World Heart Day 2008
World Heart Day is celebrated every year on the last Sunday of September. Heart and stroke diseases are the world largest killer, claiming 17.5 million lives each year. The theme of this year world heart day is "Know your Risk". We have collected some useful information on heart diseases and various risk factors. A team of doctors from Norvic International Hospital have contributed these informations which are complied in this article.
Heart Attack
-Dr.Yadav Bhatta
Heart is a muscular pump made of a special type of muscle and functions as a very important organ of our body. It pumps out blood received from different organs of our body into the lungs so that blood gets filled with oxygen and receives it back into the heart. The heart then pumps this "oxygen saturated blood" to the whole body to provide oxygen and nutrients to each and every cell of the body. When this special muscle of the heart dies suddenly due to lack of blood supply to it, a "heart attack" is said to have occured. As heart has such a vital role in maintaining life, any insult to its function leads to catastrophic situation including death. This signifies the importance of early treatment of heart attack and the need to take steps to prevent. With modern treatment provided in time more than 90% patients of heart attack can be saved. Two tablets of aspirin chewed is the first aid treatement of heart attack.
High Blood Pressure!
- Prof D. B Karki
High Blood Pressure (BP) in adults (18 years or older) is defined as systolic BP of 140 mm Hg or greater and or diastolic BP of 90 mm Hg or greater.
Risk of cardiovascular death beginning at 115/75mm Hg doubles with each increment of 20?10 mm Hg. Persons with normal BP at the age of 55 years have a 90% lifetime risk for developing high BP.Person with elevated BP may have headache, dizziness or no symptoms at all. The cause of high BP is found in about 10% patients only. The most important complications are stroke, heart attack, heart failure, renal failure and eye problems. If BP is not treated 50% of patients will die of Coronary Artery Disease or Congestive Heart Failure & 20% will die of Stroke. Salt restriction, weight reduction, stopping smoking, regular aerobics, increase intake of fresh fruits and vegetables are advised. `The decision to take Blood Pressure lowering drugs upon the individual patient. Blood Pressure should be maintained around 130/80mm Hg and the drugs should not be stopped without consulting the physician. (Pic. 1. Human Heart)
Diabetes and Tobacco
-Dr. Shekhar Rajbhandari
Diabetes and Heart Disease:
Diabetes is one of the major risk factor for CAD. People with diabetes experience higher morbidity and mortality after a heart attack than people without diabetes.
Diabetes also increases the risk of heart failure. Patients with diabetes are two to five times more likely to develop heart failure than those without diabetes.
Tobacco and Heart Disease:
Cigarette smoking is the single most important modifiable risk factor for CAD and leading cause of death. The rate of tobacco users are increasing among adolescents, young adults and women. Even among non-smokers, inhaled smoke, whether from passive exposure or from cigar and pipe consumption, also increase coronary risk
Cessation cigarette consumption constitutes the single most important intervention in preventive cardiology.
Few Facts about Your Cholesterol !
- Dr. Rajiv Pande
Cholesterol is the fat component of the blood.It exerts harmful effect to the body if its level is more than the normal range in blood.It gets deposited on the wall (inner side) of the arteries causing narrowing of the affected arteries.If the affected arteries are significantly blocked then it can cause diseases like Angina, Stroke, which often are life threatening or can make life crippled. Considering its adverse effect on health it is recommended that every effort should be made to keep its blood level within reasonable valve (can differ from patients to patients) Hence, anybody with above mentioned conditions or even those after the age of 45 years should contact family physician and undergo evaluation.Cholesterol can be controlled with regular physical exercise, avoid fatty, fried foods and encourage eating fresh vegetables and fruits. There are also medicines to lower cholesterol level, which should be taken with the physician advice . Ideally, Total cholesterol should be kept below 200mg%, LDL below 100 mg%, TG below 150mg% & HDL above 45 mg%.
Echo and TMT:
-Dr. H.S. Sodhi
Echo Cardiogram:
An echocardiogram is basically an ultrasound of the heart. It is a painless, non-invasive test to determine the anatomy and functional integrity of the heart. An echo cardiogram can give us all the information about anatomical defects in the heart, whether present at birth or acquired later. A cardiac ultrasound is now an essential ingredient of almost all cardiac check ups.
Treadmill Test:
A treadmill test is used to determine indirectly whether the coronary arteries are patent or not.
In this test the patients is made to walk on a treadmill with ECG monitoring. The heart rate of the patient is increased to a certain limit during exercise and specific ECG changes looked for.
