Monsoon and Heart Diseases

     Monsoon is a blessing to India. Intolerable summer ends with the rains and worries about the scarcity of water and food for that year vanish. But monsoon comes with its darker side, these are the epidemics. These diseases directly or indirectly affect the heart.

1 Respiratory diseases.

    Repsiratory diseases vary from simple cold to severe pneumonia. Most of us are now familiar with these, thanks to the COVID-19 epidemic. These lead to extra work load on the heart and the patients who are already suffering from heart disease may land up in hospitals with heart failure. To prevent these general hygiene precautions should be followed. High risk patients should use masks outside whenever possible. Elderly patients and patients with high risk should get vaccinated against common respiratory illnesses, take the help of your Doctor regarding this. If patient acquires the infection he/she should get it treated as soon as possible before any complications happen.

2 Gastrointestinal Diseases

   Monsoons comes with the epidemics of gartroenteritis, again it can be milder forms or very severe forms like cholera. Loose motions and vomitings reduce the water in the body and decrease the blood pressure. With doctors advice the patient may need to reduce the dose or stop some of the cardiac medicines temporarily such as diuretics (e.g. Dytor ,lasix). ORS should be taken as recommended to avoid dehydration.High risk patients should better be admitted to hospital ,I.V. fluids can be given in monitored settings.Renal function tests may need to be checked frequently in heart disease patients suffering from loose motions. Gradual restarting of the medication also will require medical professional's help. 

Mosquito born diseases 

    Malaria, Dengue become rampant during rainy season. Heart disease patients shuld take extra precautions to avoid mosquito bites. If get infected immediate investigations and treatment is warranted. High risk patient should get admitted to hospital. As mentioned above precautions should be taken to avoid dehydration. Few people may develop acute heart failure without any previous illness (myocarditis) that requires hospitalisation and close monitoring.

           Take hygienic precautions, drink good quality water, avoid outside food, keep your surroundings clean. Wish you a happy and healthy Monsoon Season.

Mission - Healthy Hearts.

Dr. Tamiruddin A. Danwade

Consultant Interventional Cardiologist,

Mother & Rhythm Clinics,

Kharghar & Seawoods, Navi Mumbai

For Appointments - +919321459928

Online Medical information (Doctor Google 😄)

       Today's era is referred as 'era of explosion of information ' It is perticurly true for medical field. Things which were difficult to read/access once upon a time now are one click away. This has emence implications mostly positive but there are many red alerts also.

       As internet is used by all sorts of people, different views are expressed by everyone. Only few people are authorities in that perticular field many are amateurs and most are quacks for example good medical knowledge is available only on specific internet sites. Geniune literature is provided by high index medical journals ( mind you free journals are rampant now a days which are managed by not so dependable sources) e.g. good cardiology papers and available on JACC, circulation, NEJM, JAPI, Indian heart Journal to name a few there are many others. Some sites compile all the knowledge on a perticular subject, these are UP-TO-DATE, MEDSCAPE , internet sites of Mayo Clinic, Cleaveland Clinic etc. Apart from this many informative videos are available the above rule applies to these also. A well experienced and learned doctor gives true information ( unfortunately some doctors also spread non-scientific information although that is rare).

     For my patients I advise learn about your disease/ illness/ medical condition it helps to treat it in a better way. Having written this I and many of my colleagues face a big issue now a days i.e. patient or a relative who has tremendous amount of information about the disease but who are still unsure 😄. These people become extremely confused and that may hinder the right and scientific decision. If the information is wrong or given by quack situation become more grave. For example in my clinic I see patients who have typical symptoms of coronary artery disease ( disease where hearts blood vessels become blocked causing major or minor heart attacks) I suggest them coronary angiography to check the blockades. Few people unfortunately come across wrong information on internet or see some videos showing non scientific information and take wrong decisions. Few others have genuine information but they are overwhelmed with it and fail to take right decisions.

