This article is written
by Mr. Shakur Tisekar. The article is dedicated to his late brother, “GAUS
TISEKAR” who suffered from Heart Disease and left for heavenly abode on 26th
December 2011.
“Mili hai bahut
sazaa unse Dil lagane ki
Nazar lag gai mere
pyar ko Zamane ki
Markar bhi KABR se Nikle hai dono hath, is ummeed se ki,
Kahi
wo na aa jai, Arzoo jo rah gai unhe gale lagane ki...”
The
above Shayari on Dil (heart) linked with Pyar (love) made me think, how many
countless shayaris have been written on heart as a symbol of love? We all
believe that love is felt in the heart. It has been a topic of many Shayars
(poets) for many centuries. If that is
so then what is the answer for following question?
Tension happens in
brain and love is felt in heart.
Then why do people get heart attack when they are tensed?
and why people get mad when Love fails?
Then why do people get heart attack when they are tensed?
and why people get mad when Love fails?
My
article revolves around this question. Second question that perplexes me is, if
heart is symbol of love then why heart disease is number one killer in India?
What you can expect in this article is how India has become a capital of heart
disease. Based on national data, you will find the projection of how many Kokan
are affected by heart disease? I have extrapolated data to estimate, how many
Kokani die each day because of heart
attack. What will be the financial impact of surgeries? (How many accredited
hospitals are in Mumbai.)
Can we
reverse the heart disease? The answer is yes and I have then explained my own
experience in this. What causes heart disease? What are the risk factors? What
are the preventive measures to delay onset of heart disease? We will discuss on
all above points therefore stay tuned.
Heart
attack is number one killer in India:
Heart
attack causes 19% of total deaths in India. The mean (average) age of
Indian people getting heart attack is 48. This reminds me the old
famous Marathi Lawani song,”SOLAWA WARIS DHOKYACHA GA, SOLAWA WARIS DHOKYACHA.”
After, India has become capital of heart disease; I think this song should be
modified as,” 48 WA WARIS DHOKYACHA GA, 48 WA WARIS DHOKYACHA”
Jokes
apart but the worst part is, one third of people are unaware of their heart
disease until they have a heart attack. This is a scary bit. My calculations
indicate that on an average, 14 Kokani people die every day due to heart
attack. The below is the statistics I have collected. At the bottom, in the
Reference section, I have mentioned all the resources from where I have
collected data for this article.
|
Kokan area -
Square KM
|
30,728
|
Kokan population
Density
|
931.7/Sq. KM
|
|
Kokan population
(2011)
|
2,86,29,512
|
Kokani Muslim
population
|
13.4%
|
|
Kokani Muslim
population
|
38,36,355
|
Kokani per capita
income
|
66000/ Annum
|
|
Kokani total yearly income
|
1889.5 million
Rs.
|
|
|
|
Death rate (
2010) per year
|
7.2/1000
|
Kokani death per year
|
206134
|
|
Death rate due to
heart attack
|
19%
|
Kokani death due to heart attack
|
39166 per year (
107 deaths/ day)
|
|
Yearly heart
surgeries required for whole India
|
2.5 Million
|
Yearly heart
surgeries required for Kokani
|
59552 per year
|
|
Average Cost of
surgery (Miraj & Bangalore)
|
2,00,000 Rs
|
Total yearly
surgery cost of Kokani
|
11.91 Million Rs.
|
55% of
people getting heart attack are below 50 years. Recently a young lawyer under
45, and my distant relative, died due to heart attack. I had no clue that he
had heart disease. He had Rs. 4-5 lakh savings from his practice with him so he
could have done heart surgery but he thought that if operation fails then his
family will not only lose him but also all his life’s entire savings.
Therefore, he simply chose to die. No one can say that he did the right thing
but this is a heart-wrenching story. I have seen a 20 year old boy dying
because of his Mitral valve damage since childhood as a result of undiagnosed
and untreated rheumatic fever. His parents simply could not afford his surgery
& therefore they had to let him go.
If young
men are dying because of heart disease, then who is going to care for people
over 50? Again, same story, everyone in the family let them suffer painful
death simply because they are helpless. I am sure you must have come across at
least one such sad story if not many in your life. The sole searching question
we all have is,” Shall we simply do nothing and let people die or we as a
community do something about it?”
Cardiac
surgery success rate in India and healthcare Hospital standard in India:
Coronary
artery bypass graft surgery (CABG) was first performed in India in 1975 about
13 years after its advent in 1962. In the mid 1990 some 10,000 CABG surgeries
were performed annually in India. Presently the annual number is about 1,
00,000. The surgery success rates in India were not as high as developed countries
until 1990. The lower success rates were attributed to technical challenges,
which cardiac surgeons in India have to face. These are chiefly related to
small coronary vessels, arterial conduits, diffuse disease and late
presentation. Kinare & Kulkarni in a smaller series from Mumbai reported
that heart weight in Indians varied from 148 to 249 g while in the West the
average weight of the heart, in males is 300 g and that in females is 250 g. (I
personally think we Indians have big heart, so what if not in dimensions) Such
smaller sized vessels pose difficulty during anastomosis and may result in
early graft closure leading to higher mortality. Come year 2000, a cardiac
surgery success rate in India was even better than developed countries. That
proved Kinare & Kulkarni report irrelevant. For example, Dr. Naresh Trehan
who is cardiac surgeon at Medanta hospital in Gurgaon, Haryana has performed
more than 60,000 cardiac surgeries with 99.5% success rate. Dr. Shetty who did
cardiac surgery on Mother Teresa at Narayana Hrudayalaya, Bangalore has carried
out thousands of surgeries with 98.6% success rates. Success rates of cardiac
surgery in US is 98.2%
As a
result, an estimated 150,000 foreigners travel to India for low-priced
healthcare procedures every year which is expected to grow 2 billion $ healthcare
industry by 2015. To improve the standard of healthcare in hospitals,
Government of India, in 2006, introduced National Accreditation Board for
Hospitals (NABH) accreditation as International accreditation was perceived to
be too difficult to achieve by hospitals in India which is not true because
Asian Heart Institute in Bandra, Narayana Hrudayalaya (Bangalore), KIMS Kerala,
Apollo hospital chains, Fortis hospital chains have successfully acquired accreditation
from JCI (Joint Commission International).
