`Ischemic heart disease is multifactorial`

Cardiovascular diseases kill 17.3 million people every year. In order to create awareness and to prevent the world’s top killer (heart diseases), in partnership with WHO, the World Heart Federation organizes cardio alertness events in more than 100 countries.

Created in 2000, World Heart Day was observed on the last Sunday of September, but as of this year, World Heart Day takes place on 29 September. In an exclusive interview with Salome Phelamei of Zeenews.com, Dr Santhosh K, verbalized on various heart ailments and their risk factors to diverse groups of people, treatment and prevention techniques.

Dr. Santhosh K did his M. B.B.S. from Mysore Medical College, and M.D. (Internal Medicine) from P.G.I.M.E.R., Chandigarh. He had also did his D.M. (Cardiology) from Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru.

Dr Santhosh K is currently serving as Assistant Professor & Interventional Cardiologist at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore Unit. He is also a Consultant Interventional Cardiologist at Columbia Asia Hospital, Mysore, and Visiting Consultant Interventional Cardiologist at Apollo BGS Hospital, Mysore.

He has treated more than 25,000 cardiac patients with various heart ailments successfully. He has performed more than 200 angioplasties, more than 100 pacemaker implantations, ICD device implanatation, Devices for congenital heart diseases. His area of interest is preventive cardiology, Acute Coronary syndrome, arrhythmias and heart failure.

What is heart disease?

Heart diseases are the group of diseases which affects structure, function and functional capacity of the heart. Commonest is the Ischemic heart disease, commonly called as heart attack where the nutrition to the heart is impaired due to blockage in the heart`s blood vessels and hence the heart muscle suffers & may become dysfunctional. Other conditions being hole in the heart, obstructions to the flow in the heart, and leakage of the valves.

What are the different groups of heart diseases and which one of them is the most dangerous?

Groups of heart diseases include:
Ischemic Heart disease
Congenital heart disease
Rheumatic heart disease
Miscellaneous group

Most common and most dangerous is Ischemic heart disease commonly called as Heart attack, where the blood supply to the heart is blocked or insufficient, which can cause exertional chest pain to heart attack and sudden cardiac death

Causes and risk factors for Ischemic heart disease (heart attack)

Most important risk factors are Diabetes mellitus, Kidney disease & Tobacco Smoking. Others being Hypertension, Dyslipidemia, Age, Sedentary Life style, Genetic factors, few biochemical markers like high hsCRP, apo-B, Homocysteine. In young Indians, tobacco smoking is one of the most important risk factors. In Asians and Indians abdominal obesity, apo-B, homocysteine plays a major role as a risk factor compared to western population.

Symptoms of Ischemic heart disease (heart attack)

Retrosternal chest pain with radiation to the left hand which gradually increases in intensity over 5 to 20 minutes, associated with sweating which increases on exertion, gets relieved on rest or nitrates is the classical symptoms. However minority may not have classical symptoms especially if they are diabetic or elderly, they can present with breathlessness, tiredness, syncope, epigastric pain.

How is Ischemic heart disease (heart attack) diagnosed and how do I know if I`m suffering from it?

Most important factor is the clinical history of chest pain which occurs on physical or psychological exertion, gets relieved on taking rest supplemented by investigations like ECG(Electrocardiogram), stress test, Echocardiogram and finally by a Coronary Angiogram.

Treatment and prevention of Ischemic heart disease (heart attack)

Treatment is via Revascularisation by a clot lysine Injection or an angioplasty in heart attack and medications like antiplatelets, Statins, B blockers, Nitrates and others. Heart attack can be prevented to a great extent by healthy life style, low calorie diet, regular exercise, avoiding tobacco smoke, good control of diabetes, renal disease, hypertension, cholesterol abnormalities and and optimal medications.

What is the difference between heart attack and cardiac arrest?

