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Category Archives: IVH Blogs

No drop of Heart Attacks and Cancer even after Smoking banned in Public Places

By Vinod Kumar

While the ban of smoking in public places in the western countries has resulted to lesser heart attacks with the average drop being 20 %, leading  health experts in India feel that the ban has not resulted of any positive development in terms of the incidence of heart attacks, cancer and other diseases.

Dr. Purushottam Lal, Chairman of Metro Hospitals and Heart Institute said that the government should bring out stringent laws to stop the usage of all tobacco products among the masses. Apart from the policies undertaken by the government, it’s the will power of the smokers along with counseling and clinical intervention and more awareness that can bring the desired results. For a smoker the chance of dying from a heart attack is 2 to 3 times greater than that of a person who does not smoke. About 1 out of 4 heart attacks is believed to be directly related to smoking.

Quitting smoking is probably the most important step to be taken to decrease the chances of coronary artery disease (CAD) and a heart attack. Although all types of tobacco smoking increase the risk of developing CAD, smoking cigarettes increases this risk more than pipe smoking or cigar smoking. Up to 30% of all deaths related to CAD are attributed to cigarette smoking.

Dr. Lal said, “Smoking causes the platelets in the blood to clump together easily by making your blood cells more “sticky” and more likely to form clots. It can also cause spasms in the coronary arteries, which reduces the blood flow to the heart in a way similar to that of atherosclerosis.”

Apart from the above, smoking also triggers irregular heartbeats or (arrhythmias). It lowers “good” cholesterol (high-density lipoprotein, or HDL). It reduces the amount of oxygen that can be carried by red blood cells in the bloodstream.

World Health Organization (WHO) estimates that smoking-related deaths worldwide will surpass 9 million annually by 2020—with 7 million of those deaths occurring in developing nations. At present Around 5.4 million deaths a year are caused by tobacco, which means every 6.5 seconds a current or former smoker dies. Twenty-five years ago, nearly 70 percent of the lung cancer deaths worldwide occurred in high-income nations. Today, 50 percent of lung cancer deaths occur in low-income nations, and by 2030 that number is expected to increase to 70 percent. With around 9 lakh deaths occurring annually, cancer has become a major public health concern in India.

“There is a universal fear of cancer,” he said. “But, with the right frame of mind, and by taking appropriate action, some cancers can be averted or cured, ” said Dr. Lal.

According to Dr. Lal, apart from smoking, air pollution – mainly from vehicles, industry, and power plants – raises the chances of lung cancer and heart disease in people exposed to it long term. There’s an excess risk of both lung cancer and cardiopulmonary disease associated with increased exposure to fine particles [in air pollution],” said Dr. Lal.

More than 30 percent of all cancers can be prevented through simple measures such as avoiding smoking, eating a healthy diet and taking exercise, limiting alcohol consumption and protection against cancer-causing infections.

“Some cancers can be detected early, treated and cured. Certain cancers like those of the mouth, breast and cervix can be cured if detected early. One should be aware of its early signs and consult a health professional at the earliest.Easy accessibility of medical care and technology has made the disease curable, ,” said Dr. Lal.

What are the risks involved in Angioplasty & Complications ?

Dr. Subrat Akhoury

Although Angioplasty is a less invasive way to open clogged arteries than bypass surgery and hence in relative to bypass surgery, angioplasty carries lower risk in carefully selected patients but there are unique & potential dangerous risks & complications. Just like many other types of invasive procedures, patients may have an allergic reaction to the anesthetic, the dye, or some of the materials used in the angioplasty. Some common risks associated with coronary angioplasty include:

  • Re-narrowing of your artery (restenosis).With angioplasty alone – without stent placement – restenosis happens in about 30 percent of cases. Stents were developed to reduce restenosis. Bare-metal stents reduce the chance of restenosis to about 15 percent, and the use of drug-eluting stents reduces the risk to less than 10 percent.
  • Blood clots.Blood clots can form within stents even after the procedure. These clots can close the artery, causing a heart attack. It’s important to take aspirin, clopidogrel (Plavix), prasugrel (Effient) or another medication that helps reduce the risk of blood clots exactly as prescribed to decrease the chance of clots forming in your stent.

