Dr. Ramesh Kawar

While you may be worried about being affected with coronary diseases just because your forefathers suffered from it, there are various factors that are absolutely in your sole control. With a little change in lifestyle and following a well-regulated routine, you can easily keep your hereditary cardiac diseases at bay.

1. Take a Healthy Diet Regularly: Increase the amount of green leafy vegetables and colourful fruits in your regular diet as they are rich in phytonutrients and other anti-oxidants, vitamins, fibres, minerals as well as anti-inflammatory molecules that would increase your immunity.
2. Regulate Your Blood-Sugar Level: Studies show that blood sugar is a great contributor to cardiac diseases. So try to replace your high-carb diet with loads of fibre, protein and healthy fats to keep your blood-sugar level in control.
3. Increase the Intake of Fibre: Try to increase the amount of fibre in your food chart by having lots of fresh fruits and vegetables, nuts and soya so that it amounts up to at least 50 grams a day. You may even include fibre supplements in your diet.
4. Stay Away From Processed and Junk Food: We know you are crazy about fast food, but you must also include sodas, processed jams, fruit juices and soft drinks as well, which are the greatest contributors to diabetes and in turn lead to heart diseases.
5. Increase the Intake of Omega-3 Fatty Acids: Try to include cold-water fish like sardine, salmon and herring along with flax seeds and sea weeds. This 'good' fat would keep your cholesterol level in check and lower down the amount of malicious LDL levels and transform them into harmless LDL particles.
6. Get Rid of all Hydrogenated Food: This implies that you should abstain from having cookies, margarine, baked stuff and crackers. Don't be fooled by the label saying, "no trans-fat" and instead look for healthy coconut, olive or sesame oil.
7. Abstain from Consuming Alcohol: Alcohol can do no good to any organ of your body. Instead, it triggers the amount of triglycerides, causes fatty liver and creates sugar imbalance in your body. By reducing alcohol consumption you can reduce inflammation, which causes various chronic diseases.
8. Have good quality supplements: Along with having a healthy diet and workout, you must try to take in multivitamin and mineral supplements regularly to keep fit and active all around the year.
9. Exercise Regularly: Researches report that a minimum of half an hour's exercise is required by our body regularly. After all, the heart is a muscle, and you must work out regularly to keep it healthy for a longer span.
10. Manage your Stress Levels: Stress alone can lead to a fatal heart attack without prior signal. Take the time out to indulge in yoga, meditation, tai chi or anything that would keep your stress levels under control and help you to lead a happier, healthier life.

These 10 easy ways will help you to prevent cardiac diseases; but you must consult a responsive cardiologist at the earliest.

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?

1) 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.

2) 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.

3) 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. These 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 hospita

3) 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?

1) ECG - Taken during palpitations and when the patient is normal is a very helpful tool. 
2) Holter - Externally applied recorder which continuously records heart rhythm for 24 hrs. 
3) ELR - Extended looper recorder, is like holter, but it records rhythm for longer durations. 
4) ILR - Internal loop recorde is attached within the body for recording rhythm for long duration. 
5) 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 electro-physiologist 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 2-3 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 electro-physiologist 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  :

1) Drug therapy 

2) Cardioversion - where either a drug or electric shock is given to stop palpitations immediately. 

3) Ablations using many sophisticated computer softwares 

4) Device Therapy like ICD (Internal cardiac defibrillator) 

5) 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.

One of the crucial types of surgery is the heart surgery, which is commonly known as the bypass. It is a type of surgery in which the chest is cut, and surgery is done on valves, muscles, and heart arteries. As per the National Heart, Lung, and Blood Institute, it is one of the most common types of surgeries, which is performed on adults. During this surgery, the prime focus is to remove the blockage from the heart so that fresh blood can easily flow into the heart. No doubt that this process is critical, but it is easily true that after the surgery you have to take extra care of yourself.

Talking of which, here are certain things that you can expect after the surgery.

1. Moved To ICU: The moment, the surgery is done, you will be moved to the Intensive Care Unit where the person’s health conditions will be monitored, vital signs will be checked, and medical professional will frequently visit to make sure that the patient is just doing fine. Once the surgery is over, you may not wake up quickly, but you will continue to breathe through the breathing tube. About food, of course, you will not be allowed to take solid food, but there is an intravenous (IV) needle will be put in a blood vessel in your chest and arm from which you will be given fluids. 
2. Recovery At Home: Once you are given the discharge, your focus should be to get recovered quickly. Recovery at home entirely depends on the heart problem for which the surgery was done. Of course, the doctor will give you necessary instructions with regards to healing incision, dealing with after effect is and understanding the signs of complications. Follow up the medicines and attend the appointments as advised to keep track of your health condition. You may face some after effects such as appetite loss, constipation and sleeping problem. If there is any complication, make sure you speak with a doctor about the same immediately.
3. Ongoing Care Is Important Too: Once the surgery is over, as said, you will have to go for frequent checkup with your doctor. During these visits, your doctor will tell you to get blood, stress test and electrocardiogram done, which will assess the working condition of the heart. You might also be given few blood-thinning medicine and bring certain changes in lifestyle and medicine.