Healthcare
Hospital Standard in Mumbai:
Mumbai’s
hospitals and doctors were top rated before 30-40 years but unfortunately
Mumbai’s healthcare standard has deteriorated in recent years. No one would
have considered going to Bangalore for treatment in 1975 but today 12 hospitals
in Bangalore & 25 hospitals in Delhi acquired India’s NABH accreditation
(out of total 125 accredited hospitals nationally) as against Mumbai’s meagre 6
hospitals. Medanta hospital in Haryana performed thousands of cardiac surgeries
using highly sophisticated Da vinci robot whereas in Mumbai, it is recently
started in Asian Heart Institute Bandra. Skill of Mumbai doctors can’t be
questioned. As an example, Dr. Panda from Asian Heart Institute, Bandra did
heart surgery on Prime Minister Manmohan Singh. Narayana Hrudayalaya hospital
has both National plus international accreditation and their cardiac surgery
cost is lot less than what we spend in Mumbai.
I don’t have first-hand experience of Narayana Hospital but it may be
worth exploring.
Accredited
hospitals in Mumbai
NABH (
National Accreditation Board for Hospital )Accredited hospitals in Mumbai:
Lilavati
Hospital Bandra, Holy spirit Hospital Bandra, Hinduja Hospital Mahim, Nanavati Hospital Santacruz,
Hiranandani Hospital, Powai, Godrej Hospital, Vikhroli
Joint Commission of International (JCI)
accredited hospitals in Mumbai:
Asian
Heart Institute, Bandra, Fortis (previously called Wockhardt) Hospital, Mulund,
Shroff Eye Clinic.
Heart
attack symptoms:
The warning signs
of heart attack can be varied and may not always be sudden or severe. You may
have just one of these symptoms, or a combination of them. They can come
suddenly or develop over minutes and get progressively worse. Symptoms usually
last for atleast 10 minutes.
Warning signs could include:
• Discomfort or pain in the
centre of your chest—
This can often
feel like a heaviness, tightness or pressure. People who have had a heart
attack have commonly described it as like an “elephant sitting on my chest”, “a
belt that’s been tightened around my chest” or ”bad indigestion”. The
discomfort may spread to different parts of your upper body.
• Discomfort in these parts
of your upper body:
You may have a choking feeling in your
throat. Your arms may feel heavy or useless.
• You may also experience
other signs and symptoms:
– feel short of breath
– feel nauseous
– have a cold sweat
– feel dizzy or light-headed.
Diagnosis
of heart disease:
The
physical exam:
The doctor will look at your skin
for good color, which shows that your body is getting a good supply of
oxygen-rich blood. Your doctor will also feel your skin for warmth and feel
your pulse to check your heart's rate, rhythm and regularity. Each pulse
matches up with a heartbeat that pumps blood into the arteries. The force of
the pulse also helps evaluate the amount (strength) of blood flow to different
areas of your body and problems with circulation. Your doctor will check for
swelling, which is a sign that your heart is not pumping efficiently.
Your doctor will use
a stethoscope to listen closely to the sounds the heart makes with each
heartbeat. The doctor can evaluate your heart and valve function and hear your
heart’s rate and rhythm by listening to your heart sounds.
Abnormal sounds include:
●
Murmur:
An abnormal whooshing sound made by blood flowing abnormally through the heart.
This may indicate a leaky heart valve.
Blood Pressure
The doctor will
measure your blood pressure. High blood pressure (hypertension) is a common
problem that often leads to heart disease.
Blood pressure is the
force (pressure) exerted in the arteries by the blood as it is pumped around
the body by the heart.
Blood pressure is a measurement of two types of pressure that are recorded as mm Hg (millimeters of mercury):
●
Systolic pressure: This is the amount of pressure in the arteries when the heart
contracts. This is the higher of the two numbers.
●
Diastolic pressure: This is the amount of pressure in the arteries when the heart is
relaxed between heartbeats. This is the lower of the two numbers.
The normal blood
pressure for an adult who is relaxed at rest is less than 140/90 mm Hg.
Blood pressure may go
up or down, depending on your age, heart condition, emotions, activity and the
medications you take.
One high blood
pressure reading does not mean you have high blood pressure. You may have to
have your blood pressure measured at different times to find out what your
typical reading is.
ECG Test:
An electrocardiogram
(ECG) is a medical test that detects cardiac (heart) abnormalities by measuring
the electrical activity generated by the heart as it contracts. The ECG can
help diagnose a range of conditions including heart arrhythmias, heart
enlargement, heart inflammation (pericarditis or myocarditis) and coronary
heart disease.
Stress
Test:
Exercise stress testing is a procedure used by
doctors to measure the performance and capacity of the heart, lungs and blood
vessels during exercise.