        My advice for this is believe on your doctor who has painstakingly learned all the medical knowledge for many long years. He/ she is the best person from whom you will get the most scientific information. Take second opinion of another medical expert in same field in case of confusion. Depend only on scientific internet sites as mentioned above. Don't get carried away by emotional videos by quacks. In case of doubts come back to your doctor who is always there to solve them.

Mission - Healthy Hearts.

Dr. Tamiruddin A. Danwade

Consultant Interventional Cardiologist,

Mother & Rhythm Clinics,

Kharghar & Seawoods, Navi Mumbai

For Appointments - +919321459928

Complex Coronary Angioplasties.

 

  Our heart is a natural pump with tremendous efficiency. It supplies blood to the whole body. Coronary arteries are relatively small but vital blood vessels that supply blood to the heart itself. Blockades in these blood vessels mainly due to cholesterol deposition lead to minor or major heart attacks which are potentially life threatening.

  Historically bypass surgery was the only treatment option available for these blockades. This  is a supra-major surgery with its own drawbacks like long recovery time, perioperative morbidity and mortality. In 1977, Dr Andreas R. Grüntzig invented the less invasive treatment option - Coronary Angioplasty. Angioplasty is a percutaneous procedure where the cardiologists pass a balloon over a wire in the coronary arteries through a small tube-like guiding catheter, and blockades are  dilated to improve the blood flow through them. Initially, it was a crude method, nothing else could be done, subsequently, stents  were invented which are metallic scaffolds implanted at the site of the block to prevent re-block. In  the last three decades, stents quality has significantly improved with fewer complications and excellent outcomes.

      Although angioplasty was discovered way back in the 1970s, still till recently, complex cases were managed by bypass surgery. Examples of the complex cases are hard calcified blocks, tortuous vessels, multiple long blocks or blocks at difficult locations of the vessels etc. With cutting-edge techniques manging, these challenging scenarios have become possible via angioplasty. Internal imaging techniques like optical coherence tomography (OCT) or  Intravascur ultrasound (IVUS) made it possible to properly delineate the properties of the blockades like the length of the block, presence of calcium or diameter of the stent to be used etc. So that a stent can be implanted in places like the left main coronary artery with ease. Guide extension catheters are become available for tortuous arteries where passing a balloon or stent is usually very difficult. Calcium cutting techniques like cutting balloons, rota ablation devices and the newest one in kitty intra vascular lithotripsy (IVL) have been introduced  so previously unexpandable blocks now can be tackled. Some technical advances in angioplasty procedures themselves have been  introduced like bifurcation stenting techniques have revolutionised the treatment of vessels with joints (bifurcating vessels). As mentioned previously, stents have become much more advanced and sophisticated so that long length blocks, small diameter vessels or very large vessels can be stented without fear of re-blockades.

  So, with the advent of newer techniques, many complex blockades can be managed with coronary angioplasties now, however, the most important decisions are when to do the angioplasty when to manage medically or when to send the patient for bypass surgery which still has a major role in modern-day cardiology practice. This is decided by a ‘Heart team’ where cardiologists and cardiac surgeons discuss and decide about the best treatment option.

           Dr. Tamiruddin A. Danwade

 Senior Consultant Interventional Cardiologis,

Mother and Rhythm Clinics,

Kharghar and Seawoods, Navi Mumbai.

+919321459928

Stress and Heart diseases

 

   In Modern era stress is independent and probably the most important risk Factor for development of heart related issues especially heart attacks. Stress can be Physical, mental or combination of both.  Today's life of continuous compitition and compulsion for high achievement has increased the stress mutifold.

     Stress can not be measured but there are few signs and symptoms which indicate that the perticular person is stressed out like 1 Continuous feeling of unhappiness without any mental illness 2 Lack of sleep 3 Inability to concentrate 4 Lack of interest in surrounding 5 Burnout stage where people want to give up there jobs or work 6 Body pain , weakness without any disease 7 High heart rate without any heart disease 8 Anger issues. 9 FOMO - Fear of missing out. 

