Articles on hypertensive heart disease

Am I Hypertensive??

Dr. Supritha K M, General Physician
BP/HYPERTENSION/HIGH BLOOD PRESSURE??We usually encounter many people saying-"I have BP!!", "I always have low BP", "My BP is always high(150/100mm of Hg) & thats normal for me!!"What is this BP?It is the pressure exerted by the blood when it flows through blood vessels.Why is BP so important??          This is the one which determines nutrients(Ex:O2) delivered & toxins (Ex:CO2) removed from target/end organs[Brain.kidney,liver]           In simple/layman's term i can put it as "The pressure of water source(through hose pipe)determines the growth of a plant"where the pipe can be related to blood vessels & plant to end organs.             Hence in case of low pressures decreased nourishment might  lead to under development/decreased performance of organs.Where as high pressure may end up causing damage to organs .What is normal BP??Systolic of 100-140mm of Hg, Diastolic of 60-89mm of Hg is considered as normal.Systolic-The pressure at the heart pumps blood sround the body.Diastolic-as the heart relaxes & refills with bloodAnything <100/60 mm of Hg is low BP>140/90mm of Hg is taken as high BPSO,My BP was 144/92mm of Hg during my last visit to doctor!! so am I hypertensive??do i have to start on medication?NO!!??There are few physiological conditions/changes during which BP can be high at certain situations:Acute illness-viral fever/respiratory infections/stressimmediately after physical activityimmediately after a large meal/caffineimmediately after smokingThe thought of going to a doctor for illness/any trivial reasons(White coat hypertension)Ideally a person without under the influence of any of the above mentioned situation & minimum of 3BP measurements taken in calm environment at different timing & different days showing >140/90mm of H is considered/diagnosed as hypertensive.How do I know I'm hypertensive/what tests can be done to detect HTN?              HTN is purely clinical diagnosis,there are no lab tests/investigations to detect HTN.                                            Hence make sure you get your pressures checked every time you get in touch with your health care                  provider (opportunistic screening)       What about the tests doctors advise when they notice High BP??-ECG,S.Creatinine,USG abdomen & other blood investigations??           These tests are done to determine the(a)possible effect of prolonged persistent high BP on end organ/damage to organs.(b)Aid in determining possible secondary causes of HTN in suspected people(Renal artery stenosis/hyperaldosteronism etc....)          Signs/symptoms to W/F in HTN??The organ damage would set in far earlier than the first symptom/sign of high BP is noted!!So,it is also called as  "SILENT KILLER". The reason why we are seeing most of known yougsters are having heart attacks, strokes leading to temporary/permanent damage to one's life. The reason why we doctors stress on regular checkup to diagnose early so that proper action can be taken at the earliest.Of course some people might have few vague symptoms like: Headache, chest discomfort during stressful environment.Which have to be addressed at the earliest with regular follow ups.       How do I manage my BP/Treatment of HTN:         (1)Life style changesChange in diet-low salt dietregular physical activity (min 30-40min 4-5days a week)Weight reductionstress managementQuitting smoking,moderate alcoholdiet rich in fruits & vegetables,low saturated fat     DRUGS/MEDICATION FOR HTN:          We often confront many patients saying:"Whenever i feel little better or on non stressful days I usually skip my medication!!!""I usually fast on thursdays & saturday ,so i don't take my medication on those days!!""I never skip my medication!!Whenever i remember during my busy schedule I take my medication daily!!""I was feeling dizzy/weakness I skip my medication!!"Dizziness/weakness could be because of High BP also,low blood sugar level & many other causes. "I was told to have BP variation few months back, since then whenever I have headache/chest discomfort  I take my father's/mother's medication as they are also hyprtensive!!"     NO!!That is not the right way....!!!    Few drugs have better effects in young/middle aged people where as they have to be avoided/used cautiously in elderly people(B-blockers) who are prone for peripheral vascular disease.      Treatment usually starts with lifestyle modifications in early diagnosis,&  without organ involvement/secondary causes.    Slowly drugs are started as single medication ,if not much changes after lifestyle modification  & dose titration done ,also multiple drugs may be involved keeping in mind patient's co-existing conditions & response to medication to achieve target BP of <130/90mm of Hg .   It is not just reaching the target BP ,it has to be maintained at it throughout the day. Which is why timing of medication is very important.        Anti-hypertensive medication has no relation with food!!So fix a timing & has to be taken at that particular time(few min margin is accepted-30min).        Taken at different timing--->alters body's biological response--->variation in hormone/chemical response--->Less effectiveness of medication--->organ damage will set in,also may demand for inadverent addition of more combination/dose escalation to reach target BP!!         To avoid these confusion ,be frank with your physician-give complete details of your signs/symptoms & daily routine so that physician is aware of loop holes of treatment!! to guide you better.Also clear any doubts & follow the advise.        How frequently should I see physician??At initial stages, once diagnosed as hypertension & started on treatment (lifestyle change/drugs) one should consult every 15days to keep a track of BP ,to see the effect of treatment & titration of drug dosage & coombination medication if requiered. Once target BP(<130/90mm of Hg)is achieved,one has to follow up every 3months for BP monitoring & once a year complete health check to keep a watch on progression/or effect of HTN on end organs,so that proper intervention can be initiated if required.     What does recent studies show?Easily stressed teens have increased risk of HTN later in life(also known as Type A personality)sedentary life style, unhealthy food habits.Coffee increases risk of cardiovascular events in young adults with mild HTN.SNORING/SLEEP APNEA-one of the very important risk factor but often neglected cause.                      TAKE HOME MESSAGE:-Check your BP whenever you meet your health care provider.-Do follow up at regular interval if found abnormal-No self diagnosis & self medication.