Talk to your doctor about how long you’ll need to take these medications. Never discontinue these medications without discussing it with your doctor.

  • You may have bleeding in your leg or arm where a catheter was inserted. Usually this simply results in a bruise, but sometimes serious bleeding occurs and may require a blood transfusion or surgical procedures.

Other rare risks of angioplasty include:

  • Heart attack.Though rare, you may have a heart attack during the procedure.
  • Coronary artery damage.Your coronary artery may be torn or ruptured (dissected) during the procedure. These complications may require emergency bypass surgery.
  • Kidney problems.The dye used during angioplasty and stent placement can cause kidney damage, especially in people who already have kidney problems. If you’re at increased risk, your doctor may take steps to try to protect your kidneys, such as limiting the amount of contrast dye and making sure that you’re well-hydrated during the procedure.
  • During angioplasty, a stroke can occur if plaques break loose when the catheters are being threaded through the aorta. Blood clots also can form in catheters and travel to the brain if they break loose. A stroke is an extremely rare complication of coronary angioplasty, and blood thinners are used during the procedure to reduce the risk.
  • Abnormal heart rhythms.During the procedure, the heart may beat too quickly or too slowly. These heart rhythm problems are usually short-lived, but sometimes medications or a temporary pacemaker is needed.

Angioplasty isn’t a cure for blocked arteries. In some cases, arteries can become narrow again. This is called restenosis. The risk of restenosis is higher when your doctor doesn’t use a stent.

Associate Director, Cath Lab & Interventional Cardiologist, Asian Institute of Medical Sciences (AIMS), Faridabad

How Should Your Diet Look Like After LASIK

Does your morning ritual consist of turning off the alarm and spending the next few minutes looking for your glasses? How many times have you wished for a perfect eyesight and have considered LASIK surgery to fulfill that wish? If you are seriously considering LASIK, it is important to remember that the main surgery and preventive measures aren’t the only things that will assure the success of the procedure; what you eat before and after the surgery also plays a big role.

A person is as healthy as the food he eats. This is a common saying and it also holds true when you get your eyes operated upon. Eating certain kinds of food will speed up healing and enable a quick recovery, while consuming others will arrest the healing process. They may even cause complications post surgery and you may risk impairing your vision. Let us look at a list of food  items and nutrients you must include in your diet and the foods you must certainly avoid after  the LASIK surgery.

What to Include

Your diet should consist of food products that are rich in the following nutrients.

Proteins

The amino acids in proteins help in healing the wounds and regenerating tissue. You can consume proteins through fish, poultry, lentils, low-fat diary products, nuts and beans. It is normal for the eyes to get a little dry after the surgery. This can be tackled by increasing the intake of Omega-3 fatty acids that are found in cold water fish. They improve the oily layer of the tear film preventing eye dryness. You can take omega-3 in pill form for several weeks to a month before and several months after surgery. Additionally, it is also excellent for improving eyesight. Flax seed oil is a good alternate to the fish oil for vegetarians.

Vitamins

Vitamin A and C have wound healing properties, therefore you must increase their intake. They can either be taken through pills or through food rich in them. Include dark, leafy, green vegetables, carrots, citrus fruits, sweet potatoes, tomatoes and sweet bell peppers.

Carbohydrates

Carbohydrates that are high in fiber help in healing after the surgery. Moreover, they help in improving eyesight and fighting eye diseases. Consume fruits, legumes,vegetables, beans and whole grains. Keep snacking on carrots during the healing period.

Fats

Consuming good fats in moderation helps in improving and boosting the response of the immune system. This is extremely important for quick healing. Foods like olive oil, seeds, avocados and nuts must be incorporated in the diet.

