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Category Archives: Cardiology

Broken Heart Syndrome Can Prove Fatal

 Dr. Aseem Dhall

It’s common that we get to hear the unfortunate news of a couple who died one after the other due to grief. Or, someone who could not cope up with the tragic news of financial loss or any kind of personal loss. These deaths are very often result of a “broken heart syndrome“, also known as stress cardiomyopathy or takotsubo cardiomyopathy, a condition that’s often brought on by stressful situations. 
Most people suffering from “broken heart syndrome” have normal coronary arteries and do not show any major blockages or clots. Infact, patients who suffer cardiomyopathy, their heartmuscle becomes suddenly weakened or stunned. And, there’s a temporary disruption in the  heart‘s normal pumping function but only in one area that leads to change in shape of heart. Whereas the remaining heart functions normally or with even more forceful contractions. Perhaps the reason this condition is also called as apical ballooning syndrome.
The symptoms of a broken heart syndrome are usually treatable, but only if diagnosed on time, and it at times reverses itself in a span of few days or weeks.
Broken heart syndrome symptoms very often mimic a heart attack as such people often have sudden intense chest pain and experience shortness of breath. These symptoms begin just a few minutes to hours after exposure to the unexpected stress. 
Other symptoms may include:
* Fatigue, feeling lethargic, sleepy 
* Electrocardiogram abnormalities are very identical to those of a heart attack
* No evidence of coronary artery obstruction
* Abnormalities in the left ventricle
* Ballooning of the left ventricle
Common Causes 
Though the exact cause of a broken heart syndrome is unclear, it is believed that a surge of stress hormones, such as adrenaline, might temporarily damage the heart of some people, especially women. But how exactly these hormones might hurt the heart or whether something else is responsible too isn’t completely clear. 
However, a broken heart syndrome is often accompanied by an intense physical or emotional event. Some potential triggers of broken heart syndrome are:
* News of an unexpected death of a loved one
* A frightening medical diagnosis
* Domestic abuse
* Losing/winning a lottery
* Having to perform publicly
* Job loss
* Divorce
* Physical stressors, such as an asthma 
Broken Heart Syndrome Versus Heart Attack 
Heart attacks are generally caused by a complete or partial blockage of a heart artery due to a blood clot formation in the wall of the artery. While in a broken heart syndrome, the heartarteries are not blocked, although flow of blood in the arteries of the heart may be reduced. And there are a number of known risk factors for broken heart syndrome, which may include:
* Sex; as the condition is believed to affect women far more often than men.
* Age is another criterion. Broken heart syndrome affects mostly people who are older than 50.
* People who have a history of a neurological condition such as a head injury or a seizure disorder (epilepsy) have a greater risk of broken heart syndrome.
* Any psychiatric disorders such as anxiety or depression, etc. 
Diagnosis and Treatment 
In some cases broken heart syndrome proves to be fatal. However, most people who experience broken heart syndrome recover over a period of time and don’t have long-lasting effects. But in some cases it may lead to other complications such as :
* Pulmonary Edema 
* Low blood pressure (hypotension)
* Disruptions in the heartbeat
Heart failure
However, if the cardiologist suspects of a broken heart syndrome, he/she will prescribe tests such as ECG which helps to detect irregularities in the heart‘s rhythm and structure, a chest XRay, Cardiac MRI, Echocardiogram and coronary angiogram, etc. Echocardiogram helps to find out if the heart is enlarged or has an abnormal 
Though there’s no standard treatment for broken heart syndrome, change of 
environment often helps to divert mind of such patients.
Once it’s clear that broken heart syndrome is the cause of underlying symptoms, the doctor will prescribe heart medications. It’s mainly treated with diuretics, agents that improve heart muscle contraction, and other therapies but there’s no surgery that’s required for the treatment of this disorder. And most of all its important to keep the patient away from any physical/emotional stress that may have played a role in triggering the disorder.
Is a Director and Head, Saroj Cardiac Sciences, 
 ISIC ,Vasant Kunj.


Hypertension : A Modern Epidemic

Padma Vibhushan Dr. Purshotam Lal

India is home to 139 million people of uncontrolled hypertension, which makes around 14 percent of the global population. In India, according to WHO, raised blood pressure has increased from 5% in the 1960s to nearly 12% in the 1990s and further it increased to above 30% in 2008, among them a significant number is in their twenties. The study highlights that high blood pressure or hypertension in adults aged 25 and above was around 40%.

High blood pressure or hypertension is silent killer as its symptoms rarely show, most of the cases go undiagnosed. Low sodium, low sugar and high potassium diet along with weight loss solutions can be a healthy approach to treating high blood pressure. Hypertension puts stress on the heart and blood vessels and is one of the major preventable risk factors for premature death from cardiovascular disease worldwide. It kills 7.5 million people worldwide each year — more than AIDS, road accidents, diabetes and tuberculosis put together.

As our heart beats, it forces blood through our arteries. This force is called blood pressure. If the pressure is too high, it is called hypertension. High blood pressure may mean that your heart has to work harder to pump blood. Your arteries may be narrow or stiff and the extra work puts you at risk of heart disease, stroke, and other problems. In our clinical practice we find that about 50 per cent of those suffering from blood pressure are not aware of it and 60 per cent of those who are aware of it are not adequately controlling it. This has led to a spurt of young patients developing heart and other diseases early. Minimizing your salt intake can help significantly. Reducing your daily salt intake from 4 grams to 2.3 grams can reduce blood pressure by 5/3mm of mercury in hypertensive people.

