Having
questions about Cardiac care? Here are a few FAQs answered by Cardiologist Dr.Refai Showkathali
1.
Does gender play a role
in heart diseases?
Absolutely…There are few differences in the way heart
disease present between genders. Coronary artery disease (CAD), which includes
heart attack, is more prone for men than women in younger age group. Studies
have shown that women are protected by some extend from coronary artery disease
until menopause. This is due to oestrogen secretion. However, this doesn’t mean
that pre-menopausal women won’t get coronary artery disease. Lately, due to
lifestyle changes and stress, there are increasing number of pre- menopausal
women presenting with CAD.
There are few other forms of cardiac diseases, which
are more prevalent in women than men. Rheumatic heart disease, for example
affect women more than men.
2. Is cholesterol
different from fat?
Cholesterol is a form of fatty substance, but not all
fats are cholesterol. There are various type of cholesterol- good (HDL) and bad
(LDL) cholesterol. There is another substance called triglyceride, which is
another form of fat, which is also harmful to the heart in excess.
3. Does geography play a
role in heart diseases?
For instance, we see
coconut oil being used extensively in kerala, but people in Kerala are not at a
higher risk for heart ailments, they are as susceptible as others, whereas if others
outside Kerala consume coconut oil their risk increases. is it a correct
perspective?
I do not think there is any clear evidence to suggest
that the heart ailments are low in kerala. On the contrary, a multi centre
study by Cardiology Society of India (CSI) kerala Chapter- showed that the
prevalence of CAD continues to be high in kerala with no urban- rural split as
seen in other states of India. This is despite the state with highest literacy
rate in India (thereby more awareness and precaution). Prevalence of premature
heart disease in rural kerala is 7%, which is nearly double that of north
India. All these put together, the main reasons for increased cholesterol
levels and premature coronary artery disease is probably due to their food
habits, including the high intake of coconut. Please see this links about this:
There are numerous debates about the usefulness of
coconut oil. There are few health benefits of using coconut oil- due to the
presence of lauric acid, which has some healing power and anti- microbial
activity, thereby helpful for external application. However, the high content
of saturated fat in coconut oil is well proven and therefore should be used in
limitation, particularly for cooking.
4. We hear that eating
almonds, walnuts help your heart. Aren't there cheaper options for the common
man?
True…Eating almonds and walnut have some beneficial
effect in preventing heart ailments. But please understand that, just by eating
these things alone without regular exercise and continuing to smoke will not
prevent from heart disease. They only give added benefit in an already healthy
person without other risk factors. My main advice would be to make sure that
the common risk factors are avoided. There are plenty of vegetables and fruits,
which have antioxidant properties that are beneficial for the well being of the
heart. The other simple things people can do is to avoid high carbohydrate
diet- so rice once a day should be enough. Millets, other wise called as Ragi
can be used as a cheaper alternative to prevent heart disease.
5. FIrst-Aid during
heart attack
Firstly, not all patients with heart attack have the
typical symptoms as described in books or shown in movies or in dramas. If they
have the typical symptoms of heart attack, such as severe central crushing
chest pain radiating to the left arm or jaw with profuse sweating, they need to
rush to the nearest heart centre. If they have medicines such as Aspirin or
clopidogrel (blood thinners) at home, they can take it before. They should not
panic, but keep taking deep breaths in and out. If they start to feel dizzy and
feels like going to collapse, it is better to keep coughing continuously. These
cough triggers will help them prevent from collapsing and this should be
continued until help arrives.
If you are a family member with the patient or
happened to be a bystander, make sure that the patient is breathing normally and
call for help (ambulance) as soon as possible. In the unfortunate event of the
person collapsing in front of you, the first thing is to put them in a sideward
sleeping position and not on their back. Then shout their name to see if they
respond and if not, feel for a pulse. This can be done by putting your index
and middle fingers in the neck at the groove between the windpipe and muscle
(side of the windpipe). If you can’t feel a pulse, extend their neck. Then
start giving chest compressions after putting them on their back. This should
be done on the left side of the middle bone in the chest, at a rate of
approximately 100 compressions per minute. This should be continued until help
arrives.
6.How do heart ailments
affect other organs?
As most of you know, heart is the lifeline of the
body, giving blood supply to all the other organs. So obviously, if the heart
is affected, there is increased risk of developing problems in the other
organs. The commonest organ affected by heart is the lung, which is closely
connected to the heart. If the heart does not pump normally, this will cause
fluid collection in the lungs there by causing breathing difficulty. Over a
period of time, poor heart pumping can lead to kidney problems due to reduced
blood supply to the kidneys. Reduced blood supply to brain can cause blackouts
and giddiness. Abdominal swelling and leg swelling are also classical signs of
poor heart function.
