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Discussion
Discussion on question 1
The heart attack or myocardial infarction many a times has atypical
presentation. People feel that they have acidity or ulcer pain or
so called gas trouble or especially in diabetics they may not have
any symptoms at all. The classical description of pain in this condition
is: pain on the left side of the chest that radiates to the left shoulder
and inner aspect of the arm forearm and the little finger of the left
side. It may manifest just as gas trouble, or as Pain at: lower jaw,
neck, stomach, back, right shoulder or rarely as pain at genitals.
The message is, if in doubt rule out heart trouble. It will make a
life and death difference. And therefore one should not waste time
in taking soda or lime or anti acid medication or waiting for family
doctor to come. Calling for cardiac ambulance is not the right option
because many a times the ambulance is busy with another call. If not
the staff takes some time to organize before they start and worst
thing is many a times the doctor who accompanies it is NOT EVEN, MBBS.
[Ideally there should be a doctor who is qualified as well as experienced
in handling this kind of emergencies.] Therefore it is the most wise
decision to rush yourself to the nearest big hospital. Why big hospital?
Because these are equipped to take care of all eventualities. What
do I mean by big hospital? It is a hospital where you have all the
facilities including bypass surgery.
Why should we rush? Because if it is heart attack with proper and
timely treatment the heart can be saved.
NEXT QUESTION.
Discussion on question 2
Coronary arteries are the pipes supplying the heart with oxygenated
[so called pure] blood.
The complete sudden blockage of these arteries will lead to the heart
attack. If the blockage is partial then the patient will have
a symptom on exertion but the muscle tissue of the heart is saved.
In case of progressive complete blockage, the nature will develop
collateral blood supply even though it is not adequate for support
during exertion, it will be enough to support the heart muscle during
rest. In case of heart attack it is important that the blood supply
to the affected portion of the heart be established within SIX hours
else the portion will be dead. And therefore one has to rush to a
big center so that the right treatment is administered on time.
NEXT QUESTION.
Discussion on the question 3:
Explanation about Angiography:
Angiography is mapping of any pipe that caries blood or it's components.
Like arteriography is the mapping of pipes that carry the oxygenated
[so called pure blood], Veinography is the mapping of veins that is
the pipes that carry the deoxygenated blood [so called impure blood],
lymphangiography is the mapping of the pipes that carry lymph. [Lymph
is blood without the red blood cells.]
Mapping of a particular set of pipes is known by the name of those
pipes. Like the mapping of the arteries of the heart is called coronary
angiography.
In this procedure, a dye is introduced in the concerned blood pipe
and pictures are recorded. This can be done by direct introduction
of dye in the concerned pipe or indirectly introducing the dye in
some other pipe. The pictures can be in the form of sequence of still
films, or cine film showing progress of the dye through the pipes.
Alternately images can be obtained with the help of a computer as
in the case of DSA [Digital Subtraction Angiography], Vascular CT
scan or Vascular MRI scan.
The coronary angiography even though can be done by any of these techniques;
the preferred mode is cine angiography.
NEXT QUESTION.
Discussion on the question 4: The term "
first 6 hours from admission" is meaningless as the results are related
to the time of onset from the sudden blockage of the coronary arteries.
The first 6 hours from onset of the blockage is a crucial time period
in this time we try to open up the coronary artery so that the muscle
tissue beyond can be saved. This is done with medicines to dissolve
the blood clot. If this is not successful one may try for emergency
revascularisation with invasive modalities like surgery or angioplasty
provided the blood flow could be established within first 6 hours.
In most of the cases this is not possible. And even if it is possible,
it carries a lot of risk. That is in this period, any invasive procedure
means, maximum benefit with maximum risk. After first 6 hours and
before 6 weeks there is maximum risk with no benefit and therefore
one should not go for any invasive treatment at this stage unless
the patient deteriorates to the point that the heart is unable to
pump and therefore you may have to add a partial artificial heart
as a means of temporary support. After 6 weeks the benefit is moderate
and risk is moderate. But the ideal thing to do is after these 6 weeks
to prepare patient fully for another 6 weeks and to do a planned surgery
after a total of 3 months from the heart attack to minimize the risk
and maximize the benefits.
NEXT QUESTION.
