it on a patient who has heart blockage with triple-vessel blockages." Will his technique find wide acceptance? Deshpande is confident: "The world of surgery is changing and so are patients. Many people hate big scars and can't tafford to stay out of work." Dr. S. Bhattacharya, the country's leading heart surgeons, points out heart block treament , that many new techniques using minimally invasie ways are coming up. "But they are still in their infancy. May be, at a later date, they will become good enough to handle porblems among Indians, but not now," he says. "I am not satisfied if I don't physically touch the mammary arter and tighten it adequately," he adds.

Deshpande's technique evolved from his training in a Belgium centre known for its minimally invasive heart surgeries for heart valves. "To keep pace with the rapid advance, I went to the Belgium centre that has performed over 2,000 minimally invasive cardiac surgery procedures for valves,' he says. Back in London, he used the same methodolgy for performing minimally invasive beating heart surgery. He inserts a special camera through a 3-mm incision to see ee pictures of the heart. "I pass three probes through the second, fourth and sixth space between the ribs. Using the camera and the probes, I dissect the internal mammary artery and bring it down to the artery that needs the bypass," he says. Then the lower most incision is widened to 3 to 5 cm to use the harmonic scalpel to clear the blockage before joining the dissected mammary artery with the problem artery.

RARE VALVE SURGERY SAVES RWANDAN'S LIFE Looking at 32-year-old Matin Butarama's lean frame, it is difficult to imagine that for five years he would get so bloated that he could barely move. A malfunctioning heart meant the Rwadan interpreter's body -"right from my toes to chest"-would fill up with liquid. After diagnosis at Uganda, Tanzania and South Africa failed to specially diagnose the problem, he flew down to Mumbai's Wockhardt Hospital in Mulund for help "After talking to him, we realised he had suffered from rheumatic fever in his childhood. As he had stopped taking preventive medicine after 15 years of age, he developed a rare problem called the rheumatic isolated tricuspid stenosis of heart ,' said cardio-thoracic surgeon Dr Ajay Chaughule from Wockhardt. Due to the defect in the tricuspid valve, he had developed a thrombus or clot which was of 6 cm in size on the right atrium, restricting the blood flow to his heart. "We are planning to get a research paper published on this rare case," said Dr Chaughule. TNN

NEW RAY OF HOPE Instead of cutting the breast bone, a special camera is used to see the heart

  • As the camera relays images to a big screen,there is no need to completely open up the patient
  • The doctors work through the space between the ribs, using high definition imaging technology and advanced surgical instruments
  • First, the team deflates the left lung so there's room to pass in the camera in a tube
  • Then a 5mm incision is made beside the left nipple to put in the camera
  • For the bypass itself, the team uses the artery which usually brings bllod from the heart to the breat blood from the heart to the breast bone. It is detached at one end and pulled to just below the blockage
  • A small incision is made on the main artery before stitching the two arteries together; the blood is then rerouted

Heart failed?Get one for Rs. 34 lakh Bangalore Hospital Performs Asia's 1 st Artifical Heart Transplant, Organ Can Be Controlled By Battery
Bangalore: If your heart has packed up, surgical procedures have failed and no natural hearts are available for transplant, it still does not mean that you have to die. Get yourself an artificial heart and doctors of Bangalore's Narayana Hrudayalaya will plug it in for you. The life-saving device costs a cool Rs 34 lakh. On March 20, 54-year-old Venkatakrishnaiah became the first Asian to have an artificial heart implant. This KPTC employee had a severe heart attack in 2003. Despite a bypass surgery, he was unable to work and took voluntary retirement. "All my children were still studying. As the sole breadwinner of the family, I was forced to take voluntary retirement. After the bypass surgery, my condition worsened and I was unable to walk six steps. But after the implantation of the artificial heart, I can walk, climb stairs and am even planning to work," said a relieved Venkatakrishnaiah. In India, about 20 million patients suffer from heart block failure disease, a number that is increasing by two million annually. About 20% of these patients die each year without aid. Patients with endstage heart failure have limited options- heart transplant or use of ventricular assist devices (VADs). Heart transplantation is limited by availability of donor organs. At present, donor supply limits heart transplantation to about 3,500 hearts globally evey year. A viable alternative is implantation of VAD. A team of doctors from Narayana Hrudayalaya lead by Dr Bagirath R and Dr T R Rajesh, along with a team lead by Dr Lyle Joyce, Surgical Director of the Ventricular Assist Device Program of Minesota, US, successfully implanted a VAD in Venkatakrishnaiah, in a surgery that took over four hours. Though there have been 220 such implants worldwide, this is Asia's first. The surgery was sponsored by Narayana Hrudayalaya. However, this device cost around Rs. 34 lakh, including tax. The total cost, surgery included, is around Rs 40 lakh. "More than 100 patients are waiting for heart implantation surgery. If the patients can afford the device, we are ready to do the surgery for free," Dr Devi Shetty, chairman of Narayana Health City, said. A left VAD is a battery-operated, mechanical pump-type device. It is a centrifugal pump that is surgically implanted in the lower part of the chest below the heart. The LVAD measuring 60mm in diameter, weighs 298 gms. It has an inflow tube that draws blood from the left ventricule into the pump. The pump then sends blood into aorta, effectively helping to unload the weakened left ventricle. There is a cable that exits from the abdominal wall to the outside of the body. It is attached to the pump's battery and control system incorportated in a compact pack, which the patients have to carry around. This form of heart transplantation is also called "destination therapy". Says Dr Rajesh: "This device can pump 10 litres of blood per minute. The 12-volt rechargeable battery is esternally connected and needs to be charged every four hours for sufficient battery back-up. It is an inseparable part of the patients." Since the battery is externally connected to the patient's body, if proper care is not taken, infection could occur. They should also avoid magnetic fields. Dr Bagirath says patients can lead a normal life after this surgery.

HEART : YOUNG & ALIVE With an increasing incidence of cases of heart disease, there are no sympathetic galances. "Did you get an angioplasty", is the question that springs to mind. The procedure that has been practised by doctors in the Westsince the 1960s has undergone a sea change in India over the last 22 years since a Mumbai-based doctor first performed the angioplasty. Even in the last few years, the balloon and stent method of opening up blocked arteries in the heart has changed. "Strategy, technology, drugs and equipment introduced regularly make the procedure more advanced ," says Dr Siddhart Dagli, consultant cardiologist at Jaslok Hospital. "Newer platelet inhibitors (used as blood thinners) have been approved by the US Food and Drug Association, and are available for use." Newer stents that are more effective and are longer-lasting are also available now. "Knowing that the drug is effective, the equipment fool proof and that unexpected compications won't arise give a doctor confidence to perform even elaborate procedures." There is also growing awareness among patients. Take Rita Jhangiani for instance. Last month, the 47-year-old bank employee felt sick at work and returned home immediately. "Because Rita arrived at the hospital while she was having the heart attack, we could completely reverse the damage to her heart muscle,"says Dr Dagli. Awareness, split-second decisions, and advances in angioplasty saved Rita's heart. Heart attacks rise among the young This news is not for the weak-hearted. A whopping 21.52 lakh Indians died of heart attacks from January 2008 to June 2009. If that is bad, read this: The number of non-institutionalised adults with diagnosed heart disease in the country now is 24.1 million. And more Indians are dying younger. "Compared to our western counterparts, Indians become diabetic 10 years earlier." This exposes them to the risk of heart diseases when young. The roller coaster lifestyle coupled with our inability to deal with stress is leading to this dangerous trend,' said cardic surgeon O . P .Sharma. These distrubing revelations are from the Indian Council for Medical Research, WHO and the Indian Heart Foundation, which have put India on red alert to control cardio-vascular disease burden in the world. Though women have heart attacks at older ages than men, they are more likely to die from the attack within a few weeks due to the age. According to the study, what is dangerous for India is that heart disease is the leading cause of death among diabetics-nearly 65% of all diabetics die from coronary heart disease. For the record, there are at least 20 million diabetics in India. Interestingly, ICMR has found that a new trend is that rural folks are also being diagnosed with diabetes and constitute 2% to 3% of the ailing population.

CARDIAC CONCERNS DID YOU KNOW? According to cardiologists, genetically the average size of coronary aorta of Indians is maller than that of our Western Counterparts. While the size of the aorta for an Indian is 1-1.2mm, it is 2.5 to 3 mm for those living in Western Countries. WATCH YOUR HEART

  • Every minute, three women died in 2008 due to cardiovascular disease.
  • For men over 40, the lifetime risk of cardio-vascular disease is one in three. For women it is one in two
  • One fifth of the deaths in India are from coronary heart disease. But by 2020, it will account for one third and majority of them will be youngsters
  • Coronary artery heart disease is the number one cause of death in India for both men and women
WHY ARE INDIANS MORE PRONE?
  • Poor stress management
  • Very little or no exercise
  • Sedantary lifestyle
  • Consumption of fat-rich food

Heart problem? Check kidneys Renal Ailments Increase Risk Of Developing Cardiovascular Diseases : Experts New Delhi : Having problems with your heart?Get your kidneys checked. Experts say chronic kidney disease (CKD) has been found to increase the risk of developing cardiovasular disease, even among people with early kidney aliments. According to cardiologists, the increasing number of kidney patients suffering a heart attack reinforces the importance of early detection of CKD, not only to slow progression to kidney failure but also to identify risk factors for cardiovascular disease. Senior cardiologist from Apollo Hospital Dr Deepak Natarajan said majority of patients suffering from end stage renal disease would die of cardiac complications. Dr Natarajan said, "Kidneys are responsible for filtering waste products from the blood. When the kidney is impaired, the waste starts to accumulate, leading to a rise in bad cholesterol levels. Clotting mechanisms also enhance the patient's risk of suffering a heart attack." Dr Natarajan estimated that 30% of CKD patients who were on dialysis suffered a heart attack within 4-5 years with mortailty rates as high as 45% over the next one year. Any cadiac intervention carried out on such patients like angioplasty or stenting increases their morbidity and mortality risks. American data shows that a CKD patient on dialysis who undergoes stenting has a mortality report of 16% compared to 4% on non-dialysed patients, over a period of six months. "Most of the data on people suffering from both CKD and heat conditions are observational. The longer these patients stay on dialysis, the larger their risk becomes. A kidney transplant then becomes crucial," Dr Natarajan said. Senior consultant (cardiology) of Moolchand Medcity KK Agarwal said CKD was now cosidered equivalent to coronary artery disease. Diabetes was the first condition labelled as CAD equivalent earlier. "This means CKD patients have more chances of dying from a heart attack. Therefore, CKD patients shoud be jointly treated by nephrologist and cardiologist. CKD patients need to control their blood presure, LDL bad cholesterol and diabetic status," Dr Agarwal said. Chronic kidney diseases and vascular diseases are expected to kill 36 million people by 2015. A pair of epidemiology studies supported by the National Institute of Diabetes and Digestive and Kidney Diseases at NIH, that appeared in the New England Journal of Medicine, found that when kidney function (GFR) dropped, the risk of death, cardiovascular events such as heart disease and stroke, and hospitalisation increased. Compared to patients whose GFR was at least 60, the increased risk of death ranged from 17% in those whose GFR was between 45 and 59 to about 600% in those whose GFR was less than 15. Heart attack risk can be heard as well as seen New research shows a stethoscope can detect a sound in the artery, which indicates a fatty build-up Heart attack risk can be heard by listening for a certain noise in the artery supplying blood to the brain, US researchers said. People with the sound, called a bruit, from the carotid artery in the neck were twice as likely to suffer an attack and more than two-and-a-half times as likely to die from heart diseas, than those without it, researchers reported in the Lancet. A carotid bruit is heard when using a stethoscope to listen to blood flow in the artery, which brings blood flow in the artery, which brings blood to the head and neck. The presence of the sound indicates there's a fatty build-up called atherosclerosis, which may explain the increased risk, scientists said. Nurses or physicians usually notice the sound by chance during a medical check-up of otherwise healthy people. "Our study has shown that the presence of a carotid bruit significantly increased the likelihood of cardiovascular death or heart attack," Christopher Pickett from the Walter Reed Army Medical Center in Washington DC, wrote in the journal report. Pickett and colleagues analysed data from 17,295 patients in 22 studies from the US, Canada, the UK, the Netherlads and Switzerland and did a follow-up for four years. In four studies comparing patients with and without carotid bruits, those with the noise were more than twice as likely to have a heart attack. Carotid bruits are a sign of a higher stroke risk, according to the American Heart Association. A carotid bruit is different from a heart murmur, which is a whooshing or swishing sound heard during a heartbeat. Pysicians should listen for carotid bruits in patients with an increased risk of suffering a heart attack to identify those that may benefit the most from preventive therapy, Pickett said. "On the basis of our results, a patient with a carotid bruit would warrant treatment with aspirin every day." 40% Indians at risk of heart ailments At Least 1 Member In 11% Households Affected; Middle-Aged In Delhi, Kolkata Most At Risk: Study New Delhi:The bad news on World Heart Day is that nearly 40% of Indians are found to be highly or at least moderately at risk of heart disease, at least one member of 11% Indian housholds is already afflicted and the middleage in Delhi and Kolkata are especially vulnerable. And if you work more than nine hours a day in a high-pressure job, watch out-you could be among the 31% that is at acute risk. Those finding are part of a study conducted by IMRB, designed by Apollo Hospitals and commissioned by quaker Oats in ten cities across the country-Mumbai, Delhi, Chennai, Kolkata, Pune, Hyderabd, Bangalore, Thiruvananthapuram, Chandigarh and Lucknow. The study aims to construct a Heart Age Index. The study of 3,400 respondents aged 25 to45 was conducted in August and September and covered a wide variety of people, including businessmen, professionals and housewives. It was donein two phases: Random and booster, which targeted specific groups. It recorded various paramenters-health, lifestyle, food habits, sleep patterns, diet, demographic profile and personal and professional data. Everyone's medical history, including cardiac illness, hypertension levels, disabetes, cholesterol and pulse, was recorded. The study found that people who worked 24 x 7 or had sedentary jobs were especially at risk. And in a bit of good news for drinkers, the study discovered no significant difference between tipplers and non drinkers in terms of risk of heart disease. It reiterated the fact that those with a family history of heart problems were at special risk, as were people who were borderline in the treadmill test and were being treated for high blood pressure and blood sugar levels. Prof Adrian Kennedy, MD, Lifetime Wellness Rx International Limited, apollo Hospitals Group Company, "the good news-that a majority of premature heart attacks and strokes can be prevented through healthy dietary regimens, regular physical activity and control on smoking and alcohol. Those who get to know that their heart is older than their real age should do much more to protect it. This will not only help them avert heart disease but also greatly improve the quality of their lives". Certain lifestyles too were more at risk-those who smoked or were passive smokers (29% were at risk), those who did not do enough physical activity/ manual work (69%) or exercise (74%) and those who ate non-vegetarian food (84%). The unhappy and depressed were found to be at maximum risk. Readers can take the Heart Health Test, designed by Apollo, on the Quaker Oats website goodmorningheart.com -and join the mission to make India heart healthy.

Sex isn't desert for cardiac patients First comes the heart attack, then comes fear of sex. Never mind that it's groundless and irrational. For people who have suffered the trauma of heart attack, fear barrier is very real. A sense of terrible, lonely fragility holds them back from the healing warmth of sex. What could be more frightening than the thought that you might have another heart attack, or even die, during intercourse? That's why so many people-estimated between 50 and 75%- either curtail their sex lives or completely draw the curtains on sex after a heart attack. (Often it's the spouse, not the patient, who's most reluctant to resume sex, studies have shown). It doesn't help that there's often a major communication gap between cardiologist and patient on the subject of patient's sexuality. Cardiologists just haven't been very good at gaying patients specific, practical advice about sex during recovery, and patients haven't been good at asking. Part of the problem is that cardiologists tend to be as uncomfortable talking about sex as anybody else. And even though many patients view them as experts on sex, often, they're really not too well informed. For one thing, the biggest fear that you 'll die during intercourse is "highly unlikely". In fact, according to a panel of six prominent cardiac rehabilitation specialists, about 80% of recovering heart attack patients can safely resume having sex ; 20% should limit sex to some extent. Despite its physical estasies, sexual intercourse actually requires much less energy than most people think. Men's heart rates at orgasm averaged only about 117 beats per minute, with an average heart rate for the period two minutes before and two minutes after an orgasm averaging 98 beats per minute. How long should you wait after a heart attack heart surgery to resume having sex? It's really first safe to make blanket recommendations about how soon it's safe to resume sex after heart surgery, since individual cases might vary. Studies have shown that doctors advise patients to wait anywhere from two or three weeks to months, depending on their condition. Patients' physical condition, rather than the mere passage of time, is a better measure of the readiness to resume sexual life. A patient who is able to climb two flights of stairs at a brisk pace can be considered sufficiently fit to have sexual intercourse. It makes sense to be prudent, but sometimes we forget: There's a deep magic and lot of healing medicine, in the sense of emotional closensess and tenderness we get from sexual contack with our mates. It doesn't necessarily have to involve intercourse-cuddling , touching, even just talking can be the best remedy for the depression, anxiety and loneliness that often follows a heart attack. Avoiding sex because you're concerned about your health is not always a good idea. Sometimes, in fact, it's terrible idea. In general, people recovering from heart attacks or surgery should follow these guidelines. Take it easy The first time you have sex after your surgery, go gently, and don't attempt interourse. Warm, unpressured, nongenital touching is best. Indulge in these gentle pleasure over the course of a week or so, and if there's no chest pain, shortness of breath or palpitations, it's safe to move on to intercourse. Rest First. Avoid sex when you're tired. Many men find that the best time for love making is first thing in the morning or just after a nap, when they're well rested. Slip into something comfortable. It's best to have sex in familiar surroundings-preferably at home in your own bed. Don't have sex when the room temperature is too hot, too humid or too cold. Warm up the bed sheets before sex, because a cold bed stresses the heart. Don't treat it like dessert. Don't have sex right after a heavy meal, which also puts and added buden on the heart. It's best to wait 2 or 3 hours after eating before having our sweetie. Forget gymnastics. Choose a sexual position that's confortable and familiar. I advise patients to avoid the top position. If you have shortness of breath while lying down, trying sitting in a chair with your partner in your lap will helpful. Listen to your body. Be alert for these warming signals of cardiac distress, and always reported them to your doctor.

Chronic diseases to bleed India' Ailments Like Diabetes & Heart Problems Will Lead To Losses Of $ 236 Bn By 2015' New Delhi: Smoking, consuming high calorie fast food and being a couch potato will not only cut short your lifespan but not also cost the country dear. The report, jointly prepared by the World Health Organisation and the World Economic Forum, says India will incur an accumulated loss of $236.6 billion by 2015 due to unhealthy lifestyle and faulty diet. The resultant chronic diseases- heart disease, stroke, cancer, diabetes and respiratory infections-which are allment of long duration and slow progression, will severely affect people's earnings. The income loss to Indians because of these diseases, which was $ 8.7 billion in 2005, is projected to rise to $54 billion in 2015. Pakistan would once an accumulated loss of $80.7 billion with income loss increasing by $ 5.5 billion to $6.7 billion by 2015. China, however, will be worse off. While its accumulated loss will stand at $557.7 billion, the loss of income of the Chinese people will stand at $131.8 billion, almost eight times more than what it was in 2005. According to the report, 'Preventing Communicable Diseases in the Workplace through Diet and Physical Activity', which was launched at the World Health Assembly in Geneva on Monday, 60% of all deaths worldwide in 2005-35 million-resulted from non-communicable diseases and accounted for 44% of premature deaths. The report also points to the fact that countries like Brazile, China, Russia and India currently lose more than 20 million productive life years annually to chronic disease. And the number is expected to grow by 65% by 2030. Calling for the promotion and implementation of workplace health programmes globally, the report says trough workplace environments, it is possible to influence the health behaviour of a large chunk of the population. In 2007, nearly 3.1 billion people were economically active. The figure is estimated to exceed 3.6 billion in 2020. "The cost to empolyers of morbidity attributed to non-communicable diseases is increasing rapidly. Workplaces should make possible healthy food choices and support physical activity. Unhealthy diets excessive energy intake, physical inactivity and tobacco use are major risk factors for non-communicable diseases, " the report said. The study cited scientific evidence that healthy diet and adequate physical activity-at least 30 minutes of moderate activity at least five days a week-helped prevent NCDs. How to combat, prevent and control NCD is one of the main items in the agenda in this year's WHA, that kicked off on Monday. WHO has already prepared a draft plan to guide member states like India in working towards initiating a national programme to control NCDs. The plan asks member countries to reduce the levelof exposure of their population to common modifiable risk factors like tobacco use, unhealthy diet, physical inactivity and alcohol consumption. But India has already initiated a National Programme for Prevention and Control of Diabetes, CVDs and Stroke through a pilot project launched in seven states. Health minister A Ramadoss said, "In India, 10% of adults suffer from hypertension while the country is home to 25-30 million diabetics. Three out of every 1,000 people suffer a stroke. The number of deaths from heart attack is projected to increase from 1.2 million to 2 million in 2010. Six million people have coronary artery disease and 5 million have rheumatic heart disease. The premature mortality and morbidity in the most productive phase of life is posing a serious challenge to out economy. It is estimated that NCDs accounted for 53% of all deaths in India in 2005. Get heart attack warning with a drop of blood Thiruvanathapuram: There's exciting news for people prone to cardiac risks. Inperhaps a first in the world, researchers at IIT-Bombay have developed a kit that uses a rop of blood to detect heart ailments and predict a possible attack. Called "iSense"' the device has been developed by IIT scientists working under the centrally-funded Centre for Excellence in Nanoelectronics. Disclosing this at the 97 th Indian Science Congress in Thiruvananthapuram on Wednesday, Prof V Ramgopal Rao of the IIT-Mumbai's department of electrical engineering said the device has completed lab trial and is ready for field trials. "The device with nano sensors can not only detect a heart attack, but also transmit its signal through a wireless interface to doctors located remotely for uick diagnosis and treatment,"Professor Rao said. He said,"The three-dimension sensors use a nano electrical mechanical system of its polymer material to convert any abnormal movement in the heart muscles into an electrical signal for detecting a cardiac symptom." The kit will not be costly, he said, adding the field trials may take another year. The kit comprises a table top box and a disposable slide with fields that changes colour depending on the condition of the heart. The technology, developed after three years,"steps in where the ECG fails," he said.

Looking into the future Cardiologists are increasingly recommending tests that predict heart attacks to convince patients to work harder at lowering the risk of cardiac problems ASIMPLE AND inexpensive test for a marker of inflammation, the C-reactive protein (CRP), is increasingly being used to predict the future risk of heart disease. Fat cells in the body produce CRP, which is linked to both inflammation and an increased risk of heart disease and stroke, and high levels of it are a reliable indicator of future heart attacks. The test costs between Rs 300 and Rs 400 in Delhi hospitals. "Tests such as the high-sensitive CRP help identify people at risk before the symptoms appear. Putting them on aspirin and statin drugs before heart disease sets in helps to lower production of CRP from fat cells and prevent disease," says Dr K.K. Sethi, director of cardiology, Delhi Heart and Lung Institute . Aspirin is a bllod- thinning drug that prevents clotting while statins lower cholesterol. Both these drugs are widely used as part of prevention therapy to treat heart disease. Obesity has long been recognised as a risk factor for heart disease but its link with CRP was established late last year. A study in Journal of the American College of Cardiology in september 2005 showed that body fat precipitates the inflammatory process that leads to cardiovascular disease. It also found that the process could be blocked with preventive medication such as statins and aspirin. Another new test is BNP- which stands for brain natriuretic peptide testing which is used to measure the amount of the BNP hormone in the blood. Normally, low amounts of BNP are found in the blood, but if the heart is stressed and working harder over a long period of time, such as from heart failure, blood levels of BNP go up. The test has a sensitivity of 97 percent. "Early diagnosis is important, more so in South Asians who tend to have diffused heart disease. Instead of one majore blockage in a main artery, they have several small plague deposits in several arteries that do not obstruct blood flow in the normal course, but can do so suddenly if they reputre,"says Dr. R.R.Kasliwal, director of preventive cardiology at the Escorts Heart Institute and Research Centre. Smaller plaques tend to be unstable and can rupture even when they have blocked just 15 per cent to 20per cent of the artery. When a clot forms over the rupture as part of the body's natural healing process, it may suddenly stop blood flow and cause a heart attack. Roughly half the people who have heart attacks have no symptoms of pain or heartburn because there is no significant restriction in their blood flow."In India, about 60 per cent heart attacks occur in their blood flow. "In India, about 60 per cent heart attacks occur in people who have arterial blockages belwo 50 per cent," says Sethi. Unlike in the West, where doctors are increasingly recommending universal use of statins and aspirin to lower heart attack risk after the age of 50 years, cardiologists here advise a more conservative approach to cardiovascular management. "Not much attention is paid to preventive lifestyle interventions such as quitting smoking and controlling bllod pressure, cholesterol and other bllod fats such as triglycerides. All of these interventions help to stabilise fragile plaque and prevent it from becoming larger and obstructing blood flow," says Kasilwal. The role of regular activity in heart disease prevention cannot be ignored. Regular exercise slows down the narrowing of the arteries to the heart and brain, encourages the body to burn up stored fat, improve cholesterol levels by increasing the level of heart-protective good cholesterol (high densit lipoprotein or HDL) in the blood, and reduces high blood pressure. "Having no heart risk factors at age 50 greatly reduces the lifetime risk of heart disease and increase longevity, so a healthy lifestyle and diet can lower risk substaintailly," says Kasliwal.

Lowering risk

  • Blood pressure below 130/80 hg/mm


  • Low density lipoprotein (LDL or bad cholesterol) over 45 mg/dl for men and over 55 mg/dl for women

  • Impaired glucose fasting below 100 mg/dl


  • Triglycerides below 140 mg/dl


  • Quit smoking


  • Opt for a high-fibre diet with plenty of vegetables and fruit, whole grains, low-fat and fat-free products, fish, pulses and legumes and unsaturated oils such as mustard, olive and sunflower.


  • Exercise for at least 30 to 40 minutes each day. Do a combination of aerobic exerises such as brisk walks(speed of at least 4-6 km/hour), yoga and weight training


  • Lose weight. Extra weight makes the heart work harder to supply blood to the body. A weight loss of 10 per cent or more lowers blood pressure and triglyceride levels.


  • Always take prescription medicines.


Heart attack disease in numbers

7 crore

Indians suffer from heart disease

50 lakh

People die of heart disease in India every year

28%

People who die of heart disease in India are less than 65 years old.

50%

people who have a heart attack have never had symptoms

60%

heart attacks occur in people with blockages less than 50 per cent

70%

Is how much your artery may be blocked before symptoms of chest pain and angina appear

66%

plaques are unstable and not treatable through intraventions

4% people can have minor heart attacks because of cardiac procedures.