A TMT is basically a screening test and is not 100% accurate. In case a TMT is positive (ie. abnormal) then a definitive test like coronary angiography is planned.
Coronary Angiography & Angioplasties
-Dr. Bharat Rawat
CORONARY ANGIOGRAPHY (Diagnosis):
Coronary Angiography is a special x-ray technique where dye is injected into the arteries that lead to the heart (the coronary arteries). The test lets the doctors see the number, exact location and extent of narrowed or blocked coronary arteries. It takes about 15 - 20 minutes.
Coronary angiography is being routinely done in Nepal and many patients are checked and benefited everyday.
CORONARY ANGIOPLASTY (PTCA) (Treatment):
Coronary Angioplasty is a non-surgical procedure in which a specially designed balloon catheter is used to open a narrowed or blocked artery. First human plain balloon angioplasty was performed in 1977. Many patients after balloon angioplasty may develop restenosis (reblockade). Thus metallic coils (stents) were introduced to keep the artery open .First stent angioplasty was performed in 1986. First medicated stent was approved by FDA in 2003.
CORONARY STENTING:
A stent is a small round metallic coil/tube designed to support the wall of the coronary artery.
Coronary Stenting is a procedure in which this stent is placed in the narrowed part of coronary artery. Today in almost all patients who undergo balloon angioplasty, a stent is placed to keep the artery open. Worldwide Coronary angioplasties are being done more & more with great success rates (about 99%).Last year above 2 million angioplasties were done world wide. In Nepal, Coronary angioplasties are currently being done at National Heart Center, Medicare Hospital and Norvic International Hospital.
Emergency coronary angioplasty at the time of Heart attack:
Emergency Coronary Angioplasty at the time of heart attack can be life saving. Although it is expensive treatment it does help patients recover faster and substantially decrease the risk of death and heart failure. (Pic.2. Angioplasty)
Coronary Artery Bypass Grafting
- Dr. Bhagwan Koirala
Coronary artery bypass grafting (CABG) is a surgical method of restoring blood supply to the heart. CABG is performed when the arteries supplying the heart itself get blocked and it is not feasible to open them with the help of angioplasty or it is too risky in terms of collateral damage if we perform angioplasty. Most commonly a patient would need coronary bypass if he/she has multiple blocks in the arteries, or has blockage at the branching or too long lesions or has blockage at the very beginning of the main artery. While doing bypass we use conduits from the patient’s body itself. Most commonly used conduit (tube) is one from inside the chest called the internal mammary artery. Other options are use of artery from one’s forearm or the veins from leg. There are different ways of doing CABG. One can do it with the help of heart lung machine and stopping the heart completely or it can also be done on a beating heart. The operation can be done either through the front of the chest or the side.
It is important to remember that operation alone, or angioplasty for that matter, does not cure the disease. Patient must continue medicines and strictly modify lifestyle to minimize the future events including the graft blockage and other complications.
All methods and techniques of CABG are now available in Nepal with results comparable with international standards. More than one hospital and more than one team are doing this procedure in Nepal on a routine basis. (Pic.3. CABG)
Cardiac Pacemaker
- Dr. Sunil Chandra Jha
Cardiac pacemakers are a set of implantable devices which are used in various conditions of heart where heart-rate stabilization is very crucial part of management. Normally heart rate is between 60-100 beats per minute. When heart rate falls below let us say, 45 beats per minute, cardiac output falls below the minimum required for the brain to function and fainting (syncope), lassitude, giddiness can occur. If these symptoms occur at a crucial point eg. driving, crossing busy roads, climbing stairs, catastrophy can happen. In these conditions cardiac pacemakers help the heart by stabilizing the heart rate not to fall below 60 beats per minute.
Recently, there are certain special cardiac devices developed which are used to treat arrhythmias (ICDs) and congestive heart failure (CRT) by biventricular Pacing. (Pic. 4. Pacemaker)
Lets go for Prevention!