Discussion on the question 5: A block of less
than 66% does not need any invasive treatment. What the patient has
to do is to change his life style and remain under surveillance. If
the site of block is critical like left main artery or left anterior
descending artery, the lifestyle modification has to be vigorous with
a closer surveillance.
A block more than 66% in these arteries [left main and left anterior
descending] with or without symptoms, or in any other arteries with
symptoms, needs to be taken care of by invasive treatment.
A block of more than 66% without any symptoms in a vessel or two other
than left main and left anterior descending locations needs vigorous
lifestyle modification with a close surveillance.
Three or more such blocks at any location with or without symptoms
need invasive treatment
WHICH INVASIVE TREATMENT?
| Criteria |
Bypass surgery with the best method |
Angioplasty by the best method |
| Benefit at the
end of 10 years |
85% |
0% |
| Risk |
Less. Same for any number of
blocks |
More. Risk is added with number
of blocks. |
| Cost |
Less |
More |
| Lifelong medication |
Not needed |
Mandatory |
| Hospital stay |
3 days |
2 days |
NEXT QUESTION.
Discussion on the question 6:
A patient with multiple blocks can survive without any intervention
but the whole life is associated with high risk of death and complications.
Also the quality of the life is very poor in the sense that he will
have to have a lot of limitations on his performance. If he is willing
to accept this he can go ahead with his choice of not having any kind
of intervention.
NEXT QUESTION.
Discussion on the question 7:
Options A B and C are not in the best interest of the patient and
I would go for the option D in the hope that the heart will recover
at some time in the next six weeks. This is called bridge to recovery.
If the patient does not recover in six weeks and donor heart is available,
I will go for transplantation. Whenever my group completes our work
on Total Artificial Heart, The patients will have this option available.
Our Total Artificial
Heart is the best in the world as it is small enough to be inside
the human body. At the same time it works like the natural heart.
[Our Artificial Heart
is not damaged with smoking, cholesterol, stress or genes!]
NEXT QUESTION.
Discussion on the question 8:
Yes! It depends upon his philosophy of life. The way he looks at life.
NEXT QUESTION.
Discussion on the question 9:
Why should he lead a dull life? The aim is correction of the only
factor that is responsible. He need not go to a village, should not
change profession or job, or should not let go all the pleasures.
Change of lifestyle does not mean drastic changes in the life and
saying good bye to all the pleasures. In fact the aim is to learn
about new pleasures and being happy.
NEXT QUESTION.
Discussion on the question 10:
The common people and most of the doctors have a misunderstanding
about salt intake. The common salt that is sodium chloride is an important
factor in our blood. If the level of this particular stuff in blood
is low then it has bad effects on our brain. And therefore the level
of this salt should be maintained in the normal range. Moreover many
of the blood pressure medicines as well as heart medicines tend to
throw out this factor out of the body and on the top of it if the
patient restricts the salt intake, he ultimately lands in coma due
to unacceptably low levels of this factor. Of course it is not good
to eat the salt in excess.
The level of sodium in blood
|
Significance |
| in Milliequivalents per
liter |
|
135 to 145
|
Normal range |
Below 130
|
Brain starts having swelling. |
| Below 120 |
Altered level of consciousness. |
| Below 100 |
Coma. |
About water:
The people who drink more water are less likely to have heart attack.
If your intake of water is more than 4 liters a day then your risk
of having heart attack is reduced by 50% as that of the general population.
Message:
Drink more water.
Do not eat salt in excess but DO NOT restrict it too!
NEXT QUESTION.
Discussion on the question 11:
Cholesterol is a very very important factor in our body. Most of our
body chemicals and their reactions are dependant upon the cholesterol.
It is the food for our brain, muscles and needed in the healing of
our wounds. Any stressful situation raises the levels of this factor
because it is needed to combat the stress. The lower levels will lead
to not only dysfunction of our brain and muscles and poor healing
of wounds but also it will lead to more chances of our having cancer
and infections.
If the normal upper limit is 250 and if your level is 290 that does
not mean you need treatment. It could be normal for you. We have to
assess the individual make up and decide about the need of treatment.
Also high level does not mean you should take medicines for lowering
it. Initially you should look for the cause of the high cholesterol
and try to take care of it. If that does not lower the levels then
we have employ some simple measures to reduce the levels.