Heart patient? Help is at hand! Why go hoslistic?
  • If you are a Diabatic person/Heart patient or even a normal person get your heart assessed at Apex Beat.
  • Non-invasive healing helps prevent bypass or other surgery in heart patients.
  • Cheaper than hospitalisation/surgical intervention.

Apex Beat, one of Mumbai's frist holistic cardiac rehabilitation centre, has launched a 'Healthy Heart' initiative. Thugh this initiative ab actively encourages patients with any kind of blockages in their arteries (from 5% to 95%) should get assessed their Heart at Apex Beat & can avail 10% discount on holistic cardiac therapy. The therapy is meant to increase blood supply to a diseased heart through collaterals around these blockages. Shares Director Dr. Rohit Sane, "Heart disease is caused due to arterial blockages.In itself, this may not cause a heart attack but the more the blockage, the higher the possilility of an attack. Patients who have reached a late stage are required to undergo bypass surgery or angioplasty. At Apex Beat, the focus is on avoiding surgery by preventing patients from reaching this late stage.

Holistic treatment: "First , we carry out a thorough assessment to determine whether or not treatment is required. Patients take an ECG (basic & resting), an Exercise Tolerance Test as well as a Pulmonary Function Test. The whole process takes less than 30 minutes. Based on the results, he or she may be asked to complete one or more therapy sessions of two hours each", says Dr. Sane. Each weekly session includes allopathic medicine and ayurveda, combined with physiotherapy and yoga. This is a globally proven physiotherapy and yoga. This is a globally proven technique of preventing and curing heart disease. With this, the centre has been successful in eliminating heart disease even as extreme as 95 to 100%. "After each therapy session, the imrpovement in heart function is measured. At the end of the recommended schedule, all patients experience measurable improvement in their cardic status," Dr. Sane asserts.

Who needs cardiac therapy? Patients diagnosed with heart disease or diabetes. People who experience breathlessness or suffer from poor quality of life, extreme stress and lack of energy. Smokers (Apex Beat also offers a special programe to reduce lung stress and the ill-effects of smoking/pollution on the quality of life).

Heart of the matter Resynchronisation therapy, a painless, bloodless procedure, offers hope for end-stage heart patients. SWARUPA P C speaks to DR. B.G Muralidhara about the new technique FINALLYthere is some hope for terminal heart failure patients. Resynchronisation therapy, one of the most advanced cardio therapies aimed at end-stage heart patients who are in need of continuous support for the normal functioning of the heart, has come as a welcome innovation in the field of cardiology. In the current Indian scenary, where heart failure is reaching endemic proportion, Resynchronisation Therapy is definitely a boon as cardiac transplantation is still in its nascent stage and medicines are not always successful. But, with this simple painless resynchronisation procedure, even the most seriously ill patients can lead a normal life. Resynchronisation therapy is a procedure that consists of a special pulse pacemaker, also called a heart failure devise. This device is intended at delivering electrical signals to help the heart contract better and increase the amount of blood flow in the body. What is more interesting is that this therapy does not require any surgical procedure and the patient is fully conscious through out the procedure. In fact it is a bloodless procedure. Resynchronisation therapy was recently administered on one end stage heart patient, who was extremely weak and was advised to take 18 medicines on a daily basis. But this therapy conducted at Trinity Hospital and Heart Foundation by Dr B G Muralidhara has sprung him back to action. Explaining the procedure, Dr Muralidhara says that this heart failure device contains a batter, a specialized computer chip and special electronics. The device is connected to threee insulated wires called leads. The three leads along with the device are inserted using a surgical procedure. The leads are designed to send electrical singals to the heart and also receive the heart's electrical signals. This helps in coordinating the heart's contractions, thus improving pumping of blood. It is still early days for Resynchronisation therapy in India, mainly owing to low awareness about the procedure and lack of specialized doctors. Only a few hospitals are equipped to conduct this produre in Bangalore. With medical technology touching new highs, time will not be far when heart transplantations will be a regular affair in India. But right now, resynchronisation is surely infusing a new hope among doctors as well as patients.

Cardiac ailments to cost India $230 b in 10 years New Delhi Over two million people ide alimanary diseases in India annually over country stands to lose $236 billion the next 10 years due to loss inactive working days and treatment says experts. Currently India is home to over 60 billion coronary heart patients and are then two million patients are succumbing to the disease every year," well known cardiologist Naresh Trehan told ANS. Trehan spoke on the eve of World Year Day on Sunday. "The burden of the disease will weigh heavily on the economic backbone of the country unless people bring a change in their lifestyles. Along with the loss in human capital, the country's economiy will suffer on account of loss in working days and treament costs," said Trehan, executive director of the Escorts Heart Institute and Research Centre here. According to a World Health Organisation estimate, India's economic loss due to heart related disease could be $303 billion, China is expected to lose over $550 billion in the next decade. Over 17 million people died of cardiovascular diseases such as heart attack or stroke in 2005, WHO says. Contrary to popular belief, over 80 percent of the deaths occurred in low an dmiddle-income countries. The WHO has warned that Indians, being genetically prone to cardiac disorders, are likely to constitute about 60 percent of the world's cardia patients by 2010. Statistics show an alarming incidence of heart diseases among youngsters in India, said S.K.Gupta, senior cardiologist at the Indraprastha Apollo Hospital. Cases of heart disease (per 100,000) increased from 145 males and 126 females in 1985 to 253 males and 204 females in 2000."According to one estimate, more than 260 people are succumbing to the diseases for every 100,000 people." Gupta said the prevalence of coronary heart diseases among the urban population was more than three times compared to the rural populace. "Changing lifestyles, no focus on physical exercise and growing work pressure in urban setups are contributing to the spread of this menace," he added. He said every year 12,000. Angioplasties were carried out in India. Nearly, 100,000 children were born every year with congenital heart diseases. Notwithstanding the urban-rural divide, the consumption of tobacco persisted, and that is "bad news", he said. Youngsters in rural areas are taking to tobacco as a "hobby" while smoking has become a lifestyle stement in cities. "The situation is really grim in India. As the number of deaths is growing gradually, the country is losing productive working days,which in turn is a loss to the economy," said K.Srinath Reddy, head of cardiology, All India Institute of Medical Sciences. Upendra Kaul, chief cardiologist at the Fortis hospital, said that due to life style problems nearly 10 percent of the urban population and around three percent in rural areas were suffering from coronary heart diseases.

60% of the world's heart disease cases will be in India by 2010 Lancet Publishes study by researchers from Bangalore, Canada London: In another two years India will account for 60% of the world's heart disease cases, nearly four times more than its share of the global population, according to a study by Indian and Canadian researchers published on Friday. The study, published in the journal Lancet, found that people with heart disease in India get slower care than people in developed countries and are more likely to die. The in-depth look at heart disease care in India also shows heart patients tend to be younger, with an average age of 57, than heart patients in many other countries. The researchers paint a picture of heart attack patients heading to hospitals in rickshaws rather than ambulances, and paying for the cheapest possible treatments out of their own pockets. India will account for 60% of the world's heart disease cases by 2010, Dr Denis Xavier at ST.John"s National Academy of Health Sciences in Bangalore and colleagues there and in Canada said. South Asians have a higher prevalence of risk factors for heart disease and tend to get it earlier. "Strategies to reduce delays to access to hospital and to improve the affordability of urgent care could reduce morbidity(sickness) and mortality," they worte in Lancet. Xavier's team studied 21,000 heart attack patients across 89 centres in 50 cities for their four-year study. They found that of 20,468 patients given a definite diagnosis, 60% showed evidence of a heart attack, compared with 40% in developing countries. The risk factors -include tobaco use, high levels of lipids in the blood due to diets rich in saturated fat, and hypertension-are the same as elsewhere, but the gap between India and developed nations have more specific causes, the study found. One was the time needed for patients suffering an acute heart problem to get medical attention. On average, it took 300 minutes to reach a hospital in India, twice as long as in rich nation. "Few patients used an ambulance to reach the hospital. Most used private or public transport" due to financial constraints, the authors note. Poverty also prevented most patients in India-where 75% of health care expenses are paid out-of pocket-from obtaining routine treatments in hospital, much less preventative surgery. Indian heart patients where just as likely as patients elsewhere to get recommended heart drugs such as blood thinners, clot busters and cholesterollowing drugs.

What's different with us Poverty prevents most patients from obtaining routine treatment in hospitals The averagetime taken to rush a heart patient to hospital is 300 minutes, twice as long as in rich nations I absolutely agree with this study's results. We are on the brink of disaster. Getting the patient to the hospital in a city like Mumbai is a Herculean task. Critical time is lost in traffic." -Dr.Pratima Rajan, Head, Dept of Preventive Cardiology, Jaslok Most worrisome is that youngsters are coming with cardiac problems and stress is to blame." DR.Vijay Bang, consultant interventional cardilogist, Lilavati HEART CARE UPDATE On World Heart Day, we explore how the latest technology is helping doctors detect heart problem earlier and with reduced risk to the patient Advances in technology, research and growing expertise have proven incardiovascular care has taken over the last few decades. GENE AND STEM CELL THERAPY Cardiovascular gene therapy (GT) with vascular enothelial growth factor (VECF) has yielded improved perfusion and reduced ischaema in prelinical models of ischemic heart disease(IHD). Stem cells delivered to areas of damaged heart muscle improve contractility and improve perfusion by inducing angiogenesis. Dr. V.K Shah, interventional cardiologist at Sir H.N Hospital, S R Mehta Hospital predicts, "Stem cell therapy holds out great promise for patients suffering from end stage heart disease. Having the potential to revive the dead tissue and regenerate the viable muscle so as to improve the heart function, in the future, it will be a treatment which will help patients avoid going in for heart devices and heart transplant." NANOTECHNOLOGY Nanotechnology is set is positvely impact cardiovascular health in coming years. Microscopic implantable drug delivery capsules and slow-release therapies can changes the way drugs are given. The potential applications in cardiovascular medicine range from diagnosis to mechanical assist devices supporting the failing heart. A new tactic being employed is the use of nanoengineered molecules called 'Nanoengineered molecules called 'nanolipoblockers' as frontline infantry against harmful cholesterol. PHARMACOLOGICAL ADVANCES The new generation cardiac drugs has improved the way doctors treat cardiac patients. CARDIAC TELEMONITORING Using advanced telemonitoring systems, both the patient's device and physiologic parameters are collected daily. These are automatically channelled into a series of easy-to-use reports for the physician to review. This improves work efficiency and when cardiac events occur it delivers timely responses. All the advances are patient friendly being less invasive, equally effective and reducing hospital stay significantly. From diagnostics to treatment and prevention, modern medicine offers cardiac patients a better quality of life.

Cardiac arrest: Giant Killer On June 25, US paramedics who responded to a 911 emergency call to singer Michael Jackson's home found he wasn't breathing at all. A cardiac arrest, they ruled. His case may have been drug-induced but sudden cardiac arest is the culprit in many instances where a seemingly healthy person drops dead all of a sudden. And research shows over 70% Indians believe sudden cardiac arrest is just another type of heart attack. There is even worse awarancess about the fact that there is only a fourminute window in which a patient can be helped. Doctors say while many cardiac patients consider heart attacks to be the most dangerous, it is sudden cardiac arrest one should fear. The reason? While a heart attack only blocks the blood to from the heart, a cardiac arrest stops the heart. The entire circulatory system stops working, leading to instant death. "A person does not die of heart attack alone, but a cardiac arrest assures death if not treated immediately" said Dr Ameya Udyavar, consultant cardiologist at Hinduja Hospital. Cardiologists say only if a heart patient takes preventive measures or is already in a hospital can he survive a cardiac arrest."The most common cause of a cardiac arrest is a heart attack. But not every heart attack leads to a cardiac arrest, " said Dr Suresh Joshi, consultant cardiac surgeon at Wockhardt Hospital in Mulund. Dr Ashwin Mehata, head of the cardiology department at Jaslok Hospital, says a cardiac arrest patient has only four minutes to survive. "In a cadiac arrest, the heart musle quivers but fails to produce the necessary contractions. This stops the blood flow in the whole body. If the blood does not reach the brain for four minutes, a person dies," said Dr Mehta. "Those who have already had an attack are more at risk. After an attack, the heart is weak and can stop working any time. But also people who have a family history of heart diseases might get a cardiac arrest without anattack. Severe electric or emotional shocks might also be a reason,"said Dr Udyavar. Heart patients are forwarned. "If the patient is already in a hospital, an external difbrillator that gives a shock to the heart is used. For those who have recovered from a heart attack, a device called Implantable Cardioverter Defibrillator can be implanted below the collarbone,"said Dr.Udyavar.

Indians are at most risk Mumbai:More and more Indians are falling prey to heart disease at a younger age. According to the Heart Rhythm Society, a health NGO, sudden cardiac arrest alone kills 1,000 people a day or one person every two minutes across the world. Approximately 4,280 out of every 1 lakhs people die each year in India alone. "We have the most number of cardiac arrest deaths due to genetic heart problems'" said Dr Ameya Udyavar, cardiologist from Hinduja Hospital. An oil-rich diet, sedentary lifelstyle, all factors contributed to this. The Interheart study, conducted across 52, countries showed Indians were more prone to heart diseases. Worse,the average age of Indians affected was 10 years younger than Caucasians.

SUDDEN CARDIAC ARREST It's a condition in which the heart suddenly and unexpectedly stops beating, consequently blood stops flowing to the brain and other vital organs

SYMPTIOMS

  • Chest pain on exertion
  • Shotness of breath on exertion
  • Jaw pain, back pain, or arm pain, especially on left side, either during exertion or at rest
  • Palpitations (a sensation of rapid or very strong heart beats in your chest)
  • Dizziness, light headedness, or fainting
  • Weakness on exertion or at rest
  • Irregular heartbeart


IN DANGER Men above 45 and Women above 55 are at increased risk RISK FACTORS
  • Family History
  • Diet
  • Smoking
  • Diabetes
  • High blood pressure
  • Obesity
  • Inactivity
  • Emotional stress
  • High total cholesterol

DIFFERENT FROM HEART ATTACK In a heart attack, there might be an obstruction in the arteries. But in a cardiac arrest, the heart stops pumping blood altogether. Ayurveda herb holds hope for heart patients Ashwagandha's Worked On Rats, AIIMS Plans Human Trials New Delhi: Ayurveda's wonder herb Ashwagandha has been found to prevent heart attack in rats. In a series of pre-clinical animal studies conducted by All India Institute of Medical Sciences (AIIMS), researchers have for the first time demonstrated how Ashwagandha(withania somnifera)strengthens heart muscles, protecting it from an attack and significantly increasing its power of endurance and survival. The herb extract has shown signs that it can stall Necrosis-accidental death of cells and living tissues caused during a heart attact. It also stalls the harmful release of chemicals by cells that die by Necrosis causing damage to other cells. The team, led by DS Arya, associate professor of pharmacology at AIIMS, is now planning to undertake human trials on 100 subjects-those who have suffered a heart attack once, those who are prone because they have hypertension and diabetes and those who have suffered stroke several times-to see if Ashwagandha extract provides them protection. Therapy with Ashwagandha, aslo known as winter cherry, has been advocated for centuries by most of India's ancient systems of medicine, against illnesses like arthritic inflammation, ensomnia, respiratory disorders, asthma, coughs and nervous disorders. But the AIIMS study has, for the first time, revealed the herb's heart protective properties. According to researcher Shirish Ojha, rats were fed three doses of Ashwagandha extract for four weeks. On the 29th and 30th day of the study, the rats were injected with two doses of a chemical called Isoproterenol(ISP) which induced heart failure. Tests then revealed that the rats which were fed Ashwagandha extract survived longer. Subsequent blood tests and examination of their heart muscles under a microscope found that the rats that had received Ashwagandha prior to ISP injections had their heart muscles intact compared to rats that did not receive Ashwangandha extract. The rats also displayed lower levels of inflammation. Arya told TOI: "Recently, we found how Tulsi protected heart against coronary diseases. Now, Ashwagandha looks even more potent. A year-long human trial, being planned, will show how effective it is on humans."

TAKE HEART Ayurveda's most popular herb Ashwagandha or Winter Cherry could soon protect you from getting a heart attack. Studies conducted by AIIMS on rats have found it can stall cell death caused by a cardiac arrest. What is Ashwagandha? Ashwagandha is Sanskrit means horse's smell. Gets is name from the odour of its root which resembles that of sweaty horse. All parts of the plant are used in herbal medicine. Where is it found? It grows prolifically in India, Pakistan and Sri Lanka. In India, it is found in MP, Rajasthan, Punjab, Haryana, UP, Gujarat and Maharashtra. In MP alone, it is cultivated on more than 5,000 hectares. The estimated production of Ashwagandha roots in India is more than 1,500 tonnes. AIIMS study findings:
  • Study conducted on 300 rats over the past 4 Years shows Ashwagandha prevents heart attact in rats.
  • It stalls necrosis-accidental death of cells and living tissues caused during a heart attack
  • Rats which were fed Ashwagandha extract, survived longer when a heart attack was induced using a chemical
  • Their heart muscles were also undamaged
  • Human trials to be conducted in a few months' time.Over 100 sujects to be recruited for the year-long study.
  • New technique to skip unwanted bypass surgeriesWill Decide if patients Need Angioplasty New Delhi: The number of unnecessary or premature angioplasty and bypass surgeries could finally see a dip in India. Cardiologists are all set to maximise the use of Fractional Flow Reserve(FFR)- a procedure in which a wire is inserted into the arteries to accurately measure blood pressure and flow to the heart and determine If the block-age would lead to ischemia. Experts say FFR will prove to be a boon especially for patients suffering from multiple blockages of heart vessels. With FFR, cardiologists will be able to quantify the risk of a particular blockage and decide whether to conduct an angioplasty or bypass or simply treat it with medicine. At present, cardiologists use their experience to decide which blockage would require intervention. Dr. Praveen Chandra, chairman of interventional cardiology at Medanta Medicity, who is going to use FFR on a 78-year-old patient with multiple coronary blocks on Saturday, said the measurement of FFR has been shown to be highly accurate in assessing whether or not to perform angioplasty or stenting on intermediate blockages. "Blockages in the coronary arteries are opened up to increase blood flow to the heart. But FFR can quantify the obstruction. If it says that the blood flow is not significantly obstructed, the blockage does not need to be revascularised (angioplasty) and the patient can be treated safely with medical therapy," Dr. Chandra said. According to chairman and chief cardiologists of Escorts Heart Research Centre, Dr Ashok Seth, India at present sees over 1.2 lakh angioplasties being conducted annually and over a lakh bypass surgeries."Though using FFR will cost a patient an additional Rs.25,000, it would still be cheaper than paying for a not-soneeded angioplasty or bypass," said Dr. Seth who is training 200 interventional trainee cardiologists on FFR at Escorts on February 24. Experts say a recent large scale study on 2,000 patients in the US and Europe showed that one-third fewer stents wee used in the FFR group and the difference in outcomes at one year were significant: the FFR group showed a 28% lower incidence of major adverse cardiac events-18.3% vs 13.2%. Another benefit seen in the FFR group was procedural cost. Since less stents were used per patient, the average cost of the procedure was $700 lower.

    Medical Marvel 1.2 lakh angioplasties and over a lakh bypass surgeries are conducted annually The use of fractional flow reserve will cost a patient an additional Rs. 25,000 Study on 2,000 patients in the US, Europe reveals one-third fewer stents used in FFR group Experts say fractional flow reserve will prove to be a boon especially for patients suffering from multiple blockages of heart vessels. With the new technique, docs will be able to quantify the risk of a particular blockage and decide whether to conduct an angioplasty or bypass or simply treat it with drugs. Heart Surgery: Quicker, safer New Delhi: Repair and replacement of heart valves, that control the direction of blood flow and the opening and closing of which produce the sound of a heart beat, will soon be done without opening patient's chest. French cardiologist Dr. Alain Cribier from the University of Rouen Hospital has found a promising technique-Percutanceous Transcatheter Implantations of the Aortic Valve-that is far less invasive that the modern day option of an open heart surgery(OHS). Cribier's technique has demonstrated, with tremendous success on several patients in France and Germany that delivery and placement of heart valve through a catheter, inserted into a blood. Vessel in the groin and snaked up into the heart, is possible and would soon become the alternative to OHS for patients at extremely high risk. US FDA is undertaking feasibility trials of using the cribier technique by trying it on 50 patients in Germany and the US. Cribier is coming to Delhi do demonstrate the technique live to leading cardiac surgeons attending the Second Asian Interventional Cardiovascular Therapeutics(AICT) conference, starting on October1. The technique will be carried out at the Evanston Hospital in Chicago and transmitted live through satellite. AICT, that will bring together 200 of the world's top cardiologists, is being jointly organized by the Max Heart and Vascular Institute, the Society for Cardiovascular Angiography and Interventions (SCAI) and the Asia Pacific society of interventional Cardiology(APSIC) Speaking to TOI, programme chair Dr. Ashok Seth said, 'While traditional valve-replacement surgery requires OHS starting with a cut through the breast bone, stopping the heart and maintaining circulation with cardiopulmonary bypass, Cribier's procedure is done on beating heart without the use of a heart-lung machine. Value replacement with OHS takes over four hours while the Cribier method takes les that an hour. Clinical trials of this revolutionary technique will finish in six months. And if FDA approves it, which it will, we plan to bring it to India". The need for a less-invasive alternative is growing in India. About 5,000 Indians undergo open-heart surgery every year to replace the aortic valve. However, over 50,000 need it. Nearly six per 1,000 people suffer from a heart attack that is caused by a blockage in the valve and the artery. In an OHS, surgeons cut the breastbone, stop the heart, cut out the old valve and put in a new one. Even young patients undergoing the surgery spend a week in hospital and take over four months to recuperate. Several others in India are too ill to even survive the surgery and are, therefore, turned away. Cribier's technique will help these patients.

    NEW HEART VALVE WITHOUT SURGERY Doctors have found a technique to replace disease heart valves without opening the chest or even stopping the heart. Present day cure is an open-heart surgery. The new technique threads a catheter through an artery in the grin and places an artificial valve inside the damaged aortic valve. 1. A balloon catheter is inserted into the groin and delivered through the veins to the heart. 2. Guided by X-rays, doctors feed the catheter against blood flow until it enters the aorta. 3. Doctors speed the heart beat and quickly push the valve into old one. 2 heart attacks,2 strokes, 5 arterial blocks, but he's fine. Mumbai: When Mauritius-based Prem Singh Sookhary(59) was informed by local doctors that he had five arterial blockages, which they were unwilling to operate due to medical complications and high risk factor, he was devastated. It was as if the doctors had sounded a death knell. That is, until he landed up on the operating table of Dr. Ramakant Panda who has also operated on Prime Minister Manmohan Singh. Now, the harrowing months when Sookhary lived in the constant fear that he would die of cardiac failure are finally behind him, as the businessman prepares to leave Mumbai for his home country, with a heart that is as food as new. With a history of heart disease-Sookhary had suffered two cardiac arrests a year ago, and survived two brain strokes(heamorrhage) in a span of seven years-doctors in Mauritius were unwilling to operate on the five arterial blockage that recent tests had revealed."Most doctors could not guarantee his recovery or even his survival post surgery," said his wife, Banoomatee. " The doctors in Mauritius told us that chances of survival would be not more than 25% if they operated on him. They said there was a high possibility the patient could suffer another stroke if a bypasssurgery was performed on him. Smookhary and his wife were no ready to accept then verdict. Due to the blockage, his daily activities were affected. "He could not walk properly, always felt suffocated and there a feeling of heaviness in the chest," said Banoomattee. Things changed for the better, however, when Dr. Panda, the managing director at the Asian Heart Institute, informed the worried family that Sookhary's survival rate was definitely more than 25 percent. He performed a successful beating heart surgery on the patient. "Apart from the risk arising out of multiple blockages, the patient was also diabetic," said Panda, adding that patient’s arteries were also very thin. Off-pump or beating heart surgery can help minimize complications that usually come with temporarily stopping the heart. According to Dr. Panda, a beating heart surgery in such complicated cases meant swift recovery and better survival. "He had five blockages but that did not mean he could not survive, "he said.

    HYPERTENSION, VESION 2.0 Renovascular hypertension, a secondary form of blood pressure, also targets under-25-year-olds. Dr Shoaib Padaria takes you through the paces

    WHAT IT IS? Renovascular hypertension is a secondary form of high blood pressure caused by a narrowing of the renal artery. The kidneys receive blood supply by means of the renal arteries. Renal artery stenosis is responsible for very high blood pressure and deterioration of the kidney. To explain it in simple bodily terms, narrowing of the renal artery reduces the flow of blood to the kidney. In response, the kidney produces the protein; renin' which is released into the blood stream. Through a series of processes, rennin is converted into an enzyme that causes sodium salt retention. Your doctor would suspect renovascular hypertension if you are under 30 or over 55 and suddenly develop hypertension.

    TYPES Renal hypertension, the most common form of secondary hypertension, occurs in two forms: 1. Plague is deposited in the renal artery (Atherosclerotic renovascular hypertension) and narrows it , disrupting blood flow. This type is most often seen in men over the age of 45 and accounts for two-thirds of the cases of renovascular hypertension. In most patients, it affects both the kidneys. 2. In the second type of disorder (Fibromuscular dysplasia), cells from the artery wall overgrow and cause the narrowing of the artery channel. This occurs mainly in women under the age of 45 and is also the cause of hypertension in 10 percent of children with the disorder. In addition to the above two, narrowing of the renal artery can also be caused by compression from an injury or tumor, or by blood clots.

    RISK FACTORS This one doesn't sound too good for us Mumbaikars. Smoking, strees, obesity, a high-salt diet, exposure to heavy metals and an inherited sensitivity toward hypertension can all increase the chances of developing both primary and renovascular hypertension. The risk also depends upon your age, lifestyle, environment and genetics. USUAL SUSPECTS As mentioned, there are two age groups which are under threat. The young, between 15 to 25 years, are those in whom the renal arteries are narrowed due to a congenital problem or a disorder (such as medial hyperplasia.) If you fall in this category and have high blood pressure, consult your doctor now. The second group, that of people over 60, are those who have had no prior history of hypertension. But high blood pressure settles in due to cholesterol deposits in the renal arteries(much like the clogging of arteries of the heart. TREATMENT Diagnosis of renal artery stenosis is possible through Doppler sonography, which is a process which determines the speed and direction of a jet of blood flow over a heart valve. However, today balloon angioplasty and setting too is opted for, in the treatment of renal; artery stenosis. The procedure has been found fairly successful in not only decreasing the elevated blood pressure but also to prevent further damage to the patient's kidneys.

