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Category Archives: Knowledge Centre

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.
 
Symptoms
 
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 
shape.
 
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.

 

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

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

Hepatitis Diagnosis and Prevention

As per World Health Organization (WHO) statistics, India is amongst the top 11 countries which carry the global burden of chronic hepatitis. Since, it accounts for a huge burden of illness, outbreaks and epidemic spread, resulting in increased death cases, the disease is one of the greatest concerns all over the world.

“The five main types of hepatitis virus include A, B, C, D and E. Infection by any of these viruses can lead to inflammation of liver and some infections can lead to liver cirrhosis or cancer. Based on the symptoms, a physical examination is done to check the enlargement of liver, skin colour and presence of fluid in the abdomen followed by a suitable antibacterial treatment. Awareness and early diagnosis is key to patient treatment as the infection can be difficult to cure at later stage,”  Dr. Rakesh Kumar, Senior Consultant, Internal Medicine, Indraprastha Apollo Hospital, New Delhi.

“A person can have hepatitis B infection for many years before diagnosis, I see a lot of patients with liver cirrhosis and primary liver cancer (hepatocellular carcinoma, HCC) as their first presentation. The most important challenges remaining in the area of hepatitis B and HCC are development of improved means of early detection and treatment. Currently, HBV-related HCC is often detected late, at a time that surgical interventions and liver transplantation is no longer feasible,” said Dr. Govind Nandakumar, Chief of Gastrointestinal Surgery & GI Oncosurgery, Columbia Asia Hospitals, Bangalore.

“Better approaches of universal HBV vaccination and identification and treatment of chronic hepatitis B are needed especially in the smaller towns and villages to allow for application of the many advances that has been made in prevention and treatment of this important form of cancer,” added Dr. Sumana Kolar.

Some of the symptoms of hepatitis include Jaundice, fatigue, nausea, stomach bloating, itching, weight loss, loss of appetite and dark coloured urine.

Below mentioned are some ways to prevent the infection:

Hepatitis A 

  • Practice proper hygiene
  • Wash hands well after using the restroom and before eating meals
  • Avoid eating at unhygienic or contaminated places

Hepatitis B and C:

  • Do not share personal grooming instrument like razors
  • Check for used needles to prevent risk of infection
  • Be careful about equipment used while tattooing
  • Before getting piercing done, ensure the equipment is clean
  • Practice safe intercourse

“About 50% of people with liver complications suffer from alcohol induced liver diseases, about 25- 30 % suffer from NASH (Non-Alcoholic Steato-Hepatitis) and 10-15% suffer from viral hepatitis and other liver diseases. Liver diseases are not only common among high alcohol consumers but many non-alcohol consumers also suffer from liver complications due to high Body Mass Index (BMI). Diabetes and obesity are the major causes that lead to fatty liver disease, increasing the risk of hepatitis infection in a person,” said Dr. Rakesh Kumar.