Also the level of the total cholesterol only is not significant. You
can have a level of 400 and yet will not have any coronary heart disease
if your HDL [So called "Good" cholesterol] levels also are
high enough.
The medicines should be avoided as far as possible as they have a
lot of side effects on all of our systems, more on the liver brain
and muscles.
NEXT QUESTION.
Discussion on the question 12:
The body level of cholesterol
is not dependent on the type of fat you have. The advertisers sell
their products by twisting the facts. And you should not fall pray
to their marketing gimmicks. Yes it is essential to have polyunsaturated
fatty acids but there are a lot of sources in our other normal diet
that can give you these fatty acids. These have nothing to do with
cholesterol levels and risk of heart disease. Also cholesterol is
an essential factor in our body. [See also the discussion on cholesterol]
Therefore it does not matter what oil or fat you eat as far as you
consume these in moderation. People blame consumption of coconut and
it's products for high levels of cholesterol and heart disease but
the interesting fact is Kerala is the state in India where we have
maximum longevity and the females over there have life expectancy
at par with the best in the world. You can meet many ladies over there
having active social life after the age of "only" 100 years
and the most interesting fact is all of them cook all their food in
coconut oil, all their preparations are not complete without coconut
milk and scrubbed coconut in huge amounts. Also they eat a lot of
fried chips with salt on it, consume lot of non-vegetarian food. Therefore
the message is do not worry about diet. Enjoy your life. That is more
important. As long as you know the limits and follow them, you will
not have any disease.
NEXT QUESTION.
Discussion on the question 13:
One should avoid smoking in any mode active or passive, and tobacco
in any form. Even in the small quantity it can lead to health hazards
which are not just related to the heart but lead to cancer, brain
disease in the form of paralysis, gangrene of the hand or legs and
so on. Therefore you should never ever smoke or consume tobacco in
any form.
If you wish to smoke wait till our artificial
heart is ready! Our Artificial Heart is not damaged with smoking,
cholesterol, stress or genes! - [Of course the risk
of other diseases remains as it is!]
NEXT QUESTION.
Discussion on the question 14:
Insulin is the chemical in the body that pushes the sugar inside the
cells. This sugar is the fuel on which the cells run their function.
If the sugar does not reach inside the machinery inside the cell does
not work and ultimately that leads to the death or dysfunction of
the parts of our body organs. Since the sugar does not go inside the
cells it remains in the blood and is reflected as high level.
As far as heart is concerned the blood vessels of the heart in general
and small tiny end portions in particular are unable to carry our
routine repair and then the scar that forms blocks them leading to
lack of blood supply.
NEXT QUESTION.
Discussion on the question 15:
Age? All are welcome!
Age is no bar for coronary artery disease. These lesions were seen
in the coronary arteries of the unborn babies too. The key to the
prevention is As long as you know the limits and follow them; you
will not have any disease.
NEXT QUESTION.
Discussion on the question 16:
Yes! Anger doubles your chances of having heart attack within next
two hours. Therefore PLEASE DON'T BE "ANGRY"!
NEXT QUESTION.
Discussion on the question 17:
This disease is transmitted from one generation to the other. But
certain manipulations can practically eliminate the possibility of
having this disease for an individual.
NEXT QUESTION.
Discussion on the question 18:
Women are protected from this disease due to the sex hormones till
they reach the end of their reproductive life. Thereafter the chances
of having the coronaries blocked become equal. To develop a full-blown
disease it takes another 15-20 years. The nature has done this to
ensure the well being of the offspring as woman of the species is
more responsible than the man!
NEXT QUESTION.
Discussion on the question 19:
More weight will lead to all these problems. And therefore one should
try to remain on the lower side of their normal weight for the height.
Weight reduction or weight maintenance does not mean you should not
eat tasty food or you should fast or you should carry out heavy exercises
in the gymnasium. It can be achieved by certain pleasant means, eating
the food you love. What you need is learning the right way to eat
the food, and the right way to digest it. There is nothing like ready
made diet charts or formula exercises. We all are different people
with different make-ups. And need different solutions for the same
problem.
NEXT QUESTION.
Discussion on the question 20:
Yes lack of exercise increases the risk of coronary artery disease.