Hypertension is an important public health problem in India. It is a modern epidemic, a silent killer; in fact, hypertension is the most prevalent chronic disease in India. Epidemiological studies show a steadily increasing trend in hypertension prevalence over the last 50 years in India contrary to the developed countries where there has been a significant decline. Over 140 million people are believed to be suffering from high blood pressure in our country and the number is expected to cross the 214 million mark in 2030. A WHO estimate in 2012 suggests that 23 per cent men and 22 per cent women above 25 years of age suffer hypertension in India.

An increasing number of healthy children and adolescents across India are being diagnosed with hypertension, which is an emerging problem that no one can afford to ignore. The evidence from studies indicates a recent increase in the prevalence of hypertension in children and young adults.

The increase in hypertension is related to rising population-mean systolic blood pressure and is associated with escalating hypertension risk factors like sedentary lifestyle, psychosocial stress, excessive salt intake, alcohol consumption and obesity. Recent studies show that for every known person with hypertension there are two persons with either undiagnosed hypertension or pre-hypertension.

To control the menace of cardiovascular diseases (CVD) we have to have an early risk identification and intervention strategy in place. And for this strategy to succeed, we need to have comprehensive health status reviews done regularly through diagnostic tests and clinical consultations. With a whopping population of 1.2 billion, accounts for one of the highest burdens of NCDs in the world. This fact has been a bane for India’s fight against poverty as well. In low-resource settings, health-care costs for cardiovascular diseases, cancers, diabetes or chronic lung diseases can quickly drain household resources, driving families into poverty. India has a NCD death rate of 701-800 per 100,000 populations (WHO, 2008), and out of this around 400 deaths in 100,000 population are contributed by CVDs. Indians are known to have earlier onset of coronary artery disease, higher mortality, higher prevalence of truncal obesity and people with hypertension. Since CVDs are preventable in many individuals with right mix of exercise diet control and lifestyle modifications, world has seen a shift in focus – from intervention to prediction and then prevention. This becomes important because identification of risk for particular disease gives the individual a critical lead time to take precautionary measures.

Hypertension is a major public health problem worldwide and is one of the risk factors for coronary artery disease and cerebro vascular disease. Development of adult hypertension may start very early in life, and children maintain their position in the blood pressure distribution over time. Increased blood pressure is a high-risk condition that causes approximately 51 per cent deaths from stroke and 45 per cent from coronary artery disease in India. It is a major risk factor for cardio-vascular diseases that killed 2.7 million people in 2004 and will result in the death of over 4 million people by 2030. Hypertension or elevated blood pressure cannot be taken lightly. It can, over a period of time, wreak havoc with one’s system. It increases a person’s risk for heart disease, stroke, kidney disease and even blindness.

Padma Vibhushan & Dr.B.C. Roy National awardee Dr. Purshotam Lal is Chairman & Chief Cardiologist, Metro Hospitals and Heart Institute.

Heart disease is bigger killer than Breast Cancer

Vinod Kumar

As India struggles to eliminate malnutrition among the rural poor, wealthy urbanites are packing on extra pounds due to sedentary lifestyles and the growing abundance of sugary, high-fat foods.

While city-dwellers account for only 5 percent of India’s billion-plus population, they consume 40 percent of the country’s fat intake, as per latest survey.

The Indian Medical Association reports that one in three residents of Delhi is now obese. Residents of the capital consume 20 percent more fat and 40 percent more sugar than they did 50 years ago. Nationwide, 31 percent of urban Indians are either overweight or obese, according to the eminent Cardiologist Padama Bhushan Dr.Purshotam Lal.

So far, most state governments have yet to implement any programs to curb the growing trend toward obesity. If they don’t step in, experts fear the problem — and the people — will just get heftier.

Dr. Lal, Chairman of Metro Group of Hospitals and Dr. B.C.Roy National Awardee remarkably pointed out that heart disease and not breast cancer is the bigger killer of women in India today. “Women have a tenfold greater risk of death from coronary arterial disease as compared to breast cancer,” says Dr Lal, who have done intensive research in the field of interventional Cardiology and have more than 20 firsts to his credit.

“Research now says that a heart attack or a stroke is more likely to be fatal in women. When women have a heart attack, the amount of heart muscle destroyed is likely to be greater, and they are more likely to go into shock, have heart failure and die,” he asserts. He adds that for women, the rate of mortality within one year after a heart attack is 44 per cent, as compared to 27 per cent for men.

Although there is a definite increase in more women coming out to report heart problems, doctors believe the issue is more complicated. Life expectancy among women has increased.

The most disturbing news about women and heart disease is that it is also affecting younger (35-45 age group) women. Dr. Lal, attributes this to stress and lifestyle changes. Many young working women today have to perform both at work and at home. The dual pressures play havoc with their hearts. “Stress plays a major role in the deposition of cholesterol in coronary arteries. The safety blanket of female hormones is not enough for women as young as 40 or 45,” explains Dr. Lal.

There has also been a substantial increase in women smokers in the cities, observe doctors. These women run a high risk of death from heart disease or a stroke. The increasing incidence of diabetes and obesity among women has also made them more prone to heart attacks. Diabetic women have three to seven times more risk of developing heart disease. Recent research is also pointing a finger at the long-term use of birth control pills in increasing such risk among women.

New research is also connecting heart problems to behavioral patterns and social conditioning. Women are accustomed to not paying attention to their own health needs. They are the caregivers who tend to postpone their appointment with the doctor to fulfill other family duties.

With some precautions, women can regain their advantageous position in the healthy heart race. How? One, through a diet that has five or more servings of fruits or vegetables daily and is low on cholesterol and saturated fats. Two, by walking at least for an hour a week; and three, by quitting smoking.