What is Palpitation?
Palpitation is a feeling of awareness of your own heart beat. It is usually described as heart rate being either too fast (racing), too slow or a sensation of missing a beat.

Types of palpitations?
Normal (Benign)
- These palpitations occur as a response to physical or mental stress like exercise, fever, pain, fear, anxiety etc. 
- They are harmless and settle on their own once the precipitating factors disappear. They do not require any medical treatment.

Abnormal
- These palpitations occur due to some underlying abnormality in either the structure of heart or the beating of heart. 
- These can be dangerous and at times life threatening. They may or may not settle on their own and require some medical treatment.

Warning signs that suggest palpitations are abnormal?
Palpitations are abnormal, if they are associated with chest heaviness, chest pain, uneasiness, sweating, weakness, giddiness, feeling of black out, fainting, nausea, vomiting, seizures. Palpitations are more likely to be abnormal in people who have some existing heart disease and these patients should report to their doctor at the earliest.

What to do during palpitations?
1. Stay calm. 
2. Call for help. If u are alone avoid driving, use a taxi or auto, go to your nearest hospital/doctor and try to get an ECG during the palpitations. If you are helping someone having palpitations, if they faint, call for help, start CPR if they remain unresponsive and take them to the nearest hospital. 

Which doctor can treat palpitations?
Doctors who specialise in the treatment of palpitations are called Electrophysiologists. They specialise in heart rhythm and are capable of performing a variety of complex tests to identify and treat different types of palpitations.

Which investigations are used to diagnose palpitations?
ECG: Taken during palpitations and when the patient is normal is a very helpful tool. 
Holter: Externally applied recorder, which continuously records heart rhythm for 24 hrs. 
ELR: Extended loop recorder, is like holter, but it records rhythm for longer durations. 
ILR:  Internal loop recorder is attached within the body for recording rhythm for long duration. 
EPS: Electrophysiology study, is the most sure shot test to diagnose, identify and treat 
Palpitations.

What is EPS?
EPS stands for Electrophysiology study. By this test a trained Electrophysiologist studies the conduction and formation system of heart beat, to understand the source, cause and type of palpitation. It is a simple and safe procedure of 2 to 3 hours and can be done as a day care procedure (by admitting the patient for a few hours in hospital, with discharge on same day).

It requires fasting for 4 hrs, some standard blood investigations and is done with local anaesthesia and if required it can be combined with treatment like ablation in the same sitting.In the procedure Electrophysiologist take catheters into your heart to study and stimulate the palpitations and understand them. Once found they can use various techniques to stop the palpitations, the techniques are called Ablation.

What are the treatment options available for palpitations?
There are many options depending upon the nature of palpitations and condition of the patient: 
- Drug therapy 
- Cardioversion where either a drug or electric shock is given to stop palpitations immediately. 

Ablations using many sophisticated computer softwares 
Device Therapy like ICD (Internal cardiac defibrillator) 
Combination of all the above therapies.

Your Electrophysiologist and you as a team can make a choice about the options that will be best for you.

Palpitations - Everything You Need to Know

High blood pressure can lead to hypertension, which is known to cause a variety of debilitating side effects or symptoms in the life of the patient. It can also lead to a number of related ailments which can affect the various organs of the body. The eyes are one of the organs that are most susceptible to this kind of spike in the body s blood pressure. Let us learn more about the connection between the two.

Retina: When high blood pressure goes untreated for a prolonged period, it can easily start to affect the blood vessels that can be found in the retina. The retina is the third or the inner most layer of the eye which is sensitive towards light and usually helps in refraction. This is where the light reaches so that one can focus clearly on an image. When the blood pressure of the patient stays high for a prolonged basis, there is significant pressure on the blood vessels in this part of the eye which can lead to an eye disease known as hypertensive retinopathy.

Symptoms: Symptoms of this eye disease include lack of clarity and focus when the eye comes to rest on an object, as well as headaches and other vision problems that typically spring from eye strain that one will go through while trying to focus even harder. It may be seen that the symptoms do not appear in the very early stages of this disease.

Diagnosis: The diagnosis of the condition is usually done by an ophthalmologist who will use an ophthalmoscope in order to project light towards the specific part of the eye so that the back of the eyeballs can be examined. The signs that the doctor will look for during the examination include narrowing of the blood vessels in this part of the eye, inflammation of the macula which is the central portion of the retina, and bleeding in the back of the eye. Also, the doctor will check for spots in the retina with the help of cotton swabs and exudates.