A common type of exercise stress test involves using
an electrocardiogram (ECG) to record electrical signals from your heart during
exercise. Alternatively, an echocardiogram may be used instead of an ECG. An
echocardiogram uses sound waves (ultrasound) to produce images of your heart. A
third type of exercise stress test involves injecting a radioactive material
and following its progress through the heart’s blood vessels. This is often
called a 'nuclear stress test' or a 'myocardial stress test'.
In some people, exercise stress testing is not
suitable. In such cases, medicines may need to be used instead of exercise to
stimulate the heart. This is called 'pharmacological stress testing'.
Echocardiogram:
An echocardiogram is a test in which ultrasound is
used to examine the heart. In addition to providing single-dimension images,
known as M-mode echo that allows accurate measurement of the heart chambers,
the echocardiogram also offers far more sophisticated and advanced imaging.
This is known as two- dimensional (2-D) Echo and is capable of displaying a
cross-sectional "slice" of the beating heart, including the chambers,
valves and the major blood vessels that exit from the left and right ventricle
Sticky
patches or electrodes are attached to the chest and shoulders and connected to
electrodes or wires. These help to record the electrocardiogram (EKG or ECG)
during the echocardiography test. The EKG helps in the timing of various
cardiac events (filling and emptying of chambers). A colorless gel is then
applied to the chest and the echo transducer is placed on top of it. The echo
technologist then makes recordings from different parts of the chest to obtain
several views of the heart. You may be asked to move from your back and to the
side. Instructions may also be given for you to breathe slowly or to hold your
breath. This helps in obtaining higher quality pictures. The images are
constantly viewed on the monitor. It is also recorded on photographic paper and
on videotape. The tape offers a permanent record of the examination and is
reviewed by the physician prior to completion of the final report.
Cardiac
CT Scan:
Cardiac computed tomography, or cardiac CT, is a
painless test that uses an x-ray machine to take clear, detailed pictures of
the heart. Doctors use this test to look for heart problems.
During a cardiac CT scan, an x-ray machine will move
around your body in a circle. The machine will take a picture of each part of
your heart. A computer will put the pictures together to make a
three-dimensional (3D) picture of the whole heart.
Sometimes an iodine-based dye (contrast dye) is
injected into one of your veins during the scan. The contrast dye highlights
your coronary (heart) arteries on the x-ray pictures. This type of CT scan is
called a coronary CT angiography , or CTA.
Coronary
angiogram:
A coronary angiogram is a special x-ray of your
heart using an injected contrast dye. The angiogram looks for heart muscle or
heart valve abnormalities. It can also see if the coronary arteries are
narrowed or blocked. An angiogram can also diagnose heart problems including
aneurysm (abnormal ballooning of the heart wall), heart arrhythmias (irregular
heart beat) or birth defects, such as a hole in the heart.
The test
is done in a special laboratory called a cardiac catheterisation laboratory
(Cath Lab), which is similar to an operating theatre. A slender catheter (a
thin, hollow plastic tube) is threaded through the largest artery in your body
(the aorta) until it reaches the coronary arteries of the heart. A special
contrast dye is injected and x-rays are taken of the blood vessels as the dye
moves through them. Another term for coronary angiogram is cardiac
catheterisation.
Risk:
This is an invasive
test. Therefore, it carries a very small risk.
Although very rare but
possible complications of an angiogram:
Some of the possible
complications of a coronary angiogram include:
●
Allergic reaction to the contrast dye, including hives and itchy skin
●
Bleeding from the wound
●
Heart arrhythmia
●
Heart attack
●
Stroke.
Cardiac PET Scan:
Although
many cardiologists still consider coronary angiography to be gold standard for
measuring heart disease, Cardiac PET scan is becoming a new Gold standard for
assessing whether or not heart disease is getting better or worse. Angiograms measure only blockages in the
artery whereas Cardiac PET scan measure how much blood flow the heart is
receiving. Also, Angiogram is invasive hence it carries some risk where as
Cardiac PET Scan is non-invasive test.
There
were 22 Cardiac PET Scan machines installed in India in 2010 which would have
been doubled by this time. All accredited hospitals in Mumbai as well as big
private hospital In Mumbai have this machine. Also, KEM hospital in Parel has
this machine. The cost of cardiac PET SCAN test in private hospitals in India
varies from Rs. 15000 to Rs. 27000 depending on the protocols used.
An interventional procedure:
An interventional
procedure is a non-surgical treatment used to open narrowed coronary arteries
to improve blood flow to the heart. An interventional procedure can be
performed during a diagnostic cardiac catheterization when a blockage is
identified, or it may be scheduled after a catheterization has confirmed the
presence of coronary artery disease.
An interventional
procedure starts out the same way as a cardiac catheterization. Once the catheter
is in place, one of these interventional procedures is performed to open the
artery: balloon angioplasty, stent placement, rotablation or cutting balloon.
Balloon angioplasty: A procedure in which
a small balloon at the tip of the catheter is inserted near the blocked or
narrowed area of the coronary artery. The technical name for balloon
angioplasty is percutaneous transluminal coronary angioplasty (PTCA) or
percutaneous coronary intervention (PCI). When the balloon is inflated, the
fatty plaque or blockage is compressed against the artery walls and the
diameter of the blood vessel is widened (dilated) to increase blood flow to the
heart. This procedure is sometimes complicated by vessel recoil and restenosis.