    CASE STUDY An 18-year-old college student recently complained of suffering from severe headaches and occasional blurring of vision. Her culprit was fibro muscular dysphasia (the second type of hypertension discussed above), the most common cause of renal artery narrowing. After examination, she was detected with renal hypertension but her kidney was functioning normally. On going through the renal artery Doppler, a severe stenosis of the mid-segment of the right renal artery was demonstrated. Later on, she underwent balloon angioplasty which yielded favorable results; i.e. immediate normalization of her blood pressure. In another case, a patient's blood pressure before starting the treatment was as high as about 200/120 mm Hg. But within a few minutes of finishing the renal angioplasty, though the patient complained of giddiness, we noticed the blood pressure to have fallen to about 100/70 mm Hg.

    WHAT SHOULD YOU DO THEN? Dramatic improvement in lowering blood pressure like the above case is only seen in a few patients, that too occasionally. In most other cases, the blood pressure would return o normal only over a period of a few weeks. It is therefore important for the doctor to decrease he blood pressure medications accordingly. Pay special attention to the daily blood pressure-regulating pills that you may be having, for missing some doses or overdose could create trouble. The scary part about this type of hypertension, especially for youngsters, is that, its symptoms are often absent or subtle. Once it is diagnosed, don't delay treatment since decreased blood supply to the kidney over a long period will eventually lead to kidney failure. The best way then, to avoid it (or for any blood-pressure-related disorder for that matter) is to watch your salt intake and exercise regularly.

    HEART DISEASE A NEW-AGE KILLER? ASK MUMMIES Orlando(Florida): You can't blame this one on MCDonald's Researchers have found signs of heart disease in 3,500-year-old mummies. "We think of it as being caused by modern risk factors,"such as fast food, smoking and a lack of exercise, but the findings show that these aren't the only reasons arteries clog, said Randall Thompson, a cardiologist at the Mid America Heart Institute in Kansas City. He and several other researchers used CT scans on 22 mummies kept in the Egyptian National Museum of Antiquities in Cairo. The subjects were from 1981 BC to 334 AD. Half were thought to be over 45 when they died, and average lifespan was under 50 back then. The main risk factors that contribute to arterial hardening today are fatty foods, lack of exercise and smoking. Sixteen mummies had heart and blood vessel tissue to analyze. Definite or probable hardening of the arteries was seen in nine. "We were struck by the similar appearance of vascular calcification in the mummies and our present-day patients,"said another researcher, Michael Miyamoto of the University of California at San Diego."Perhaps the development of atherosclerosis is a part of being human." One mummy had evidence of a possible heart attack but scientists don't know if it was fatal. Nor can they tell how much these people wighed-mummification dehydrates the body.Of those whose identities could be determined, all were of high social status, and many served in the court of the Pharaoh or as priests or priestesses. "Rich people ate meat, and they did salt meat, so maybe they had hypertension (high blood pressure), but that's speculation,"Thompson said. With modern diets,"we all sort of live in the Pharaoh's court', said another of the researchers, Samuel Wann of the Wisconsin Heart Hospital in Milwaukee. The oldest mummy with heart disease signs was Lady Rai, a nursemaid to Queen Ahmose Nefertari who died around 1530 BC-200 years before King Tutankhamun. Stent in neck can prevent strokes San Antinio: People at risk of a stroke because narrowed neck arteries can be safely treated with a less drastic option than the surgery done now, the largest study ever done on these treatments concludes. If Medicare agrees to cove it, hundreds of thousands of Americans a year might be able to have an artery opening procedure and a stent instead of surgery to remove built up plaque, doctors say. A stent is a wire-mesh tube that props the blood vessel open. Stents have long been used to fix heart arteries but are approved for use in the neck only for people too sick for surgery. The new study, in people too sick for surgery. The new le severe disease, suggests stents may find much wider use. "The sea of people" who could benefit" is gigantic". Said Dr. walter Koroshetz, deputy director of the national Institute of Neurological Disorders and stroke, the study's main sponsor. However, the treatments have different complications, and not all doctors are convinces stents are as safe. Three previous studies found they were not, including one published online on Thursday by the British journal The Lancet. The reason: Even though stents prevent strokes in the long run, the procedure itself can trigger a stroke if a bit of plaque travels to the brain. The new study revealed a trade-off; Strokes were a more frequent complication with stents, while heart attacks were more common after surgery. Doctors say which option a patient chooses may depend on their general health, what risks they are willing to accept and how badly they want to avoid surgery. "There may be advantages and disadvantages in different types of cases" for stents or surgery, said Dr. Barry Katzen, medical director at Baptist Cardiac & Vascular Institute in Miami, who had patients in the study. 'Like many areas of medicine patients will have a Choice." A new research says inserting a stent into clogged neck arteries is as effective and safe as surgeries at preventing strokes.

    Heart Failure in a metro: Too little action, too late Mumbai: The majority of heart failure patients across India troop to doctors for help long after the disease had advance to severe levels, according to a new nine-city study released on Sunday worse, the study found that just about 11% o those seriously-ill patients actually underwent seriously-ill patients actually underwent treatment because the costs associated were prohibitively high. Doctors feel that knowledge about heart problems and their symptoms in India is mainly restricted heart attacks, which is mainly restricted to heart attacks, Which is mainly caused by blockages in heart's arteries. The fatality associated with a fast-beating or a slowly-beating heat is not well known among Indians. "Over 60% of the heart-failure patients included in the study went to a doctor only after their heart's pumping function had reduced in the study went to a doctor only after their heart's pumping function had reduced by half," said Dr. Ajay Naik, an interventional cardiologists who presented the findings of the first-ever Panarrhythmia and Heart Failure Registry at a medical conference held in the city on Sunday. Life expectancy for a severe heart failure patient is between one and five years. Even Mumbai, the financial hub with comparatively better awareness and medical care, fared poorly.

    Killing Lack of Awareness Heart fails when its pumping action is poor. At times, poor pumping causes a build-up of fluid called congestion in the lungs and other body tissues. Accoding to the American Heart Association, people of 40 years of age and more have a 1 in 5 chance of developing congestive heart failure in their lifetime. NANOTECH TACKLES HEART DISEASES Scientist have created a nano device that can attach itself to infected arteries and release medication when required. The device may be safer alternative to heart stents… Researchers at MIT and Harvard Medical School have built nanoparticles that can cling to artery walls and slowly release medicine, an advance that potentially provides an alternative to drug-releasing stents for patients with cardiovascular disease. The particles, dubbed" nanoburrs" because they are coated with tiny protein fragments that allow them to stick to target proteins , can be designed to release their drug payload over several days. They are one of the first such targeted particles that can precisely home in on damaged vascular tissue, says Omid Farokhzad , associate professor at Harvard Medical School and an author of the paper appearing in the Proceedings o the National Academy of Sciences. Farkhzad and MIT institute Professor Robert Langer, also an author of the paper, have also developed nanoparticles that destroy tumours.

    The nanoburrs are targeted to a specific structure, known as the basement membrane, which lines the arterial walls and is only exposed when those walls are damaged. So the nanoburrs would be used to deliver drugs to treat atherosclerosis (a condition where the arteries get clogged) and other cardiovascular diseases. In the current study, the tam used paclitaxel, a drug that inhibits cell division and helps prevent the growth of scar tissue that can clog arteries.

    "This is a very exciting example of nanotechnology and cell targeting in action that I hope will have broad ramifications, "says Langer.

    COULD BE USED INSTEAD OF STENTS The researchers hope the particles could become a complementary approach that can be used with vascular stents, which are used for most cases of clogged and damaged arteries, or in lieu of stents areas not well suited to them, such as near a fork in the artery.

    The particles, which are spheres 60 nanometers in diameter, consist of three layers. The researchers can control of three layers. The researchers can control the timing of the drug's release and have achieved drug release over 12 days, in lab tests.

    In tests in rats, the researchers showed that the nanoburrs can be injected intravenously into the tail and still reach their intended target –damaged walls of the left artery. The burrs bound to the damaged walls at twice the rate of non-targeted nonoparticles. Because the particles can deliver drugs over a longer period of time, and can be injected intravenously, patients would not have to endure repeated and surgically invasive injections directly into the area that required treatment, says julliana Chan, a student and lead author of the paper.

    The team is testing the nanobourrs in rats over a two-week period to determine the most effective close for treating damaged vascular tissue. The particles may also prove useful in delivering drugs to tumours.

    "This technology could have broad applications across other important disease, including cancer and inflammatory disease in the heart", says Farohzad.

    Made in lab: New weapon against cholesterol

    Tiny Particles Mimic 'Good Carriers', Scoop up cholesterol Before They Grow Into Deadly Deposits Of Plaque

    The particles that ferry cholesterol through the blood-stream are popularly known as "bad" or "good": bad if they deposit cholesterol on vessel walls potentially clogging them; good if they carry the cholesterol on to the liver for excretion.

    Now scientists have created tiny particles in the laboratory that mimic those good carriers, scooping up the cholesterol before it can grow into dangerous deposits of plaque. The surfaces of these new particles are coated with fats and proteins so they can bind tightly with the sticky cholesterol to transport it through the bloodstream.

    The particles may someday be important in treating cardiovascular disease, said Andre Nel, Chief of the division of nanomedicine and director of the Center for Environmental Implications of Nanotechnology at the University of California, Los Angeles.

    "Researchers have endowed these artificial particles with the same properties as natural particles that circulate in the blood," called high-density lipoproteins, or HDL, he said. The artificial carriers can clean up sites where plaques can otherwise rupture, leading to strokes and heart attacks.

    The particles may be useful not only in cardiovascular therapy, but also in diagnosis. The researches have put god and other metal cores, at the center of the particles, Nel said, so that they show up well in medical imaging. Such imaging could be used, for example, to monitor plaques as they build up in blood vessels.

    At the Chicago campus of northwestern University artificial HDL nanoparticles have been designed by Shad Thaxton , an assistant professor in the urology department, and Chad Mirkin, a professor and director of the international Institute for Nanotechnology at the university's Evanston campus They have founded a company, AuraSense, to commercialize the technology.

    The Northwestern researches replaced the fatty core found in natural HDL with gold nanoparticles, Mirkin said. "The gold core serves as a scaffold for attaching molecules that are the same as those on the surface of naturally occurring HDL," he said. "We have demonstrated that our synthetic version of HDL binds cholesterol very tightly not only in the laboratory, but in animals. "

    At the Mount Sinai School of medicine in Manhattan, Willem Mulder, an assistant professor of radiology and gene and cell medicine, and his research group have developed HDL-like nanoparticles intended primarily for imaging and diagnosis. The particles have centers of gold or other materials, Mulder said, depending on the type of imaging to be used.

    The research may one day benefit people who develop deposits of atherosclerotic plaque, said Gregory Lanza, of the School of Medicine at Washington University in St. Louis.

    After bypass, home in 48 hours

    A Minimally Invasive Procedure Called LESS Patients Return To Normal Life in Two Months.

    Forty-six-year-old Kasturi Badra has taken early morning jogs to stay healthy. What is different about the Dombivli homemaker's regimen is that two months ago she underwent cardiac bypass surgery " My mother's back to her hectic schedule, even running every morning," says her son Jigar.

    While hear surgery patients would take it easy for eight weeks and keep off hectic work for another month thereafter, Kasturi has been able to thereafter, Kasturi has been able to mobilise herself quickly because of a little-known innovation in cardiac bypass surgery. Called the LESS n option, it involves cutting only a small portion of the breast bone. Thus automatically reducing recovery time.

    "A patients is ready to leave the hospital within 48 hours of the surgery," says Dr. Mahendra Singh, cardiac surgeons at Fortis Hospital in Vashi , who has pioneered the procedure in India . He recalls how a patient's wife surprised to here that her husband could go home to celebrate his birthday, which was just two days after the surgery.

    Dr. Singh calls LESS (Which stands for Low-End Sternum Split, in which only a two-three-inch cut is made on the sternum) the cosmetic bypass surgery. "Instead of the nine-inch cut of a traditional bypass, in which the entire sternum is cut open," says the surgeon, who has so far performed 75 operations using LESS.

    Cardiologists Sudhir Vaishnav at the Asian Heart Hospital in the Bandra Kurla Complex says that LESS is great technique to reduce the morbidity associated with heart surgery. "But only skilled surgeons can perform this surgery in which only a small hole is made. Accessing and dissecting the mammary artery for a graft is difficult in this method," he says.

    Another cardiologist who doesn't want to be named says it is not advisable to do a bypass surgery when a minimally invasive method of stenting can be used. "However, techniques such as LESS can ve used when the blockage is a difficult arch that is usually difficult for cardiologists to access with their catheter." He adds.

    MINIMALLY INVASIVE SURGERY WHEN LESS is more

    Normal heart surgery patients would rest for eight weeks and keep off hectic work for another month thereafter. Those who have Low-End Sternum Split(LESS) surgery, an innovative cardiac bypass procedure, can get back to normal life faster. Less involves cutting only a small part of the breast-bone instead of a traditional 9" cut. A patient can leave the hospital 48 hours after the surgery. Only skilled surgeons can do this surgery.

    The Stomach for innovation

    Kolhapur oncosurgeon Suraj Pawar has innovated on conventional surgery to remove a cancerous oesophagus, making it simpler. Generally the diseased part is removed and the stomach cut and sutured to double up as a food pipe. Doctors make an incision or four to five holes in the chest through which they operate.

    But the new technique requires only three holes in the chest, and cab be carried out with just one assistant as against the usual three or four. The patient suffers less pain and scarring than in conventional surgery. It remains to be seen whether the method gains wider acceptance in the medical community.

    NOTE worthy

    NOTES (Natural Office Transluminal Endoscopic Surgery) gives the patients the benefit of faster healing, little pain and no scars. Under this procedure, an endoscope is introduced through a natural body orifice such as the mouth, rectum or vagina to perform the procedure.

    1. Tiny instruments and cameras enter organ like stomach or liver

    2. Surgeons observe images captured inside the body.

    3. Tiny incision is made to access diseased part.

    4. Diseased part such as tumour or appendix is gathered in bag and drawn out.

    This surgery will leave no scars.

    Mumbai: After the popularity of minimally invasive surgery, here comes stitchless surgery-well, almost. Ask Laxmi Mane name changed) who underwent an abdominal surgery on Wednesday and wax mobile four hours later. "My mother didn't realise that she had undergone a procedure," said her son. Mane is happy that she has an unscarred abdomen.

    Across the city, doctors are using newer techniques to give patients the benefit of painless and scarless surgeries. While Mane was operated using the NOTES (Natural Orifice Transluminal Endoscopic Surgery) method by DR Roy Patankar at Joy Hospital, Chembur –the first time in western India---surgeons in Mumbai are increasingly using a single-port (one-hole incision) to operate.

    In NOTES, an endoscope is introduced through orifices such as the mouth, rectum or vagina. Mane (56) came to Joy Hospital with severe stomach pain. The liquid in her stomach had drained out thrice in six months, but no cause had been detected.

    "We decided to use NOTES and the latest endoscopic imaging techniques to detect abnormal cells," said Dr Patankar. He used a trans-vaginal approach to introduce a flexible endoscope into her stomach. A specially fitted monochromatic light lit up abnormal cells, making it easy to gather liquid from them. "Thus, after three biopsied that showed negative, we got a positive test for cancer," said the doctor. Mane had ovarian cancer that had spread to her stomach.

    Senior GI surgeon DR. Avinash Supe at KEM Hospital said NOTES is a demanding method. Another senior surgeon said it required proficiency in endoscopy and laparoscopy.

    20-Kg tumour removed from abdomen

    Mumbai: Removing a malignant tumour is hard enough. But when it weighs 20kg, it's a Herculean task. Yet that's what a team of doctors at Raheja Hospital, Mahim, did recently. The tumour was removed from a female patient's abdomen on November 9.

    Kolkata resident Saswati Sen (26) discovered just after the birth of her son in March that she had a malignant tumour. In six months, the cyst in her ovary grew big enough to push against her diaphragm, congest her lungs and make it difficult for her to breathe.

    "when she came to us, she weighed over 60kg. Other hospitals had tried chemotherapy to reduce the size of the tumour but in vain. A CT scan showed that the tumour filled her entire abdomen, leaving little space for her intestine," said Dr. Sanjay Sharma, consultant oncologist at the Asian Institute of Oncology, Raheja Hospital. He added that a week after the operation, Sen weighed just 46 kg.

    This was not Sen's first brush with cancer, more than 18 months ago, doctors in Kolkatta detected a tumour in one of her ovaries and removed it. But she developed a tumour in one of the other ovary. "The pain was so terrible that I couldn't eat, and I could barely walk a couple of steps," said Sen. The doctors had trouble sedating her, said anaesthetist Sanjay Upadhye.

    "We had to remove her uterus and part of her liver along with the tumour,' said Dr. Sharma.

    Heart trouble is striking early: Study

    Mumbai: Blame it on the high levels of stress, but there is no denying that city's women have a reason to worry about the state of their hearts.

    An all-India health survey shows that Mumbai's women have high levels of LDL or bad cholesterol that is considered a risk factor for heart disease. In fact, the age of 40 years had worri some levels of LDL.

    Medical archives have, down the ages, stressed that women get natural protection from heart diseases due to their hormonal monthly cycle. "Until A recently, it was observed that the incidence of heart disease among women in the child-bearing are was eight times than in men in the same age group. Their risk increased as soon as they reached 60 years, they were as much at risk as men their age," said leading cardiologist Dr A.B. Mehta.

    But this trend no longer holds true, added Dr. Mehta, who is the director of cardiology at Jaslok Hospital on Peddar Road. Heart diseases are now emerging in younger women.

    Consider the Saffolalife survey which measured the cholesterol levels of 8,000-plus Indians. It showed that over 40% of the women surveyed in Mumbai had LDL levels of over 130. Among Mumbai's women who are over 50 years of age, over 55% had skewed cholesterol levels. Over 30% women surveyed in Bangalore had LDL levels of over 130 after the age of 40.

    Says Dr. Mehta, "Nowadays, it is not uncommon to angina as muscular problem "If a man gets chest discomfort, he will immediately to the doctor, but this is not the case with women. And it is high time this changes," warns that Indian women should undergo regular health checks for heart disease as soon as they reach 45 years of age.

    The survey said over 40% of the women in Mumbai had LDL levels of over 130. Among Mumbai's women above 50, over 55% had skewed cholesterol levels. Over 30% women surveyed in Banglore had LDL levels of over 130 after the age of 40

    Cherry Pie could cut cholesterol and diabetes risk - and taste good too

    Aslice of cherry pie a day may help stave off heart disease, research has found. The fruit also lowers cholesterol levels and may reduce the risk of diabetes. The darker the cherry the better, as the health effect comes from the pigment responsible for their red colour. And sour cherries-used in pies, jams and juices- are more beneficial than the sweet dessert variety.

    The researcher team, from the University of Michigan in the US reached their results by adding powdered cheriest to the food of a group of rats. After three months, the rats had significantly lower cholesterol levels than another group who had stayed on their normal diet. The cherry rats also fared better when measured for levels of insulin and other factors linked to metaboloic syndrome a condition which often leads to heart disease or diabetes.

    Researcher Dr Steven Bolling said the benefits came from small amounts of cherries, just one per cent of the animals' diet. Dr. Boilling said the team now plans to start trials on humans. The key to the cherry's success is anthocyanins, natural compounds which help stop cholesterol clogging up arteries. Sour cherries are especially rich in anthocyanins. Studies have shown that cherries also offer hope for relieving the pain of arthritis and may help us get a good night's sleep by regulating our natural cycle.

    The fruit has been used in medicine for hundreds of years. Ground-up cherry stones were used to counteract the pain of chest conditions and stomach problems in the 15th and 16th centuries.Eating whole cherries was once thought to ward off kidney stones and herbalists brewed the stalks into a tea to treat bronchitis. Improved treatments have almost halved the death rate from severe heart attacks across the Western world, a major study showed yesterday.

    The research team, co-ordinated by Edinburgh University, analysed 44,372 patients admitted to 113 hospitals in 14 countries. For patients whose arteries were completely blocked the death rate had fallen from 8.4 to 4.5 per cent over six years.Deaths in patients with milder heart attacks fell by a smaller margin.

    The study, published in the Journal of the American Medical Association, also found that patients suffering from all forms of heart attack were now less likely to be hit by strokes or further attacks.

    Only 11% heart patient

    Mumbai: A multi-city study raises alarming concerns about the lack of awareness about heart failure and the high cost of treatment.

    Dr. Amit Vora, interventional cardiologist with Lilavati Hospital who conducted the Mumbai leg of the study, said, "It was a revealing study , said, " It was a revealing study because we found that even among the affluent persons, acceptance about arrhythmia(irregular heart beat) and heart failure was poor. Even delivery of treatment of adherence to treatment was poor".

    In other words, the number of patients who actually get a permanent pacemaker to stabilise their heart beat or CRT (cardiac resynchronisation therapy to correct the heart's conduction problems) on their doctor's advice is poor.

    A major cause for this, apart from the poor awareness, is the cost factor, conceded the study, which was sponsored by a multinational company. "treatment for arrhythmia and heart failure could range from Rs 40,000 to Rs 8 lakh," said Dr. Ajay Naik.

    Not surprisingly then, consider the study's analysis of 1,000 patients with regard to treatment. While 73 patients were advised a permanent pacemaker, only 19 actually got it. Among 97 other patients who were advised to undergo radio frequency ablation to electrically cure their heart's uneven rhythm, only 20 opted for it. Although 139 patients were advised to undergo a cardiac re-syn-chronisation therapy 9CRT), only five underwent the procedure which costs between Rs. 3 and 8 lakh. Similarly, of the 119 who were advised to get an implantable cardiover cefibrillator (to set right the heart's electrical impulses), only 3 got it.

    Women, who made up for one-third of the 2,200 patients studies, came in with more severe symptoms than men perhaps because of socioeconomic reasons.

    Incidentally, this is the first study to map the various types of heart failure problems among Indians."So far, we used western data. While India has generated some data, this pertains to heart attacks," said Dr. Vora. About 60% patients suffer from heart failure and another 15% with atrial defribillation."These conditions are considered the final frontiers in heart disease as they have high fatality associated with them." The other conditions are bradycardia(where heart beats slowly) and supraventricular tachycadia ( uneven beats in upper chambers.)

    "But less than1 11% of those advised treatment actually took treatment," said Dr. Naik. The reasons, he said, ranged from poor diagnosis by primary physicians or the patient's refusal to go to the next level of consultants. "At times, different views from various cardiologists themselves may confuse the patients. Finally, the costs are prohibitive at Rs. 40,000 to Rs. 8 lakh."

    HEART OF THE MATTER

    RISK FACTORS

    Previous heart attacks.

    Coronary artery disease

    Irregular heartbeat(arrhythmia)

    High blood pressure (hypertension)

    Heart valve disease (especially of the aortic and mitral valves)

    Cardiomyopathy (disease of the heart muscle)

    Congenital heart defects

    Alcohol and drug abuse.

    SYMPTOMS

    Trouble breathing or lying flat because of shortness of breath

    Patient feels tired, weak, and is unable to exercise or perform physical activities.

    Weight gain from excess fluid

    Chest pain

    Neck veins are swollen

    Skin is cold and Sweaty

    Pulse is fast or irregular

    Restlessness, confusion and low attention span.

    TREATMENT

    Medicines

    Angioplasty

    Intropic therapy in which drug is given through small catheter placed directly in an artery.

    Heart value repair or replacement

    Pacemaker insertion

    Correction of congenital heart defects.

    Coronary artery bypass surgery

    Mechanical assist device

    Heart transplantation.

    1.6m stroke cases a yr by 15

    Govt. To Release Norms To Manage Ailment Today.

    New Delhi: By 2015, India will report 1.6 million cases of stroke annually, at least one-third of whom will be disable. Stroke is a major cause for loss of life, limbs and speech in India, with the Indian Council of Medical Research estimating that in 2004 , there were 9.3 lakh cases of stroke and 6.4 lakh deaths due to stork in India, most of the people being less than 45 years old. Experts say that if deaths as well as disability are counted together, then India lost 63 lakh of disability-adjusted life years in 2004.

    WHO estimated life years by 2050, 80% stroke cases in the world would occur in low and middle income countries mainly India and China. This is the reason with India is now coming out with a national guideline for stroke management, which will be released by MoS for health Dinesh Trivedi and ICMR director-general Dr V M Kotoch at AIIMS on Friday.

    Prepared by Dr. kameshwar Prasad, director of AIIMS' clinical epidemiology unit, along with doctors from Nizam's institute of Medical sciences, command Hospital in Louknow and PGI Chandigarh, the guidelines cover the management of stroke from ones to chronic care and focus on patients with first stroke or recur strokes. Increasing life expectancy at birth, rising urbanisation, changing lifestyles and rising stress levels are bound to increase stroke cases.

    WHO IS AT RISK?

    Those with high blood pressure, diabetes, high blood fat are specially at risk, more than 16% of people above 20 years of age suffer from high BP, fifty percent of those with high BP are not even aware of fit. Of those with who are aware , only 50% take measures to control it, and of those who take these measures, only 50% are adequately controlled. "Thus, only 12.5% of patients with high BP are adequately controlled," said dr. Prasad of this AIIMS.

    Stem cell shots help patients recover: Study

    New Delhi: A single shot of 100 million bone marrow stem cells is helping server stroke patients return back to normal life. Given within a month of suffering the stroke that led to partial paralysis, 90% of patients who received the shot at All India institute of Medical Sciences during a p pilot study regained their ability to carry out simple day-to-day activities like taking a shower or changing clothes within the first six months.

    Neurologists from AIIMS along with doctors from PGI (Chandigarh), SGPGI(Lucknow), Armed Forces Medical Collage (Pune) and Army R &R Hospital (Delhi) have been conducting a collaborative trial since June 2006 see if stem cells taken from the patient's own hip bone helped repair the damage of a severe stroke after being injected back into the patient's antecubital vein (in the forearms, near the elbow).

    Though the study results of 120 subjects is expected by October, the initial analysis of 19 patients (38-75 years of age)-11 who received the stem cell shot and eight who did-not have thrown up some exciting results.

    Speaking to TOI, Dr. Kameshwar Prasad, Professor of neurology at AIMS, who will announce this finding at the National Congress of Indian Stroke Association on Friday, said around 90% of 11 patients who received the stem cell shot were able to carry out daily activities like walking, using the toilet, taking a bath, dressing and eating independently, within six months of the stroke. None of these patients could carry out such activate at the beginning of the study. In comparison, 75% of those who didn't receive stem cells could perform equally. Again, 50% of those who received stem cell therapy recovered from neurological deficiencies like weakness of one limb and inability to walk caused by the stroke and greatly reduced their handicap in comparison to 16% in the control group.

    As far as managing to carry out previous activities like playing golf, working in office and cooking were concerned, 45% of those who received the shot showed progress as against 12.5% of those who didn't receive stem cells. Dr. Prasad said, "We will complete out analysis by October on 120 patients and only then will we know stem cells' actual benefits on stroke patients. Till now, 52 patients are being analysed."