7.Your definition of a
healthy heart
There is no clear definition of healthy heart in
medical terms. As long as the heart is pumping well, without any blockages in
the heart- this is considered to be healthy. The best way to find this out is
doing regular exercise of moderate intensity lasting 45 mins per day for at-least
5 days a week without any problem. This is the recommendation from the world
health Organisation (WHO) to have a healthy heart. Moderate intensity means
achieving atleast 75% of the target heart rate for the individual- which could
be achieved by any form of exercise- brisk walking, jogging, cycling, swimming
etc..It is the intensity of the exercise to stress the heart is more important
than the type of exercise you do.
8. Pick one major
contributing factor for heart diseases
In our country, Diabetes stands out to be the
commonest contributing or risk factor for heart diseases. You may have heard,
time and time again that, India is considered to be the diabetes capital of the
world. But the good news is, if your diabetes is under control, you can
continue to live healthy for long time. Being a diabetic patient itself is not
a problem; it is the control of diabetes, which has an impact in your heart,
and of course, other organs of the body. Diagnosing early is another way of
preventing the complications of Diabetes.
9. Are alternative
therapies as successful as allopathy in treating heart conditions?
Being an
allopathic doctor, I’m not trained in alternative medicine and therefore I’m
not aware of the effects of alternative therapy. The one thing I would say is
as long as there is evidence-based medicine, with trials been conducted on
large number of people to prove the efficacy and safety of therapy; I would not
have any problem in that. Allopathic medications are tested in big clinical
trials before being released in the market.
10. How is angiogram performed?
Coronary angiogram
is a simple procedure to look for blockages or narrowing in the blood vessels
that supply the heart. As most of you know, the heart supplies blood to all the
other organs of the body. But the heart itself needs nutrients and this is
supplied by coronary arteries, which are called the lifeline of the heart,.
Nowadays, Coronary angiogram is performed in cardiac catheter lab, mostly
through the wrist and rarely through the groin. This is performed under local
anaesthetic without putting into sleep and the patient can be discharged on the
same day. This involves putting a small tube through the wrist and reaching the
heart. An iodine-based dye is injected through this tube and pictures are taken
by an xray camera in different angles while the patient lies on the cardiac
catheter lab table. The procedure takes around of 5-10 minutes in most patient
and can walk out of the hospital on the same day. Depending on what we find on
the coronary angiogram, further decisions will be taken about treatment options
after discussion with patient and family.
11. How is angioplasty performed?
Angioplasty
is a procedure to open up the narrowed blood vessels in the heart, which is
diagnosed by doing an angiogram. Most angioplasties are performed through the
wrist and the procedure is very similar to angiogram to start with. It involves
passing a slightly bigger tube in the wrist and passing wires and balloons to
stretch the artery first. This is followed by inserting a stent in the artery
to keep the artery enlarged preventing re-narrowing in the artery. Stent is a
mesh like metallic tube which is left in the artery without any harm to keep
the artery open and improve the blood flow. Depending on the number of
blockages, the procedure times vary anything between 20 minutes to couple of
hours. Most angioplasties do not take more than an hour. Once the procedure is
over, the patient will be shifted to the ward and can be discharged in a day or
two. We normally recommend to keep it easy for the next 2 days at home and then
can get back to their normal life over the next week. Once after1 week, if the
heart function is not damaged- there is no restriction to carry out their
normal life. The crucial thing is to make sure that the medicines are taken
regularly until review by the cardiologist.
This is a
question asked by patients time and time again after having an angiogram.
Unfortunately, There is no simple answer to this question. It depends on
various factors and circumstances of the individual patient and the expertise
of the doctor looking after the patient. The technology of stenting is growing
dramatically and now we are using the fourth generation of stents, which has
very good long-term results. This is the reason why in western countries, the
number of bypass surgeries are declining over the years….Thanks to the
technology, angioplasty can be performed in most patients, even in complex
situation. There are so many advantages of angioplasty, particularly due to the
quick recovery time compared to surgery.
However, there are certain group of patients who do well with bypass
surgery than stents over a long period of time. Irrespective of the treatment
given, patient has to continue some important cardiac medication and keep their
Diabetes, Hypertension and Cholesterol under control to prevent further
problems in the future. The blood thinner medicines should not be stopped
without discussing with the cardiologist.
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