Therefore it is essential to have exercise every day. Exercise does
not mean standing in local train or bus. Nor does it mean standing
at the work place. But at the same time it is not necessary to join
a gymnasium for exercise or to carry out some heavy difficult activities.
Of course if you can join a gymnasium it is good but is not the best
option. There are a lot of pleasant ways to carry out exercise. Walking
is one of simple exercise however unfortunately many people do not
know how to walk. Walking the wrong way will put you in trouble. Also
the walking for preventing heart disease is different from the one
to reduce your weight. Also you need to know the limits. There is
not a single formula that is sufficient to take care of all. And the
prescription of exercise has to be tailored to suit an individual.
For example some one is benefited only with running whereas there
may be another individual in whom even walking may not be possible.
Some of the yogic exercises will benefit an individual whereas in
others they may be a risk to the life.
NEXT QUESTION.
Discussion on the question 21: All the answers are correct!
Exercise has a lot of benefits.
First gives you pleasure.
Second it raises the levels of good cholesterol [HDL].
Third reduces the levels of bad cholesterol.
Fourth it reduces the blood sugar level.
Fifth reduces peripheral resistance thus reducing the blood pressure.
Sixth is it burns calories so helps in the body weight reduction.
Seventh is the relief from stress.
Eighth is it can practically eliminate the chances of coronary artery
disease.
Ninth is it can reverse the coronary artery disease.
Tenth is it improves collateral circulation to the part where there
is less blood supply.
Eleventh is it will improve function of all the body organs.
Twelfth is it will slow the process of aging.
WARNING: The most important thing to remember
is the choice of exercise has to be appropriate. Otherwise it will
put your life in risk. Even the yogic exercises including the asanas
and the pranayama if are not suitable in a particular medical condition
or even in healthy individuals if not performed properly will lead
to complications including death.
NEXT QUESTION.
Discussion on the question 22:
Yes high blood pressure is a risk factor for this type of heart disease.
Also it does put a lot of strain on the heart muscle. Therefore one
should try to restrict the blood pressure at normal level. There are
two values that the physician informs you one is lower than the other.
The upper one is called the systolic pressure and shows the maximum
force generated by your heart to overcome the resistance to the flow.
The lower one is the diastolic pressure and it shows the amount of
resistance to the blood flow. Out of the two the diastolic one is
very very important to prevent the complications of the high blood
pressure. And one has to try to keep it as low as possible. [Please
also see the discussion on the next question.]
NEXT QUESTION.
Discussion on the question 23:
The diastolic pressure of 80 or less than 80 is associated with zero
complications. If it is beyond that value your chances of having complications
increase. Therefore the aim is to keep the diastolic pressure at that
level or below. To keep the pressure low medicines are helpful but
are not the permanent solution because these medicines have side effects.
[In fact all the medicines including the Ayurvedic medicines have
side effects the only thing is these are not scientifically studied
and therefore are not known. Not known does not mean these do not
exist. It is more dangerous to have a drug with unknown side effects.]
The ultimate destination is drug free healthy leaving. And that is
achieved through lifestyle
modification.
The old concept of different "normal" diastolic pressure
values for different ages has been proven being wrong by the new research.
NEXT QUESTION.
Discussion on question 24:
Mere absence of disease does not mean health. Meaning of health is
much broader and encompasses a lot many aspects. We have not just
the body but the mind too. But we exist in many more dimensions. You
need to have a good family and good society too. Even that is not
enough. You need to care for the well-being of the nature and spiritually
too you need to progress on the right path. If either of these factors
are disturbed you will be in trouble.
And not just the well-being of all of these dimensions individually
but the harmony in between that is what matters. Harmonious existence
of all these dimensions in a fit condition means health.
NEXT QUESTION.
Discussion on the question 25:
In this patient mental stress is the cause of his cardiac problem.
He is in a job that has targets. The Targets target your heart and
the dead lines make you dead! All the people who work in the high
stress jobs fall pray for this disease.
The key is to device protective mechanisms against stress.
One of the approaches is to learn techniques to combat stress.
The other one that I advocate is not to have stress at all.
But the short cut is to leave the stress
to The God [and your heart to me! ]
Thank you very verrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrry
much!
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