    1.6m stroke cases a yr by 2015
    Govt. To Release Norms To Manage Ailment Today.

    New Delhi: By 2015, India will report 1.6 million cases of stroke annually, at least one-third of whom will be disable. Stroke is a major cause for loss of life, limbs and speech in India, with the Indian Council of Medical Research estimating that in 2004 , there were 9.3 lakh cases of stroke and 6.4 lakh deaths due to stork in India, most of the people being less than 45 years old. Experts say that if deaths as well as disability are counted together, then India lost 63 lakh of disability-adjusted life years in 2004.

    WHO estimated life years by 2050, 80% stroke cases in the world would occur in low and middle income countries mainly India and China. This is the reason with India is now coming out with a national guideline for stroke management, which will be released by MoS for health Dinesh Trivedi and ICMR director-general Dr V M Kotoch at Aiims on Friday.

    Prepared by Dr. kameshwar Prasad, director of AIIMS' clinical epidemiology unit, along with doctors from Nizam's institute of Medical sciences, command Hospital in Louknow and PGI Chandigarh, the guidelines cover the management of stroke from ones to chronic care and focus on patients with first stroke or recur strokes. Increasing life expectancy at birth, rising urbanisation, changing lifestyles and rising stress levels are bound to increase stroke cases.

    WHO IS AT RISK?

    Those with high blood pressure, diabetes, high blood fat are specially at risk, more than 16% of people above 20 years of age suffer from high BP, fifty percent of those with high BP are not even aware of fit. Of those with who are aware , only 50% take measures to control it, and of those who take these measures, only 50% are adequately controlled. "Thus, only 12.5% of patients with high BP are adequately controlled," said dr. Prasad of this AIIMS.

    Stem cell shots help patients recover: Study

    New Delhi: A single shot of 100 million bone marrow stem cells is helping server stroke patients return back to normal life. Given within a month of suffering the stroke that led to partial paralysis, 90% of patients who received the shot at All India institute of Medical Sciences during a p pilot study regained their ability to carry out simple day-to-day activities like taking a shower or changing clothes within the first six months.

    Neurologists from AIIMS along with doctors from PGI (Chandigarh), SGPGI(Lucknow), Armed Forces Medical Collage (Pune) and Army R &R Hospital (Delhi) have been conducting a collaborative trial since June 2006 see if stem cells taken from the patient's own hip bone helped repair the damage of a severe stroke after being injected back into the patient’s antecubital vein (in the forearms, near the elbow).

    Though the study results of 120 subjects is expected by October, the initial analysis of 19 patients (38-75 years of age)-11 who received the stem cell shot and eight who did-not have thrown up some exciting results.

    Speaking to TOI, Dr. Kameshwar Prasad, Professor of neurology at AIMS, who will announce this finding at the National Congress of Indian Stroke Association on Friday, said around 90% of 11 patients who received the stem cell shot were able to carry out daily activities like walking, using the toilet, taking a bath, dressing and eating independently, within six months of the stroke. None of these patients could carry out such activate at the beginning of the study. In comparison, 75% of those who didn't receive stem cells could perform equally. Again, 50% of those who received stem cell therapy recovered from neurological deficiencies like weakness of one limb and inability to walk caused by the stroke and greatly reduced their handicap in comparison to 16% in the control group.

    As far as managing to carry out previous activities like playing golf, working in office and cooking were concerned, 45% of those who received the shot showed progress as against 12.5% of those who didn't receive stem cells. Dr. Prasad said, "We will complete out analysis by October on 120 patients and only then will we know stem cells' actual benefits on stroke patients. Till now, 52 patients are being analysed."

    Indians share US Prez's bad cholesterol, but at more risk

    The Bad & The Good

    Cholesterol cannot dissolve in blood. It has to be transported to and from the cells by carriers called lipoproteins. Low-density lipoprotein (LDL), high-density lipoprotein (HDL), along with triglycerides and Lp(a) cholesterol, make up the total cholesterol count, which can be determined through a blood test

    HDL(Good Cholesterol)

    Up to one-third of cholesterol is carried by HDL. Doctors says HDL carries cholesterol away from the arteries and back to the liver, where it's passed from the bodyl, so it's known as good cholesterol. But low levels of HDL(less than 40 mg/dL) can increase the risk of heart disease.

    LDL(Bad cholesterol)

    When too much LDL circulates in the blood, it builds up in the inner walls of the arteries. It forms plaque that narrows the arteries .It forms plaque that narrows the arteries and make them less flexible.If a clot blocks a narrowed artery, it can cause a heart attack.

    Cholesterol is a soft, fat like, waxy substance in the bloodstream and in all body cells. It is important as it's used to produce cell membrances, some hormones & helps some body functions. But too much cholesterol is a risk for coronary heart disease(leading to heart attack) and stroke (brain attack)

    TOTAL BLOOD CHOLESTEROL LEVELS

    DesirableLess Than 200 mg/dL

    Borderline or High Risk 200-239 mg/dL

    High Risk240 mg/dL and above

    High BP tops list of global killers

    Report Alarming As Over 10 Cr Indians Afflicted

    New Delhi: High blood pressure is the world's leading risk factor for mortality, being responsible for 13% of all deaths globally.

    It is followed by tobacco use (8.7%), high blood glucose(5.8%), physical inactivify (5.5%), obesity(4.8%) and high cholesterol(4.5%) which among them contribute to almost 30% of all deaths globally. According to the World Health Organisation's latest global health risks report, high BP, high Blood glucose, physical inactivity, childhood malnutrition and unavailability of clean water and sanitation are the top five global health risks.

    Addressing these five factors alone-that are respobsible for one-quarter of the 60 million deaths estimated to occur annually-can increase global life expectancy by nearly five years, WHO said. "More than a third of global child deaths can be attributed to a few nutritional risk factors such as low childhood weight, inadequate breastfeeding and zinc deficiency," said Colin Mathers, coordinator for mortality and burden of disease at WHO.

    Eight risk factors account for over 75% of cases of coronary heart disease, the leading cause of death worldwide. These are alcohol consumption, high blood glucose, tobacco use, high BP, high body mass index, high cholesterol, low fruit an dvegetable intake and physical activity. Most of these deaths occur in developing countries. The report said obesity caused more deaths than underweight globally.

    Unhealthy and unsafe environments caused one in four child deaths worldwide.WHO said that in low-income countries, easily remedied nutritional deficiencies prevented one in 38 newborns from reaching the age of five.

    According to experts in India, the WHO report should come as a warning signal, specially for India which has the world's largest number of people with high BP. Over 10 crore Indian adults presently suffer from high BP, the measure of the force of blood against the walls of the arteries. India also has the highest number of people with high blood glucose.

    So what is causing so many people in India to suffer from high BP? Dr. Ashok Seth, chairman and chief cardiologist of Escorts Heart Institute and Research Centre, said, "Lifestyle factors, such as physical inactivity, a salt-rich diet with fried and fatty foods, and alcohol and tobacco consumption are some of the main reasons behind this epidemic. BP should be under control at all ages."

    Chief of Max Hospital's interventional cardiology unit Dr.Deepak Natarajan said,"WHO recently pointed out that in 2007, seven million people died of heart attacks and an equal number due to stroke. The common risk factor between the two is high BP. What's worse, in India 50% people don't know they have high BP. Of the rest, 25% aren't even being treated for it. People should therefore come forward and always get their BP checked."

    'Miracle milkshake' toward off Alzheimer's ?

    It may sound utopain, but you may soon be able to keep Alzheimer's at bay by drinking a "Miracle milkshake" everyday, claim experts. A team is developing the memory-boosting strawberry shake containing a cocktail of brain nutrients found naturally in breast milk, which it claims would help stave off dementia including Alzheimer's disease. The memory boosting milkshake for Alzheimer's patients could be available within two years, leading British newspaper the Daily Mail reported. In fact, tests have showed that taken once a day with breakfast, the strawberry shake significantly improves short term memory in those in the early stages of the devastating Alzheimer's disease.

    High blood pressure toll to boom within 20 years

    Unhealthy lifestyle might bring a boom in high blood pressure, with the sufferers exceeding a billion within 20 years, a new study has found. One in four adults suffer from high blood pressure which increases the risk of heart disease, stroke and death. Lifestyle factors, such as physical inactivity, a salt-rich diet with high fatty foods, and alcohol and tabacco use could see the problem spreading from developed to developing economies, like India and China.

    According to The Lancet Medical Journal, the number of BP patients may rise to 1.56 billion by 2025, up from 972 million in 2000. Another editiorial has claimed that the rise in BP is due to poor observance of medication by patients."Many patients still believe that hypertension is a disease that can be cured, and stop or reduce medication when blood pressure levels fall. Physicians need to convey the message that hypertension is the first, and easily measurable, irreversible sign that many organs in the body are under attack," the editorial was quoted, as saying."Perhaps this message will make people think more carefully about the consequences of an unhealthy lifestyle and give preventative measures a real chance," it said.

    Currently, a person in the Western world has a greater than 90 percent lifetime risk of developing high blood pressure or hypertension. Dr.Isabel Lee, of The Strokes can be prevented by the control of high BP. "Every five minutes someone in the UK has a stroke-that's 150,000 every year. Yet, over 40 per cent of these strokes could be prevented by the control of high blood pressure. Whilst it is important to get your blood pressure measured regularly, it is equally important that people who are prescribed bllod pressure medication continue to take it even once their blood pressure is back under control," Lee Said."GPs need to ensure that patients are made fully aware of the importance of continuing with their blood pressure medication. People can also take additional steps to help improve their lifestyles and reduce their risk of high blood pressure by stopping smoking, having a healthy diet and exercising regularly," she said.

    New Op Could 'cure' high blood pressure in an hour

    Surgery Will Allow Sufferers To Come Off Medication Completely

    A new operation which could effectively cure high blood pressure has been developed by scientists, offering hope to hundreds of thousands of sufferers.

    In What is being hailed as the most exciting development in the field for 50 years, doctors can treat the condition with a simple procedure in under an hour, reported the Telegraph.

    The technique, which is relatively straightforward and cheap for the National Health Service, could reduce the risk of a major heart attack or stroke in such patients by half. The Daily Telegraph can disclose that the new procedure, which involves placing tiny burns on a nerve responsible for high blood pressure in some people, has been carried out in Britain for the first time.

    An estimated 15 million people in Britain suffer from high blood pressure. About one in 10 sufferers cannot control the condition with medication or cannot tolerate the drugs, leaving them at greater risk.

    Dr.Mel Lobo, a specialist in clinical hypertension at Barts and the London NHS Trust, said:"This is the most exciting development in hypertension since the advent of anti-hypertension since the advent of anti-hypertension since the advent of anti-hypertension medication 50 years ago. It is hard to forecast the limitations and it, could eventually be compared to medication."

    The new procedure, called renal sympathetic-nerve ablation, involves inserting a wire into a blood vessel close to the kidneys to burn through nerves which carry signals that stimulate high blood pressure.

    It disrupts signals from the brain telling the kidneys to keep blood pressure raised. Initial tests suggest it can be effective within three months.

    Anthony Henry, 68, a retired chef from Stratford in East London, became the first person in Britain to have the operation. Henry, who is diabetic and has already suffered a stroke and a deep vein thrombosis, was awake throughout the procedure and spoke to Professor Martin Rothman, the cardiologist who performed it.

    Henry's blood pressure has already come down, just two weeks after the operation and it is thought most patients will see an improvement within three months.

    Heart- Stopping facts about India's health

    By 2015, there will be 100% rise in deaths due to cardiac ailment: WHO

    Telling figures

    4 Indians die every minute due to heart ailments

    Out of every 7 people who die due to heart ailments, one is an Indian

    The number of people dying due to cardio vascular diseases is 167 lakh per year while

    HIV/AIDS causes 23 lakh deaths per year.

    Number of people with cardiovascular diseases is estimated to be 641 lakh in 2015 from 380 lakh cases in 2005.

    Heart ailments are the leading cause of deaths worldwide and India is the leading contributor to deaths due to heart ailments in the world with 24 lakh deaths reported per year

    Statistics

    Cardiovascular disease(CVD) is the most common cause of deaths in India.

    Approximately 16 lakh deaths occur in India every year due to CVD

    50% of heart patients in India are under 45 year of age.

    Studies in India have shown that heart attacks in India occur 10 Years earlier than in the west

    Age no bar

    Ten years ago, men who were detected with heart disease, were predominantly in their fifties and sixties. But today 30% to 40% of my patients are below 40, said a cardiologist

    Cardiologist speak

    One are of women's health which has perhpas generated the maximum amount of controversy and confusion is hormone replacement therapy. Untile recently, it was thought that this therapy consisting of estrogen and progestin in varying combinations and was protective for the heart. However, results from recent studies have contradicted these findings. The current scientific recommendations for hormone replacement say that hormone therapy should not be used to prevent heart disease.

    An unfortunate scenario is the affliction of younger population. More unfortunate is the stress that the family and the patient go through. Though there is a steady increase of coronary artery disease, it is the younger lot (30-45 years) which is being diagnosed with this alliment. Apart from mental agony, it is also a major financial burden as many in this age group have just started earning and are mostly uninsured.

    The incidents of youngsters going in for cardia consultations in the age group of 25-40 years are not uncommon anymore. And, many of them are from the BPOs and IT industry where the job is highly target-orinented. Women suffering from diabetes, hypertension, stress, obsity and who lead a poor lifestyle and smoke have an evelvated risk of developing blockages.

    Till five years back, any lady with normal menstrual cycle was completely ruled out of any cardiac anomaly. But that is changing rapidly now. Diabetes is largly behind rising heart attacks. In fact, girls having a strong family history of heart attacks should be more alert now.

    The Culture Of Scans, Where Healthy People Go For Check-Ups For Early Disease Warning , Is Catching On In India.

    THE FINDINGS

    India's per capita government health expenditure is one of the lowest in the world; it spends only Rs. 280. The same figure in the United States is more than Rs. 1 lakh.

    India lost Rs. 36,000 crore beacuse of heart diseases, stroke and diabetes in 2005; this could exceed Rs. 8,00,000.

    Over 80% of American companies that employ 50 or more people have a preventive healthcare programme for employees in some form or the other.

    Two-thirds of respondent firms in India have preventive health care as part of their corporate governance strategy. But less than on-third make provisions for comprehensive preventive health-care measures (like check-ups and lifestyle counselling) for employees.

    Employee-wellness programmes reduce health-plan costs(sick leave, disability pay and workers' compensation) by 25%

    82% of respondent firms agree that preventive health-care measures increase corporate productivity and profitability.

    PREVENTIVE HEALTH PACKAGE INCLUDES

    Physical Examination
    Eye Chcek-Up
    Urnine & Stool Routine Test
    Blood-Group & Rh Factor Identification
    Serum Calcium
    Cardiac Risk Profile
    ECG
    Complete Blood Count
    Erythrocyte Sedimentation Rate
    Stress Test
    Chest X-Ray
    Diabetes
    Kidney Profile
    Lipid Profile
    Liver-Function Test
    Hypertension Profile
    Cancer-Screening
    It may take from one to three hours and is generally recommended to those above 35 years.

    THE BIGGEST KILLERS

    Cardiovascular diseases and cancer have emerged as the biggest killers in India

    INDIA'S DISEASE PIE

    Diseases of the circulatory system; 27%

    Others: 13%

    Congenital anomalies: 1%

    Diseases of the genitourinary system (gential system and drinary system)3%

    Perinatal diseases (diseases occuring around the time of birth): 3%

    Diseases of the digestive system: 4%

    Infectious and parasitic diseases: 4%

    Diseases of the respiratory system: 7%

    External causes (like accidents and murders): 11%

    Ill-defined conditions: 11%

    Cancer: 17%

    CARDIAC CONDITIONS

    A united Nations report puts the number of coronary heart patients in India at 60 million; 30 percent of these patients are below 40.

    Cardiovascular diseases cause 2 million deaths in India every year.

    Indians will constitute 60 per cent of the world's coronary heart diseases patients by 2010, say World Health Organisation estimates.

    Cardiovascular disease cost the global economy Rs. 9,44,000 crore every year (in terms of loss of working days and cost of treatment).

    CANCER CAPITAL
    New Delhi has the world's highest incidence of gall bladder cancer.

    Pondicherry has the world's highest incidence of cancers of the tongue and mouth (taken together).

    Wardha has the world'shighest incidence of only cancers of the mouth.

    Kohima Has the world's highest incidence of nasopharyngeal cancer (cancers of the nasal tract and the pharynx taken together).

    Aizwal has the world's highest incidence of lower pharyngeal cancer (cancer of the lower pharynx).

    70 per cent of cancers in India are still detected very late and awareness in rural areas continues to be poor.

    THE URBAN-RURAL DIVIDE

    88% of urban areas have health-care facilities compared to only 25% of rural areas; again, 90% of the health-care facilities in rural areas are manned by only one practitioner.

    An average resident of a rural area has to travel 2 km to reach a health-post that has a paracetamol tablet, 6 km for a blood test and 20 km for hospital care.

    Only 20 % of India's hospital beds are in rural areas but they have 70% of the country's population.

    STROKE: SILENT KILLER IN A STRESSED CITY ACTION IN TIME AIDS RECOVERY

    CEREBRAL CONCERNS

    What Is A Stroke?

    A stroke is a medical emergency that occurs when blood flow to the brain stops. Within minutes, brain cells begin to die.

    The Warning Signs

    Headche, especially if the stroke is due to bleeding in the brain. It starts suddenly and may be severe

    Muscle weakness in the face, arm, or leg

    Numbness or tingling on one side of the body

    Trouble speaking or understanding others peaking

    Problems with eyesight, including decreased vision, double vision, or total loss of vision

    Sensation changes that affect touch and ability to feel pain, pressure, different temperatures, or other stimuli

    Changes in hearing or alertness (including sleepiness, unconsciousness, coma), personality or emotional changes

    Confusion or loss of memory

    Difficulty in swallowing, writing or reading

    Loss of coordination and balance

    Clumsiness, trouble walking

    Dizziness or abnormal sensation of movement (Vertigo)

    Lack of control over the bladder or bowels

    PREVENTION

    Do not drink more than 1 to 2 alcoholic drinks a day

    Exercise regularly: 30 minutes a day if not overweight; 60-90 minutes a day if overweight

    Get blood pressure checked every 1-2 years, especially if high blood pressure runs in the family

    Quit smoking and avoid fatty foods

    Check cholesterol (and LDL "bad" cholesterol measure should be 70 mg/dL)

    Support Groups

    There are about 3,000 stroke support groups in United States but only one support group in India. 3,000 people die of a stroke in the city every month

    HOW TO IDENTIFY STROKE

    Look for these simple signs to identify a stroke early so that appropriate treatment can be started

    Face: Ask the person to smile. Does one side of the face droop?

    Arms: Ask the person to raise both arms. Does one arm drift downwards?

    Speech: Ask the person to repeat a smiple sentence. Are the words slurred? Is the person able to repeat the sentence correctly?

    If a person shows any one or more of these symptoms, he should be rushed to the hospital immediately

    THE 2 TYPES

    The more common kind, called Ischmic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain. It accounts for 80% of the cases.

    Haemorhagic stroke is caused by a blood vessel that breaks and bleeds into the brain. Ministrokes' or transient ischemic attacks (TIAs) occur when the blood supply to the brain is briefly interrupted. It accounts for 20% of cases.

    CAUSES:

    Common causes of ischemic stroke are

    Atherosclerosis

    High blood pressure

    Alterial dissection

    Heart attacks

    Heart rhythm disturbances

    Risk Factors:

    High blood pressure

    Diabetes

    Family history of stroke

    Heart disease

    High cholesterol

    Increasing age

    Sedentary lifestyle

    Certain medications like birth control pills, increase chances of blood clots & therefore a stroke

    TREATMENT

    Patients of an acute ischemic stroke should take a Tissue Plasminogen Activator within 3- 6 hours of onset of the symtoms. It helps dissolve the clot.

    Surgical treatment is the best option for patients who suffer a haemorrhagic stroke

    HEARTY MYTHS

    FEMALE SEX

    LESS COMMON & PROTECTED

    This is true only till menopause. After that, that is beyond 70 years of age women qual men. If there are risk factors, then we see heart disease at a younger age.

    LESS DANGEROUS

    In fact, heart disease is more dangerous and the fatality rate is higher in women.

    DON'T NEED AGGRESSIVE TREATMENT

    Unfortunately, women don't go for check-ups, and less number of procedures are done in women. In fact, as the disease is more aggressive, they require an equally intensive approach.

    AGE/RACE

    DISEASE OF THE ELDERLY

    This is no longer so. Heart disease is routinely making tis appearance in the age group between 30 and 40.

    DISEASE OF THE RICH

    Not true again, as rural lifestyle is catching up with the rural-urban prevalence narrowing down.

    MENTAL STRESS

    STRESSFUL ACTIVITY IS HARMFUL FOR THE HEART

    On the contrary, stress can be stimulating. Hard work, a person relishes, never kills anyone.

    HYPERTENSION (High BP)

    SILENT

    Unfortunately, High BP has no symptoms, and headache is mostly coincidental. However, if the BP fluctuates violently, then the patient may have a headache or vomiting, but it may be too late. Most often, it is routinely detected during medical check-ups. It affects almost 30 per cent of the adult population.

    NO CURE

    There is no permanent cure for BP, and lifelong treatment is required. No system of medicine can remove BP from its root cause.

    SIDE EFFECT

    Most of the BP medications are safe, and only have a nuisance value side effect. The real danger is because of uncontrolled high BP and not the medications.

    DIABETES

    NO CURE

    Like BP, diabetes also has no cure at present


    PERCEIVED SIDE EFFECT OF TREATMENT

    Patients resort to alternative medications. Like BP, there is no form of medication, which can provide a permanent cure.

    CHOLESTEROL

    I AM THIN

    Weight has nothing to do with cholesterol. Diet and production by the liver decide the level of cholesterol in your blood. Even if you take only boiled food, the liver will produce cholesterol, as the body requires it. When in excess, it is deposited in the arteries at an accelerated pace and results in blocks.

    TREATMENT

    Consists of diet and medications to be continued in the long run. The important medication for this is Statin. While on Statin, liver tests are to be done every three months. Majority of the patients can continue Statin without any side effects on the liver for a lifetime.

    SMOKING & TOBACCO

    I DON'T INHALE FUMES

    Absorption takes place from the mouth. Also, the tip of the cigarette has a high temperature, which has a harmful effect.

    I SPIT IT OUT

    Tobacco gets absorbed from the mouth. Even local effect results in chronic irritation and mouth cancers.

    I DO STRENUOUS WORK

    Common excuse for not kicking the habit.

    I CAN'T MAKE DECISIONS

    This is like whipping a tired horse, and results in poor output

    I DON'T PASS MOTION

    Passing motion is a conditioned habit. With proper training a person can pass motion without use of tabacco

    I GET GAS

    A part of the inhaled smoke goes to the stomach. As smoke cannot be absorbed, it is released either as burp or as wind. It also irritates the stomach and results in hyperacidity

    PANACEA/ SYMPTOMS

    GAS

    Often, patient mistake gas for a heart attack. Any exertional symptom, which subsides with rest, is due to the heart.

    SUDDEN ONSET

    A heart attack comes without warning. This is because a non-critical block suddenly bursts causing sudden cessation of blood flow due to a blood clot.

    NORMAL ECG

    The ECG is the diagnostic tool, but a normal ECG does not rule out heart attack. Additional blood tests and an echocardiogram are also done.

    DRUGS

    ALLOPATHIC DRUGS HAVE SIDE EFFECTS

    Most medicines are tested rigorously. Medications produced are pure and produced in clean environment.

    Traditional medications may not be produced in the same kind of controlled environment , and there are reports of heavy metal poisoning with some of the preparations given by unualified practitioners claiming to offer miraculous cures.

    COSTLY DRUGS HAVE SIDE EFFECTS

    Yes, money spent in research has to be recovered, and hence will cost more. However, the side effect profile of allopathic medications will not be different from placebe(sugar-coated capsule).

    HABIT FORMING

    It is disturbing when patients do not take the emergency tablet sorbitrate for fear of getting habituated to it. It is better to get relief and not have a heart attack, than worry about addictions.

    PAINFUL

    The only pain is of the local anaesthesia injection. Thereafter, the entire procedure is painless.

    ANGIOGRAPHY MEANS SPOT ANGIOPLASTY

    Angiography and plasty is the same. The bookings are done so that after the angiogram, with consent, plasty is done back to back. When an angiogram is suggested for significant symptoms, it means there is likely to be a critical block. In such a case, it is important to choose your doctor and trust his judgment.

    ANGIOGRAPHY MEANS BYPASS

    About 50 per cent of the patients, undergoing angiogram, have critical blocks in their major arteries requiring surgery

    BYPASS SURGERY

    BYPASS IS RISKY

    Today, it is a safte procedure, and carries a risk of less than a percent in good hands.

    BYPASS IS COMPLEX

    It is a spuramjor surgery, and can be performed on the elderly without incremental risk

    BYPASS THE BYPASS

    Hype has been created that arterial clearance therapy can dissolve the blocks. The treatment of chelation therapy is NOT recommended by the Amercian College of Cardiology Guidelines for treating patients with heart diseas.

    WHAT CAN YOU DO TO WARD OFF CARDIAC DISEASES, TB, HIV/AIDS, RENAL FAILURE AND CANCER? TOI SPEAKS TO DOCTORS

    5 ALIMENTS THAT ARE KILLING MUMBAI

    KILLER NO 1: HEART ATTACK

    TOLL between 2004 and 2006 in Mumbai's hospitals: 37,193

    It is an established medical fact that Indians are genetically more prone to heart diseases. What is worrying doctors is that Indians-especially those in urban hubs like Mumbai- are getting it at a younger age. It is also presumed that a worringly high 9 percent to 11 per cent of persons above the age of 45 in urban India have heart disease.

    DOCTOR SPEAK

    a vast majority of patients who get admitted to the intensive care units of hospitals with acute heart attacks are totally asymptomatic. Most of them say they were healthy till the day before their heart attack. Some even mention that they have competed in a marathon or two or climbed 10 glights of stairs without gasping for breath. Yet, suddenly, they collapse.

    It is now known that if a person has over 70 per cent obstruction of blood flow, then s/he will experience pain or symptoms.

    But, in these patients, there is a sudden rupture of this plaque (the obstruction) that leads to a clot formation and the obstruction becomes 100 per cent, leading to a sudden heart attack. There is no way to detect such obstruction on a mass-screening basis as the tests are invasive and expensive. But what Mumbaikars can do is undergo a health check-up once every year after they are 35.

    People who have at least two risk factors for heart diseases (among smoking, hypertention, diabetes) should be more vigilant.