Balloon angioplasty
with stenting:
In most cases, balloon angioplasty is performed in combination with the
stenting procedure. A stent is a small, metal mesh tube that acts as a scaffold
to provide support inside the coronary artery. A balloon catheter, placed over
a guide wire, is used to insert the stent into the narrowed artery. Once in
place, the balloon is inflated and the stent expands to the size of the artery
and holds it open. The balloon is deflated and removed, and the stent stays in
place permanently. During a period of several weeks, the artery heals around
the stent. In this way, restenosis is somewhat diminished.
Angioplasty with
stenting is most commonly recommended for patients who have a blockage in one
or two coronary arteries. If there are blockages in more than two coronary arteries,
coronary artery bypass graft surgery may be recommended.
Drug-eluting stents
(DES): Drug-eluting stents
contain a medication that is actively released at the stent implantation site.
Drug-eluting stents have a thin surface of medication to reduce the risk of
restenosis.
Concern was raised in
2006 regarding the safety of drug-eluting stents due to the risk of blood clots
forming on the stent, causing a heart attack. The Food and Drug Administration
(FDA) continues to feel that DES, when used according to approved indications,
are safe and effective.
Source: Update to FDA Statement on Coronary
Drug-Eluting Stents (January 4, 2007).
If you receive a
drug-eluting stent, your doctor will prescribe certain medications for several
months after your procedure to prevent the risk of clotting in the stent. It is
extremely important to keep taking the medications as prescribed until your
doctor tells you otherwise.
Rotablation
(Percutaneous Transluminal Rotational Atherectomy or PTRA): A special catheter,
with an acorn-shaped, diamond-coated tip, is guided to the point of narrowing
in the coronary artery. The tip spins around at a high speed and grinds away
the plaque on the arterial walls. This process is repeated as needed to treat
the blockage and improve blood flow. The microscopic particles are washed
safely away in your blood stream and filtered out by your liver and spleen.
Cutting balloon: The cutting balloon
catheter has a balloon tip with small blades. When the balloon is inflated, the
blades are activated. The small blades score the plaque, then, the balloon
compresses the fatty matter into the arterial wall. This type of balloon may be
used to treat the build up of plaque within a previously placed stent
(restenosis) or other types of blockages.
Bypass Surgery:
A
heart bypass operation is performed to 'bypass' a narrowed segment of coronary
artery. This is usually done by inserting a section of the patient's saphenous
vein, taken from the thigh or lower leg. This is also called coronary artery
bypass graft surgery (CABG)
Heart
bypass surgery is performed under general anaesthetic. The saphenous vein (from
your leg) the internal mammary artery (from your chest wall) or the radial
artery (from your wrist) can be used as grafts. Commonly, between two and four
coronary arteries are grafted, depending on the location and severity of the
blockages.
The
surgeon accesses your heart using one of two possible incisions: either cutting
down the length of your breastbone (median sternotomy) or cutting beneath the
left nipple (thoracotomy). A heart-lung machine maintains your blood
circulation while your heart is deliberately stopped. The vein or artery is
then grafted onto the narrowed segment of coronary artery, which allows the
blood flow to bypass the blockage.
Sometimes, the
operation is performed while the heart is still beating (this is called
'beating heart' or 'off-pump' surgery).
Cardiopulmonary Resuscitation - CPR
Cardiopulmonary
resuscitation, or CPR, is a lifesaving rescue method that anybody can and
should learn. It is a combination of both rescue breathing and chest
compressions to provide blood flow to the brain and heart.
Lab test
to conform heart attack:
When the heart is
deprived of oxygen, the muscle fibers are damaged, and their components like
troponin,
Creatine kinase (CK), Myoglobin (Mb) leak in to the bloodstream.
Measuring these enzymes in lab, heart attack is confirmed.
What are heart
diseases?
There
are two extreme views in medical fraternity. One extreme view advocates that
cholesterol is everything in heart disease where as another extreme believes
that cholesterol has little to do with heart disease. The reality lies in
between these two extremes. Although Cholesterol is just one of the several
risk factors, it is indeed a big contributing factor in Coronary artery disease
related deaths.
There is
some time congenital (birth) heart defects like hole in heart chambers, many
times mitral valve is damaged if rheumatic fever is not treated, few people
suffer from aortic valve leakage, few are born with genetic muscle disease that
affects muscle of the heart, and some people have severe irregular heartbeats
that become fatal. These all diseases have very fancy and sexy names. If you
want to know it, please see website address mentioned in the reference.
Coronary artery disease:
As
explained above, there are many heart diseases however this article is focussed
on coronary artery disease.
What
causes coronary blockages to form?
Blockages
form when the lining of a coronary artery is damaged. The body attempts to
repair this by putting the physiological equivalent of a Band-Aid over the
damaged area. This Band-Aid is made of cholesterol, collagen and other
materials. If the injury to the lining is chronic, then the Band-Aid begins to
pile up, one on top of another. Over time-in few decades theses begin to build
up and form coronary artery blockages. The body’s attempt to heal itself
becomes destructive & deadly when the injury is chronic and repetitive.
How much
artery blockage is safe?
Blockages
up to 50% are considered as moderate risk. Anything above 50% needs immediate
intervention by life style changes. Blockages of 70% and above are considered
as extremely dangerous and surgery is preferred because any small blood clot or
small heart spasm is enough to cause massive heart attack if arteries are
blocked over70%.
What are
the risk factors of Coronary artery disease?