(Nine tips for a healthier heart)
1. Eat a variety of food, including plenty of fruits and vegetables.
2. Avoid too much sugar, saturated fats and fast food.
3. If you drink alcoholic beverages, do so in moderation.
4. Be physically active; walk 30 to 60minutes at least 5 times a week.
5. Maintain a desirable weight.
6. Stop consuming tobacco in any form.
7. Find time for adequate mental relaxation. Enjoy quality time with your spouse,children and friends.
8. Get periodical checks of your blood pressure, lipids and blood sugar.
9. Laugh aloud: enjoy every moment of your life.
Dr Bharat Rawat
MD, DM
Condultant Cardiologist &
Executive Director
Norvic International Hospital
Email:drrawat@norvic.wlink.com.np
Heart Attack
-Dr.Yadav Bhatta
Heart is a muscular pump made of a special type of muscle and functions as a very important organ of our body. It pumps out blood received from different organs of our body into the lungs so that blood gets filled with oxygen and receives it back into the heart. The heart then pumps this "oxygen saturated blood" to the whole body to provide oxygen and nutrients to each and every cell of the body. When this special muscle of the heart dies suddenly due to lack of blood supply to it, a "heart attack" is said to have occured. As heart has such a vital role in maintaining life, any insult to its function leads to catastrophic situation including death. This signifies the importance of early treatment of heart attack and the need to take steps to prevent. With modern treatment provided in time more than 90% patients of heart attack can be saved. Two tablets of aspirin chewed is the first aid treatement of heart attack.
High Blood Pressure!
- Prof D. B Karki
High Blood Pressure (BP) in adults (18 years or older) is defined as systolic BP of 140 mm Hg or greater and or diastolic BP of 90 mm Hg or greater.
Risk of cardiovascular death beginning at 115/75mm Hg doubles with each increment of 20?10 mm Hg. Persons with normal BP at the age of 55 years have a 90% lifetime risk for developing high BP.Person with elevated BP may have headache, dizziness or no symptoms at all. The cause of high BP is found in about 10% patients only. The most important complications are stroke, heart attack, heart failure, renal failure and eye problems. If BP is not treated 50% of patients will die of Coronary Artery Disease or Congestive Heart Failure & 20% will die of Stroke. Salt restriction, weight reduction, stopping smoking, regular aerobics, increase intake of fresh fruits and vegetables are advised. `The decision to take Blood Pressure lowering drugs upon the individual patient. Blood Pressure should be maintained around 130/80mm Hg and the drugs should not be stopped without consulting the physician. (Pic. 1. Human Heart)
Diabetes and Tobacco
-Dr. Shekhar Rajbhandari
Diabetes and Heart Disease:
Diabetes is one of the major risk factor for CAD. People with diabetes experience higher morbidity and mortality after a heart attack than people without diabetes.
Diabetes also increases the risk of heart failure. Patients with diabetes are two to five times more likely to develop heart failure than those without diabetes.
Tobacco and Heart Disease:
Cigarette smoking is the single most important modifiable risk factor for CAD and leading cause of death. The rate of tobacco users are increasing among adolescents, young adults and women. Even among non-smokers, inhaled smoke, whether from passive exposure or from cigar and pipe consumption, also increase coronary risk
Cessation cigarette consumption constitutes the single most important intervention in preventive cardiology.
Few Facts about Your Cholesterol !
- Dr. Rajiv Pande
Cholesterol is the fat component of the blood.It exerts harmful effect to the body if its level is more than the normal range in blood.It gets deposited on the wall (inner side) of the arteries causing narrowing of the affected arteries.If the affected arteries are significantly blocked then it can cause diseases like Angina, Stroke, which often are life threatening or can make life crippled. Considering its adverse effect on health it is recommended that every effort should be made to keep its blood level within reasonable valve (can differ from patients to patients) Hence, anybody with above mentioned conditions or even those after the age of 45 years should contact family physician and undergo evaluation.Cholesterol can be controlled with regular physical exercise, avoid fatty, fried foods and encourage eating fresh vegetables and fruits. There are also medicines to lower cholesterol level, which should be taken with the physician advice . Ideally, Total cholesterol should be kept below 200mg%, LDL below 100 mg%, TG below 150mg% & HDL above 45 mg%.
Echo and TMT:
-Dr. H.S. Sodhi
Echo Cardiogram:
An echocardiogram is basically an ultrasound of the heart. It is a painless, non-invasive test to determine the anatomy and functional integrity of the heart. An echo cardiogram can give us all the information about anatomical defects in the heart, whether present at birth or acquired later. A cardiac ultrasound is now an essential ingredient of almost all cardiac check ups.
Treadmill Test:
A treadmill test is used to determine indirectly whether the coronary arteries are patent or not.
In this test the patients is made to walk on a treadmill with ECG monitoring. The heart rate of the patient is increased to a certain limit during exercise and specific ECG changes looked for.
A TMT is basically a screening test and is not 100% accurate. In case a TMT is positive (ie. abnormal) then a definitive test like coronary angiography is planned.