         Stress can lead to high BP, premature development of diabetes, high cholesterol levels and most importantly can lead to development of heart disease and precipitation of heart attacks especially in young people. 

       Many of my patients ask me why they developed heart disease as they don't have any traditional risk factors like high BP, Diabetes, Smoking or obesity. When I take a detailed history I observe their life is extremely stressful. I give these patients following advice.

1. Try to plan and streamline your life in such a way that you are not continuously busy.

2 . Take some time off in every day work. Take afternoon nap if possible.

3 Don't work on weekends keep Sundays ( if possible Saturdays) for yourself.

4 Take regular breaks - Go for vacations.

5 Exercise daily - 30 to 40 of aerobic exercise ( walking/jogging/cycling/swimming) 10 to 15 minutes of streching exercise ( mild gym/ Yogasann like Surya namaskar)

6 Breathing exercises like meditation.

7 Follow your hobbies and take out time for them whatever it may be like reading, listening to music or traveling etc.

9 Take a good refreshing sleep everyday  - 6 to 8 hours.

10. Develope good social support system family and friends. Dine together once in a while.

11. Give a break to social media intermittently, don't see any screens(TV/Mobile/Tablet) 1 hour before going to bed.

12 Experience joy of letting it go sometimes no need to chace the targets every time.

Dr. Tamiruddin A. Danwade

Consultant Interventional Cardiologist.

Mother and Rhythm Clinics

Seawoods and Kharghar

+919321459928

Heart Failure and Heart  transplantation.

   Heart Failure is major health problem all over the world. It means heart becomes so weak that it can not pump enough amount of blood to the body organs to function normally. As a result the organs like Lungs, Kidney, Liver, Brain etc. start failing and ultimately resulting in death if not treated timely. It can be a acute heart failure occuring suddenly or chronic heart failure which can progress over a period of months or years. There are various treatment options which we will discuss subsequently, heart transplantation is the most advanced and ultimate treatment option.

       Heart's  function can be broadly divided into two parts, one is contraction so that it will pump the pure  blood to various organs and relaxation so that it will accommodate the returning impure blood. Heart failure can occur due to abnormalities in either of these functions. Contraction capacity decreases by weak heart muscles, most common cause is heat attack. Other causes are high blood pressure, diabetes ,inherited heart muscle weakness, excessive alcohol consumption, dietery deficiencies etc. Heart has four natural valves regulating blood flow in its four chambers, blockade or leakage in any of these valves can cause heart failure. Relaxation abnormality again can occur because of old age, high blood pressure, diabetes inherited muscle abnormalities etc. Apart from these common causes there are innumerous other causes of heart failure.

     Patient suffering from heart failure will  experience breathlessness which can be mild to severe, later phases patient will not be able to lie down straight because of shortness of breath. Profound weakness, fatigue may be experienced by the patient. They may develop swelling over legs initially and later phases whole body can get bloated up. In advanced heart failure other organs will get damaged kidney may fail so the urine output will decrease, liver will fail and jaundice will appear, ultimately brain starts getting affected and drowsy ness which may progress to unconsciousness. In advanced heart failure death will  be inevitable if not treated aggressively.

       As heart failure is a heterogeneous disease treatment of it is also varied. Most important is to treat the underlying cause if it is treatable e.g. treating blockages in coronary arteries by angioplasty or bypass surgery, proper treatment of blood pressure and diabetes, treating vitamin deficiency, abstinence from alcohol etc. Once it is taken care off oral medications are available to decrease the symptoms also to halt the progression of disease. Life style modifications like proper diet,  exercise,  proper rest lack of stress is of profound importance. In advanced HF heart become so weak that even after all this measures the symptoms may not go away completely, recurrent hospital admissions will be required many times advanced life support like ventilator, dialysis will be necessary. Eventually these modalities also will be ineffective and patients will succumb. Recent Advances are ventricular assist devices ( we can say partial or complete artificial heart) which are far from perfect and extremely costly, and last but not the least heart transplantation.