●
Genetic: If
there is history of heart attack in the family, the risk of acquiring heart
disease is high
●
High
cholesterol level: As
explained above
●
High
blood pressure: When blood pressure is elevated, the blood hits the
side of the arterial wall with increased force thereby causing injury to the
lining of the coronary arteries. To repair it, cholesterol is deposited. This
reduces inner diameter of blood vessels that again increases the blood pressure
further & it becomes the vicious circle.
●
Diabetes: Insulin
produced by pancreas regulates sugar level in blood. This insulin besides
regulating blood sugar level, stimulates the secretion of Lipoprotein Lipase, an
enzyme that increases the uptake of fat from bloodstream in to fat in body’s
cells. As a result, when body produces more insulin, it is more likely to
convert dietary calories in to body fat. When body becomes insulin resistant, pancreas
produces more insulin to compensate insulin resistance which increases the
conversion of those calories in to body fat. Excess insulin may enhance the
growth of arterial smooth muscle cells which in turn starts clogging up
arteries. That is why people with diabetes have higher rates of heart attacks.
●
Nicotine: Most
people know that cigarettes are major cause of lung cancer but relatively don’t
know that smoking causes many more deaths from heart disease than from lung
cancer. The nicotine and other toxic substances in tobacco are absorbed in to
the blood and injure the lining of the coronary arteries. Nicotine also causes
coronary arteries to constrict and blood clots to form and lodge the coronary
arteries.
●
Spasm:
Coronary arteries are not rigid like lead pipe; the arteries are flexible which
can constrict, thus reducing coronary blood flow. When a coronary artery goes
in to spasm, it can injure the lining of the artery, leading to cholesterol
deposition and plaque build-up leading to clogging the arteries. Depending on spasm
intensity, severe spasm can cause bleeding in to the walls of the vessels,
causing the wall of the artery to bulge in to the artery. Severe anxiety or
shocking news may also cause spasm. Stimulants: Cocaine especially Crack and
amphetamines are perhaps the most potent stimulants of arterial constriction,
blood clot formation and plaque haemorrhage (bleeding). Other stimulants such
as caffeine, may do this but to a much lesser degree.
●
Blood
clot:
Heart attack usually occurs when a small blood clot lodges in an artery that is
already significantly blocked with cholesterol and other deposits.
●
Age: As we
age, our arteries slowly get clogged. In India mean age of getting heart attack
is 48, therefore anyone above 40 years age
have a high risk than person below 25.
●
Emotional
Stress:
Based on research findings, importance of emotional stress as a cause of heart
disease is now achieving widespread acceptance. Studies have indicated that
emotional stress increases blood pressure and cholesterol level no matter what
diet you are eating. Type of stress is not important. It is noticed that Tax
consultants have increased cholesterol levels at the end of financial year, Medical
students (I believe this will be true for all students but study was done only
on medical students) have high cholesterol levels during their exam period. A
brutal study from Dr. Boris and Dr. Genja published in Soviet scientific
journal demonstrated very clearly as to how emotional stress can cause coronary
artery blockages to form. In their very cruel experiment, male baboons were
taken from their female mates and placed in separate cages. Then the males were
forced to watch their mates copulate with a rival monkey. After four months of
this, the isolated male monkeys had significant increases in coronary artery
blockages.
How does
emotional stress lead to coronary heart disease?
Emotional
stress comes in two basic categories: Acute and Chronic. Acute stress means
nasty flare up of stress that last for a short time only. 'Chronic' stress means
there is a long standing persistent stress. Our body is designed to cope up
with acute stress well and not chronic stress. Our body responds to acute
stress by trigger mechanism known as flight or fight response which prepares us
either to fight or run away. The body does this in two ways. First, there are
direct connections between heart and brain. This is the answer of first
question I raised in the beginning of this article. These nerves called
sympathetic nervous system stimulate receptors in the heart that makes it beat
faster, harder and can cause the coronary arteries to constrict. Second, the
brain causes adrenal glands to secret stress hormones such as adrenaline and
steroids such as Cortisol, which circulate in the blood until they reach heart.
It causes a series of body responses. One of them is arteries in our arms and
legs begin to constrict, so that less blood will be lost if we become wounded.
Our blood clots more quickly to avoid blood loss. This is short time measure to
overcome danger however with emotional stress, it is chronic in nature. We
often don’t have time to recover from one stressful situation before we get hit
with another. Faster Heart beats for prolonged period causes blood pressure to
go up which injures the lining of coronary arteries. Also, stress related spasm
injures lining of the coronary arteries too. This leads to piling up
cholesterol that clogs the arteries leading to heart disease.
Can we
prevent heart disease ?
Why do
blood clot where it is not supposed to clot in the first place? Why arteries go
in to spasm & what mechanism activates the mechanism that causes coronary
artery blockages to form? The answer lies in our life style we choose each day,
what we eat, how we respond to stress, how much we exercise and whether we
abuse our body with nicotine, drugs etc.
Diet: Strict changes in
diet and life style can not only prevent heart attacks but can actually reverse
the clogging of the arteries. A diet high in saturated fat and cholesterol
provides the building blocks for coronary atherosclerosis (forming plague in
arteries). Diet can affects the heart very quickly, not just over a period of
years as is commonly believed until now. Even a single meal high in fat and
cholesterol may cause body to release hormone called thromboxane which causes
the arteries to constrict and blood to clot faster- One reason why heart
patients often get chest pain after eating a very fatty meal and why so many of
them end up in emergency room after a rich holiday feast or rich Kokani wedding
reception party.