What to Avoid :

 If you love the following, then you must gather a lot of will-power to avoid them for a couple of weeks after the surgery if you wish to go through a smooth, complication-free recovery period.

Trans-Fat Rich Food

While the good fats must be included, bad fats such as trans-fat rich foods must be strictly avoided altogether after LASIK surgery. They will hinder with the repairing process and increase the chances of being prone to eye disorders. You must keep fried food and margarine away for a few weeks.

Salts and Spices

Including too much salt or spices in your diet post surgery multiplies the chances of eye complications. Food items like tacos, hot dogs and processed food increase the risk of osteoporosis and make your bones really weak. This has serious implications on the eyes. Thus you should stay away from all those foods which speed up osteoporosis if you have undergone the LASIK surgery. Foods high in salt and spices can cause impaired eyesight, which might be difficult to recover from. Avoid caffeine, red meat and smoking. All these delay the recovery process and prevent you from achieving the optimal results from the surgery.

Confectionaries and Bakeries

This will be bad news for those with a sweet tooth. You should not even look at sugary items like confectionaries, candies, bakeries and chocolates for a minimum of 3 months after your surgery. Anything with excess sugar is bad for your eyes, so it is advised to keep the sugar at some distance after the surgery.

Subtracting these from your dietary chat for few months may seem a hard prospect, but it will serve you well ten out of ten times.

 Author Bio: 

Aaron Barriga is attached with Insight Vision Center, Fresno, California.

 

Effects of long-term Diabetes & newer Therapies for Diabetes Control

Dr Tejal Lathia

India is home to over 50 million adults with Diabetes and this number is likely to increase to over 120 million by 2040. Diabetes Mellitus is characterized by high blood sugar levels. Exposure to high blood sugar leads to weakness, weight loss, increased thirst and frequent urination. The long term complications include damage to eyes, Heart, Kidneys and Nerves resulting in loss of vision, Heart failure, Kidney failure and often, amputation.

There are two main types of Diabetes Mellitus – Type 1 and Type 2. Type 1 Diabetes Mellitus predominantly occurs in children and adolescents, and is characterized by complete deficiency of Insulin (a hormone required to keep blood sugar levels normal) in the body. Such patients are completely dependent on Insulin injections for their survival.

Type 2 Diabetes Mellitus results primarily from an imbalance in the demand and supply of Insulin. Though insulin is present in the body, it is not sufficient to control the blood sugars. However, newer research has caused a paradigm shift in the way we look at Diabetes. Not only insulin but other hormones like Glucagon, GLP-1 play a part in Diabetes. The way the Kidneys handle blood sugar is also of importance. These myriad defects have resulted in the coinage of the term – ‘Ominous Octet’.  Identifying these novel defects has been helpful in the sense that we now have medicines to tackle these individual defects opening up a new era in the treatment of diabetes.

Case study:

A 56 year old gentleman, presented to our hospital for a routine health check-up. He has been diagnosed with Diabetes Mellitus 5yrs ago, for which he has been on medications. Recently, he was also diagnosed with Hypertension. His fasting blood sugar was 150 mg/dl and post-meal blood sugar was 200 mg/dl, which is satisfactory to the patient.

However, on evaluating for complications, it was found that there are changes in his eyes because of Diabetes, which threatens his vision, though he has no symptoms. The nerves of his feet are damaged with reduced perception of pain and temperature. His Serum Creatinine (measure of his Kidney function) is abnormally elevated; this leaves the patient shocked.

Diabetes Mellitus unfortunately is a silent killer. There are no symptoms of the damage it is doing to the body, before it is too late. And once the damage is done, it is irreparable. A common misconception is that if the blood sugar level is below 200 mg/dl, you are safe. A normal person’s fasting blood sugar is below 100 mg/dl and after-meal sugar is less than 140 mg/dl. Any increase in the blood sugar values above this leads to damage of vital organs.