Is Sitting Increasing Your Heart Risk?

Ms. Swati Kapoor, Dietitian/Nutritionist
A sedentary lifestyle may increase the risk of diseases like diabetes and heart problems. It is really important to do some moderate to intense physical activity everyday. Physical workout in the form of exercise is very beneficial for all ages. It releases good hormones and helps to reduce stress, which is also responsible for lifestyle diseases like diabetes, heart problems and obesity.According to the US Center for Disease Control and Prevention (CDC), heart failure affects over 5 million people in the US, where it contributes to around 1 in 9 deaths and costs the nation an estimated $32 billion a year.According to new research published in the American Heart Association journal Circulation: Heart Failure says –“Sitting for long periods increases heart failure risk in men, even for those who exercise regularly”The question that arises is that how does sitting increase the risk for heart failure. The reason given by Prof. Sara Rosenkranz is that when we sit for a long time, the muscle contraction activity lowers, due to which a molecule called lipoprotein lipase or LPL, shuts down. LPL converts fat into energy, for use by the body. She also explains that "We're basically telling our bodies to shut down the processes that help to stimulate metabolism throughout the day and that is not good. Just by breaking up your sedentary time, we can actually regulate that process in the body."One way to avoid prolonged sitting during the workday is to switch to a standing desk. An easier, no-cost solution is to set your smartphone timer to go off every 30 to 60 minutes during the day. When the alarm rings, “Stretch and move around the office to avoid any prolonged sitting,” Dr. Manson recommends.So, along with exercise, it is really important to also spend some time standing. Also, when we are sitting, we tend to eat more unnecessarily and even binge. Make it a point, whether you are at the workplace or at home, to spare some time in between to get up and walk around or at least do some light stretches.

Are You a Sitting Duck to Heart Disease?

Dr. Vishwas Virmani, Physiotherapist
Stand up. Stretch your muscles, they’ll thank you for it.When was the last time you had a heavy lunch, headed back to work, sat and worked at a stretch for 2 hours? Probably not too long ago. Studies have proven that people who sit for four hours or longer at a stretch are at a higher risk for chronic illnesses such as diabetes and heart disease.Modern lifestyle and technology have helped us get ahead but not at their own cost. There are many studies that categorically prove the ill effects of sedentary lifestyle combined with crazy work hours. This means that finishing that urgent presentation without listening to your body could spell disaster for your heart. One of the greatest causes for heart attacks- sitting for long hours either at work on in front of the television, could be the worst thing you’re doing to your body.But it’s not all bad. There’s still hope for us folks that are stuck to comfy chairs all day. Bringing small changes in your daily life can go a long way. Small breaks taken in between work to just walk up to the coffee machine or climbing stairs instead of taking the elevator are seemingly inconsequential things that can actually make a difference.While hitting the gym everyday might not be possible, squeezing in just 30 minutes of exercise on most days of the week could be your ticket to a longer, happier life. Pick an activity you enjoy- cycling, walking or even skipping. Anything’s good as long as it gets you off your couch!So go on, take the stairs on your way back from work. Skip that late night movie and wake up for a morning stroll instead. Your heart will thank you for it!