National
Cholesterol Education Programme guidelines advise patients with high
Cholesterol level to reduce fat intake to 30% of total calories and to reduce
cholesterol consumption from 500 Milligram to 300 milligram per day. Unfortunately, this guideline does not work
for most of the people and Cholesterol level will still be too high. Even
reducing fat intake to 20% does not make huge difference. We all, including our
doctors then believe that high cholesterol level is genetic and can’t be
controlled by diet changes at all. Doctor tells us, “Well, you will have to
start taking cholesterol lowering drug for the rest of your life.”
There is
a genetic variability in how efficiently or inefficiently a person metabolizes
dietary saturated fat and cholesterol. Some people can eat almost anything yet
their blood cholesterol levels do not increase very much. Others find that even
a small amount of dietary fat or cholesterol makes their cholesterol level
increase. Most of us are somewhere in between on this spectrum. It all depends
on how many LDL- Cholesterol receptors you have in your liver cells as their
primary role is to bind & remove cholesterol from blood stream. The more
Cholesterol receptors you have, the more efficiently you can metabolize. The
number of cholesterol receptors you have is, in part, genetically determined.
Only 5%
of people have genetically high Cholesterol levels that remain elevated
regardless of life style.
75% of
our fat is produced by body so we don’t need too much dietary fat externally.
To reverse heart disease, all the foods we eat needs to be cholesterol free.
The daily fat intake needs to be below 35 gram with less than 14 gram Saturated
fat.
Fat does
taste good but if we decrease the amount of fat in diet, our palate will
readjust. After a while, we will find that diet with less fat taste delicious
and food used to taste so good will begin to seem too rich or oily. Diet should
be balanced with less fat, high proportion of complex carbohydrate and adequate
proteins.
Complex
carbohydrates include fruits, vegetables, grains, and legumes (beans) in their
natural forms. Sugar in complex carbohydrates are absorbed slowly, thereby
helping to keep blood sugar level constant and so they don’t stimulate our body
to produce excessive amounts of insulin. Fasting in Ramadan is best with diet
full of complex carbohydrate (Sehri) in the morning as you feel full of stomach
nearly whole day.
However, complex carbohydrates behave like
simple carbohydrates when they are refined. That is what we all Kokanis do. We
remove bran and fibre part from our rice and wheat flour and refine in to white
flour which is the most unwise thing to do. Since bran and dietary fibre is
removed from our Kokani roti, chappati and rice, sugar in rice, chappati, roti,
gets absorbed very quickly in our body and provokes insulin response.
Simple
carbohydrate-sugar and sweeteners like high fructose corn syrup; alcohols etc.
which our body converts to sugar are absorbed rapidly causing blood sugar to
rapidly increase.
Can we reverse heart disease?
Yes
certainly. One of my uncles has done this successfully. I have reversed my
heart disease as well. Let me tell you my story.
In March
2005, I felt congestion in my chest. I
went to my General Practitioner, who took my ECG. The ECG graph looked beautiful & artistic
to me but for some reason my GP did not like it so he referred me for Stress
Test. My GP did not like my stress test report either. He referred me to Cardiologist.
He confirmed me that I have heart disease. He booked me for angiography and I
was told that if blockages are more than 70% then they will go for angioplasty.
The word angioplasty gave me impression that doctor is doing some alterations
in my heart by plastic surgery to make it as a designer heart which will be
more presentable to whoever I share my heart with. Doctor found all my three
arteries blocked by 58%. Since one artery is blocked at the junction point,
doctor told me that I need bypass surgery and angioplasty is not suitable for
me. He said we will wait for two years so that blockages would reach 70% level.
He gave me 100mg of Aspirin to take every day to avoid blood clot.
Doctor
advised me against going to gym and to do exercise. He said people with
coronary artery blockages; exercise actually increases the tendency of blood to
clot and arteries to constrict which may lead to heart attack. I was explained
that normal coronary arteries produces a substance called endothelium derived
relaxation factor or EDRF, that dilates the coronary arteries, allowing more
blood to flow to the heart. Due to
clogging of the coronary arteries, much less EDRF is produced so arteries tend
to constrict due to exercise, reduce blood flow that may lead to heart attack.
When I
came to India and met Alli mamu (Dr. Allimiya Parkar, Cardiologist), I asked
him whether blockages can be reversed? He said yes and asked me to read, Dr.
Ornish’s book reverse your heart disease. He told me how Sayeed mamu (Alli
mamu’s brother) reversed his heart disease after first heart attack purely by
diet. I followed the advice in the book. I don’t smoke and I don’t drink
alcohol but I was having dilemma about exercise. I followed the safe exercise
formula given in Dr. Ornish book that worked well. My cardiologist realised
that I have improved drastically so he keep postponing my heart surgery. After
5 years, he checked my blockages again. The blockages were reduced from 58% to
42%.
Slight
reduction in blockages results in great improvement in blood flow. If half inch
pipe line is replaced with one inch pipe line in water supply, the flow is
increased by four times. Same principle applies in arteries as well.
Safe
exercise level:
Half an
hour walk daily is good enough exercise. There are two formulae used for safe
exercise. The safe heartbeats are calculated as
0.80
(220- your age)
The
other method is called Karvonen Equation, which takes in to account resting
heart rate;
Safe
heartbeats= [(maximum heart rate – resting heart rate) x (0.80) + resting heart
rate]. First formula is my favourite as it is just easy.
Reducing
stress level:
Getting
connected with people & getting connected with God by praying or meditation
are the best way to keep stress under control.