There are certain phases of recovery which will take time eventually. The first phase is the lengthy one that can last for around 6-8 weeks. Once you get a discharge from the hospital, you will be given instructions that you must follow with good care. This will pace up the healing process and make the process better.

Angioplasty is referred to as a cardiac procedure which involves widening the narrowed section of a coronary artery. Usually performed by an interventional cardiologist, this procedure is performed in a cardiac catheterization lab, short for a cath lab. An interventional cardiologist takes extra care to review the risks, in addition to obtaining your counsel prior to preparing you for the procedure. The physician also refers to your medical history in order to determine the amount of anesthesia that should be used.

What happens during the procedure?

Although mild sedatives will be administered to help you relax, the process requires you to remain awake throughout the procedure. 

The procedure of angioplasty involves cardiac catheterization. The doctor numbs the intended site through medications and inserts the catheter. Following such, the doctor inserts a thin sheath in your artery, oftentimes in your groin or arm. A long, narrow, empty tube known as a catheter, is then carefully guided through the sheath, through the blood vessels and into the arteries near the heart. 

A little amount of liquid is then injected through the catheter which is moved through the chambers, valves and vessels of the heart. This movement is then pictured with the help of X-rays, with which the doctors can diagnose the condition and working of the coronary arteries and the heart valve.

The surgical procedure lasts for around 1.5 - 2.5 hours but the preparation and post - surgical procedures may take several hours. A patient is usually made to stay overnight to be monitored by medical personnel.

For Angioplasty through Radial Artery root, there is no need for prolonged immobilisation (lying in bed for 6-7 hours). Once the procedure is done, you can sit and do all your routine stuffs.

What to expect before an Angioplasty?

Most people are made to undergo a blood test and electrocardiogram before having an angioplasty. Usually scheduled a day before the procedure, such tests usually require separate appointments. Usually patients are restricted to eat since 12 hours before the exam.

What happens post-procedure?

After the procedure, you will be instructed to remain flat for 5-6 hours without bending your legs, so as to prevent bleeding. The nurse will instruct you as to when you can get up from your bed. You may not be permitted to drink or eat until the groin sheath is removed as such can cause nausea.
According to the procedure, the doctor will provide you with adequate after care advice.

This is Dr. Ramesh Kawar and I’m interventional cardiologist attach to Bombay Hospital, Beach Candy Hospital, Surana Group of Hospitals and in Malad Lifeline Hospitals. I’m in the field of interventional cardiology from last 20 years doing an intervention for coronary and non-coronary situations. For vulvar situations, for congenital heart diseases and other interventional fields. Today we are going to talk on hypertension. As you know hypertension is a very common illness which is affecting as a non-communicable disease which is affecting Indian population at large.

If you see the prevalence of hypertension in India in rural population is somewhere around 5-7% while in urban population it is around 10%. So a huge chunk of our population is suffering from hypertension. Unfortunately, diagnosis and the treatment of hypertension remains poorly managed in the sense that almost 25 % of our patients are not diagnosed. Though they are suffering from hypertension around to the latest ACCH guidelines. Almost 25% remains undiagnosed, roughly around 25% they are diagnosed but they are not treated properly.

Similarly, around 25% of these patients who are diagnosed are treated poorly. Only 25% of our patients who are suffering from hypertension is are being treated properly. So there is a roughly 25% rule. It is important to treat patients with hypertension why? Because if we keep these patients untreated they are going to land up in a lot of cardiovascular disease problem like patients suffering from a stroke because of either ischemic stroke or bleed in the brain or they may suffer a heart attack like myocardial infarction or die from erythema because of hypertensive heart disease.

They may also suffer from kidney problem and lead to end-stage renal disease and dialysis. They may suffer from a retinal problem with loss of vision. So it is very important to treat and control their blood pressure so as to prevent all these deadly diseases. Now there are various stages of hypertension. Normally we say that a patient whose normal blood pressure is less than 120mm systolic and less than 80mm diastolic then we call as stage 1 hypertension where your blood pressure systolic blood pressure is between 132-139.