What to Do When Someone Has a Heart Attack

Dr. Rudradev pandey, Cardiologist
Definition A heart attack occurs when oxygen fails to reach the heart. The vital organ needs oxygen, contained in your blood, which travels through the arteries to the heart. But if an artery has a blockage in it, blood doesn’t reach the heart and the heart’s cells die, resulting in a heart attack.A heart attack is a serious, life-threatening situation — but many people who witness someone experiencing the symptoms of a heart attack don’t treat it that way. IF YOU HAVE SUSPICION OF ANY HEART PROBLEM GO AND CONSULT TO YOUR DOCTOR RATHER THAN SELF-MEDICATION. Symptoms Of Heart Attack: The symptoms of a heart attack aren’t always obvious and often differ between men and women. Those symptoms can be subtle — perhaps one reason why some people don’t make it to an emergency room — or they can be very painful. Knowing what to look for can help you know when to take action for a friend, colleague, or loved one in distress:For men: The typical male symptom is a crushing pressure behind the breastbone, also called the sternum. That pressure, can radiate to your arms (often the left arm) and can go into the back, shoulder blades, and jaw above to umblicus below. Men suffering a heart attack can break out in a sweat, may vomit or feel nauseating.The onset of pain may be gradual and last several minutes or more. Sometimes the pain fades and comes back.For women: Women can have any of the same symptoms that men experience, but women often have more “atypical” symptoms, such as shortness of breath, and they may feel some indigestion. A woman having a heart attack may also experience pain in her jaw, and could feel a little faint.These symptoms are not what most people think are indications of a heart attack, Dr Pandey says. “Doctors and patients have to be very wary when it comes to heart symptoms with women,” he says. And for good reason: Heart disease kills more women than any other health condition.What to doIt’s good to have a plan in place before a heart attack occurs, especially if the person has close relatives who have had heart attacks. According to Dr Pandey, smoking & tobacco chewing play a big part in who has a heart attack and who doesn’t. Genetics of patient also plays important role. especially in young patients with heart attack.Chances of recovery are much better if the affected artery can be opened up within an hour-and-a-half of the heart attack, making it essential to get the person having the attack to the emergency room immediately(Primary PTCA) “By the time 90 minutes go by, you want to get that artery open,” Dr Pandey says. “If you’re in a rural emergency room, and [the medical team can’t open the artery], you need clot-busting drugs.” followed by transfer to hospital with cath lab facilityYou Think It’s A Heart Attack? Dr Pandey says it’s extremely important for caregivers and friends to know the symptoms of a heart attack. Call 108 if you even suspect it's a heart attack and here’s what you can do before help arrives:Stay close. Do not leave the person to find medications to give them . It's better to call for help first; emergency personnel can administer aspirin or any other appropriate treatmentsGive a dose of sublingual nitriglycerine. If the person has been prescribed nitroglycerin in the past for heart disease, and the medication is close at hand, you can give them a dose. BUT NOT MORE THAN TWO TABLETSGo for comfort. Make the heart attack victim more comfortable by placing them in a comfortable position, loosening clothing, and staying close to provide reassuranceIf needed, give CPR. Studies have shown that CPR given by a bystander can double or triple a victim's chance of surviving cardiac arrest. If you are with someone who suddenly collapses, stops breathing, or is unresponsive, start performing hands-only CPR at 100 chest presses a minute with minimal interruptions. It’s just as effective as standard CPR

How Is Life After a Heart Attack

Dr. Nishith Chandra, Cardiologist
People think, after a heart attack, they cannot have a normal life. But if you take certain precautions and adopt lifestyle changes, you can live and enjoy almost normal life. Once you survive a heart attack, you tend to realize how close your brush with death has been and how important your lifestyle choices can be. Most people go on to live a productive life after a heart attack provided they can adhere to making healthy choices. Here's what you can do if you have experienced your first attack and want to change for the better:1. Start at the hospital: A person usually stays in the hospital for 3 days after an attack to monitor their condition. This duration increases if you have complications that involve procedures like a bypass surgery. Your first significant change will come in the form of your medication routine. Your existing dosage may be adjusted and you'll possibly be prescribed newer medicines that will treat and control your symptoms. You'll not only need to know the names of all your medicines, but when you have to take them. It's best you know exactly why you are taking each one of them, if there are other more economic alternatives since this may last a lifetime and what side effects they may have.2. Maintaining your mental health: Once bitten, twice shy applies for heart attack victims too. Not only do they live in a constant worry about another attack, every small symptom like a harmless muscle pull can trigger the fear factor. You also get into the "heart patient" dependent mode based on how much help you need to recover. Check for support groups and other heart attack survivors in your locality to see how they are coping. Read more about your recovery and try to keep a positive frame of mind.3. Go to a cardiac rehab: Many hospitals have a rehabilitation program that you can participate in as an outpatient or you can go to a clinic that specializes in it. Such programs help speed up your recovery. It is run by people who will hand hold you in bringing positive changes in your life to protect and strengthen your heart. You'll learn activities that positively improve heart functions and reduce your chances of developing complications or dying from heart disease. You'll also get benefit from exercises that'll be taught by a certified exercise specialist.4. Make a change in your lifestyle: Quit smoking that is an obvious one. You'll now have to lead a more active lifestyle with daily exercise. You'll also need to actively manage your diabetes and obesity. None of these changes can happen in a day. In fact, behavioral scientists suggest that you need to practice a new activity continuously for twenty one days for it to become a habit.