Treatment: The best and only way of treating this condition is by keeping one s blood pressure in control with the help of medication prescribed by the doctor.

Prevention: There are many ways of preventing the onset of this disease, including losing weight so that there is less pressure on the body. Also, one must stick to a healthy diet and exercise regularly after taking recommendations on the appropriate exercises from the doctor. Additionally, it is also important to see a doctor on a regular basis so that there is constant monitoring and regulation of the medicines and the blood pressure.

Blood Pressure - How it Affects Your Eye Sight?

For a long time cholesterol in totality was seen as a bad thing for your body although the truth was a little more complicated than that. Cholesterol primarily is divided into two types, one of which can be categorized as bad cholesterol and the other as good cholesterol. Let's have an in-depth look at both the categories.

LDL or Low Density Lipoprotein aka bad cholesterol: Cholesterol is a wax like chemical, which is found all over the body and it has important functions to perform. Cholesterol is carried all over the body by Lipoproteins. The low density lipoproteins are denoted as bad cholesterol as they can accumulate on the walls of the blood vessels and cause blockages resulting in many ailments. LDL levels of 190 and above are considered dangerous. 

Some of the risks associated with it are:
1. Heart disease
2. Stroke
3. Atherosclerosis
4. peripheral artery disease among many others

HDL or High Density Lipoprotein aka good cholesterol: This is a form of cholesterol which is usually desired in higher quantities as it removes LDL from the system by dislodging it from the arteries and then carrying it through the blood stream into the liver. The liver then breaks it down and removes it from the body. Thus, higher number of HDL cholesterol is always desirable. 

Some of the ideal numbers for HDL cholesterol within the body are:

Women - Ideal: 60 mg/dl, dangerous: 50 mg/dl or lower
Men - Ideal: 60 mg/dl, dangerous: 50 mg/dl lower

The role of triglycerides
Good and bad cholesterol levels also depend on the levels of triglycerides within the body and not just LDL or HDL cholesterol. Triglycerides are another type of fat which are used to store energy within the body but can also affect your health. It is most associated with atherosclerosis when the levels of triglycerides are high within the body. 

Some habits that contribute to high levels of it are:
a. Lack of physical activity
b. Obesity or being overweight
c. Excesses in alcohol consumption
d. Smoking
e. Bad diet and others

Thus the good cholesterol versus bad cholesterol war also includes other factors, most of which can be easily changed by making subtle changes in lifestyle and incorporating healthier habits. This will increase the good cholesterol and the other relevant elements and reduce the bad.

Good Cholesterol Vs Bad Cholesterol and Factor involved in It

A stroke may be called a brain attack. It may happen to any person at any time. A stroke occurs when blood supply to the brain is cut off. The brain cells become oxygen deprived due to the stroke and eventually die. Dead brain cells result in brain dysfunction due to which patients lose control over muscle and memory.

Strokes can be mild to life threatening and requires immediate medical attention. Stroke requires advanced care and should be treated by extensively qualified and experienced medical experts. 

Neurosurgery satisfies all the required clauses for treatment of stroke and accounts for being one of the best ways for management of stroke. Renowned hospitals have a dedicated neurosurgical wing and a team of neurological specialists who know how to deal with stroke the best.

Vascular Neurology
This form of neurology focuses on patients who have undergone a stroke or have experienced symptoms of stroke. A multidisciplinary approach is taken for the prevention of recurrent cerebrovascular conditions.

Types of stroke

Ischemic stroke: This kind of stroke occurs when there is a blockage in a blood vessel, which supplies blood to the brain. This form of stroke is the more common. The underlying cause of this stroke is known as atherosclerosis, which is a condition where fatty deposits occur in the walls of the blood vessels and cause blockage in them.
Hemorrhagic stroke: This type of stroke occurs when a blood vessel gets weak and ruptures into the brain. This is caused by two types of weak blood vessels known as aneurysm and arteriovenous malformation.
Transient ischemic attack: This type of stroke is also known as a mini stroke. These attacks occur because of blood clots. The blockage caused is temporary or transient in nature.
Treatment of Ischemic stroke

Tissue Plasminogen Activator: This is one of the best ways to treat ischemic strokes. This medicine is given to the patient intravenously. It dissolves the blood clot and improves blood flow to the area of the brain which is affected. The medicine should be given within three to four hours after stroke symptoms appear.
Endovascular procedure: This is a process by which the blood clot is removed using a catheter, which gets inserted into the area of the blocked blood vessel. It helps in restoring blood flow to that area. 
Treatment of Hemorrhagic stroke

Endovascular procedure: Several endovascular techniques and methods are used so that the weakening of blood vessels is reduced and less bleeding is caused.
Surgical treatment: Different modes of neurosurgery may be undertaken to stop bleeding and for relieving pressure within the skull.