Medications like DPPIV inhibitors, SGLT2 inhibitors, GLP-1 agonists as well as newer insulin co-formulations are the key to the future of Diabetes management. Newer rapid acting and ultra-long acting insulins have further strengthened our armamentarium against Diabetes.

There is no substitute for lifestyle modifications though – regular aerobic exercise like walking, cycling, swimming (at least 150 mins per week) and a diet which eschews refined carbohydrates and excess oil is mandatory. These lifestyle changes need to be followed throughout life. Early diagnosis and aggressive treatment of the disease with medications, is imperative to avoid complications and improve quality of life of a Diabetic.

Is a Consultant Endocrinologist, Hiranandani Hospital, Vashi

 

Why are Youth these-Days More Susceptible to Heart Disease

Dr Zakia Khan

Deaths caused due to heart disease are usually attributed to the adult population. What is less known is that young adults are not spared of this main cause of death worldwide. The Coronary Artery Risk Development in Young Adults (CARDIA) conducted a study to find the reasons for youth being susceptible to heart diseases and what are the reasons that put them to this risk. Around 5,000 young adults from the age of 18-30Yrs were a part of this study and were monitored for up to 15 years to learn about what resulted into them acquiring heart diseases. Every man in the 3rd and 4th decade is affected by this disease. It is noted that the youth who smoke up to 10 cigarettes a day are likely to develop heart diseases by 50%. A rise in cholesterol levels can irk heart rates and the risk increases by 50%; rise in blood pressure levels increase the risk rate to up to 30%.

The increase in heart disease in younger adults are caused due to habits of smoking, stress(work and non-work related), unhealthy diet, lack of sufficient physical activity and excess consumption of salt and packaged food in some cases. To curb these issues, we need to first understand how to minimise these triggers. Parents should help their child to maintain healthy diet and motivate them to excise on a regular basis, so that they can control high blood pressure issues, since it is quiet common among who are overweight. They also need to help them maintain their salt intake. Warn them about the dangers about smoking and the effects nicotine has on the blood vessels, causing the blood vessels to narrow down and make it harder for the blood to flow through the vessels. If after many efforts of controlling the diet and increasing the child’s physical activity it still doesn’t lower their blood pressure, a physician should be consulted to seek immediate intervention.

The numbers are not going to decrease unless drastic steps are taken. The problem is that we are leading a very sedentary lifestyle that doesn’t allow us much physical activity. Today’s youth is stressed out mentally as well as physically. A major solution to this is drastic lifestyle modification that will help prevent premature heart attacks. Thrive on healthy food instead of relying on junk food, this is simple to adopt and very effective. Despite having a busy schedule, try and make time to organise, prioritise and balance your lifestyle. Take up either yoga or dance or any other form of exercise that is therapeutic and helps in keeping you physically and mentally healthy.

Is a Interventional Cardiologist, Fortis Hospital, Kalyan

Brain Stroke Increasing At An Alarming Rate

Dr. Rahul Gupta

With approximately 1.5 million new cases reported every year, stroke is becoming an important cause of premature death and disability in India. Stroke in India is increasing at an alarming rate, especially among youth. The main cause for this increase includes stress levels, poor diet and a sedentary lifestyle. If left untreated, it can cause irrepressible damage to brain cells, impeding motor and speech skills.

A stroke attack can happen to anyone and across all age groups, social strata and gender. It is alarming to see the increase in stroke cases and the age bracket for stroke decrease, as almost12% of stroke patients are under the age of 40 years. Those suffering from high blood pressure, diabetes, high blood cholesterol and intake of oral contraceptives are especially at risk. It is important to stress the importance of awareness programs to stress the fact that stroke is treatable and preventable.

A stroke occurs when the blood supply to the brain is cut short due to a clot, known asischemic strokeor rupture of the blood vessels, known as hemorrhagic stroke. While 87% of strokes are ischemic by nature, a majority of them can be treated. It is important to identify the symptoms of this attack, such as – changes in Face, Arms, Speech and Time (FAST). Uneven face like drooping of the mouth, one arm hanging down and slurred speech are some of the common symptoms of a stroke and timely treatment can help them prevent the same from occurring.