    KILLER NO 2: TUBERCULOSIS

    TOLL between 2004 and 2006 in Mumbai's hospitals: 26,951

    It is estimated that 2 million cases of tuberculosis are reported in India every year. India also accounts for around 30 per cent of the world's cases. What has been worrying Mumbai's doctors is the changing form of the disease: tuberculosis of various organs(like bone and spine) has increased phenonomenally in the last few years. There also is evidence that Mumbai is home to many patients with MDR (multi drug-resistant) and XDR ( extremely drug-resistant) forms of tuberculosis.

    DOCTORSPEAK

    India has the maximum number of patients suffering from tuberculosis and so it does not exactly come as a surprise that it is a leading killer in the city as well.

    Besides, with so much filth in the city and because of the fact that two thirds of Mumbaikars stay in slums thirds of Mumbaikars stay in slums and a huge number travels by crowded trains, it is even less surprising that tuberculosis is so rampant in Mumbai.

    When a tuberculosis patient coughs, s/he release over 300 million bacilli in one go. People around inhale the germs, becoming susceptible to the disease. Air pollution is going up. The concentriction work is on; all these are good mediums for the tuberculosis germs to spread. It is not surprising that the, too, rich are no longer immune to it. It is time people stopped depending on the administration and took it upon themselves to clean up their surroundings.

    KILLER NO 3: CANCER

    Toll between 2004 and 2006 in Mumbai's hospitals: 18,107

    Cancer cases in India are likely to go up by 50 per cent by 2020, say studies. Mumbai, with its stress-ridden lifestyle, dietary changes and substance abuse (tobacco) is not going to fare any differently.

    DOCTORSPEAK

    Cancer is the second leading cause of death across the world. If it is among the top five killers in Mumbai then it is a reflection of our rapidly urbanising society. Cancers are also related to lifestyle reasons.

    It is now a well-know medical fact that factors like smoking, poor dietary habits and obesity increase the probability of the disease.

    There are two important lessons for Mumbaikars; first, Mumbaikars should look at preventive steps like lifestyle changes (cutting down smoking) that can reduce the chances of getting cancer by 25 per cent; second, mass screening programmes are not the answer to beat cancer.

    We need to focus on cancer awareness. If people can recognise the symptoms, then they have a better chance at treatment and life.

    When a Hollywood actor spoke about undergoing a colonoscopy on TV, it resulted in massive awaraness about colon cancer. As a result, over the years, the US has registered a drop in number of colon cancer cases.

    KILLER NO 4: KIDNEY FAILURE

    Toll between 2004 and 2006 in Mumbai's hospitals: 6,533

    Kidneys have become synonymous with rackets but the disease is among the fastest-growing ones in the country. India is the diabetes capital of the world and the incidence of kidney diseases is also likely to rise. It is estimated that 150-200 in every 10 lakh suffer from end-stage renal disease.

    DOCTOR SPEAK

    There is an incresing trend of lifestyle diseases like blod pressure and diabetes.Kidney failure is an effect of these diseases. As there are more cases of diabetes and hypertension, there is a higher incidence of Kidney failure.

    Moreover, there is not a single item that is not adulterated. Be it water, milk, fruits or masalas, everything has a percentage of adulteration. Some of these materials are metallic and pisonous.

    As all of these elements pass through the kidney(which is an organ that removes toxicity in blood), there is bound to be an effect on the organ. What can people do to stay healthy? They should not become obese and should eat good food and drink enough water.

    KILLER NO 5: HIV/AIDS

    Toll between 2004 and 2006 in Mumbai's hospitals3,826

    It is often said that Mumbai exports HIV/AIDS to the rest of the country. The migrant labourer is supposed to be the most vulnerable to this sexually transmitted disease, which cripples the immune system. In Mumbai, the incidence of the disease is low (less than 1 per cent) in the general population but it is a whooping 42 per cent among commercial sex workers.

    DOCTOSPEAK

    Since Mumbai has 74 HIV/AIDS-testing centres, people who have indulged in high-risk behaviour can walk in any time for a test. Even if a person tests positive for the virus, he or she can avail of free medicines and free treatment for opportunistic ailments for up to Rs. 3 lakh.

    There are two things that people can do to prevent the spead of this disease: first, adopt means to prevent the disease (use a condom, for instance); second, don't take medicines from quacks who promise a cure. It must be remembered that HIV/AIDS was the number on killer a decade back.

    But, due to awareness, it became the number 10 killer (nationally) last year.

    THE WORST TO THESE 10 DISEASES HAVE BEEN RESPONSIBLE FOR THE MAXIMUM NUMBER OF DEATHS IN BMC AND STATE-RUN HOPSITALS IN MUMBAI BETWEEN 2006-2008

    Disease Deaths PeopleAdmitted
    Heart Attack 2,230 21,831
    Tuberculosis 2,133 25,109
    HIV/AIDS 1,411   9,616
    Renal Failure    881 10,208
    cancer    534   6,282
    Malaria    447 22,962
    Jaundice    158   2,545
    Viral Fever     49 55,045
    Typhoid     11   1,896
    Cholera      3     160
    Young Population suffers HEART ACHE

    According to the World Health Organisation (WHO) around two million people in India die of cardiovascular diseases annually, 32 per cent of these deaths are in the age group of 35-44 years. On the even of World Health Day on Sunday, medical experts across the country are alarmed at the younger generation falling prey to heart ailments. However, there seems to be a consensus that early detection and preventive diagnosis can bring down the number of people suffering from heart ailments considerably.

    Besides, early diagnosis can also save India from incurring economic losses due to loss of crucial man hours. India lost a whooping $9 billion in 2005 due to cardiac disease, cancer and diabetes. The WHO estimates that the figure will further rise to $237 billion by 2015. Figures also suggest that every Indian household spends about Rs. 11,000 in at least one episode of heart disease per year.

    Also, a recent study presented by the Indian Council for Research on International Economic Relations (ICRIER) has pointed out that 74 per cent of overall health expenditure by a family is on curative care. "Even if we can shift 10 per cent of that expenditure to preventive care it will help the economy immensely," said Ali Mehdi, one of the researchers from ICRIER. The study also said that two-third of India's population is between the age group of 15-59 years. Given that our government spends only 1 per cent of its GDP on health care, it is more logical for people to go for preventive rather than curative care, added Mehdi. Currently, an average Indian household spends about 80 per cent of their income on curative care and the figure is as high as 29 percent at the union level.

    Talking about newer techniques, Prof Roxy Senior, research cardiologist at the Birmingham University suggested that 'carotid ultrasound' will soon be the need of the hour. It is a non-invasive procedure where in a diagnosis of the carotid artery (supplies oxygenated blood to neck an dhead) can indicate whether there is a thickening of the coronary artery. Senior also warned that India is vulnerable to a major heart endemic given that an estimated 60 million people are undiagnosed heart patients."Using ultrasound imaging of the carotid artery in the neck helps to predict heart attack sound is a painless and non-invasive test that uses high frequency sound waves to create images of the two arteries in the neck. "But the most important part is that immediate treatment following the carotid ultrasound might save ailments." Doctors blame it on sedentary lifestyle, lack of physical activities and smoking for the swelling number of heart patients. "This can be overpowered by physical activities and balanced diet,' said cardiologist Dr.K.Kasliwal of Apollow hospitals , Delhi.

    Four Indians die of a heart ailment every minute. Cardiologists predict that India will soon be the heart attack capital of the world. A special report by sumitra Deb Roy & Deepa Suryanarayan on the eve of World Heart Day.

    Pulse of the matter

    Heart ailments are the leading cause of deaths worldwide.

    One in every seven persons who die of heart ailments in the world is an Indian.

    India has the highest number of deaths due to cardiovascular diseases with 24 lakh deaths reported per year.

    Four Indians die due to heart ailments every minute.

    The number of deaths due to cardiovascular disease is 167 lakh per year, as against 23 lakh deaths per year caused by HIV/AIDS in India.

    The number of people with cardiovascular diseases in India is estimated to rise to 641 lakh in 2015 from 380 lakh in 2005.

    62 per cent of the population in India is overweight and prone to cardiovascular diseases

    The number of hypertensive people in India was 118.2 million in 2000. The figure is expected to rise to 213.5 million.

    The biggest risk factors leading to cardiovascular disease are obesity, smoking, diabetes and high blood pressure.

    " Indians are 12 to 14 per cent more likely to succumb to a heart attack than people abroad. We must also remember that Indians, particularly Gujaratis, have the highest incidence of heart disease in the world."

    "I have been noticing more young patients developing heart disease. Around 5 to 10 per cent of my patients are below 40 years old. Ten years ago it was not even two per cent. Similarly, every month we operate two to three patients who are below 30, whereas ten years ago, I used to get just one patient of that age in a year. What is alarming is that according to the latest data, even the rural population is fast catching up with the urban population."

    "If the population does not take preventive measures right now, cardio vascular disease will reach epidemic porportion in the coming years. The death rate due to heart disease has doubled in both Mumbai and Pune in the past 20 years. In terms of treatment, bio-degradble stents will be used more, which will simplify surgery even further. We now have minimally invasive surgery and beating heart, surgery, and trains catheter valve replacement, the later being a turly revolutionary technique in interventional cardiology."

    World class healthcare

    The name that comes to one's mind when one thinks of good hospitals in Bangalore is none other than that of Mallya Hospital. It is a great boon to the people of Karnataka and the neighboring states that this hospital has grown over the years with substantial increase in bed strength, infrastructure and an assurance of quality patient care with a human touch using state-of-the art technology. The multidisciplinary approach to diagnosis and care is designed to have a continuum of sage and high-quality care, which has even drawn overseas patients.

    With the launch of the latest version of 64 slice Cardiac CT, Mallya Hospital is on par with World standards in Diagnostic Cardiology. "Much focus is on Preventive Cardiology these days and we are practicing the same here," says Mr. D.K. Audikesavulu, Lok Sabha MP and the managing director of Mallya Hopsital.

    64-slice cardiac CT is a novel procedure to detect coronary artery blocks. Non-invasively. Based on clinical symptoms, cardiologists can now use this diagnostic procedure in the early detection of coronary artery blocks in a few seconds.

    The major advantage of the cardiac CT scan is that it can be performed on out patients. People who are over 40 , diabetic, hyper tense, obese, smokers and those with other precipitating factors can opt for a cardiac evaluation.

    "The number of cardiac patients who visit out hospital is a witness to the level of awareness among the public with regard to the use of Cardiac CT in diagnosing heart ailments well within the safety Zone of life," commends commodore indru Wadhwani, president, Mallya Hospital.

    The location of the hospital, accessibility from any part of the City and the availability of cardiologists along with a dedicated team of technical staff round-the-clock plays a major role in the management of heart ailments. With regard to Mallya hospital this has become more meaningful. "We are getting quite a number of my cordial infarction ( heart attck) cases and are able to deliver very good results, as the delay in transit is minimal due to the central location of the hospital, coupled with round –the –clock experts 'availability.

    The modern Catheterization Laboratory and the team are able to perform Primary Angioplasty with-in-the first six hours of attack, which gives excellent results, "Say Dr. V.K Srinivas, Interventional cardiologist

    Heart operations have evolved over the years and are now accepted as the mainstay of corrective procedure for some of the heart ailments, especially in by-pass surgeries. NO doubt that a certain patients need only heart surgeries for their lives.

    "Repair the engine without stopping! That is without stopping! That is what we do here in cardiac Surgery," explains Dr. Divakar Bhat, chief Cardiothoracic Surgeon, as he narrates the achievements and advancements made in 'Beating Heart Surgery or Off-pump Surgery'.

    Unlike the conventionally heart surgery, this technique ensures 99% success rate and patient recovery is faster. The good news is that now the cardiac surgery package comes at an unbelievable package of Rs. 90, 000, the lowest among the city corporate hospitals. Heart surgeries related to hole-in-the-heart, correction of congenital cardiac disorder and a host of pediatric and adult surgeries are performed here.

    In a nutshell, the Dept. of cardiothoracic surgery has, over the years, ensured healing years, ensured a healing touch fir ailing hearts.

    Are you next in line?

    HEALTH Did you know that 200 out of 100,000 people above the age of 20 are affected with every day in India?

    Watch Raju as he struggles to pick up a tablet that has fallen on the floor. Every instinct in me is screaming, 'help him, help him,' bit I restrain myself. The doctors have said he is to do everything himself. Seven and a half minutes later he succeeds in picking it up," says his wife.

    Raju is a retired Indian Air forces pilot. All his life, physical fitness has been top priority. Even a slight fluctuation in his BP could mean being grounded-every pilot's nightmare. Raju never let that happen. His BP has always been normal, as has his cholesterol. He has no diabetes and his heart is sturdy. But one night, after work, he just slumped to the ground he had stroke. He is 48.

    Catching them young.

    Wasn't it only 60-plus people who suffered strokes? Not anymore. Now, almost everyone knows of someone in their family or circle of friends who has had a stroke. It is getting them younger and younger.

    Why? M.B. Pranesh, Head of Department, Neurology, PSG Hospitals, says it is because of bad life style. "Obesity, inadequate sleep alcohol, smoking, a sedentary life-style and a bad diet combined with lack of physical activity can lead to stress. And someone who has one, or all, or a combination of these factors is ripe for a stroke, " he says.

    Shirish M. Hastak, Neurologist at Lilavati Hospital, Mumbai, echoes Pranesh's words.

    "Urbanisation of society is responsible for vascular disease and the brain and the heart are the most vulnerable. Adopting a western lifestyle has further increased the incidence of strokes," he says.

    How does one prevent stokes? "A satvik lifestyle is the answer? Says Dr. Pranesh.

    "Look at yoga guru B.K.S. Iyengar. He is 80-plus and his mind has complete control over his body. Of course, everyone can't be like him, but we certainly can aspire top do so. It is important to control one’s emotions. Moderate them and taper them down," he advises. .

    According to both doctors strokes don't just happen.

    Hypertension is one of the leading causes.

    "It is necessary to keep a check on one's blood pressure, sugar and cholesterol," says Dr. Pranesh and adds that those with a history of strokes in the family should be extra alert .

    In fact, dr. Hastak says monitoring of blood pressure and hypertension should he done from a much younger age. "Children of hypertensive parents sometimes have a higher blood pressure. So they should watch out."

    Are there any tests that might tell where or not a person is likely to get a stroke?

    "Unfortunately, no such test has yet been devised for the brain yet," says dr. Hastak.

    "Unlike the heart, for which there are tests that monitor heartbeats when the person is at rest and after a treadmill test, the brain needs a constant supply of oxygen whether the person is at rest or in action, "he says. According to Dr. Pranesh , "As a routine, there is no test. But, If the doctor suspects a potential stroke, he recommends a Doppler test that evaluates blood flow through an artery. However, it is an expensive test and not something one does as a matter of routine," he says.

    Lifestyle makeover.

    And, Dr Pranesh points out that drugs and tests are no substitute to lifestyle change.

    "A recovering stroke-victim can and should get back to work. He only needs to pace himself better. If he has been working 12-14 hours a day, he should cut that down half. He should ensure long walks, adequate sleep and a healthy diet. He should be more aware of himself," advises dr. Pranesh.

    Both doctors agree that awareness is the key to preventing strokes.

    "Create more stroke support groups," says Dr. Hastak.

    A stoke support group is currently functioning at the Lilavati Hospital.

    "It is free and helps people understand strokes better. It teaches them to recognize, prevent, treat and rehabilitate patients, "he says.


    Another stroke support group is in the process of being set up at Delhi) .

    When something stops the normal blood flow to the brain., the flow of oxygen to the brain cells stop and the cells die. Then, tow kinds of strokes happen.

    Ischemic strokes When a blood clot blocks the blood vessels, stopping flow of blood to the brain. Or, when arteries become narrow and get clogged with plaque (cholesterol and othr fatty stuff that stick to the walls of blood vessels).

    Hemorrhagic stroke When a blood vessel bursts and floods the brain with blood.

    In India,200 out of 100,000 people above the age of 20 are afflicted with strokes every day.

    Men Vs Women

    If women are not piled with enough liquids after childbirth they ate prone to severe de-hydration that could lead to the possibility of strokes.

    Men are more prone to strokes than women. But post-menopause, women are as susceptible as men.

    Immediate symptoms

    Weakness in one side of the body

    Difficulty in speech

    Double vision

    Facial weakness

    vertigo

    Headache

    Eat healthy, live better

    Naini Setalvad cooks up an ideal diet plan to prevent the progression of heart disease.

    DAY BREAKFAST

    MID MORN

    ING

    LUNCH MID EVENING DINNER
    >Monday Organic oats porridge with ¼  cup soya milk, sweetened with 1 tsp. organic honey with one crushed walnut Apple

    Carrot salad+vegetable

    Made  of green french beans +jowar roti + 1 bowl pulse
    Carrot  juice + 50 g almonds and walnuts.

    Clod tomato soup  + whole grain bread +

    tofu

    Dal + Stuffed
    Tuesday Organic  whole grain bread with veggies plain or grilled plus 2 tsp soya dip  pear Lettuce tomato salad+steamed veggies+grilled fish +brown rice

    Lettuce tomato salad+steamed

    Veggies+grilled fish +brown

    rice

    palak  soup +

    vegetable +mix vegetable pulao with massor dal

    Wednesday Organic upma with lots of vegetables and 30 gm peanuts Orange

    Kachumber+roti

    +

    dal

    +vegetables caulliflower
    Carrot and Tomatto mix juice + Vegetables + Dal + Stuffed Peanuts

    Tomatto Rasam +  Baingan bharta +

    Mung dal + Bajri roti

    Thursday Organic brown rice poha with  lots of vetetables and 30 gm peanuts Banana Broccoli and Zucchini salad cloured peppers tomatoes + grilled vegetables +whole grain bread + 100 grams salmon. Mix green juice +50 g of mixed nuts (pista walnuts almond cashew nuts)

    Steamed fish with

    herb topping grilled

    Tomatoes and Brown rice

    Friday Mix of 3-4 fruits Sweet lime Saute vegetables + brown rice mix with vegetables Beet, carrot and Palak juice + 50 g of nuts and seeds (sesame sunflower)

    Vegetables+Dal+

    Stuffed vegetable paratha + Kidney

    beans (Rajma)

    Boiled or Steamed

    Fish with steamed

    veget abies + Baby Potatoes with skin Tandoori fish +Vegetables +

    Steamed rice

    Saturday

    Idli with sambhar+

    green

    chutney

    Pome

    granate

    Salad of mix raw vegetables tossed with sunflower seed+ steamed fish and brown rice Cucumber, ginger and lime juice + 50 g of pistas Boiled  or Steamed Fish  with steamed veget ables + Baby Potatoes with skin
    Sunday Muesli with soya milk Pamelo or grape fruit Salad beet carrot tomatoes leafy green vegetables+Jav atta roti +1 cup pulse (moong) Tomato and celery juice+50 g almonds Tondoori fish + Vegetables + Steamed rice

    Dinner: The meal plan must include raw salad and plenty of vegetables

    Nuts have zero cholesterol

    Research suggests that dietary adjustments can prevent, reverse and retard the damage caused by free radicals, chemicals addictives and preservatives.

    A stitch in time ...

    When Rahul , a 45-yar-old executive, developed a stomach ache after a heavy lunch, he thought it was 'gas'. He swallowed a couple of antacids, hoping the pain whole go away. A little while later, he started sweating. His wife then became panicky and called their family doctor who advised them to rush to the nearest hospital. In the emergency room, he was told that it was heart attack and he was immediately treated. His life was thus saved.

    What is a heart attack?

    A sudden blockage of one of the arteries of the heart (coronary artery), causing damages to the heart muscle, is called a heart attack.

    Warning signs of a heart attack could be any of the following:

    Prolonged chest pain of discomfort, especially with sweating.

    Stomach pain not relieved by antacids.

    Severe pain in the left arm or shoulder.

    These symptoms are usually triggered off by emotional stress physical activity or heavy meal.

    Risk factors.

    A person with one or more of the following risk factors should be on high alert:

    Close relative like father, mother, brother or sister is suffering from heart disease.

    If he has high BP and/or diabetes.

    Heavy smoker.

    High cholesterol.

    Overweight and leading a sedentary life.

    Under heavy mental stress in professional or personal life .

    First aid.

    If your relative/friend experiences any of the above mentioned warning signs, try to stay calm and not panic.

    Do not make him/her walk or undertake any physical strain.

    Make him sit or ask him to lie down and make him as comfortable as possible.

    Call for help and get somebody to phone for an ambulance. If an ambulance. If an ambulance is not available, rush him in a private vehicle to the nearest hospital.

    The first hour a patient suffers chest pain is the 'golden hour' during which prompt medical attention can save many lives. If he is a known heart patient, then ask him to keep half a tablet of Sorbitrate under his tongue while waiting to take him to the hospital. If the patient has collapsed, then mouth-to-mouth breathing and artificial cardiac massage (CPR-cardiac massage (CPR-cardio pulmonary resuscitation) is recommended.

    Prevention of heart attack.

    It is known fact that 25 per cent of heart victims in India are below 40 years of age. Hence it is very important that a person whose close family has a heart problem should check himself up regularly . Eating a healthy diet, detecting and controlling diabetes and BP, stopping smoking and losing weight are some measures to reduce the chance of suffering a heart attack.

    Daily exercise and reducing stress by yoga and meditation will also go a long way in reducing BP. Finally, heart disease and heart attacks are preventable. Finding ways to incorporate heart-healthy habits into your lifestyle may well mean you enjoy a healthier and happier life for years to come.

    BP is a silent killer.

    Are you listening ?

    LIFESTYLE@WORK

    If you don't want to be part of a new statistic that claims that over 10 crore people suffer from high blood pressure in India, we suggest you follow these tips.

    LIFE@WORK tells you why it's necessary that you alter your lifestyle and diet habits, ASAP

    Consultant physician at Hinduja and Lilavati Hospitals, Dr. Anjali G. Ballani is not surprised with a statistic that says India is the world's BP capital. 'With the kind of lifestyle we've adopted, poor eating and sleeping habits are bound to follow."He elucidates his point by explaining the disoriented life of a BPO employee, "They work on US time, and this disrupts their meal time and sleeping patterns."Plus, competition has increased stress and pressure on the job front by two folds, which leads to palpitations and rapid heartbeats, he explains. Bingeing on fast food that is high in salt, a lack of physical activity and growing stress have resulted in hypertension among patients as young as 23, today. Family history can also be partly responsible for hypertension.

    One in every 10 patients with high blood pressure, is between 20 and 30 years of age.

    What NOT to eat: FOODS high in salt like peanuts, wafers, ham pork, salami, papad and pickle EGG YOLK>RED MEAT>BUTTER AND GHEE should be consumed in limited quantities

    ONLY AND DEEP-FRIED food should be avoided

    A Combination of these 4 often causes hypertension

    POOR DIET: With lack of time to eat in peace , most professionals opt for fast food junk items, that are high in salt. A high salt diet causes high blood pressure.

    LACK OF EXERCISE: Since most of us spend close to 12 hours at the office, there is no time left to work out. Physical activity is necessary to prevent the body from falling prey to diseases.

    STRESS: Intense competition, unreasonable targets lead to stress. If targets are not achieved, the job is at stake. Job insecurity only adds to the tension, causing palpitation and rapid heartbeats.

    LIFESTYLE: Thanks to independence a high salary brings, new generation employees are over-spending, often living beyond their means and indulging in excessive late-night partying, smoking and drinking, if their finances are in trouble, they are stressed at the thought of having to do without these perks.

    Workout, if you don't want hypertension:

    EXERCISE FOR 45-MINUTED, 5-days a week: The intensity of the workout is not important; you can even opt for a low-key workout like a brisk walk. The duration and regularity of the workout are more important.

    YOGA AND MEDITATION:


    To stay calm, yoga and meditation are a must.

    Why high blood pressure is just the beginning

    Hypertension affects 4 vital organs:

    EYES (loss of eyesight)

    BRAIN (brain stroke)

    HEART (heart attack)

    KIDNEY (kidney failure)

    You could be suffering from high blood pressure, If you experience

    RESTLESSNESS

    UNEXPLAINED SWEATING

    PALPITATIONS

    HEADACHES

    You must get your blood pressure checked regularly because:

    Hypertension is most often as seen at a later stage. Many a time, a heart attack or in medicinal terms, a Myocardial Infarction could arise way before headaches and palpitations; hypertension is a silent killer.

    You must keep in check, your:

    Cholesterol should be less than 100, HDL cholesterol should be more than 50-55

    SUGAR LEVELS

    TRIGLYCERIDES should be less than 125 GMS

    Eat healthy

    Add these foods to your diet and chomp your way to good health

    Some edibles are especially good at protecting the brain's delicate nerve cells blood vessels from the damage that accompanies aging. Most of them squelch free radicals, the renegade oxygen molecules spun off as the brain goes about the business of the mind. Most of the foods that are smartest for the brain are also mode good for the heart because both rely on a steady oxygen supply. The risks for cardiovascular disease correlate with risks for cognitive decline.

    Dark green vegetables

    Chemicals called homocysteines are a normal part of protein metabolism, but high levels are linked with cognitive decline and Alzheimer's disease (as well as heart disease), which accounts for most cases of demtia in the U.S. According to Katherine Tucker, director of the dietary assessment research program at the Human Nutrition Research Center of Aging, " homocysteine has a toxin has a toxic effect on arterial walls too, which makes them a bad combination". In order to break themselves down, homocysteines require folate and B12 or B6, vitamins found in vegetables like collard greens and Swiss chard.

    Salmon, sardines and herring

    Herring and sardines contain large amounts of omega-3 fatty acids, which tend to increase levels of serotonin, a mood-enhancing brain chemical, Salmon is low in calories and saturated fat, yet high in protein. In addition to being an excellent source of omega-3s, salmon are an excellent source of selenium, a very good source of protein, niacin and vitamin n B/12, and a good source of phosphorus, magnesium and vitamin B6. A study form the rush institute for Healthy Aging in Chicago found that people who eat at least one fish meal a week are significantly less likely to end up with Alzheimer's disease.

    Spinach

    Spinach research has finally caught up with mom's advice: Spinach turns out to be full of antioxidant power. James Joseph, chief of the Neurosciences laboratory of the Human nutrition research Centre on Aging, finds spinach beneficial in slowing down age-related problems in the central nervous systems and cognitive deficits. A salad with spinach has more than three times the amount of folate than one with iceberg lettuce.

    Grape juice

    Drinking red wine in moderation increases longevity. But since alcohol slows down the brain's ability to function properly, grape juice may be a smarter beverage choice. New research shows that grape juice significantly improves short term memory and motor skills, It's not just the heavy dose of antioxidants. Grape juice increases production of the neurotransmitter dopamine. Whole grains and brown rice

    One of the best thing you can do to improve intake of nutrients is to witch to brown rice. Its filled with vitamins and magnesium, which seems to be important to cognitive health. Whole grains contain vitamin B6, which aids in reducing homocysteine levels. Americans often don't get enough vitamin b6, because they mostly eat processed foods. Olive oil

    A staple of the highly touted 'Mediterranean Diet', olive oil contains the potent antioxidants called polyphenols, Olive oil has been shown to reduce blood pressure and cholesterol levels. The extra-virgin variety is best.

