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