When medical treatment is delayed, millions of neurons are damaged and higher functions of the brain are affected. Therefore, it becomes critical to provide the patient with timely medical assistance as stroke requires a prompt multidisciplinary treatment.

Over 20 million people suffer from stroke, out of which five million die and another five million are disabled. According to The National Center for Biotechnology Information (NCBI), stroke is one of the most common cause of mortality after coronary artery disease. Also, it is a common cause of chronic adult disability. The lifetime risk of stroke after 55 years of age is 1 in 5 for women and 1 in 6 for men.

The following 10  things may help one to prevent/avoid stroke:

  • Lower blood pressure-Your goal: Maintain a blood pressure of less than 120 (top number) over less than 80 (bottom number).
  • Lose weight- Keep your body mass index (BMI) at 25 or less.Try to eat no more than 1,500 to 2,000 calories a day (depending on your activity level and your current body mass index).
  • Exercise more- Exercise at a moderate intensity at least five days a week.
  • Drink alcohol in moderation
  • Treat atrial fibrillation- If you have symptoms such as heart palpitations or shortness of breath, see your doctor for an exam.
  • Treat diabetes – Keep your blood sugar under control & monitor your blood sugar as directed by your doctor.
  • Quit smoking-Smoking accelerates clot formation in a couple of different ways. It thickens your blood, and it increases the amount of plaque buildup in the arteries.
  • Maintain Healthy BMI and hip to waist ratio.

 Is the man behind the department of Brain and spine surgeon at Fortis Hospital, Noida. He was trained at Nagoya Japan, which has made him an expert in Endovascular procedures.He worked in many government hospitals including PGIMS, Rohtak, PGIMER Chandigarh & Govind Ballabh Pant institute of Postgraduate Medical Education & Research, New Delhi. Dr. Rahul Gupta has performed surgeries on hundreds of patients with head and spine injury. He has treated numerous complex spine ailments like metastatic tumors, osteoporotic fractures (vertebroplasty), degenerative diseases and listhesis.

Foreign Patients Prefer India for Medical Treatment

Medical Tourism is the most recent trend in globalization of the health care industry that is booming and gaining prominence in developing countries. With the availability of the cheapest and the most accredited health care facility, India is expected to become the leading hub for patients seeking medical treatments across the world.

​This has  led to the emergence of a new leader in the Global medical tourism industry- India.

Overtaking Thailand in the recent years amongst the corridors of health, India is poised to become the hub for best medical treatment facilities across the world by 2020.

Globalization has promoted a consumerist culture, thereby promoting goods and services that can feed the aspirations arising from this culture. This has changed the character of the medical care sector, with the entry of the corporate sector. Besides the urgent need for quality treatment services, people across the world are making India, the Focal point for cost effective facilities available.

With the integration of surplus talent, technology, tourist attraction, trade and tradition, India is a potential place to promote itself as a Premier Global Healthcare destination and enable streamlined medical services.

Medical Tourism as a Global Industry

This process is being facilitated by the corporate sector involved in medical care as well as the tourism industry – both private and public. Foreign patients travelling to India to seek medical treatment have drastically increased since 2013. This is due to the fact that India offers medical facilities, including critical care at one-tenth of the cost of U.S. The Government’s role and support along with online portals like indiavirtualhospital.com to boost medical tourism is also focusing on several areas including quality standards and easy visa processes to make India a global destination for healthcare services. India is a great location for foreign patients because this is a place where entire range of healthcare sector finds place.

Medical tourism chooses India as their favorable destination because of the key opportunities in Indian healthcare sector in the form of efficient infrastructure and technology. The health insurance market and national medical system here are well developed, which is convenient for visitors from the West and Middle East. They also find the hospital expenses very affordable. The travel and tourism industry already accounts for one of every nine job opportunities created in India, currently aggregating over 20 million employees. It is estimated that this industry generates more jobs per unit investment than any other sector.