Earlier was 142-149 but now with the latest guidelines, 2017 ACCH guidelines recommend that any person who is having systolic blood pressure between 132-139 and a diastolic blood pressure of 80-89 is classified as stage 1 hypertension. And anything more than 140mm of systolic and more than 90mm of diastolic is classed as class 2 hypertension or stage 2 hypertension. Respective their stage we have to take a proactive step to control their blood pressure either by non-pharmacological means or by pharmacological means.

Non-pharmacological means should we tried for each and every patient whatever stage is, it is very important and there are various ways in which you can control blood pressure. If you are obese then reduction of weight will help you in controlling your blood pressure, reduction of salts intake less than 2-3 grams per day will help you in reducing your blood pressure. Similarly increasing potassium intakes like fruits-vegetable lot of vegetables and fruits especially fruits containing citrus fruits like juicy fruits like oranges, sweet limes all these will help in bringing down your blood pressure.

Regarding the salt intake, you have to avoid all the salty things like a pickle, pepper, baked products, processed foods, junk foods, you have to avoid all these to reduce your salt intake. Home cook food is best. Besides salts and potassium and weight reduction, other non-pharmacological majors which will help you in controlling your blood pressure is sedation of smoking if you are smoker, reduction of alcohol to less than 60ml per day for adult males and less than 30ml for women should encourage.

Then also regular physical activities is very very important in controlling your blood pressure. You should walk to at least 30-45minutes of the brisk walk at least 5-6 days a week if not for all days but the minimum for 5 days a week and 30-45minutes of brisk walking. You can also do yoga, meditation and other things to control your blood pressure. If your blood pressure doesn’t come under control with these majors then one can start with pharmacological treatments. You have to control your blood pressure by whatever means.

Even if you have to take 1 medicine 2 medicines 3 or even 4 number of medicines it is very very important to keep them under control with the help of drugs which are very effective in controlling your blood pressure. If you control your blood pressure properly you are less likely to suffer from other cardiovascular disease mortality. So it is very very important to control your blood pressure. Be aware about your blood pressure and try to control it by whatever means which includes non-pharmacological treatment as well as pharmacological treatment. So to book an appointment with me you can contact me through lybrate.com.

A heart attack can wreak havoc, throwing a person's life completely off balance. The condition, also known as Myocardial Infarction, often catches a person unawares. As per a survey, close to 7.35 lakhs people (both men and women) suffer from a cardiac arrest and associated disorders in the US every year. Early diagnosis and preventive measures can make a world of difference. Unfortunately, many people ignore or tend to miss out on the early symptoms characteristic of a heart attack.

A heart attack can be very much averted. All you need to do is, listen to your body and pay attention to the following warning signs. Act before it is too late.

1. Indigestion, nausea: Nausea, vomiting or indigestion is important, yet most commonly ignored early symptoms of a heart attack. More common in women than their male counterparts, the symptoms are often mistaken for over exhaustion or stomach upset. Nausea, in particular, can be triggered by many conditions and hence the negligence. A person may also complain of stomach ache or heart burns.Though the symptoms may appear to be nothing serious, seeking an immediate medical assistance will not hurt either. A little alertness will only help you in the long run.
2. Pain and discomfort in the chest: This is a warning that should be taken seriously by all means. This symptom can be an indication of a condition as serious as a blocked artery, an important trigger for a heart attack.
3. Dizziness: Seldom will you find people losing their sleep over something as common as dizziness. While the lack of a sound sleep can make a person feel dizzy and light headed, the symptom (often accompanied by chest pain) could also be an outcome of a low BP (triggered by improper functioning of the heart). Look for the symptoms carefully and act accordingly.
4. Sharp pain episodes: Many people experience a sharp pain that originates in the chest and gradually spreads outward towards the arms. The symptom is a clear indication of a heart problem, ignoring which will only spell doom. Sometimes the pain can also spread to the jaw or the throat.The symptom is a strong warning that your heart needs immediate care and attention.
5. Sudden and unexplained sweating: Sweating due to hot and scorching summer is understood but unexplained sweating can be dangerous.
6. Over exhaustion: If small or regular chores that you could do in the wink of an eye are suddenly leaving you tired and exhausted (climbing the stairs for instance), it is time for you to consult a doctor.
7. Irregular heartbeat: The irregular beating of the heart can also be an indication of a heart problem.
8. Swollen feet: A heart problem can interfere with the ability of the heart to pump blood. As a result, the affected person may have swollen feet, ankles, and legs.
9. Cough: A cough that lingers for long (often accompanied with a pink mucus) is an important indication of a damaged or diseased heart.

In case you have a concern or query you can always consult an expert & get answers to your questions!