    Garlic

    This pungent herb fends off aging via its antioxidant properties. It also contains strong antibacterial and antiviral compounds that help shake off stress induced colds and infections. Raw, crushed garlic is best; cooked garlic is less powerful but still benefits the cardiovascular system.

    Facing up to the cardiovascular epidemic

    On World Heart Day today, the focus is on the need for a paradigm shift

    The cardiovascular epidemic, which is a global health problem, is set to affect India in a big way. The incidence of cardiovascular disease (CVD) is increasing in all the developing countries. The World Health Organization (WHO) estimates that worldwide, 24 million people a year will die of CVD or stroke by the year ---. A study conducted in ---Andhra Pradesh found that 32 per cent of all deaths were caused by CVD.

    The incidence of CVD is 47 per cent in the developing countries as against 27 per cent in the developed countries in people below 70 years. In the U.S; 13 per cent of the gross domestic product (GDP) is spent on health, whereas in India the figure is less than 4 per cent. In India, the onset of CVD is at an early age, it is more severe and the progression is rapid and aggressive. This pattern is accounted for by ethnic predisposition, genetic background, and abdominal obesity, low levels of good cholesterol (HDL), high incidence of diabetes mellitus, lack of exercise, consumption of 'fast food' and lack of motivation for lifestyle modification.

    Symptomatic patients who some to the hospital are investigated and subjected to angiography and angioplasty or bypass surgery if so economic burden not only of the patient but also insurance companies, employers and the nation as a whole. Surprisingly, less than 10 percent of patients coming to corporate hospitals in India have optimal insurance coverage. There is a need to shift attention from sickness to wellness to prevent the CVD epidemic, rather than treat people after the disease manifests itself in severe form.

    Preventive strategies

    The primary means of prevention are modification, control and treatment cardiovascular risk factors before one suffers a heart attack. It is essential to detect them early and give proper direction regarding lifestyle modification, diet exercise and drug therapy. Weight reduction and emphasis on maintaining the ideal weight are necessary for obese individuals. Control of blood pressure, optimal control of diabetes, reduction of bad cholesterol like total cholesterol, LDL cholesterol and triglycerides, are advised. The level of good cholesterol can be raised by means of regular exercise and proper dietary habits. The consumption of red meat, egg yolk and fried food should be avoided. A check-up at least once in six months is mandatory.

    Stress reduction can be achieved by means of proper counseling, exercise, yoga and meditation, Smoking, the "pub culture" and fast foods should be boycotted. There is no evidence to show that lifestyle modification alone can reduce CVD. Preventive medication, including statins, is essential too.

    In the developing, countries, among the high-risk population CVD can cause approximately 31 deaths per 10,000 population. Lowering the cholesterol level by 1 mmol a litre (38.5mg) can reduce the number to 21.Lowering blood pressure and cholesterol levels to normal can reduce it to 13.If smoking cessation can also be achieved, the rate can fall to as low as six per 10,000.

    This data emphasise the need for preventive medication to target populations such as software professions such as software professionals and diabetics. Opportunistic referrals, such as for pre-employment check-ups, could also be targeted.

    Polypill (which contains a cholesterol-lowering statin, blood pressure-lowering ACE inhabititor and a blood thinner, Aspirin) is useful for the high-risk population . The compliance rates are high. Its use for five years are high. Its use for five years reduces CVD risk by 65 per cent. Whether it will also reduce the incidence of stroke is not substantiated.

    Polypill does have some limitations. It is a fixed-dose combination and the strength of the medicines cannot be changed as and when necessary. Coughing caused by the blood pressure-lowering component of the medicine may lead to non-compliance with drug intake.

    By using Framingham Risk Scoring (JAMA 2001), the risk of CVD in a population is stratified as low-risk (if less than 10 per cent) , medium risk (10-12 per cent ) and high-risk (more than 20 per cent.)

    Pollypill is not ideal for high-risk individuals with very high blood pressure, diabetes and other risk factors, where frequent dosage adjustments and different drug combinations may be essential. Supplying Polypill free of cost to a given community may not result in desired effects as there is 22 percent less adherence seen with free medication.

    Cost effectiveness


    Polypill costs approximately Rs. 250 a month. The cost can be subsidies by the government. The preventive government. The preventive strategies are ideally suited for the medium-risk subset of patients form the rural and semi-urban areas who do not generally come to hospitals. Low-risk patients do not need preventive therapies. In fact, its use in the low-risk subset will only increase the financial burden to the healthcare provider. A majority of the high-risk subset of patients of the high-risk subset of patients is certain to go to the physician for treatment due to the multiple risk factors involved.

    It is surprising that health insurance agencies and employers are willing to pay for interventions but not for preventive medication. It will be a positive step if health insurance includes preventive medication for reimbursement as it will reduce the number of heart attacks, and thereby hospitalisations and interventions that are definitely costlier.

    Risk factors should be considered as points in the disease continuum, as rightly proposed by Prof. Ritchie of the University of Aberdeen, and their treatment or control should be desirable, acceptable, achievable and sustainable. For example, statin treatment for high cholesterol has a strong evidence base for its desirability. But affordability and achievability will depend on the number of people treated. And the number of people treated, in turn depends on the CVD risk in a given population. The media can play a major role in educating and motivating the target population which is certain to increase the rate of self-referrals.

    In the next decade, there should be a paradigm shift from intervention to prevention, from sickness to wellness. To be cost effective this should be targeted at the medium-risk population whose members usually do not come to physicians.

    The present healthcare delivery system is grossly inadequate to face the threat-- cardiovascular epidemic . To be manpower needs can be me through public-private partnerships. Governments and corporate hospitals can come together to chalk out and implement preventive strategies. Non-governmental voluntary organizations can be involved to optimize the preventive health care services to the community.

    Fighting the impending cardiovascular epidemic in a developing country like India is almost akin to David fighting Goliath. I have attempted to give a few suggestions to help combat the CVD risk in India. These are the views of a clinician. (cardiologist), and not of a politician. Policymaker or epidemiologist. Announce of prevention is better than a pound of cure.

    Cardiac PET /CT scan

    Cardiac PET/CT is an example of the most advanced technology for detecting heart diseases early and accurately. It provides unparalleled images of blood flow to the heart enabling the detection of blockages in the coronary arteries. The high-speed, multi-detector CT detects calcium in the coronary arteries and can be used to peer inside the arteries. This shows the formation of plaque before a heart attack or stroke.

    Angiograms and CT angiograms Show Only Vessel Anatomy. PET/CT scan shows both blood supply to the cardiac musculature as well as blood vessel anatomy.

    Cardiac PET Scan

    Positron Emission Tomography (PET) scans show the chemical functioning of organs and tissues, while other imaging techniques such as X-ray, MRI and CT scans show the structure. That makes PET technology particularly useful for the detection of coronary artery disease.

    How it works

    Ammonia N13H, a radioactive tracer that emits subatomic particles called positrons, is injected into the patient's arm. The blood stream carries the positrons to the heart muscle. A special Pet camera detects the emitted positrons and constructs a picture of the heart.

    PET scans reveal the health of the vessels supplying blood to the heart, heart muscle and surrounding tissues. The most common use of PET imaging in cardiology is to identify heart muscle, weakened but hot damaged irreversibly blocked arteries-the information cardiologists use to determine whether a patient's heart muscle will benefit from coronary artery bypass surgery or angioplasty.

    PET scans can detect over 95% of people who have significant blockages of coronary arteries and produce reliably normal results in over 95% of people with no heart disease.

    PET scans are non-invasive and painless

    Sometimes, intravenous medicine is used to stress the heart in conjunction with the PET scan.

    Pet scans rarely produce 'false positives' so they are often used to confirm other tests when a false positive is suspected.

    The radiation you are exposed to during a PET scan is roughly equivalent to that of a Kidney x-ray.

    PET scans take about one-and-a-half hours.

    Most people are candidates for PET scans. Howver, pregnant women, nursing mothers and people who have recently suffered stroke usually cannot have PET scans.

    Who does it benefits?

    A person with the following risk factors should ideally undergo PET/CT scan of the heart you determine whether he or she is at risk of having coronary artery disease: obese, stressful jobs, diabetic high blood pressure, high cholesterol, smoker and strong family history of coronary artery disease presetting with atypical chest pain.

    Heart Disease is the leading killer today and a heart attack is the most visible sign of heart disease. More specifically, cardiovascular disease is the number 1 causes of death for individuals aged 65 and above.

    Cardiac PET stress testing provides improved accuracy in patients unable to exercise on a treadmill or whose physical characteristics would produce a suboptimal result with prior methods of nuclear stress testing. In addition to lower radiation exposure than current nuclear stress testing, patients will benefit from reduced testing time. The entire test can be completed in 45 minutes or less versus 3-4 hours with current nuclear stress testing. Cardiac PET scanning is one of the most accurate diagnostic tests for the detection of coronary artery disease ad assessment of blood flow to the heart. It is also the gold standard for determining viability of heart tissue for revascularization. Cardiac PET is used by physicians to determine whether angioplasty, bypass surgery or cardiac transplant should be recommended.

    Women &Heart Disease

    Each year more than 2,25,000 women die from coronary heart disease , almost six times the number of deaths caused by breast cancer . Detection of coronary heart disease is often difficult to detect in woman due to their physical characteristics and the inability to accurately diagnose pre-test symptoms. Women show fewer true positive scans than men who undergo current nuclear stress testing. Coronary heart disease such as ischemic is often overlooked in women. The diagnostic accuracy of cardiac PET is significantly higher in women when compared to current nuclear stress testing.

    WORLD HEART DAY

    From diagnosis to treatment and prevention, modern medicine promises to offer cardiac patients not only increased longevity but also a better quality of life, finds Dr. Vasundara Atre

    TACH TOOLS THAT SERVE THE HEART

    CARDIOVASCULAR care has been revolutionized in the past few years. Advances in technology, research and the growing experience are instrumental for the leap.

    ADVANCES DIAGOSTIC AND PREDICTIVE TOOLS

    Early diagnosis is the key to better management . Newer imaging techniques such as ultrasound, Cardiac Magnetic resonance Imaging (CMRI), PET (position emission tomography or cardiac viability study), and Cardiac computed Tomography, the nuclear heart scan (or Radionuclide Imaging or Radionuclide Imaging or Radionuclide Ventriculography ) allow closer look at the heart and great vessels at little risk to the patient, In patients suffering from coronary artery disease, the electron-beam computed tomography (EBCT)-identifies calcium within the plaque found I n the arteries. More calcium indicates a higher chance of coronary artery disease.

    All these tests can be used to determine heart function and status at 'rest' and under 'stress' conditions the stress tests.

    Dr. G N Mahapatra, consultant and head of department, Nuclear Medicine & RIA, Saifee hospital says," My ocardial perfusion imaging also has predictive value. It gives important information whether following an old myocardial infarction, the heart muscle would recover back to its normally functioning pattern after angioplasty, or bypass surgery."

    In addition, genetic testing and evaluation of certain markers is becoming increasingly commonplace to identify people at increased risk of cardiovascular disease.

    By the right blend of biotechnology and information technology, world-class diagnostic services have been brought to India by many players like Thyrocare to the nooks and corners of the country at costs, which almost everyone can afford.

    ADVANCES IN TREATMENT MODALITIES CONGENITAL DEFECTS

    Says Dr B.K Goyal, cardiologist and President of Indian college of International cardiology , "closure devices are being used for closing abnormal openings or holes within the heart or blood vessels without surgery." The devices are folded into special catheters like the one used for angiography.

    VALVULAR DISEASE

    In patients in whom the hart’s valves malfunction, repair or even replacement may be required.

    The treatment may include ballon valvuoplasty to relieve a valve obstruction. The cardiologist inserts a catheter, a thin plastic tube with a special ballon attached, into the heart. The ballon is then inflated to stretch open the narrow area of the heart valve relieving the obstruction.

    Some patients may be eligible for an advanced valve heart surgery procedure technique called Port Access valve Surgery, which allows the operation through small openings (ports) between the ribs. A heart-lung machine, also used in a less invasive manner, keeps the patient's blood circulating while the heart is stopped.

    CORONARY ARTERY DISEASE

    It is set to be a major killer in India by 2020. The interventional treatment modalities include either catheter interventions or bypass surgery.

    In coronary angioplasty, the bloc-ages are dilated and/or mechanical devices called stents implanted at the site of the blockage. These days, the radial artery of the hand is being used instead of the traditional groin femoral artery. In the last few years, drug eluting stents (DES) that deliver a drug eluting stents (DES) that deliver a drug in addition to keeping an artery open have been introduced. The released drug inhibits the inner Lining of the artaery from proliferating, preventing reblocages.

    The trend in cardiac surgery is inclining towards minimally invasive surgery-smaller incisions and less invasive procedures.

    Dr. S S Bhattacharya, cardio-thoracic surgeon, Breach candy Hospital, Bombay Hospital and Lilavati Hospital, Mumbai elaborates, "A new era has dawned, in coronary artery disease surgery , with the advent of off pump beating heart surgery, where blocked vessels are bypassed without using the heart lung machine or stopping the heart. The revolutionary 'Octopus' a stabilizer device that steadies the part of the beating hart that is being operated upon, has contributed to the advances in beating heart surgery."

    He adds, "Today, the internal mammary artery located within the chest wall, which has inherent advantages, is used as a conduit for bypassing the blocks."

    Improved technology has led the way to more precise instruments and highly sophisticated equipment. Dr. Saksena, cardiothoracic surgeon, Bombay hospital says, "Surgeons can perform computer –assisted cardiac surgery, referred to as robotic surgery, with superior precision. It enables the surgeon to perform the surgery with tools that mimic the feeling of having their hands inside the chest, when in act only a small incision has been made."

    RHYTHM DISTURBANCE

    The heart is an electric pump. The electrical impulses are transmitted in a synchronized manner to all the hart chambers, allowing harmonized contraction of the heart muscle. This ensures proper blood delivery to the body. Some individuals are prone to developing uncoordinated or irregular electrical impulses resulting in ineffective pump action. In some case ablation therapy is applied to obliterate abnormal electrical pathways.

    Explains Dr. Goyal, "Implantable pace makers, implantable defibrillators and ventricular assist devices are used to protect against devices are used to protect against slow heart rhythms and sudden arrhythmia-related deaths. In patients requiring a heart transplant surgery, heart assist devices are often used which take over the majority of the heart's pumping function , allow the heart to rest, heal, and grow stronger while they wait for a donor heart."

    STEAM CELL THERAPY


    Dr. V K Shah, interventional cardiologist, Sir H.N hospital, STR Mehta Hospital and Wochardt Hospital predicts, "Stem cell therapy is a novel approach. It holds out great promises for patients suffering from end stage heart disease. It has the potential to revive the dead tissue and regenerate the viable muscle so as to improve the heart function."

    Now you can Bypass the bypass! Choose. You can spend up to Rs. 3.5 lakh on an angioplasty later or sign up today for a preventive cardiology programme that will pull you into shape for a fraction of the cost. Sudeshna chatterjee investigates.

    FILM star Akshay Kumar is a worried man. And why not? By 2010, one out of four Indians will be suffering from cardiac problems. If you are wondering just what the connection between the action hero and cardiology is, let us solve the mystery for you. Akshay is the good heart ambassador for the Institute of Preventive Cardiology. His role is to spread awareness about the importance of preventive cardiology.

    SO WHAT EXACTLY IS PREVENTIVE CARDIOLOGY?

    Doctors advise minor changes in lifestyle to counter future cardiac ailments even if you think your ticker's in top form now. How does the programme work? Padmashree Dr. AB Mehata. Director, cardiology, jaslok, Hospital, Mumbai, explains, "A through checkup of the person is done. Risk factors ---Identified . Stress test and EGG are carried out. This constitutes the cardiac profile of the person. Accordingly, certain exercises are recommended. Usually, exercises or the treadmill or bicycle are recommended .Usually, execises or the treadmill or bicycle are recommended. Usually, exercises or the treadmill or bicycle are recommended. Usually, exercises or the treadmill or bicycle are recommended. Regular brisk walking for about 30-45 minutes or swimming /cycling can also be incorporated as an alternative exercise programme." According to Dr. Mehta, the diet is usually low in fat, (especially saturated fats) and includes lots of green vegetables and fruits. If the person is not-vegetarian, then he or she can opt for freshwater fish and chicken. There are also tips for stress management like regular practice of yoga and medication or listening to soothing music.

    WHY IS A PREVENTIVE CARDIOLOGY PROGRAMME NEEDED?

    The efficacy of such lifestyle modification was brought to light recently at the World Cardiology Congress in Barcelona, Spain researchers of Euroaction – a project in preventive cardiology designed to reduce heart problems by improving lifestyles-presented their findings, which indicate that lifestyle modification alone can go a long way in reducing cardiovascular ailments.

    Indians have a genetic predisposition to developing cardio-vascular ailments, says Mumbai-based preventive cardiologist Dr. Pratiksha. Every hour, cardiac ailments rack up 91 fatalities across India and the age at which people are diagnosed with cardiac ailments is decreasing. Earlier, people are diagnosed with cardiac ailments is decreasing. Earlier, people above the age of 40 would be considered at risk. "Now, people as young as 30 can also be seen suffering from cardiac ailments. Perhaps that is why the need for preventive cardiology is all the more significant today'" says Dr. Pratiksha, who is also founder-director of the Institute of Preventive cardiology. Which has branches in Chennai. Nagpur and Surat.

    There has been a spurt in lifestyle –related disease like diabetes and hypertension. Which has ensured a higher number of cardiac ailments. Japan and Finland have a smaller number of cardiac patients, thanks to their way of living, says dr. Pratiskha. "Thankfully, in the last couple of years, we are seeing patients coming for a checkup at the mere hint of a chest pain. Earlier, they would dismiss it as rheumatic or muscular pain, "says Dr. Mehta, In fact, there are also people queuing up for these tests even when there are no complaints. "T his is due to several reasons. More people are taking up insurance policies, hospitals are offering concessions are insisting on medical records of new recruits," observers Dr. Ajit Menon, cardiologist at Mumbai's Cumballa Hill Hospital and Lilavati Hospital. With the preventives in place, it is possible reduces or postpone the ailment that one would have suffered from, says Dr. Mehta. According to Dr. Menou , "Prevention of corollary disease can happen at two levels: prevention of the disease before it manifest and prevention from compilations and recurrence."

    And while the doctors give the medical perspective, people have seen the benefits of preventive cardiology in practice too. Says Akshay: "I have seen pre ventive cardiology giving results. The problem with Indians is that they do not go for an annual health checkup . Their diet, which is extremely oilbased, further affects the system. Though I don't have a family history of cardiac problems. I believe that in matters of the heart, prevention is definitely it better than crue! Despite observing a strict regimen of exercise, eating on time and consuming food cooked in minimum oil., I always go for an annual health checkup, since in life-threatening diseases, the symptoms are revealed at an advanced stage." So the benefits are reflected on the health charts as well as bank balance

    HOW MUCH DOES SUCH A PROGRAMME COST? As Dr. Mehta points out. At the jaslok Hospital, the cost of a compete session (two months ) of cardiac prevention (inclusive of consultation charges) is about Rs. 5,000. Against that, a bypass surgery would cost anywhere between Rs. 90,000 and Rs. 2.5 lakh. As for angioplasty, the charges range between Rs. 90,000 and Rs. 3.5 lakh. Forty –three-year-old Nitin Kshirsagar, an advertising professional, took the preventive programme about two months ago, to be on the sage side, as his father had undergo angioplasty . Though Nitin has always been careful about being fit. the programme has benefited his health, he feels. For example, his skin is glowing and there is a spring in his step.

    So avoiding cardiac problems aside, just living a healththeir lifestyle could do wonders for your energy and social life too!

    Rotablator for complex cardiac cases

    With aging population on a rise in India more complex coronary cases are being seen by cardiologists. Many patients with these complex (hard calcific blocks) blockages' in the arteries supplying the heart muscles (coronary arteries) possess a challenge to the interventional cardiologist as routine ballon angioplasty and stent placement may not be easy, and at times impossible. Not all cases can be sent for various reasons. A rotablator is – to treat such complex blockages, which is much less invasive than surgery and can be sager than other minimally invasive.

    Catheter based procedures. For these complex calcific blockages, a atherectomy(plaque debulking) puts less strain on the arterial walls than the routine balloon angioplasty.

    What is a Rotablator? The rotablator system uses a tiny olive shaped diamond-tipped burr. The burr travels though a catheter over a thin guide wire into the blood vessel supplying the heart (coronary artery). Once close to the hard calcific blockages, the rotablator spins between 140,000 to 200,000 revolutions per minute and is driven by turbine technology. As it crosses at the blocked or narrowed area. It ablates or stands or pulverizes away the hardened calcific blockages (plagues). These small bits of plaques then harmlessly travel through the blood stream and are eventually eliminated from the body circulatory system.

    Is it safe?

    It is critical to understand that a rotablator is designed not to damage artery wall. The Rotablator burr is designed to cut away only inelastic, hard material as calcific plaque. Normal, healthy tissue is elastic and is deflected out of the way. The mechanism of action is similar to shaving, in which the razor cuts the hard, inelastic while the soft, elastic surrounding skin.

    Is it a routinely used device?

    No, only handful of interventional cardiologists in the country are trained to operate this device, with the increasing number of complex cases that are being treated at Dr. LH Hiranandani Hospital, they tool the Initiative to permanently obtain this machine so as to benefit the select group of highly complex coronary interventions.

    Redo Bypass surgery

    Dr. Ramakanta Panda, India's pioneering heart surgeon and Mumbai's doctor with soul introduces a regular Asian Heart Institute cardiac column in Bombay Times on the occasion of world Heart Day.

    Heart blockages develop because of risk factors like smoking, high blood pressure, diabetes family history and food habits. Bypass surgery and Angioplasty are done for blockages, which are life threatening. Though bypass surgery can take care of blockages, it doesn't prevent development of future blocks. Similarly if surgery is not done properly or if the vein graft from the leg is used, a person may need surgery again because of re-blockages. Second bypass surgery or redo bypass surgery is complex and risky because after the first surgery. The heart and lungs stick to the breast bone. Heart arteries become difficult to identify and there is a high risk of injuring the heart and major arteries during opening the chest. Beating heart surgery reduces the high risk if redo bypass. In the traditional form of surgery, the heart is stopped and connected to the heart lung connected to the heart lung machine. However, in a beating heart surgery, the heart is not connected to the heart lung machine and the surgery is done while the heart is still beating. The advantage is a quicker recovery and fewer complications.

    What makes Asian Heart Institute (AHI) unique?

    AHI has developed an expertise in redo bypass surgery. At AHI redo bypass surgery is done on a beating heart arterial grafts (i.e, arteries from other parts of the body) are generally used.Arterial grafts are more long lasting compared to vein grafts.

    Very few centres in the world have been able to combine these three levels of difficulties to deliver successful results . In the last six years, more than 700 redo bypass surgeries have been performed at AHI and in the last two years the AHI team has achieved Zero mortality in redo bypass surgery.

    Healthy heart tips for the workplace

    Give a kickstart to your day with a hearty breakgfast, have food rich in carbohydrates and proteins for energy and increased metabolism.

    Take the stairs instead of the elevators.

    Park at the fathest spot and walk to the office.

    Say no to sugar in your many cups of tea/coffee during the day.

    Limit your tea/coffee to two cups to avoid excess caffeine.

    Save yourself from stress by taking a break from time to time.

    Medical miracle: Heart tumour removed

    New Delhi: In what would seem like a medical miracle, a 40-year-old man, suffering from a tumour in his heart, had 60% of the right chamber of his heart removed and then reconstructed through surgery. The operation took place in Safdarjung Hospital on Wednesday. Doctors say the patient is doing fine and will be discharged soon.

    Ajit Kumar Singh from Jharkhand was referred to safdarjung Hospital some weeks ago. Singh was diagnosed with a tumour in the right atrium of the heart-an extremely rare condition. Due to financial constraints, Singh left it untreated will recently when he developed a swelling in the neck and lower body. His liver had also enlarged. " I had trouble breathings and had selling all over my lower body," said Singh, who is recovering in the cardiac ICU here.

    The tumour had covered almost the entire chamber and was exerting pressure on the right ventricle and blocking the interior vena cava, a large vein which carries de-oxygenated blood from lower half of the body into the heart. As a result, blood stagnated in the lower body. "He also had swelling in the neck and face because his superior vena cava was also affected. The tumour was big and we had no option but to take out 60% of the right atrium," said Dr Jagdish Prasad. Chief cardio-thoracic surgeon and medical superintendent, safdarjung Hospital, who operated on Singh.

    In a two-hour surgery, the doctors removed the tumour and reconstructed the right atrium with pericardium, which is the outer covering of the heart."The hollow space had to be filled up. We used the pericardium to make up for the huge space that was created. The danger of pulmonary embolism was high. We had to stop the patient's heart to perform the surgery . Such surgeries are very expensive, but we operated on him free of cost," said Prasad.

    According to doctors, a tumour in the heart is a rate condition and occurs only in 0.01% of cardiac cases, out which most tumours are seen in the left atrium.

    128-slice cardiac CT aids in the diagnosis of Congenital Heart disease

    Echocardiography and catheter cardioangiography have been the primary cardiac imaging modalities, but both hav e limitations. Echocardiography is limited by a small filed of view, a limited acoustic window, poor depiction of extracardiac vascular structures & airways, and operator dependence . catheter cardioangiography is limited by the overlapping of adjacent vascular structures, difficulty in demonstrating systemic and pulmonary vascular systems simultaneously, catherization-related complications(especially in young children), and relatively high doses of ionizing radiation and iodinated contrast material. Computed tomography (CT) and magnetic resonance (MR) imaging have important roles in overcoming these limitations

    Cardiac imaging with CT and MR imaging always relies on technical developments because high temporal and spatial resolution is necessary for the satisfactory evaluation of CHD. In addition, multiplanar evaluation is essential because each vascular structure has its own axis-an axis that is different from the axes of the adjacent vascular structures.

    Many of the fore-mentioned limitations are overcome with magnetic resonance imaging (MRI), especially in depicting the anatomic as well as functional assessment of the heart, but it can be time-consuming and may require a longer period of patients sedation; therefore, the use of MR imaging in seriously ill or uncooperative patients is often limited .MR imaging (Both anatomic as well as functional) will typically require one hour (under adequate sedation in case uncooperative patients) and another hour of post processing.