6 Ways Exercise Can Reduce Your Risk of Heart Attack

Ms. Swati Kapoor, Dietitian/Nutritionist
A sedentary (inactive) lifestyle is one of the top risk factors for heart disease. Exercise is beneficial for preventing heart ailments. It is also a major modifiable risk factor in reduction of non-communicable diseases such as cardiovascular diseases. Regular exercise of moderate intensity reduces the incidence of coronary events and mortality from CHD (Coronary Heart Disease) by around 50%. It is essential to remember that the body weight is affected by the balance of “calories consumed” and “calories-burned”.Benefits of regular exercise or some sort of intense physical activity is:-1) Decrease workload on heart:-Exercises that put the heart and lung to stress are called aerobic exercises. Aerobic exercise increases heart size and strength. The heart’s stroke volume is also increased. The heart then needs to pump fewer times per minute to circulate the same amount of blood. This represents a long-term reduction in the heart’s workload.2) Increase HDL :-Exercise raises blood levels of HDL (good cholesterol) creating a more favourable ratio of HDL to LDL (bad cholesterol). This effect is more marked in men, although high intensity exercise will have the same effect on women. Studies also show that, exercise stimulates enzymes that help move LDL from the blood (and blood-vessel walls) to the liver. From there, cholesterol is converted into bile (for digestion) or excreted. So, the more you exercise, the more LDL your body expels and your blood’s LDL gets lowered, which protects you from heart disease.3) Improvement in blood circulation:-Exercise enhances the circulatory system by increasing the oxygen carrying capacity of blood and increases the blood volume. Regular physical activity increases Lipo protein lipase concentration which in turn reduces CHD risk. This is because lipase enzyme plays a role in the digestion of the fat.4) Lowers blood pressure :-Exercise help in lowering blood pressure levels by improving endothelial vasodilator function and left ventricular diastolic function. In lay man language, it means, exercise lowers blood pressure levels.5) Lower blood sugar level:-Exercise increases the sensitivity of the cell so that cells can utilize insulin very effectively. During exercise, when muscles contract, it allows your body cells to consume the glucose irrespective of whether insulin is available or not.6) Exercise lowers your stress levels:-While exercising, the happy hormone or Serotonin gets released into the body. Serotonin keeps your stress level down and also controls emotional eating.Exercise also keeps your cravings for junk and unhealthy food in control, which is amongst the most common reasons for heart diseases. Junk food contains saturated fat which is not good for the heart and it even contains high amounts of sugar, which lead to an increase in the body's glucose levels.In general, to achieve maximum benefits, you should gradually work up to an aerobic session of at least 20 to 30 minutes, at least three to four times a week. Exercising every other day will help you maintain a regular aerobic exercise schedule. Every exercise session should include a warm up phase, a strengthening phase, and a cool-down (stretching) phase. “Being fit is more important than weight or body mass index for heart health,” says Martha Gulati, M.D., the lead author of the study and an associate professor of medicine at Ohio State University in Columbus.Due to Indian genetic risk of heart diseases and diabetes, Indians are recommended to exercise for 5 days a week, at 40-50 minutes. But as we said earlier, work your stamina up from a slow start.So along with diet, exercise plays a major role in the health of the heart, so never skip your exercise session. Make it a permanent part of your lifestyle and you will reap it's long term health benefits.