The
other thing to control stress level is to apply 90/10 rule in our entire life
situation. You may already know about 90/10 rule and its story but it is
worthwhile to mention here to reinforce it again.
90/10
rule: 10% of life is made up of what happens to you. 90% of life is decided by
how you react.
What
does this mean? We really have no control over 10% of what happens to us. We
cannot stop the car from breaking down. The plane may be late arriving, which
throws our whole schedule off. A driver may cut us off in traffic. We have no
control over this 10%. The other 90% is different. You determine the other 90%!
How?
By your reaction. You cannot control a red light, but you can control your
reaction. Let's use an example. You're eating breakfast with your family. Your
daughter knocks over a cup of coffee onto your business shirt. You have no
control over what just happened. What happens next will be determined by how
you react. You curse. You harshly scold your daughter for knocking the coffee
cup over. She breaks down in tears. After scolding her, you turn to your wife and
criticize her for placing the cup to close to the edge of the table. An
exchange of verbal abuse follows. You storm upstairs and angrily change your
shirt. Back downstairs you find your daughter has been too busy crying in hurt
to finish breakfast and get ready for school. She misses the bus. Your wife
leaves immediately for work, upset and angry.
You
rush to the car and drive your daughter to school. Because you are late, you
furiously drive 40 miles an hour in a 30 mph speed limit. After a 15 minute delay
and throwing $60 (traffic fine) away, you arrive at school. Your daughter runs
to the building without saying good-bye.
After
arriving at the office 20 minutes late, you find you forgot your briefcase.
Your day has started terrible. As it continues, it seems to get worse and
worse. You look forward to going home. When you arrive home you find damage and
hurt in your relationship. You can only expect, “Not tonight…” answer from your
spouse and no smile from your daughter.
Why?
All because of how you chose to react in the morning.
Here
is what could have and should have happened. Coffee splashes over you. Your
daughter is feeling apologetic and sorry. You gently say with a smile,
"It's OK honey, I know you didn't mean it."
Grabbing
a towel you rush upstairs. After grabbing a new shirt and your briefcase. You
come back down in time look through the window and see your child getting on
the bus. She turns and waves. You and your spouse kiss before you both go to
work. You arrive 5 minutes early and cheerfully greet the staff. Your boss
comments on how good of day you are having.
Notice
the difference? Two different scenarios. Both started the same. Both ended
different. Why? Because of how you CHOOSE to react. You really do not have any
control over 10% of what happens. The other 90% is determined by your own free
will.
Body
Mass Index and heart disease:
My
weight was 70 Kg when I got heart disease. Sayeed mamu had 60 Kg weight when he
suffered his first heart attack. Both weights were ideals in terms of body mass
index. Obesity is considered a risk
factor for heart disease but we were not obese so I asked question to Alli
mamu,” I am not obese person then why I got heart disease?” He asked me,” What
was your weight at the age of 25?” I said,” 50” He said,” Heart growth stops at
the age of 25. Heart is designed to take care of body weight at the age of 25.
Arteries also are designed to take care of body weight at the age 25. In fact
everything in our body is designed to take care of weight at the age of 25.
There is 10% inbuilt overload capacity. Your weight has increased by 40% which
means you are obese as far as heart is concerned. If some one’s weight is 100
Kg at the age of 25, and his weight is increased to 110Kg then he is not obese
from hearts perspective. When I read Kulkarni report about how Indian men’s
heart size is small & diameter of coronary arteries are less compared to
westerners, it made sense to me. I can visualise, Andrew Simond’s heart,
arteries and organs will be bigger than Rahul Dravid now. I think many Indian
people are not obese but they increase their weight considerably compared to
their weight at 25 making them vulnerable to heart disease.
Religion
and heart disease:
Fasting
in Islam is good for the heart. Also, Zakat system in Islam can take care of
all health problems of Muslim community. Prayers are good for reducing stress.
Going for Umra & Hajj is like great stress busters too as you forgets all
the worldly things and get connected to Allah. It is like recharging the
battery, recharging our soul.
This
is equally true for all the other religions as well. Going in temple,
meditation, performing religious rites has similar effects like prayers in
Islam.
Meditation & Yoga: Ancient monks Swamis, Sufis, have
demonstrated how inner peace and happiness can be achieved with the help of
meditation & self realisation. In mid
seventies, studies in in Boston, New York, California, England and other parts
of the world were proving that meditation can lower blood pressure, reduce
cholesterol level, and decrease the frequency of irregular heart rhythm &
so on. Yet, almost all of these techniques ultimately derive from Yoga. Herbert
Benson, M.D.; a well known cardiologist at the Harward Medical school, spent
two decades conducting pioneering research on beneficial effects on meditation.
He found that meditation can lower BP, decrease premature heartbeats, inhibit gastric acid secretion,
& produce other beneficial effects. Jon KabatZinn, Ph.D., director of
stress Reduction Clinic at the University of Massachusetts medical school, has
found similar results using yoga techniques with his patients.
The
system of yoga was first compiled by Patanjali somewhere between 5000B.C. &
A.D. 3000. In his book, Yoga Sutras, Patanjali outlined general principles showing
step by step how a person can find inner peace & knowledge through Yoga.
Patanjali did not limit his instructions to any particular technique or
religion, for Yoga is not religion. Exercise does not conflict with any
religion. Same thing is true about Yoga. It is a system that can help broaden a
person’s present experience of his/ her own philosophy, religion & daily
life. Yoga complements rather than replaces western approaches and medical
care.
