Cardiology Procedure

Beriberi Disease

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

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

There are two types of beriberi disease:

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

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

Who’s most at risk for beriberi?

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

Other people at more risk for developing beriberi include:

• Breastfed babies whose mothers are thiamine deficient

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

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

• Anyone with hyperthyroidism condition, which might prevent thiamin absorption

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

• Anyone with high levels of stress

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

What are the symptoms of beriberi?

The symptoms of beriberi may differ depending on its type.

Symptoms of wet beriberi may include:

• Increased heart rate

• Shortness of breath

• Waking during the night due to shortness of breath

• Swelling in the legs and feet

• Severe lack of energy or constant fatigue

Symptoms of dry beriberi may include:

• Vomiting

• Difficulty walking

• Confusion

• General pain and body aches

• Numbness in the hands or feet

• Paralysis in the lower legs

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

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

• Memory loss or inability to form new memories

• General confusion

• Rapid eye movement

• Involuntary eye movement

• Blurred or double vision

• Loss of muscle coordination

• Hallucinations

What causes beriberi?

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

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

How is beriberi diagnosed?

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

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

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

How is beriberi treated?

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

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

New Hope for Patients at Risk of Stroke

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

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

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

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

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

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

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

Why Quitting Smoking Is The Hardest Thing To Do

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

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

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

Smokers at higher risk of COVID-19 infection

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

Why is it hard to quit smoking?

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

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

Difficult Roads Lead to Beautiful Destinations 

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

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

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

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

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

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

Smoking: Should I Use Nicotine Replacement to Quit

Smoking: Should I Use Nicotine Replacement to Quit?

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

Your Choices

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

Key Points In Making Your Decision

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

Consider The Following Factors When You Make Your Decision:

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

Types of Nicotine Replacements

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

Here Are Some Things To Consider While Making That Choice:

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

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

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

Travelling and Driving After Heart Attack

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

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

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

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

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

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

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

Driving

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

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

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

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

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

Heart Failure

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

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

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

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

Implantable Cardioverter-Defibrillator (ICD)

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

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

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

Vehicle Insurance

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

Your Licence

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

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

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

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

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

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

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

Medicines And Driving

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

Metabolic Syndrome

Metabolic Syndrome

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

1. Too much fat around your waist.

2. Borderline or high blood pressure.

3. Borderline or high blood sugar.

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

5. Low “good" HDL cholesterol.

What causes it?

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

What are the symptoms?

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

What increases your risk?

You are more likely to have metabolic syndrome if:

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

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

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

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

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

How is it treated?

Get more exercise

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

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

2. Raises HDL, the “good" cholesterol.

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

Change how you eat

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

To get started:

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

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

3. Eat lots of fruits and vegetables.

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

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

6. Eat beans, lentils, and nuts.

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

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

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

Take medicines if necessary

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

Dr Deepak Krishnamurthy MD, DNB
Senior Interventional Cardiologist 

Book an appointment with Dr Deepak Krishnamurthy - https://www.sakraworldhospital.com/doctors/dr-deepak-krishnamurthy-institute-of-cardiac-sciences/35

Intravascular Ultrasound (IVUS) for precision angioplasty

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

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

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

Aortic valve Surgery: Types of Repair and Reconstruction

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Other Kinds of repair

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

Link to the lecture program is given below

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

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

A link of the proposed program is given below

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

What You Should Know About Coronary Angiography

What is Coronary Angiography?

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

When is a Coronary Angiography needed?

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

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

2. or in those who have a positive treadmill, 

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

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

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

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

Are there any risks involved?

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

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

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

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

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

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

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

How is a Coronary Angiography performed?

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

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

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

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

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

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

What is a Heart Attack?

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

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

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

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

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

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

What are the classical symptoms of a Heart Attack?

Common heart attack signs and symptoms include:

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

2. Nausea, indigestion, heartburn or abdominal pain

3. Shortness of breath

4. Fatigue

5. Lightheadedness or sudden dizziness

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

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

How can a Heart Attack be diagnosed and treated?

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

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

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

Dr. Sreekanth B. Shetty
Senior Consultant & Head - Interventional Cardiology
MD (Internal-Medicine), DM (Cardiology)
Institute of Cardiac Sciences

Unstable Angina: Causes, Symptoms and Prevention

What is Unstable Angina? 

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

What causes Unstable Angina?

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

What are the characteristic symptoms of Unstable Angina?

Characteristics of unstable angina (a medical emergency) include:

1. Can occur even at rest

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

3. Is often unexpected

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

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

6. Might signal a heart attack

How can Unstable Angina be diagnosed and managed?

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

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

Dr. Sreekanth B. Shetty
Senior Consultant & Head - Interventional Cardiology
MD (Internal-Medicine), DM (Cardiology)
Institute of Cardiac Sciences

Angina: Causes, Symptoms and Prevention

What is Angina?

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

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

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

What causes Angina?

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

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

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

What are the symptoms of Angina?

Symptoms associated with angina include:

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

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

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

How can Angina be diagnosed and managed?

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

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

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

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

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

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

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

Dr. Sreekanth B. Shetty
Senior Consultant & Head - Interventional Cardiology
MD (Internal-Medicine), DM (Cardiology)
Institute of Cardiac Sciences

Successful Knee Replacement Surgery on a High-Risk Cardiac Patient

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

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

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

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

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

Trans fat is double trouble for your heart health

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

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

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

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

What is trans fat?

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

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

Trans fat in your food

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

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

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

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

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

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

Reading food labels

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

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

How low should you go?

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

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

How trans fat harms you

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

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

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

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

What should you eat?