    128-slice MDCT comes close to fulfilling many6 requirements. Dose-reduction technology (like ECG-synchronized tube current modulation, etc.) makes CT angiography a reasonable option compared to standard angiography. It provides a quick (virtually eliminating the need for prolonged sedation) non-invasive isotropic high-resolution 3D imaging of the cardiovascular systems and enhanced capabilities for simultaneous evaluation of lung parenchyma and whole of thoracic anatomy. Time-resolved cardiac CT angiography (ECG-triggered prospective imaging) can provide good depiction of coronary artery anatomy. MDCT has the capability of complete 4D imaging, thus providing additional functional data like ventricular function, but this comes at the cost of excessive radiation.

    Advantages' of MDCT in CHD

    Short examination time

    Fewer requirements for sedation

    Simultaneous evaluation of airways, lung parenchyma and whole thoracic anatomy

    High spatial resolution, 3D multiplanar imaging.

    CORONARY ARTERY DISEASE : (CAD)

    Coronary artery disease is condition of heart where arteries supplying blood to the muscles of hart are blocked which result into chest pain ( Angina Pectoris) heart attack & sudden death. These blockages which are deposits of excess fat are silently developing form teenage. When a person gets symptoms of chest pain the blockages have already exceeded 70-80%. Heart attack is a terminal event of the entire disease process with a high mortality rate of more than 50% if not treated I adequate time. Surgical procedure like by-pass & Angioplasty provide temporary solution on the treatment of CAD, as recurrences are quite common.

    25-30% of people have underlying disease of which Heart attack is the first symptom, hence Cartography becomes an important test for the early detection of disease & preventing a major heart attack & premature death.

    CARDIOVASCULAR CARTOGRAPHY

    Is a non-invasive painless test performed to assess the function & efficiency of heart and reliability detect the severity of coronary Artery disease at i's early stage. The 20-30 minute test generates meticulous information that was never possible rough any of existing diagnostic tools.

    Cartography is helpful in planning treatments for advanced cased of CAD & its equally important for 30 plus age group to trace the initial development CAD & start reversal therapy accordingly

    INFORMATION OBTAINED BY CARTOGRAPHY

    Cardiac out put, left ventricle ejection fraction, cardiac contractility arterial blood pressure, systemic vascular resistance, blood clotting tendency, Abnormal heart beats, global & regional blood flow to heart, myocardial oxygen demand/supply/reserve.

    WHO REQUIRES CARTOGRAPHY

    Primary Prevention:

    Applicable to normal individual to evaluate functional status of their heart.

    Screening procedure for CAD

    Master health check for those who are more than 30 years of age.

    All sports person-Athletes, Fitness experts & Physical instructors.

    Secondary Prevention:


    For high risk group who are prone for CAD for early detection.

    Family history of CAD before 60 years

    Stressful and sedentary life specially busy executives corporate, businessmen & professionals.

    Hypertension/Diabetes mellitus /obesity.

    High lipid profile

    Smoker/Tobacco chewers/Gutka

    Assessment of cardiac efficiency

    (Pre-operative check-up for non-cardiac surgery)

    Tertiary Prevention:

    For CAD patients in their monitoring and medical management for their rehabilitation & disability limitation.

    For confirmation of coronary artery disease.

    Before or after angiography to determine circulatory status of the heart and evaluate the need and effectiveness of surgical procedures.

    All patients having angina to assess their blood supply to heart, to know deficient areas.

    Follow-up benefits of patients who have undergone bypass/angioplasty and for early detection of reoccurrence of blockages.

    After heart attack for cardiac rehabilitation

    To monitor and evaluate reversing of heart disease through medicines and lifestyle management.

    Identification of progress to arrhythmogenicity (abnormal heart beats).

    EECP-a natural bypass for heart patients

    Why do I get chest pain?

    Chest pain is caused by gradual blockage of the coronary arteries or blocked arteries restrict blood flow to the heart muscle. Your heart gets oxygen and nutrition from the blood that muscle. Your heart gets oxygen and nutrition from the blood that flows through these arteries. Prior to 1997 the options to beat your chest pain were limited to meditation, angioplasty, Bypass surgery-Now a new treatment called EECP is introduced.

    What is Enhanced External Counter Pulsation?

    EECP is the first nonsurgical, non – pharmaceutical or mechanical treatment approval by US FDA for patients with mechanical treatment approved by US FDA for patients with cheats pain and heart failure, it helps to increase blood supply. The beneficial effect obtain after the completion of treatment persists for year together.

    Why there is a need for another treatment?

    Despite the advances in cardiology in treating chest pain and heart failure the problem still persists. Drugs do not always provide relief and invasive procedures have their own associated risk factors. EECP can provide the patients with all the advantages similar to that of invasive procedures without undergoing them.

    What does EECP treatment include?

    In an EECP session, the patient lies on a padded table. Three large inflatable cuffs-similar to blood pressure cuffs-are strapped around the calves, lower thighs and upper thighs. The patient's heart is monitored by an electrocardiograph display in the machine, which through the computer regulates the inflation and deflation of the cuffs. During the part of the cardiac cycle when the heart is as rest(diastole), the cuffs are rapidly inflated in upward. Just before systole (heart contraction), the cuffs are simultaneously deflated

    How long does this treatment take?

    EECP involves 35 days of treatment: Each treatment session is for 1 hour and the patients are asked to come six days a week for six weeks, it is very important that the patients adhere to the one hour time scheduled fixed by the hospital or medical center and the patient is expected to continue the treatment without break.

    What is collateral circulation?

    Formation of network of tiny blood vessels, which make it possible for blood to detour around or narrow arteries, is called collateral circulation. However the development of collateral circulation is a gradual process and not everyone has the same ability to develop this network at the rate that will relieve Angina, EECP treatment triggers and accelerates this collateral circulation and makes it permanent.

    How does EECP treatment work?

    EECP increases the blood flow to the heart muscle not receiving enough blood supply. It is achieved by EECP treatment by (1) Forming new vessels around the blocked artery.(2)Because of increase blood flow and pressure during EECP there is high pressure in open coronary arteries and lower pressure in closed arteries, blood finds its way to the low pressure Zone or area, which has the decreased blood supply by opening the collaterals. These collaterals eventually become permanent.

    Does EECP give symptom relief as Bypass and Angioplasty?

    All these current mode of treatments help the heart by increasing the blood flow to the area of heart muscle not receiving adequate blood supply. Once the blood supply is increased towards normal the patient's chest pain will be decreased or eliminated and this exercise tolerance will improve.

    How do I personally know the treatment has helped me?

    Patients can walk more distance without chest pain.

    Patients would have fewer or no angina

    Episodes of angina would be less painful.

    Patients can return to work and can participate in their active life style once again.

    Patients would be more enteric and confident.

    EECP Treatment

    During EECP hearts natural mechanism of forming new vessels is enhanced which markedly increased, the blood supply to the heart muscles, EECP also tends to improve your endothelial cell function that lines your coronary arteries, which determine your chance of getting heart attacks. EECP creates natural bypass.

    EECP Advantages over surgery

    Noninvasive

    Outpatient

    Low risk

    No additional mediation required

    No recuperation time require

    No side effect

    Patients have reported increase exercise tolerance energy and free from chest pain following treatment without risk of surgery.

    Bypassed transplant to live

    Mumbai: Batting a heart disease, along-side a chronic kidney ailment could well be termed as fighting two monsters together. For small time contractor and Andheri resident Umer Chohan,51,it meant selling off his an central property and immense suffering for three years---both physical and mental.

    Having survived on medicines and dialysis for nine months, a kidney transplant was the only available option for Chohan. But just as he was close to finally getting a kidney transplant that a could have relieved him of the annoying pain of undergoing dialysis, his doctor broke the news that his dysfunctional kidneys had massively damaged his heart . "my wife was donating one of her kidney, and all the required tests were done. The transplant was slated to take place in a few days, said Chohan. But just before the transplant, doctor asked me to go for a mandatory cardiac check-up, he said had massively damaged his heart The tests results were like a bolt for the blue for Chohan as they revealed that he had 90% blockage in three of his arteries. With those reports, everything was put on hold. Chohans doctor informed him that his weak kidneys had impaired the supply of blood to his heart and jeopardized its pumping abilities."I was immediately taken in for a bypass surgery as the doctors were afraid that I could die of cardiac arrest even before kidney failure," he said.

    Nephrologists DR. Hemant Kumar of LiIlavati hospital, who treated Chohan said once kidneys fail, more toxins in the body affect functioning of blood, adding the challenge is to save a kidney patient from a heart-related death.

    Chohan says though his cardiac surgeon allowed him to undergo a transplant within six weeks of his bypass in plant within six weeks of his bypass in December 2008, he opted for the transplant only last July. " Both the kidney and heart disease had taken a toll on me and my family But after the bypass and the successful transplant, I feel I have got a second chance to live" he said.

    'Heart School' to help cardiac patients

    American hospital's 'classes' impart comprehensive information about maintaining a healthy heart to cardiac patients.

    It's been a long time since 66-years-old Judy Borgula has seen the inside of a classroom, but a near-death experience forced her back to school-"Heart School". Borgula, of Georgia, was one of a dozen students taking notes at a recent seminar at St. Joseph's Hospital in Atlanta.

    Like Borgula, some of those attending were former patients at the facility. She suffered cardiac arest in the back of an ambulance four months ago and was revived by paramedics,"I'm lukcy to be here," Borgula said. But she's not sure she's ready to make some important lifestyle changes. "It's hard to change a pattern of a life-time," she says.

    Borgula may not have a choice. She has venticular tachycardia, a potentially dangerous irregular heart rhythm. She ended up having a pacemaker and a defibrillator implanted. At Heart School, Borgula learned about reducing risk factors for heart disease by eating a healthy diet, exercising and not smoking. She gave up cigarettes when her heart problems started.

    "Heart School is for anyone who has had any kind of cardiac event," explains instructor Cecile Upchurch, a registered nurse. No application or special qualifications are needed. The program is offered quarterly and is open to the public. "When you're in the hospital, it's very stressfl," Upchurch says."You're just trying to think about how you're going to be getting through the day. Heart School comes into play when you've been home and you've been able to rest and recuperate and are ready to make those changes in your life."

    The three-hour presentation offers comprehensive information about maintaining a healthy heart. "Research shows there are some wonderful, basic things we all need to do and can do to have good health, and that's what we try to teach," says Traci Spickler, an exercise physiologist.

    To domonstrate, she sits on the floor and shows the students some simple stretching exercises. She then pulls a chair to the fornt of the room and tells the class to stand up an dsit down several times. She says it's one way to get in a workout without fancy equipement or training."Thirty minutes of exercise most days of the week will provide you health benefits," she says.

    Fear prevents many recovering cardiac patients from getting started on an exercise regimen, Spickler says. "What we like to do is diminish that fear by giving good information about to how to start exercising safely and effectively."

    She advises everyone to check with a doctor before starting any workout routine. She also warns that they may be asked to do a stress test, a series of exercises that check cardiac function in a controlled medical setting. The last hour of Heart School is devoted to diet. Dietitian Doris Adler displays sample sizes of meat to demonstrate the importance of portion control. She stresses the need to add fruits and vegetables.

    As she's leaving the classroom, Borgula admits she's a bit ovewhelmed, but vows to start a healthy lifestyle. Her heart problems took her by surprise, and she warns others not to be complacent. "It would be a very smart thing for people to begin taking care of themselves when they are younger. Don't wait until something happens."

    New-age School

    At the school, patients are taught about reducing risk factors for heart disease by eating a healthy diet, exercising and not smoking

    Patients are askedto take a stress test, a series of exercises that check cardiac function in a controlled medical setting.

    The last hourof the class is devoted to diet. Doctors displays models of sample sizes of meat to show the importance of portion control.

    An arterial switch that made a bundle of joy

    It was during a routine ultrasound scan in the eighth month of her pregnancy that doctors told Neha Goel (25) that all was not right with here baby's heart. Her unborn child baby had transposition of the great arteries (TGA), a rare condition in which the child's main arteries are switched (the aorta and the pulmonary artery are transposed). "It was scary. This was my first baby and I didn’t want to lose it. But, thankfully, we had a month's time to plan what to do," said Neha.

    Neha delivered a baby girl on September 21 in Kokilaben Ambani Hospital, Andheri. Five days later, the baby was operated for TGA. "We operated on the baby and made an arterial switch. It was a complex operation. But since I had done three such operations before, the parents of the baby were confident she will be fine," said Dr.Suresh Rao, paediatric heart surgeon at Ambani Hospital.

    The family, which resides in Goregaon (E), took their bundle of joy home on Tuesday."We wanted to be sure that our baby will be safe. We were charged Rs. 2.245 lakh, but that was the least of our concern. We were lucky to have got a hospital that also had a paediatric cardiology unit, otherwise we would have to rush to Bangalore," said Amit Goel, the relieved father.

    Stroke victims get younger

    New Data Shows A Fourth Of Them Are Below 40 Yrs Old

    More than one-fourth of (brain) stroke patients in India are young people below the age of 40, claimed doctors at All India Institute of Medical Sciences (AIIMS). According to the doctors who conducted a sudy on the prevalence of brain-related diseases in India, young students and women suffering from pregnancy-related problems like infection constitute a large chunk of the population suffering from this neural problem. This was not the case earlier, when a stroke was usually associated with people much order.

    Said Dr. A.K. Mahapatra, head of the department of neurosurgery at AIIMS: "At AIMMS, we get 250-300 stroke cases every month. Of them, 70-75 are young people including school and college going students. The rising incidence of smoking and drinking, which leads to thickening of blood vessel walls and disrupts cholesterol and sugar levels in the body, among student is one reason for this."

    Dr.Anup Kohli, consultant neurologist, Apollo Hospital, sadi Indians are genetically predisposed to stroke problems."Most of us have family histories of diabetes, high cholesterol and heart problems. The imitation of a western lifestyle-by eating more junk food, drinking and doing recreational drugs-by youngsters has put them at increased risk of developing heart and brain-related problems, including strokes, at an early stage," he added.

    Kohli said a balanced lifestyle, more exercise and awareness about lifestyle diseases were required to check this. The excessive use of contraceptive pills by young girls increases the risk of a stroke," said the doctor, adding that 80-85% of people suffer from ischaemic strokes, in which the blood vessels supplying oxygenated blood to the brain get blocked.

    About 15% people suffer hemorrhagic strokes, in which bleeding from a damaged blood vessel within or around the brain damages or puts pressure on the brain tissue.

    Dr.M.V. Padma Srivastava, professor of neurology at AIIMS, said pregnancy related problems like excessive loss of blood, infections and the fact that many people because of social custom do not give women water for some time following the birth of a child also cause strokes. She said many people are not aware of stroke symptoms and by the time a patient comes to hospital, the problem has worsened.

    "One should approach a neurologist in case any stroke sumptoms appear. These include sudden and severe headaches, loss of vision or unexplained dizziness," said Dr. Srivastava.

    City hearts beat to fat, sugar Cholesterol

    High Risk Of Cardiac Arrest, Finds Study

    Mumbai: All is definitely not well with the heart of the city-both young and old. a study on Mumbaikars by P D. Hinduja Jospital reveals some gloomy facts, highlighting the need for urgent steps to stem the impending cardiac epidemic. Metabolic factors that increase risk of heart disease by two fold and diabetes by five fold, was unbelievably high in the sample group.

    The study conducted on 560 people (302 men, 246 women) aged 20-90 revealed 20% had more than three out of five metabolic factors like obesity, diabetes, high triglycerides (bad cholesterol), low HDL-c (good cholesterol) and elevated blood pressure. An equally worrying revelation was that 79.01% were overweight or obese. As many as 95% had at least one abnormal parameter.

    The prevalence of metabolic factors was much higher in males at 25.16% as compared to females at 12.6%.But most importantlyl, the study revealed beyond doubt that young hearts were particularly at risk of developing cardiovascular diseases as most of those who showed low levels of HDL-C or good cholesterol were in the age group of 20-40 years. "About 65% of those with less of good cholesterol were between 20-40 years," said Dr.T.F.Ashavaid, head, department of Laboratory Medicine, PD Hinduja Hospital, who oversaw the project, adding obesity was one of the biggest concerns.

    Lipoprotein A (LPA), believed to be responsible for heart attacks at a younger age, was found in elevated levels, and femals particularly were high on this parameter."The study showed about 26.37% of males and 33.73% females had elevated levels of LpA," said researcher Apurva Sawant. "Just about 5% of the sample size was free of factors adding to morbidity," said Sawant.

    Similar was the case with triglycerides or bad cholesterol. About 40% had elevated fasting bllod glucose levels and triglyceride. "Indians have a peculiar form of dyslipidemia where triglyceride is more and HDL is less, it makes them more prone to heart problems, " said Dr. Ashisha Contractor, head of preventive cardiology and rehabilitation, Asian Heart Insititute. But experts say it may not be enough to blame genes. "Genetics can be managed with a good lifestyle," said Contractor."Less physical activity and more refined food is putting the population at a heightened risk."

    Young, Stressed & under attack

    Rise In Cardiac Patients Below 30 Years Of Age

    Amit Neogi's marriage was just four days away. Probably why everyone around chose to brush aside his complaint of an intolerable chest pain, attributing it to his anxiety for the big day.After all at 23, few would have suspected Neogi to have a heart problem.

    But he insisted on a checkup and the results stunned his family. His main front artery had a 99% blockage. He immediately underwent an angioplasty, two weeks back.

    Heart problems at his age do not surprise many cardiologists in Mumbai any more. Many say they treat at least one case in the age-group of 25-35 in a week. For instance Holy Family Hospital in Bandra had seven cases in the last eight days of cardiac arrest patients below 40 years, three of them below 32. One of them, Anjeet Kumar, 30, suffered a cardiac arrest at Dadar station and is recuperating. Dr. Brain Pinto, the cardiologist who treated Anjeet, attributed the attack to stress as he was free of conventional risk-factors like smoking, diabetes, obesity, hypertension, etc. "Not only younger men but also younger women are coming with heart problems," he said.

    But the absence of conventional risk factors in these patients is making cardiologists anxious. When 27-year-old gym enthusiast Ganesh Gaikwad came to Kokilaben hospital in Andheri with a chest pain, he least suspected a heart problem. He was non-diabetic, a non-smoker, non-drinker and exercised regularly. He still had a complete arterial block, said interventional cardiologist Dr. Sudhir Pillai, who treated him.

    The most potent reason according to some cardiologists, is that youngsters develop small clots in the arteries. "The clots tend to get ruptured due to strenuous activity, and get exposed to the free flowing blood in the body," said Dr. A.V.Ganesh Kumar, head of interventional cardiology, LH Hiranandani Hospital. The sudden mixing of foreign bodies in the blood explains why youngsters get heart attacks out of nowhere, he explained.

    Pillai cautions when someone young gets a heart attack, it is more potent, like Stanley Rego (29), currently recuperating at MGM Hospital in Vashi, who suddenly collapsed with chest pain. Interventional cardiologist from Lilavati hospital Dr. Vijay Bang feels family history has to be used effectively. Many youngsters have a genetic predisposition for developing heart problems and families where elders have heart issues should be on their toes, he added.

    Cardiologists feel a change in diagnosis protocols is necessary. Treadmill or stress tests may not be adequate to pick small clots, said Kumar, adding coronary angiography tests pick up even 10% blockages.

    Pinto says exercising and proper diet ward off attacks. "A healthy lifestyle can prevent this cardiac epidemic where we are seeing patients at least 10-15 years before they should see a cardiologist," he added.

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    Sudden pain, perspiration

    Last Wednesday anjeet Kumar (30) was on his way to Dadar station to receive his sister and her child. Gripped by a sudden excruciating pain ih his chest as he climbed the foot-over-bridge, he understood the pain ws unusual, as was the perspiration."I could feel something was seriously wrong. I called up my friend in andheri and told him I was feeling terribly unwell," he said. But he didn't realise he had suffered a cardiac arrest. "I could feel a tightness and dryness in my throat. I was gulping down bottles of water, juice or whatever was available but the tightness refused to go," he said. Anjeet is now recuperating at Holy Family hospital, Bandra, where he underwent an angioplasty with a stent put in one of his clogged arteries. He said he never had any serious health problems before the attack. "I don't think my stress levels are that high. This has taken me and my family by surprise," he said adding he is committed to making some lifestyle changes.

    Surprise check, life-saver

    Last year, Pawan Rao's (Name change) 32 year-old younger brother, and It professional, dropped dead while playing football with his friends in California, US. The post-mortem revealed he had 90%, blockages and suffered a massive cardiac arrest. When Pawan (33) came to Mumbai for his brother's final rites, their doctor at LH Hiranandani hospital suggested he undergo a cardiac evaluation, as his father too was a heart patient and had an angioplasty to remove blockages. The check-up turned to be a life-saver for Pawan, who is also based in the US. A CT angiography revealed he had two blockages, one 70-80%, the other about 50%,said Pawan's father Ramesh. He had to undergo an angioplasty, and two stents were placed in his arteries. "I wish my younger son too had opted for such a test," said Ramesh, also thankful Pawan's heart probelms were detected in time." "Pawan is trying to mend his lifestyle now," Ramesh added.

    Healthy, but 2 blockages

    Ganesh Gaikwad (27) loves going to the gym and having a well crafted body has always been his passion, for which he has stayed off cigarettes and alcohol. A few months ago, after an hour of gymming Ganesh felt an irritating pain in his chest that aggravated every passing moment. The Kandivali resident brushed aside the pain for a day and popped pain killers. But his sister pushed him to get an ECG done."It showed I had two blockages of about 80% and 90%," said Ganesh. He was immediately taken for an angiography and an angioplasty on the same day at the Kokilaben hospital."I have a family history as everyone including my father and his brothers had heart problems," he said. Ganesh is a regular at the gym again. "I am glad the blockages came to light in time, a week later it was my sister's marriage," he said. Anxiety over the marriage could have given him an attack, his doctor told him.

    New Pacemaker to monitor heart at home

    New Delhi: There is heartening news for cardiac patients, especially those in need of pacemakers. Leading cardiologists in the Capital are encouraging the use of a new pacemaker with a home monitoring system that int he event of an emergency would inform the doctor immediately.

    Introduced in India by a German company, the Cardio Messenger eliminates the need to remain in constant touch with a doctor. The pace maker provides a detailed medical report of the patient to the doctor on its own."It is a dramatic advance in the field of cardiology. It saves patients extra trips to the hospital for monitoring of the pacemaker or the Implantable Cardioverter Defibrillator (ICD) or Cardiac Resynchroisation Therapy (CRT) device," said Dr. T.S.Kler, executive director, Escorts Heart Institute and Research Centre, and the first cardiologist to use the technology in India. Dr. Kler recently implanted the home monitoring pacemaker on 61-year-old Neerja Aggarwal, who suffered freuent blackouts.

    In this new system, a special pacemaker with shortrange radio frequency transmitter is implanted near the patient's heart. This pacemaker collects all the necessary medical details on a regular basis and sends it to a mobile patient device, the Cardio Messenger. The device then sends data collected from the pacemaker to a service centre in Berlin, which in turn alerts the patients device, which in turn alerts the patient's doctor about his or her condition. "In case a patient's heart beat drops, the pacemaker would send a signal to the mobile device which would inform the service centre and the doctor would be informed about the patient's condition within minutes. Some times it so happens that the patient doesn't get to know if something has gone wrong with the pacemaker, but with this the chances of such incidents is low," said Dr. Ashokseth, chairman and chief cardiologist, Max Heart and Vascular Institute.

    Apart from the patient's heart condition, incidents of circuitry failure in the device, status of battery etc too would be reported to the doctor. The doctor would be informed either though an sms or email or fax depending on the option selected. The cost of the home monitoring system is nearly Rs.1.25 lakh. "It is one-of-it-kind heart devices and the cost would include the sms or Net charges . The patient doesn't have to pay for the transmission charges," said Dr. Werner Braun of the manufacturing firm.


    1 in 25 Indians faces 90% stroke risk

    Carries A Gene Mutation That Raises Heart Failure Chances After 45: Study

    Washington: In India an dother south Asian Countries, one in 25 people carries a gene mutation that causes heart failure, a new research has found.

    Loyola University Health System researcher Sakthivel Sadayappan said that studying this gene and the protein it encodes could lead to new treatments for heart failure. He has studied the gene and protein for 15 years. Investigating the protein could provide a better understanding of the mechanics of heart function during health and disease,'Sadayappan and first author David Barefield said.

    Previous studies by Sadayappan and other researchers found that about 4% of people who live in India., Pakistan, Sri Lanka, Indonesia and Malaysia carry the mutation. Carriers have about a 90% chance of developing heart failure after age 45.

    About 60 million people worldwide, including about 40 million Indians, carry the mutation.

    Sadayappan said the mutation likely arose in a single person roughly 33,000 years ago, and spread throughout south Asia. The gene encodes for a protein, called cardiac myosin binding protein-C (CMYBP-C), that is critical for normal functioning of the heart. In the mutated gene, 25, base pairs (DNA letters) are missing. As a result, the tail end of the protein is altered.

    Due to this modification, the protein is not properly incorporated into the functioning unit of cardiac mucle called sarcomere. Conseuently, the heart does not contract properly

    In young carriers, the heart can compensate for this defect. But as the person ages, the heart is no longer able to compensate. Heart muscle becomes inflamed and does not work well, a condition called cardiomyopathy.

    The most common manifestation of cardiomyopathy is heart failure- the heart can't pump enough blood to the rest of the body. There is no current treatment to prevent heart failure in people who carry the mutated gene. However, a heart-healthy diet and exercise can delay onset of heart failure, and heart failure drugs can manage symptoms.

    Sadayappan said stem cell theraphy could be a possible treatment. Stemcells would be taken from a patient's heart, genetically engineered to replace the mutated gene with a healthy gene, and then injected back in the patient's heart. But such therapy has not been tested. Nor is there a commercial test for the gene. But Sadayappan and others are actively researching howcMyBP-C functions. and improved understanding of this crucial protein could lead to new drugs to treat heart failure.

    The study has been published in the Jornal of Molecular and cellular cardiology.

    Difference 1 mm can make in angioplasty

    City Doc Gives Sheath A Miss, But Jury Is Still Out On Safety Of Procedure

    Mumbai:It was no regular angioplasty that Ghatkopar resident Birendra Singh under went last week. Not only did the doctors make a tiny puncture on his right wrist instead of opting for the traditional groin route, the puncture itself was much smaller than usual, and the procedure endusred minimal invasion. A stent was inserted into 50-year-old Singh's arteries with a wire and a catheter; no sheath ws used.

    According to doctor Dr Narayan Gadkar, the interventional cardiologist in Kohinoor Hospital in Kural (west) who conducted the procedure, the angioplasty Singh underwent guaranteed less dependence on medication at a slightly lower cost.(See box). "Generally, after puncturing the artery with a wire, we introduce a sheath (a 2.8 mm diameter tube), through which we put a catheter that is generally 1.8 mm in diameter. But I tried a new method, in which we put in a catheter without the sheath," says Dr.Gadkar. The innovation ensured 1 mm of less invasion in the patient's artery and, hence, less pain.