Coronary Angiography & Angioplasties
-Dr. Bharat Rawat
CORONARY ANGIOGRAPHY (Diagnosis):
Coronary Angiography is a special x-ray technique where dye is injected into the arteries that lead to the heart (the coronary arteries). The test lets the doctors see the number, exact location and extent of narrowed or blocked coronary arteries. It takes about 15 - 20 minutes.
Coronary angiography is being routinely done in Nepal and many patients are checked and benefited everyday.
CORONARY ANGIOPLASTY (PTCA) (Treatment):
Coronary Angioplasty is a non-surgical procedure in which a specially designed balloon catheter is used to open a narrowed or blocked artery. First human plain balloon angioplasty was performed in 1977. Many patients after balloon angioplasty may develop restenosis (reblockade). Thus metallic coils (stents) were introduced to keep the artery open .First stent angioplasty was performed in 1986. First medicated stent was approved by FDA in 2003.
CORONARY STENTING:
A stent is a small round metallic coil/tube designed to support the wall of the coronary artery.
Coronary Stenting is a procedure in which this stent is placed in the narrowed part of coronary artery. Today in almost all patients who undergo balloon angioplasty, a stent is placed to keep the artery open. Worldwide Coronary angioplasties are being done more & more with great success rates (about 99%).Last year above 2 million angioplasties were done world wide. In Nepal, Coronary angioplasties are currently being done at National Heart Center, Medicare Hospital and Norvic International Hospital.
Emergency coronary angioplasty at the time of Heart attack:
Emergency Coronary Angioplasty at the time of heart attack can be life saving. Although it is expensive treatment it does help patients recover faster and substantially decrease the risk of death and heart failure. (Pic.2. Angioplasty)
Coronary Artery Bypass Grafting
- Dr. Bhagwan Koirala
Coronary artery bypass grafting (CABG) is a surgical method of restoring blood supply to the heart. CABG is performed when the arteries supplying the heart itself get blocked and it is not feasible to open them with the help of angioplasty or it is too risky in terms of collateral damage if we perform angioplasty. Most commonly a patient would need coronary bypass if he/she has multiple blocks in the arteries, or has blockage at the branching or too long lesions or has blockage at the very beginning of the main artery. While doing bypass we use conduits from the patient’s body itself. Most commonly used conduit (tube) is one from inside the chest called the internal mammary artery. Other options are use of artery from one’s forearm or the veins from leg. There are different ways of doing CABG. One can do it with the help of heart lung machine and stopping the heart completely or it can also be done on a beating heart. The operation can be done either through the front of the chest or the side.
It is important to remember that operation alone, or angioplasty for that matter, does not cure the disease. Patient must continue medicines and strictly modify lifestyle to minimize the future events including the graft blockage and other complications.
All methods and techniques of CABG are now available in Nepal with results comparable with international standards. More than one hospital and more than one team are doing this procedure in Nepal on a routine basis. (Pic.3. CABG)
Cardiac Pacemaker
- Dr. Sunil Chandra Jha
Cardiac pacemakers are a set of implantable devices which are used in various conditions of heart where heart-rate stabilization is very crucial part of management. Normally heart rate is between 60-100 beats per minute. When heart rate falls below let us say, 45 beats per minute, cardiac output falls below the minimum required for the brain to function and fainting (syncope), lassitude, giddiness can occur. If these symptoms occur at a crucial point eg. driving, crossing busy roads, climbing stairs, catastrophy can happen. In these conditions cardiac pacemakers help the heart by stabilizing the heart rate not to fall below 60 beats per minute.
Recently, there are certain special cardiac devices developed which are used to treat arrhythmias (ICDs) and congestive heart failure (CRT) by biventricular Pacing. (Pic. 4. Pacemaker)
Lets go for Prevention!
(Nine tips for a healthier heart)
1. Eat a variety of food, including plenty of fruits and vegetables.
2. Avoid too much sugar, saturated fats and fast food.
3. If you drink alcoholic beverages, do so in moderation.
4. Be physically active; walk 30 to 60minutes at least 5 times a week.
5. Maintain a desirable weight.
6. Stop consuming tobacco in any form.
7. Find time for adequate mental relaxation. Enjoy quality time with your spouse,children and friends.
8. Get periodical checks of your blood pressure, lipids and blood sugar.
9. Laugh aloud: enjoy every moment of your life.
Dr Bharat Rawat
MD, DM
Condultant Cardiologist &
Executive Director
Norvic International Hospital
Email:drrawat@norvic.wlink.com.np