Why India is the leader in health services?

India is known as the Health capital of Asia. With several multi and super specialty hospitals across the country brings in an average of 1500 international patients each day. The growing trend of medical tourist attraction in India can be linked to the affordable treatment, on-priority consultation with no waiting time, and the best in class facilities offered from various hospitals. Further advantages include –

  1. Ease of travel –The government has removed visa restrictions on tourist visas that required a two-month gap between consecutive visits for people from Gulf countries which is likely to boost medical tourism. Moreover visa on arrival eased off the stay for many medical travelers coming to India with a medical reason for upto 30 days.
  2. Cost effective –the treatment cost in India is atleast estimated to be only one-tenth of the cost when compared to any developed country. With the most popular and the state of the art alternative medicines and treatment, AYUSH, India finds a prime position amongst the foreign patients.
  3. Quality healthcare service –India has 28 JCI accredited hospitals, though a foreign patient seeking treatment in India opts for the best Doctor Hospital combination. The technological advancements in healthcare IT has helped them in seeking the best satisfactory pair.  With the advent of online portals like indiavirtualhospital.com the services taken by the medical traveler has eased off.  Many hospitals also give the option of continuing the treatment through telemedicine.
  4. Language –Despite India’s diversity of languages, English is an official language and is widely spoken. In the region of Delhi-NCR which is fast emerging as a hotspot for medical tourism, a number of hospitals have hired language translators to make patients from other countries feel comfortable along with helping them for better facilitation.

 

Net Chatting and PS4 Gaming Trigger Obesity In Children

Dr. Arun Prasad

If your child prefers to spend more time sitting at home and chatting on WhatsApp and Facebook or indulging in PS4 gaming rather than playing with his friends in a park or play area, then it is time for you to sit up and become alert. Such a habit of your child is inviting a string of serious diseases, including diabetes, high blood pressure, cancer and heart ailments which are triggered by obesity.

Problem of childhood obesity becomes difficult to control at a later age even through controlled diet, exercise and some other measures to reduce weight. As a result, one has to take recourse to surgical procedures or the bariatric surgery to reduce obesity.

There is a shortage of playgrounds and evening activities for the children in most of Indian cities. At the same time, there is tremendous pressure on children to study more for competitive examinations and attend coaching classes. This effectively consumes their weekends too. The only source for entertainment for the stressed out children is either PS4 gaming or WhatsApp, Facebook and laptops.

Such a situation leads to a mismatch of body metabolism during the most formative years of the person, something that becomes very difficult to reverse at a later age. The individual later finds himself/herself in a difficult situation and has to try out various diet, exercise and weight loss programmes.

Obesity starts during childhood and it is important to educate children and young parents. Health education through media, newspapers and teaching institutions should address this monstrous problem before it gets out of hand.

A chubby child is not ‘healthy’ and cute is the message that we need to give across to the public. Processed foods and shortcut meals are the biggest culprits. This, combined with the lifestyle pressures of a young urban family, makes healthy eating a real challenge.

This is not easy now as the body is already poised at a different level and metabolism is now skewed. Last resort for many individuals is bariatric or weight loss surgery which is now increasingly becoming a surgical specialty of its own.

The increasing menace of obesity is not just for looks and cosmetic reasons. Obesity has its fallouts in terms of health and life span. Obese individuals, especially the morbidly obese (body mass index BMI of more than 32.5), have an increased risk and incidence of various medical diseases like diabetes, blood pressure, cholesterol, liver problems, infertility and sleep apnea. It also reduces the life span of an individual through an increased risk of heart attacks, stroke, kidney and liver failure.

 Is a senior bariatric surgeon at Apollo Hospital, New Delhi. He is the vice president of Obesity & Metabolic Surgery Society of India (OSSI).