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

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

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

Blog by

Dr.Deepak Krishnamurthy
MD,DNB - Senior Consultant,
Department of Interventional Cardiology

Heart attack: The Golden Hour

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

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

Window of opportunity:

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

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

Steps to be taken:

• Recognize the symptoms

• Call for help immediately

• Reach the hospital promptly.

Watch out for these signs: 

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

• Breathlessness without any chest discomfort, especially in diabetics.

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

What’s wrong and how to fix it?

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

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

Be prepared:

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

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

• Try to go by ambulance.

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

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

Prevent the attack:

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

What to do if a person suddenly collapses?

Follow these pointers diligently:

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

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

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

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

Preventing heart disease and strokes never too early

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Blog by

Dr. Sreekanth B. Shetty
HOD & Senior Consultant,
Interventional Cardiology,
Sakra World Hospital.

Chronic Total Occlusion Angioplasty

Are you suffering from complex heart blockage?

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

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

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

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

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

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

Blog by

Dr. Sreekanth B. Shetty,
Senior Consultant- Interventional Cardiology,
Sakra World Hospital

Life Changing Cardiac LIS

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

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

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

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

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

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

Blog by

Dr. Adil Sadiq
Senior Consultant & Head - Adult Cardiothoracic Surgery,
Sakra World Hospital, Bangalore

Heart Attacks A heart stopping tale

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

What is a heart attack?

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

What causes a heart attack?

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

What are the symptoms?

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

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

What should I do in case of a heart attack?

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

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

Am I at risk?

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

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

Can I prevent heart attacks?

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

Will a heart attack treatment affect my daily life too?

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

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

Sakra Cardiac Sciences for Complex Angioplasty

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

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

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

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

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

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

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

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

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

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

Mr. A, a 35 year old software professional had been looking forward to a holiday with his family. It would be a much wanted break from his stressful schedule. Work had been hectic and he was doing 14 hour shifts and taking work home. He had always smoked but it only got worse in the last few months. An active sportsman during his college days, he had virtually stopped exercising and has been noticeably putting on weight. His friends were making fun of his “beer belly”. Weekends were for partying with friends to beat the stress. Lunch was mostly at the office cafeteria. Of late he felt tired easily and short on stamina. He had been planning to get his annual health check up; it had been pending for the last 2 years. The last time his doctor had warned him that his sugars and lipids were creeping up and he had to pay attention.  That morning he started feeling a nagging heaviness in his chest and a hollow discomfort in the arm. He also had little cold sweat and felt nauseous.

He thought it may be because of the food he had the previous night might caused him acidity. His wife however was worried .She knew he needed urgent attention. She brought him to the Emergency Room at Sakra World Hospital, which was 10 minutes drive from home. After a quick physical evaluation, the doctors at the ER did an ECG and found that he was having a heart attack. They were glad that the family had arrived without wasting time because early treatment would mean less damage to the heart and quicker recovery and return to normal life. The doctors assured the family that, though heart attacks are dreadful, with a quick opening of the occluded artery of the heart by doing an angioplasty, risk would be substantially reduced.

Mr .A was taken to the Cath-lab within 20 minutes of arrival and an angiogram was done through his wrist artery (Radial access – lest discomfort compared to the conventional groin artery approach) . His right coronary artery was found totally blocked in its mid part and that was cleared with angioplasty and stent. He had immediate relief of chest pain and the cardiologists were satisfied to see the prompt recovery on the ECG. He spent 2 days in the hospital including one day in the CCU and was discharged .The pre-discharge ECHO (Scan of the heart) showed that the damage was very minimal. He had a near normal Ejection fraction of 55%. EF below 35 % would have put him at risk of heart failure.His wife’s presence of mind and getting him to the right place at the time made a big difference.

Time in treatment is one of the biggest determinants of outcomes in heart attacks as in any life-threatening medical emergencies. Reaching a fully equipped hospital at the shortest possible time is important rather than to go through multiple levels of care in between. Hospitals equipped with a cath lab with 24x7 availabilities of cardiologists, supported by a team of trained nurses and technicians available round the clock can provide the best care for heart attacks. A fully equipped ER run by highly trained Emergency specialists and Nurses helps achieve prompt response to any life threatening emergency.

He has now promised himself that he will create a proper work life balance and have a healthy family time. He has since stopped smoking and reduced alcohol intake. A diet rich in veggies and fruits, healthy nuts like almonds and walnuts, using healthy oils like olive oil, rice bran oil and sunflower oil has replaced fast foods. Rice based diet has been replaced with whole wheat, all bran and oats. He is now walking regularly, at least 45 minutes on most days of the week. Yoga has given him relaxation and peace. He has been advised to strictly follow the medications to avoid recurrences of his heart problem.

Mr.A has taken this episode as a course correction in his life to put him on the path of healthy living. He has taken it upon himself to guide his children to an early adoption of healthy lifestyle .He is amongst the millions of young Indians who because of rapid urbanization and increasing affluence are suffering the consequences of excess without moderation in consumption and no parallel increase in attention to lifestyle .Lifestyle disorders like diabetes, hypertension, high cholesterol and obesity are on the rise and these in turn increases the risk of heart diseases and stroke. Preventive interventions are always more cost effective. These interventions focus on modifiable risk factors like diabetes, hypertension, high cholesterol, smoking, obesity and sedentary lifestyle.

There are other risk factors that are not modifiable, such as advancing age, male sex and family history of Coronary disease. Though heart attacks are said to be less common amongst women, they still constitute a major cause of morbidity and mortality in women. Additionally women are more prone to delayed diagnosis because of absence of classical symptoms of heart attacks. Also women with heart attacks tend to have more complications than men.Heart attacks, though amongst the deadliest of the diseases, are probably also the easiest to prevent.