Role of Neurosurgery in Management of Stroke

Hypertension is a condition where the blood has to exert extra pressure to flow through the blood vessels. While there is a genetic component to it, the more strong contributing factors are modified lifestyle and dietary changes. There are also a lot of environmental changes that have contributed to this new epidemic. While earlier people in their 50s and 60s would be diagnosed with hypertension, now there are people in 30s and 40s taking hypertension pills. Excess fat accumulation is the major cause of hypertension in younger patients.

There begins the complexity of the issue. Hypertension which requires medications to control it, they lead to side effects and bring in a host of other diseases like diabetes, and obesity which in turn bring in a whole lot of complications. A more easy way to manage would be to prevent and of course, after onset, look at how naturally it can be managed.

Ayurveda has numerous substances that have been proven to have beneficial effects in controlling blood pressure over the past 1000s of years.

1. Celery or ajwain helps blood vessels to dilate and reduces concentration of stress hormones in the blood.

2. Ashwagandha has a wide range of actions and improves the body's ability to handle physical and mental stress. This in turn improves blood pressure, obesity, and depression.

3. Citrus fruits contain vitamin c which prevents fragility of the capillaries (thinner blood vessels).

4. Cow's urine prevents hardening of blood vessels and is of curative value in those who have blood pressure due to hardening of blood vessels. 

5. Triphala which is a combination of amla, haritaki, and bibhitaki helps reduce inflammation that leads to blood pressure, thereby helping to control it.

6. Jatamansi - by helping the free radical damage on the arteries, it protects the arteries and prevents cholesterol accumulation. It also is a very well-proven stress reliever and has additional benefits on hypertension.

7. Arjuna - by helping the metabolism of the bad cholesterol in the liver, this protects the inner lining of the heart and thereby helps control hypertension.

8. Calcium and potassium containing substances help remove sodium and thereby improve blood pressure.

9. Natural herbs like brahmi, sarpagandha, shankhpushpi, and chandana are effective ayurvedic cure and treatment for hypertension.

10. Rasayana treatment from ayurveda is having excellent results, however everyone requires unique rasayan as per their body types.

11. Watermelon helps in dilation of the blood vessels.

12. Aloe gel, barberry, calamus, valerian, skullcap, gotu kola cayenne, myrrh, motherwort, hawthorn and jatamansi have all been shown to help manage hypertension over thousands of years.

13. A glass of warm milk mixed with saraswat powder is also helpful for patients with high blood pressure.

These are natural remedies which were a part of diet since times immemorial. Including them in the diet, reducing processed foods, regular exercise, avoiding alcohol and smoking can be some natural ways to prevent and if required control hypertension. Stress is here to stay, but can definitely be managed with a little conscious effort.

Control Blood Pressure With Ayurveda

How many of us have heard about Extracorporeal Membrane Oxygenation (ECMO) before Tamil Nadu, Chief Minister late J Jayalalithaa was put on it for recovery? Hardly a handful. Patients who are placed on the device have 50-50 chance of survival and while it could not help the late Chief Minister, her condition put a spotlight on ECMO.

What is ECMO?
ECMO is a life support device that is put in place when a patient's heart and lungs stop functioning completely post a cardiac arrest. When the patient does not respond to Cardio Pulmonary Resuscitation (CPR), the patient is put on ECMO.

Function of ECMO
The core function of the device is to separate carbon dioxide from the blood and add oxygen into it. It takes the load off from heart and lungs, providing critical time to the body organs for its treatment and recovery.
Patients are only put on ECMO, if there is a chance that the condition can be reversed.

How does ECMO work?
The device drains blood from a vein, which is attached to an oxygenator machine. The machine then removes carbon dioxide from the blood and adds oxygen to it. Depending upon the condition of the patient, the warm blood is either pumped into the body with the help of the machine or is transferred back into the body through an artery.

How long a patient can be on ECMO?
After seven days of being put on ECMO,there are chances of patient getting an infection.
In case the patient contracts an infection, it is recommended to take the patient off ECMO support.

All About ECMO - Extracorporeal Membrane Oxygenation 

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