Other
side effects of Cholesterol:
We
all talk about clogging coronary arteries because it leads to heart attack
& death however all our arteries in our body starts clogging as we age. If
arteries leading to brain are clogged, it causes stroke. However, partial
Clogging of brain arteries may not be life threatening but it can affect
quality of life. Blood supply to brain gets reduced so 45 year old person’s
brain will not be as sharp as 20 year old students. People at 45 age, have
difficulty with memory. They can’t do university degree at this age. This is
because of partial clogging of arteries. When clogging of arteries reduces
blood flow to digestion system, you will find that you are not able to eat
anything and everything you like and get away with it as you used to, when you
were 25 year old. And God forbid, Penis thrombosis can make married person’s
life upside down. Even partial clogging of penile arteries can affect quality
of person’s sexual abilities. Therefore, if nothing else motivates Kokani men
to eat less fatty stuff then at least this side effect should motivate our
married Kokani men. Everything we are talking about is not to enhance our life
but to improve quality of life.
In
summary, Prevention is always better than cure. To prevent heart disease, we
should give utmost importance to diet, exercise and reducing our stress level.
We should not abuse our body with smoking, drinking alcohol & drugs. Heart disease can be reversed with life style
changes. We don’t need to change drastically. We just need to give up on our
current sedentary life style. We need to get connected with our people and God.
About Author :
Authors introduction in his own words:
My name is Shakur
Tisekar living in Sydney, Australia, with wife and two sons. Having done my
schooling till SSC from Siraj ul Islam, High school, Furus, I completed Diploma
in Electrical Engineering from Saboo Siddik college. I started my career with Bombay Electric Supply
Trandport-BEST, as we know today, for a few months and later joined Brihan
Mumbai Corporation-BMC. In the meantime I also got married. A few years later I
did Bachelor of Engineering from Sardar Patel College, followed by MBA
(Finance) from Newport University. I also did a research project from United
states Agency for International development through National Productivity
Council, Chennai, and bagged a few certificate courses including Personality
Development and Post Graduate Diploma in Teaching in Curtin University, Perth.
After passing Technology Architect, Proven Specialist Exam, I now work as a
Technology Consultant Analyst in an American IT company. Well, I am not only
boring nerd, but I enjoy all good things of life, this includes Bollywood
movies, Music, Sports like Cricket, Chess,
and sometimes reading novels too.
Background of article:
About six month back,
I read Cancer awareness post by Dr. Wasim Phoplunkar on Facebook.
Dr. Manzer Sahibole also wrote an article on women related issues in
iKokni. I realised that similar awareness is required for Heart disease as
heart attack is a number 1 killer in India. While playing Chess and
simultaneously chatting with my late brother, I suggested him that he should
request Dr. Wasim to create awareness about heart disease as well. What he
replied to me was totally unexpected,” Shakur, Why can’t you write awareness
article, yourself? I said, “Bhaijan, are you kidding? How can you expect an
Engineer writing medical article and that too on serious topic like heart
disease? We have plenty of highly qualified Doctors. They will grill me
literally.” My brother replied,” If you do with good intention, no one will
grill you. Just start creating awareness and Doctors will correct you if you
have erred in your article and will add their input.”
I did not take his
advice seriously. As many of you may be aware that my brother is no more with
us now. Four weeks before, I happened to read that same chatting again and I
decided that I will write an article as per my brother’s will. That is why you
are reading this article.
This article is
written for common man or layman like me. Therefore, I have tried to avoid
medical jargons as much as is practically possible. Those who know little about
Latin language, would easily understand Jargons, like, Hyper means high, hypo
means low, tension means pressure, Pancreatitis means inflammation of pancreas,
infarction means tissue death due to lack of oxygen, myopathy means muscle
disease, so on and so forth. But again I am assuming that majority would not be
conversant with Latin language, therefore, instead of using cardiac infarction
term I have used heart attack. However, I have not gone overboard and
translated medical term such as Lipase enzyme as,” PACHAN DRAVVYA” etc.
Lastly, I request
every reader to feel free to correct me wherever you believe that I have given
unauthentic information or made mistakes. I will be more than happy to be
corrected because reaching correct information to our people is more important
than my own little ego.
References:
http://articles.timesofindia.indiatimes.com/2010-04-30/edit-page/28136764_1_capita-income-maharashtra-job-losses
http://articles.cnn.com/2009-04-02/health/india.heart.disease_1_mutation-heart-disease-heart-attacks?_s=PM:HEALTH
DR. DEAN ORNISH’S
PROGRAM FOR REVERSING HEART DISEASE… DR. ORNISH
http://articles.timesofindia.indiatimes.com/2012-02-11/india/31049617_1_death-rate-lowest-death-health-centres
http://www.heartfoundation.org.au/SiteCollectionDocuments/Dietary-Fats-Dietary-Cholesterol-and-Heart-Health.pdf
http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n31.pdf?q=publications/synopses/_files/n31.pdf
http://www.ijri.org/article.asp?issn=0971-3026;year=2008;volume=18;issue=4;spage=290;epage=294;aulast=Rangarajan
http://www.theaustralian.com.au/archive/business-old/the-henry-ford-of-heart-surgery-devi-shettys-business-model-delivers-cheap-medical-care/story-e6frg90x-1225801548287
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747449/
http://www.heart.com/heart-rate-chart.html
http://nabh.co/main/hospitals/accredited.asp
http://www.jointcommissioninternational.org/Accreditation-and-Certification-Process/