 

 

Do your legs hurt when you walk ? You could be having Peripheral Arterial Disease

Dr. K. K. PANDEY

Peripheral Arterial Disease (PAD) used to describe any disease of the peripheral vasculature of the body. PAD causes impairment of blood flow causing a wide spectrum of clinical conditions and diseases. The symptoms vary according to the area affected and degree of obstruction. Most commonly it is used to refer to decreased blood flow to the legs.  If not treated, this has the potential of causing limb loss and eventually death.

PAD results from any disease causing narrowing or blockage of the lower limb arteries,with atherosclerosis disease being the most common etiology. Atherosclerosis development commences in the teenage years and then progresses over a period of time (usually decades) to cause significant flow limiting stenosis and obstruction. If not treated in time, it can cause significant discomfort in the legs including your ability to walk and in severe cases gangrene.

When these blockages occur in the heart they cause chest pain called angina and in the brain can cause strokes.

Some of the risk factors for PAD include increasing age, smoking, diabetes mellitus, Hypertension and hypercholesterolemia. If your family members have blockages in the arteries of the legs then you are also at increased risk of PAD.  As many as 40% of patients with blockages in the arteries of the heart also have blockages in the arteries of the legs.

Most patients with peripheral artery disease are asymptomatic. The most common complaint is pain or discomfort in the muscles (buttocks, thigh, calves or feet) of the leg on exertion that is relieved with rest. Some patients may also experience heaviness and cramps on walking. The severity of symptoms will depend upon how many arteries are affected, how narrowed your arteries are, how quickly you walk, and whether you walk up an incline or stairs.

As the disease progress and severity of the blockages increases there may be rest pain in the legs, non-healing or slowly healing wound and eventually gangrene that may require amputation of the extremity.

If there is co-existent nerve damage you may feel burning, vibrations and decreased sensation in the feet.

Changes in extremity appearance depend on the duration and severity of PAD. With significantly reduced blood flow, the skin becomes thin with functional loss of the dermal appendages, which is evident as dry, shiny, and hairless skin. As the blockages increase the legs may become cool to touch.  Patients with PAD often have diabetes and they may have weakness in the legs.

There are multiple tests that can be done to detect the PAD. The Ankle Brachial Index(ABI) measures the resting blood pressure at the ankle compared with the blood pressure in the arm. The ratio is used to assess the presence of blockages. Usually the ratio is close to 1, but if it low that is a marker of blockages.

Other more advanced testing like ultrasound, CT scan and MRI can also be done to assess for blockages.

Once diagnosed, it is important that the disease be treated aggressively. This includes risk factor modification and treatment of PAD in general. The main risk factors for PAD are cigarette smoking, diabetes mellitus, high blood pressure, and high cholesterol or lipid.

Lowering cholesterol can prevent worsening of PAD and can reduce the symptoms of claudication. Quitting smoking and improving control of diabetes and high blood pressure may also improve claudication symptoms (ie, pain), but even more importantly, it helps to reduce the risk of coronary artery disease. Various medications can also be given to improve the symptoms of claudication.

Exercise programs reduce the symptoms of claudication, including increasing the distance and time that one can walk before developing symptoms. Supervised exercise training involves walking on a treadmill or a track for 45 to 60 minutes at least three times per week.

In selected patients with severe pain and discomfort, particularly if medical therapy has been unsuccessful, your doctor may recommend a procedure to increase the amount of blood flow to the extremities. Revascularization procedures can be generally divided into two general categories: “catheter-based” procedures, such as balloon angioplasty and stenting, or surgery. The selection of revascularization technique depends upon a variety of factors, such as your particular anatomy, severity of symptoms, prior interventions and your overall health and fitness.

Catheter based techniques such as balloon angioplasty and stenting have evolved tremendously and are the default choice for most interventions. The procedure is done under local anesthesia and the patient is send home the next day.

Peripheral artery disease is an important cause of morbidity and mortality and if not treated appropriately and if not treated appropriately and aggressively can lead to amputation and in severe cases even death.

 Is a senior cardio thoracic & vascular Surgeon at Indraprastha Apollo Hospitals, New Delhi.

 

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.