Heart attack is the disease where the nutrition to heart is affected abruptly by blockage in the heart blood vessel. Cardiac arrest is the condition where the heart stops to function or beat. Heart attack may or may not lead to cardiac arrest. Cardiac arrest need not be always due to heart attack. Other diseases also can cause cardiac arrest.

It is said that stroke and heart-related diseases still continue to be top killers worldwide. What is the prevalence of stroke and heart disease? Which age groups are at greatest risk for heart disease?

Stroke and heart diseases are the top killers worldwide, as well in India. The problem we are facing in our country is that both the diseases are increasing year after year. Point prevalence of stroke per year in India is 203 per 1,00,000 population. Cases of CVD may increase from about 2.9 crore in 2000 to as many as 6.4 crore in 2015. 50 to 69 years of age is the most commonly affected age group with ischemic heart disease. However in view of change in life style, more and more young age individuals are suffering from the disease nowadays.

What happens if heart disease is left untreated over a long period of time? Which treatment is best when dealing with such patients?

Any type of heart disease for that matter left untreated can cause severe functional impairment of heart and, can cause abnormal heart beats which we call as Tachy or Brady arrhythmia. Anybody can continue to have symptoms like chestpain, breathlessness, tiredness. Functional capacity of the individual may be hampered, ultimately leading to death.

How long will an Ischemic heart disease (heart attack) take to recuperate from it?

On an average, it takes 4 to 6 weeks for complete recovery. However they can start moving around as early as within 24 hours and start doing their routine, less strenuous activities by 2 weeks if they don’t have any complications. Few minorities may persist to have symptoms lifelong depending on what percentage of heart muscle is damaged in them.

Young women are catching cardiovascular diseases nowadays, how can it be prevented?

Both young men and women are catching cardiovascular diseases especially Ischemic heart disease (heart attack). Basically because of life style changes in the form of increased incidence of smoking, unhealthy (high calorie) food habits, increase in stress at work and at home, and insufficient physical exercise. By modifying the above mentioned risk factors it can be prevented.

Impact of cardiovascular disease on- Indian economy (India is placed in the `lower middle` income group).

Recent increase in the disease in younger age group has affected the economically most productive class. Cost of the medications, hospitalization, absence from work, physical and psychological burden to the patient and the family is affecting the Indian economy in a huge way.

Is Ischemic heart disease (heart attack) hereditary? And, at what age should I begin paying attention to heart health if heart disease is in my family history?

Ischemic heart disease (heart attack) is multifactorial. One of the risk factor is a family history of premature Ischemic heart disease (heart attack). If there is a family history of Ischemic heart disease (heart attack) at a younger age ( less than 40 years in a male, less than 50 years in a female) then it is considered as a family history of premature ischemic heart disease. Various consensus body is given various recommendations. If a family history of premature ischemic heart disease is present, then screening for the heart disease should start as early as at 25 years of age or atleast 10 years earlier than the documented youngest family member with Ischemic heart disease (heart attack) whichever is earlier.

How is heart disease related to AIDS, stress and lifestyle factors?

Stress and life style factors like smoking, unhealthy (high calorie) food habits, increase in stress at work and at home, sedentary life style has advanced the disease by almost a decade affecting the most economically productive age group. Significant number of AIDS patients can have heart diseases. AIDS can cause accelerated deposition of cholesterol in heart blood vessels by the disease itself or by the medications given to treat AIDS and can cause premature heart attack. AIDS also can cause other heart diseases in the form of enlargement of the heart, functional impairment of the heart muscle, accumulation of fluid around the heart, infection of the heart and finally early death.

Suggest some of the prevention methods of cardiovascular diseases:

Medication: Antiplatelets like Asprin, Statins in selected subgroup of population, adequate control of diabetes and other diseases which have cardiovascular risk

Physical activities: Regular exercises like walking for atleast 30 minutes, 5 days a week, jogging, running, cycling, swimming, treadmill.

Diets: Low fat diet- Food rich in fibres like vegetables, fruits & green leafy vegetables, reduced quantity of animal fat and red meat and avoiding fried foods.

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