    Angioplasty is a procedure to open narrowed or blocked blood vessels (cornory arteries) that supply blood to the heart. Singh, who suffered a heart attack on May 30, said: "During the angiography, doctors at Kohinoor Hospital discovered there was a blockage in my arteries," Dr.Gadkar had already performed around 50 angiographies without the sheath, and after consulting with Singh, found an ideal candidate in him for the new procedure."Our only requirement was a different catheter for the angioplasty once we realised that the patient had a blockage. We put in a stent and a balloon, and the procedure was over in 30 minutes," said Dr.Gadkar. But he's quick to add that the sheathless procedure can be hazardous to a patient if too much pressure is put on the artery.

    "The artery near the groin is a big one, and has space for even two catheters with sheaths. But the wrist artery is a thin blood vessel-even thinner for Indians. When we insert a sheath in this artery, we are stretching it to a limit. If stretched beyond limit, the artery can burst,or the patient may suffer from hematoma an dmay even reuire a blood transfusion, " said the doctor.

    Stray cases where sheathless angioplasty has been performed in other countries have made it into medical journals. Nevertheless, the cardiology community here remains divided over the efficacy and safety of the new procedure. The sheath is often see as a protective measure. Said Dr Ameya Udyavar from Hinduja Hospital:"Only a part of the sheath is inside the artery. The rest is outside, from where we administer medicines to control blood pressure. If something goes wrong with the cathetrer, we can remove it and insert another one through the same sheath, without puncturing the patient again," he said, adding that the new procedure could be used if done with care.

    Dr. Sudhir Vaishnav of Asian Heart Hospital said:"A sheath is required for proper entry into the artery. The catheter, having a blunt tip, could traumatise the artery. There is no mention in the "normal" literature that it is safe to perform an angioplasty without a sheath. Under local anaesthesia, th epatient will not feel any pain, no matter how big a tue you insert."

    A heart-mending story

    In a first-of-its kind procedure in the country, doctors treat andheri resident Dinah D'Souza who had a 40 mm hole in her heart-without a bypass surgery

    It was unfortunate for 29 years-old Dinah D'Souza that she had been born with the rare condition of a hole in the heart. What made matters worse for her was that, as time passed, it developed into a 40 mm hole which is rather unusual. To treat a hole of this size, so far there was no option but by pass surgery. However, in the first-of its-kind endeavour, doctors at Nanavati Hospital managed to successfully correct the defect in Dinah's case-without any surgical intervention.

    Generally, in patients with atrial septal defect (ASD), the size of the hole in the heart is around 20-35 mm and treatment involves a costly surgically invasive bypass operation. andheri resident Dinah consulted three high profile cardiologists, all of whom suggested the routine bypass surgery. But Dinah was afraid of undergoing invasive surgery and kept exploring options. In time, a friend led her to renowned cardiologist Dr Bharat Dalvi, who said he would treat her without a by pass.

    To correct ASD, doctors use an ASD closure device which resembles an umbrella, and is generally suitable for a hole of 35 mm. As Dinah's case was an exception, a device to fit the size of the hole in her heart was not available in the market. A speciall 44 mm custom-made device had to be ordered from abroad. And, when it arrived a fortnight later, the procedure was successfully done at Nanavati Hospital.

    "I was confident of the procedure and everything worked out fine. We were concerned about the size of the hole in the heart. But after observing the patient for a month and a half we are confident that she is doing well. This is the only case of its kind that I have handled," said Dr.Dalvi, who runs a clinic at Matunga.

    "I was aware of my disease since I was a teenager, but didn't have a problem till I had a daughter. After her birth, I began getting bouts of breathlessness and decided to seek treatment," Dinah told Mumbai Mirror. She added, "I was unaware that the size in my case was rare, but the doctors counselled me well. I'm now doing fine with just two tablets a day which I have to take for a year."

    "We had full faith in Dr.Dalvi who explained the whole process to me. His assurance that he would conduct the bypass free of cost if the device did not work really helped, and we went ahead with his suggestion," said Ronald, Dinah's husband.

    WHAT IS ASD

    ASD is a form of congenital heart defect that allows blood to flow between the left and right atria via the interatrial septum. The interatrial septum is the tissue that divides the right and left atria. Without this septum, or if there is a defect in this septum, it makes it possible for blood to travel from the left side of the heart to the right side, or vice-versa.

    EXPERT SPEAK

    "Treating such a huge hole in the heart without surgery is really commendable. This could have only been done by a cardiologist with exceptional skill," said Dr Ramakant Panda, Senior Cardiac Surgeon, Asian Heart Institute, Bandra.

    "Patients with such an ASD size are generally recommended bypass surgery because it's difficult to treat this condition otherwise. This is indeed a rare procedure which all cardiologists will look forward to using," said Dr.Harish Mehta, Cardiologist, Khar.

    Heart attack kills patient's sex life

    Surviving a heart attack can kill your sex life. But it doesn't have to, and a new study shows doctors play a key role in whether it does. Patients were less likely to resume having sex if their doctors did not talk about when it was safe, the study found.

    Many heart attack survivors fear that a tryst could land them back in the hospital-or even in the graveyard. But the chance of that is extremely small, doctors say.

    "people perceive it might kill them. And it's not just the person with the heart attack, but also their partner" said Dr.Stacy Tessler Lindau, a gynaecologist and sexuality researcher at the University of Chicago."If you can walk up two flights of stairs or do moderate exercise, then it's OK to have sex."

    Lindau led the study, the largest ever on this topic, and was to present results at an American Heart Association conference in Washington. It involved 1,184 male and 576 female heart attack survivors taking part in a bigger nationwide study, funded by the federal government. The average age was 60.

    Less than half the men and only about a third of the women said advice about resuming sex was part of the instructions they got when leaving the hospital. Even fewer had that talk with their doctors over the next year.

    One year after their heart attacks, more than two-thirds of the men and 40% of the women reported some sexual activity. They were 30% to 40% more likely to be having sex if they had talked with a doctor about it.

    A heart attack should not keep people from enjoying sex said Dr. Edward Havranek, a Denver-based cardiologist an dleader of the Heart Association conference. "The risk of having a heart attack during sex is really, really low," he said. "The amount of actual physical exertion people have during sex is actually lower than one might think.It's not as demanding as shovelling snow."

    Think on your feet, to save your heart

    India might soon be the heart attack capital of the world. But if we take timely action within the first hour, 80 per cent of the fatal ones can be reversed. Dr. Hasmukh Ravat tells you how

    If no one in your immediate family has a history of cardiac ailments, chances are that you'd have over looked the 'to-do' posters about heart attacks at your physician's clinic. However, given the high rate of heart attacks in India you can never be sure when there might be one in your family. Here's how you can be better prepared to help a patient.

    THE GOLDEN HOUR

    To understand the precautions, you must know what exactly conspires within your loved one's chest as he/she grapples with the incident. Heart attacks occur due to the closure of one of the three arteries. Hence, blood supply stops and the heart (a muscle as large as you fist) starts getting damaged within moments.

    Your task is to re-establish the blood flow in the blood vessel before further damage. The earlier, the better. Also, if an extensive amount of heart cells die, the remaining cells may not be able to keep the heart pumping. To avoid this, one should facilitate the opening of the artery either by medicine or by quick-angioplasty in the first hour of the attack.

    The term 'golden hour' was coined by military surgeon Adams Cowley, who'd said,"If you are critically injured, you have less than 60 minutes to survive. You might not die right then-but something has happened in your body that's irreparable."

    TAKE YOUR CHANCES

    Why is there so much stress on the initial hour? That's because stats say that more than 80 per cent of heart attacks which could be fatal can be reversed by timely action during the first one hour of the attack. Also, even more critical for survival are the first 30 minutes because action taken then can spell the difference between life and death.

    Conversely, if you don't have the know-how of handling a heart-attack, it can be fatal for someone else; if the artery does not open in the first hour and if the attack goes down drastically. All this would eventually cause mortality or immobility. Chances of the artery opening if you slip in a medicine? 40-45 per cent. Which is why we say, take your chances.

    WHAT YOU NEED TO KNOW

    While it's natural to panic while witnessing a heart attack, you must gather yourself soon and take these crucial steps if you suspect someone showing untoward behaviour/signs...

    Check the patient's breathing an dthe carotid pulse(by placing a finger on the side of the throat, below the line of the ear) if they're both functioning.

    Make him/her lie on the floor, tit him/her to the left and make him/her lie on the side.

    Raise the legs 12-18 inches up till the knees near the abdomen. This will enable more blood flow to heart.

    Bring him/her back to lying position. Blow air in the mouth (Mouth-to-mouth respiration) After this, immediately place one palm just over the lower part of the sternum (breast bone). Keep the other palm on this palm and pump hard. Do this twice per second for about a minute.

    Continue blowing of air an dpumping tillyou feel the heart beat retuning to normal.

    Once the breathing is normal, seek your nearest medical expert.

    A STITCH IN TIME

    When south Mumbai resident Rohitan Bamboat, 50, called out to wife Mehru while watching TV, she didn't take him seriously. But it was only after he walked in, complaining of chest pain, that it struck her that trouble was around. "He was sitting up straight in the bed, and I spotted his palpitations. First, I dissolved a Dispirin in water and gave it," she recalls. Then, almost simultaneously, Mehru performed two actions which saved her husband."I called our cardiologist. Next, I called my chemist to deliver Angised tablet, which I slipped under his tongue. Within half an hour, the doctor arrived and took an immediate cardiogram," she says.

    Bamboat was hospitalised within an hour of the incident and a 99 per cent artery block was discovered. A healthy recovery later, Bamboat pursed alternative medicines and has kept the heart attack at bay. The cardiologist admitted later that it was the timely action taken by Mamboat's wife that had saved him.

    Matters of the heart

    On the occasion of world Heart Day on 27 September, various events are being planned by organisations across the country.

    A story that Dr. B.K. Goyal, the well known cardiologist, likes to tell visitors these days is about a 28-year-old domestic servant who was brought to Bomay Hospital with symptoms of a heart attack. The man did have a mild attack, which was discovered after repeating his ECG at least thrice, but his heart did not suffer much damage because the doctors treated him with a recetly discovered medicine. Subsequent investigation revealed that the arteries of his heart were not blocked, but had shut down temporarily because of a spasm. The real culprit a long-standing habit of chewing tobacco! This particular patient was not an exception, but merely the latest example of a growing trend of people in the lower middle class who develop diabetes, high blood pressure and heart disease considerably more often than their employers.

    "At least four million people in India suffer heart problems serious enough to require medical intervention, such as cardiac surgery or angioplasty, and their number is increasing steadily," Dr.Goyal says. This means the facilities for heart surgery in the country, whether in the public health system or the large corporate hospitals, are grossly insufficient to meet the demand, and the situation is likely to remain that way in the foreseeable future.

    The economic impact of attempting to provide adequate healthcare services is also quite staggering. Even in public hospitals, the expense involved in an open heart surgery is not less than Rs.80,000-90,000, while the cost of a bypass surgery in most private hospitals is about Rs.2 lakh, and the expense involved in angioplasty with a stent procedure could be up to Rs.3 lakh. Thus, if we assume the average expense per patient is about Rs. 1.5 lakh, the total burden of curative treatment for four million people is about Rs.60,000 crore- that is, four times the total annual health budget of the entire country! even if these stupendous amounts of money were somehow made available, the number of medical centres in India capable of conducting such hi-tech procedures would prove grossly insufficient. According to some experts, there are less than 100 fully equipped centres in the entire country. The capital expenditure required to set up enough hospitals to take care of all the patients waiting for heart surgery would be beyond the capacity of the private and public sectors put together.

    Hence, the only way to bring down the huge numbers of sick people is for everyone to take preventive measures as quickly as possible. "World Heart Day, being observed on 27 September, is a good occasion to remind ourselves about what we all have to do," Dr.Goyal says. On this day, commemoratie events are organised in various parts of India, as well as in different countries all over the world, usually based on a particular theme announced by the World Heart Federation.(www.world-heart-federation.org). The theme for 2009 is'Work with heart'.

    In keeping with the WHF theme for this year, the Cardiological Society of India (CSI), Kerala chapter, has planned a health awareness programme in several districts of the state, a medical exhibition involving medical schools and nursing schools aimed at public education, and a seminar on 'Healthy heart in the work place' involving cardiologists, doctors working at large factores, trade union leaders and factory owners. Likewise, the Mumbai-based National Society for Prevention of Heart Disease and Rehabilitation (NSPHERE) has planned a 'Walk for your heart' in the suburbs of Mumbai; and the Indore chaptper of CSI will organise a 'Run for your heart' on the same day. Others have heart disease screening camps, both for the general public and for specific groups such as school students.

    Other organisations that have planned events include: Doorstep Cardiology, Pune; Hridayalaya, Trivandrum; Institute of Integrative HealthCare, Pune; Manipal Health Systems, Salem: Narayana Hrudayalaya Institute of Cardiac Sciences and Research centre, Bangalore; Padmavathy Heart Institute of , Kerala; People Health Services Pvt Ltd, Bangalore; PSG Hospitals, Coimbatore; N.S.Institute of Medical Sciences, Kollam; Sanecare; Srinivasa Heart Centre, Andhra Pradesh; Sugapriya Hospital, Madurai; and Vydehi Institue of Medical Sciences, Bangalore.

    Most of these events will be aimed at avoiding risk factors such as use of tobacco, excessive alcohol consumption, high blood pressure, obesity, physical inactivity and unhealthy diets. abnormal bood lipid levels, that is high total cholesterol, high levels of triglycerides, high levels of low-density lipoprotein (HDL) cholesterol, all increase the risk of heart disease and stroke. Changing to a healthy diet, exercise an dmedication can modify an individual's blood lipid profile.

    An important risk factor is tobacco use-whether it is smoking or chewing tobacco, it increases the risk of cardiovascular disease. The risk is especially high if you started smoking when young, smoke heavily or are a woman. Passive smoking is also a risk factor for cardiovascular disease. Stopping tobacco use can reduce the risk of cardiovascular disease significantly, no matter how long you have been smoking.

    Physical inactivity increases the risk of heart disease and stroke by 50 per cent. Obesity is a major risk for cardiovascular disease and predisposes you to diabetes. Diabetes is also a risk factor for cardiovascular disease.

    Type-2 diabetes is another major risk factor for coronary heart disease. Having diabetes makes you twice as likely, compared to someone who does not, to develop cardiovascular disease. If you do not control diabetes, then you are more likely to devlop cardiovascular disease at an earlier age than other people and it will be more devastating. If you are a premenopausal woman, your diabetes cancels out the protectie effect of estrogen and your risk of heart disease rises significantly.

    How to's of exercise

    While regular walks and a higher level of physical exercise ae an integral part of most doctors' recommendations, NSPHERE has a word of caution for people who have been placed on regular medication for controlling high blood pressure."On the occasion of World Heart Day, I would like to emphasise that people who ae on medication for uncontrolled blood pressure or diabetes should not go for their morning walk except after proper consultation with a cardiac specialist," says NSPHERE president and noted cardiologist Dr. V.T.Shah.

    Another mistake that many people make is to go for their morning walk immediately after getting up in the morning, and taking their medication after coming back. What they should do instead is to take the medication first, allow sufficient time for the medicines to start their action, and then go out for their daily walk."Many cases of heart attacks and even deaths ae reported during or after the morning exercise. So get a stress test, blood glucose and fitness test done before you start an exercise programme, especially in the morning," says Dr. Shah. Another misconception that people have is that yoga is an exercise. In fact, yoga helps to de-stress the body an dmake it more flexible. Hence, it is a good idea to perfor yoga and then start the regular routine of exercises.

    While alot of the discussion and debate on heart disease revolves around ischemic heart disease (responsible for heart attacks in adults), a sizeable proportion of patients waiting for heart surgery are young children with heart valve defects or other problems. Two common reasons for this are: rheumatic fever (which affects the heart and various joints in the body), and congenital heart disease (which is already present at the time of birth). In this regard, the recent inauguration of a paediatric heart surgery centre at the Kokilaben Ambani Hospital in Mumbai is a step in the right direction. The timing is also appropriate, since it comes just two weeks before World Heart Day. It is Mumba's first hospital to have a world-class facility, multi-specialty unit, state -of-the-art infrastructure and a dedicated team of trained round-the-clock congenital paediatric cardia surgeons, paediatric cardiologists, paediatric cardiac anesthesiologists, intensive care specialist, perfusionist, nurses, counsellors and other paramedical staff."We expect to be performing at least two surgical operations each day before too long," says Dr. Suresh Rao, the paediatric heart surgeon who moved from Kerala's Amrita Institute of Medical Sciences three months ago, to head the unit here.

    Working with him will be two other paediatric heart surgeons, four research fellows and a team of specially qualified nurses and technicians.

    Popular diabetes drug raises risk of heart attack : Study

    (Avandia) reported an increasing evidence of heart risk, strokes and death, fuelling a debate on this hotly-contested drug, world-wide and in India, and raising questions on whether it should be banned by regulators.

    The issue assumes significance in India as rosiglitazone is a widely-prescribed diabetes drug, marketed by at least 10 companies, including Torrent, Dr.Reddy's Cipla and Glaxo SmithaKline (GSK) India.

    Avandia has been under the scanner over the last three years, when one of the first studies reported that it increased heart attack risk in diabetics, after which the US Food and Drug Administration (FDA) issued a safety alert. Subsequently, the drug was marketed with a 'black box warning'.

    The latest study commisioned by the FDA, and published in the Journal of American Medical
    Association (JAMA) observed 2,27,571 Medicare beneficiaries aged 65 years or order, who initiated treatment with rosiglitazone or a related drug, pioglitazone, from July 2006 to June 2009, and who underwent follow-up for up to three years.

    A total of 8,667 heart attacks, strokes, heart failure and deaths were observed during the study period. Patients who were prescribed rosiglitazone reported 6% more heart attacks as compared to those on pioglitazone; 27% more strokes; 25% more heart failoure an d14% more deaths.

    Dr.David Graham of the FDA, the study's lead author; said the results are alarming.

    Dr.Anoop Misra of Fortis Hospitals, Delhi, said,"In view of repeated and decisive data, rosiglitazone has no place in the management of diabetes. In India, this drug should be banned due to less than adequate knowledge of adverse effects by general practitioners in remote areas, and poorly informed patients."

    A GSK India Official declined to speak on the issue, while the drug controller general was not available for comment.

    The JAMA study was released two weeks before a crucial US FDA advisory panel meets to decide on the medicine's future.

    In India, the drug is more popular in towns, an dwidely prescribed in an estimated 20-30% of diabetics.

    LUDHIANA: In what would be good news for parents whose newborn kids or infants are found to be suffering from paediatric/congenital heart disease (CHD), they might no more have to head for Delhi for treatment of the disease as city hospitals are gearing up to open paediatric heartcare clinics in the city. The first such clinic was inaugurated on Saturday by SPS Apollo Hospital while other hospitals are planning to do so in the next year.

    Parents from different districts of Punjab are to visit either Chandigarh or Delhi for treatment of heart diseases their kids are suffering from, but with inauguration of this clinic, their treatment would be much more accessible. And in the near future, other city hospitals are bound to follow suit.

    In Hero DMC, a separate wing for treatment of newborns, complete with a special intensive care unit and equipment that goes with it, is operating, but when it comes to serious cases, they tend to refer kids to Delhi. They would open a full-fledged centre most probably in the next year. Christian Medical College and Hospital (CMCH), on the other hand, has a team of doctors to provide treatment to kids suffering from the disease and it is working towards further expansion.

    Doctors believe the disease could easily be diagnosed during pregnancy period after conducting a simple test foetal echo-cardiology, through which doctors could judge whether the disease is curable. If the problem is treatable, they advise parents to go for the delivery, otherwise they suggest them abortion.

    Commenting on ignorance among people in general and among doctors in particular, Dr TS Gambhir, senior consultant paediatrics at SPS Apollo Hospital, said lack of awareness is one of the prime causes of delayed detection of the disease.

    He added that in our country, births largely occur without supervision of a paediatrician or neonatologist and the ability of most paediatricians to detect heart diseases is very limited.

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    US and Europe but is yet to be approved in India. Now, an Indian has gone ahead and tried it, paving the way for those who would like to opt for the technique abroad until it is approved back home.

    Santosh Dugar, a 52-yearold realtor from Kolkata, flew to Hamburg, Germany, in May to undergo MitraClipping to plug a leaking valve. The surgery has been successful.

    Dugar had undergone an angioplasty and a pacemaker was fitted to correct his condition. But that was not enough. He needed to get a leaking valve stitched.

    The only way out seemed the conventional open heart method, which could have been risky in his case. "An open chest surgery might have been fatal.

    He had consulted the best surgeons in India but they advised him to stick to just clinical therapy. MitraClipping was the only method applicable. So, I helped him get in touch with a hospital in Hamburg that agreed to do it," said cardiac surgeon P K Hazra, who served as the second operator in the surgery.

    Around 150 such surgeries have so far happened in west European nations. "I got in touch with Ola Franzen of Eppendorf Hospital in Hamburg. He agreed to do it and took me as a second operator. The surgery passed off smoothly and Dugar was back in India in a week's time," said Hazra.

    MitraClipping is done by inserting a tiny clip-like device in a catheter that reaches the heart and plugs the leaking valve. Hollywood actress Elizabeth Taylor was one of the first celebrities to have a Mitra-Clip. It is believed the clip is far safer than surgery and nearly as effective. A study presented at the American College of Cardiology conference found that people with conventional surgeries suffered major complications six times more than those with the MitraClip. It is already on sale in Europe and manufacturer Abbott Laboratories hopes to win approval to start selling it in the US next year. In India, the therapy is expected to receive the go-ahead by 2011.

    "Next month, a Delhi hospital will perform the first aortic valve replacement in India. We expect MitraClipping to receive the green signal in a year. It holds out hope for patients who can't undergo an open heart," said Hazra, who attended a training programme in Hamburg and took part in five surgeries there.

    "It took my father just a couple of days to recover. He didn't have to be hospitalized in India. He is back to work," said Ravi Dugar, the patient's son. While a MitraClip costs Rs 5 lakh, expenses of the technique to get it inserted - if done in Europe - could be more than Rs 20 lakh. The cost is expected to be half of that once the procedure begins in India.

    Boon for COMPLEX SURGERIES 1 How is MitraClipping done?

    It is done by inserting a tiny clip-like device in a catheter that reaches the heart and plugs the leaking valve 2 Why is it better than conventional heart surgeries?

    A study presented at the American College of Cardiology conference found that people with conventional surgeries suffered major complications six times more than those with the MitraClip 3

    When will it come to India?

    How much does it cost?

    A MitraClip costs Rs 5 lakh and the surgery, if done in Europe, could cost more than Rs 20 lakh. The cost is expected to be half of that once the procedure begins in India

    Hollywood actress Elizabeth Taylor was one of the first celebrities to have a MitraClip

    US and Europe but is yet to be approved in India. Now, an Indian has gone ahead and tried it, paving the way for those who would like to opt for the technique abroad until it is approved back home.

    Santosh Dugar, a 52-yearold realtor from Kolkata, flew to Hamburg, Germany, in May to undergo MitraClipping to plug a leaking valve. The surgery has been successful.

    Dugar had undergone an angioplasty and a pacemaker was fitted to correct his condition. But that was not enough. He needed to get a leaking valve stitched.

    The only way out seemed the conventional open heart method, which could have been risky in his case. "An open chest surgery might have been fatal.

    He had consulted the best surgeons in India but they advised him to stick to just clinical therapy. MitraClipping was the only method applicable. So, I helped him get in touch with a hospital in Hamburg that agreed to do it," said cardiac surgeon P K Hazra, who served as the second operator in the surgery.

    Around 150 such surgeries have so far happened in west European nations. "I got in touch with Ola Franzen of Eppendorf Hospital in Hamburg. He agreed to do it and took me as a second operator. The surgery passed off smoothly and Dugar was back in India in a week's time," said Hazra.

    MitraClipping is done by inserting a tiny clip-like device in a catheter that reaches the heart and plugs the leaking valve. Hollywood actress Elizabeth Taylor was one of the first celebrities to have a Mitra-Clip. It is believed the clip is far safer than surgery and nearly as effective. A study presented at the American College of Cardiology conference found that people with conventional surgeries suffered major complications six times more than those with the MitraClip. It is already on sale in Europe and manufacturer Abbott Laboratories hopes to win approval to start selling it in the US next year. In India, the therapy is expected to receive the go-ahead by 2011.

    "Next month, a Delhi hospital will perform the first aortic valve replacement in India. We expect MitraClipping to receive the green signal in a year. It holds out hope for patients who can't undergo an open heart," said Hazra, who attended a training programme in Hamburg and took part in five surgeries there.

    "It took my father just a couple of days to recover. He didn't have to be hospitalized in India. He is back to work," said Ravi Dugar, the patient's son. While a MitraClip costs Rs 5 lakh, expenses of the technique to get it inserted - if done in Europe - could be more than Rs 20 lakh. The cost is expected to be half of that once the procedure begins in India.

    Boon for COMPLEX SURGERIES 1 How is MitraClipping done?

    It is done by inserting a tiny clip-like device in a catheter that reaches the heart and plugs the leaking valve 2 Why is it better than conventional heart surgeries?

    A study presented at the American College of Cardiology conference found that people with conventional surgeries suffered major complications six times more than those with the MitraClip 3

    Dr Pradhan said to be able to meet the challenge medication needs to be altered. "Seeing your doctor is the first step towards prevention. Keeping the history of the patient and his specific needs in mind, the doctor would increase the potency of the blood pressure control medicine or add a new drug as required," he said, adding that skipping one's medicines during winter was a crime. "One has to understand that the risk of stroke doubles for a patient during winters and medicine was the only way for prevention," he said.

    Considering low-salt diet was essential to keep blood pressure under control, doctors also warn against additional sources of salt during winters. The season is full of options that tend to add extra salt in one's diet. Munching on winter snacks like matar ghugri (green peas), peanuts and pop corns or adding items like chutney which is very common in the Indian setting must be avoided. "Every drop counts you see...patients rarely realise that the intake of salt in their diet has gone up and later pay the price for the indulgence," said Poonam Tewari, consultant dietician at a private hospital.

    Heart related complications also rise among those suffering from blood pressure problems as the increased pressure stresses the heart. It is a known fact that occurrence of heart attacks in people with hypertension and high blood pressure is twice as high during winter "The rise in blood pressure can prove fatal for those with a history of cardiac disease," said RK Saran, head of cardiology department, King George's Medical University. "The cause of trouble here is that blood becomes thicker and stickier, a condition that favours clot-formation," he explained.

    His colleague Dr Rishi Sethi added that cholesterol levels too tend to go up during winter. Coupled with flu-like symptoms and respiratory infections, it may lead to inflammation that contributes to the rupture of artery-clogging plaques. Cold winter morning.

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