      Heart transplantation is done in relatively young patients with advanced heart failure which we have discussed previously. Donor heart is taken from the brain dead but otherwise healthy donor. This surgery is done only in few tertiary care hospitals. In India recently many cardiac transplantations are being done due advances in medical facilities and awareness for organ Donation. At Apollo Hospital, Navi Mumbai till now we have done two successful heart transplantations.

Dr. Tamiruddin A. Danwade.

Consultant Interventional Cardiologist and Heart failure specialist,

Apollo hospitals, Navi Mumbai.

COVID 19 and Heart Problems.
    
Social distancing is a KEY.
Avoid unnecessary going out of home.   Don't touch your face, nose or eyes. Wash your hands frequently. Use masks in Public places.

Maintain immunity
 Eat lot of fruits and vegetables ( wash them properly before eating).  Eat adequate amount of proteins. Follow regular dietary advice by Doctor. In summer drink extra water to maintain hydration.

 Exercise
  Continue exercising while maintaining the social distancing. Walking in hallway for 30 minutes, few stretching exercises , Yoga may be enough to keep you healthy.

Take Proper rest
 Sleep for 6 to 8 hours.

Most important
 Take medications on time. Monitor your blood pressure and blood sugar. Consult your doctor for health related issues don't avoid it - Many online platforms are available for video/audio consultations use them. e.g. Apollo 24 7.
Cardiac  issues - If any chest pain, breathlessness, palpitations or any unusual symptoms which can be related to heart don't ignore it. Remember heart  problems are number one killers in the world even in COVID era. Visit nearest hospital in such case, now hospitals are well geared up. For example in Apollo hospital every single precaution is being taken for your safety.

And last but not the least be 'POSITIVE' we together will fight and beat this unusual enemy soon.

Dr Tamiruddin A Danwade
Consultant Interventional Cardiologist
Apollo hospital Navi Mumbai.

How to identify probable Heart Attack.
   Heart attack is number one killer in the world. More people die because of this than many other causes combined together.
 Timely identifying the symptoms and prompt treatment can save many lives.
 Here I want to enumerate most important symptoms by which most of us can identify a probable ongoing heart attack.
1 Most important concept we need to understand is  that few people are more at risk than others, those are
A.  Hypertensives (People suffering from high blood pressure) B. Diabetics ( High blood sugar patients) C. Obese patients D. Smokers E. People who have already suffering from heart ailments F People who have a family history of heart attack ( close family member suffered from a heart attack like mother father brother or sister)
  If these high risk subset of people develop the symptoms I am mentioning below the chance that it is a heart attack is high.

2 Chest pain - It is the commonest symptom, typically the location is  in the middle of the chest excruciating in quality radiating to left shoulder, left hand, back or throat many times associated with profuse sweating.
But there are many variations like A. Only heaviness/ pressure sensation in chest B. Only burning sensation in the chest( so mistaken for acidity often) C Only back pain D Only throat pain etc.

3 Breathlessness - Sudden onset breathlessness is a symptom of heart attack especially in Diabetics and elderly.

4 Sudden loss of consciousness (syncope)
This is more serious symptom and heart attack should be strongly suspected.

5 Apart from this heart attack can Present many unusual forms like A. Right sided shoulder pain B. Abdominal pain C.  Any pain from thoat to umbilicus especially in high risk subsets. D Only uneasiness etc.
 
If above symptoms are there one should A. Ask for help immediately B. Avoid exertion for example  if you are running or even walking stop doing that and rest. C Arrange a transport to Nearest hospital with good facilities. D If possible call your Doctor so that precious time will not be wasted, remember every second is important.

Health is wealth.

Dr Tamiruddin A Danwade
Consultant Interventional Cardiologist,
Apollo hospital Navi Mumbai.