4 Habits That Are Damaging Your Heart!

Dr. Dt. Souvick Dey, Dietitian/Nutritionist
Certain habits can cause damage to your heart even if you maintain a healthy diet and exercise regularly. According to researchers, working people having who have a desk job are more prone to suffer from heart conditions due to stress in their work life, lack of proper rest, limited movement, etc. Most of the times you tend to ignore your bad habits as the side effects do not occur immediately but can cause serious damage to your heart. Following are the common bad habits that you should avoid for a healthier heart-1. Sitting all daySomething as seemingly trivial as it is, sitting all day can have an adverse effect on your heart. According to studies, if your job involves sitting on a desk for more than five hours then you have double the risk of suffering a heart failure compared to a person who has an active lifestyle. Make sure you take at least a five minute walk in an hour to reduce chances of hardening the arteries. A sedentary lifestyle has serious side effects on your overall health too.2. Stress too much Stress causes the body to release adrenaline which influences the way your body functions. In that case there might be an increase in heart rate or your blood pressure level. Over time, stress can cause damage to the blood vessels in your heart and increase your risk of sudden stroke or heart attack.3. Overdoing it on saltExcessive sodium can spike your blood pressure thereby making your more vulnerable to heart conditions. Processed foods like potato chips, canned vegetables, frozen meals and meats contain a fair amount of sodium which can have an adverse effect on your heart. It is important to take the nutritional value of these foods in account before purchasing it so that you get the ones with lowest amount of sodium.4. Not getting enough sleepThe heart rate dips when you sleep and goes up and down as a response to your dreams in various stages of your sleep. It is important for your heart to rest as it actively works in your waking hours. Sleep deprivation has similar effects on your heart like stress and can wreck your cardiovascular health. It is of utmost importance to sleep for at 7 hours to keep your heart healthy

How to Diagnose Heart Attack ?

Dr. Nishith Chandra, Cardiologist
Heart Attack is  caused by blockage of the blood flow to the heart muscles.  Reduced blood flow leads to death of some portion of the heart muscle wall. While the word heart attack sounds almost fatal, it need not be the case. Knowing how to identify an attack and being aware of some simple measures can help save lives. SymptomsThe tell tale signs of a heart attack are as follows:- chest pain and discomfort usually described as a tightness or burning in the chest region- pain along the left side of the shoulder and neck, going up into the jaw, down to the arm- nausea and vomiting - profuse sweating - difficulty breathing - dizzy or fuzzy feeling - tired, extreme fatigue- anxious, apprehensive feeling However, be also aware that there are a lot of people who experience a silent heart attack. Women, obese, elderly, and diabetic patients can have silent attacks and depending on severity, either they go on with life as usual or can have a fatal attack.DiagnosisOnce you are doubtful of a heart attack, the next step is to reach the closest medical facility for a diagnosis. In addition to a detailed examination and history, the following two tests will be performed.1. Electrocardiogram (ecg): a 12-lead ecg will measure electrical activity of the heart and identify irregular electrical activity, which is indicative of a myocardial infarction.2. Blood tests: presence of certain enzymes in the blood, ck-mb and troponin are indicative of a heart attack. A complete electrolyte profile also will be done, and increase or decrease of some electrolytes is helpful in diagnosing a heart attack.3. In addition to these two, chest radiography, cardiac angiography, echocardiogram, stress test, and computed coronary tomography may also be required to confirm the diagnosis.ManagementOnce diagnosed, the first step would be to relieve the symptoms, negate the effects of reduced blood flow, and restore cardiac function. 1. Dissolve the clot - using blood thinners like aspirin & clopidogrel 2. Nitroglycerin - to dilate the blood vessels and improve blood flow, especially to the heart muscles3. Anticoagulant therapy - blood thinners are usually used to avoid blood clot formation; aspirin and heparin are the most commonly used agents.4. Drug therapy - blood pressure maintaining drugs like beta blockers and/or angiotensin-converting enzyme (ace) inhibitors are also used5. Use of statins - statins are used to reduce the amount of cholesterol in the blood and stabilize plaque deposits.In very severe cases, angioplasty and stenting or coronary bypass surgery may be required. Educating people on how to identify a heart attack and manage it is very useful and can help save lives.

Know About Heart Failure

Dr. V.Ganesh, Cardiologist
Heart failure is a life-threatening condition in which the heart is unable to pump enough blood to different parts of the body.It can affect the left side or right side or both sides of the heart.Causes of heart failure Coronary artery disease:  narrowing of blood vessels that supply oxygen-rich blood to the heart.Cardiomyopathy : diseases of heart muscle that cause enlargement of the heart.Hypertension: High blood pressure.Valvular heart disease: diseases affecting valves between chambers of heart.Myocarditis : Inflammation of heart muscle caused by a virus.Heavy consumption of alcohol.Diabetes.Thyroid diseases.heavy alcohol consumption SIGNS AND SYMPTOMS OF HEART FAILUREShortness of breath while walking ,climbing stairs or at rest.Swelling of legs,edema( leg swelling).General tiredness or weakness,A chronic cough,Chest discomfort.Walking up during the night with sudden breathing difficulty.PHYSICAL EXAMINATION revealsIrregular or rapid heartbeat,Distended neck veins,Signs of fluid around the lungs,Lung crackles,Blood pressure may be normal, high , or low.INVESTIGATIONSX-RAY:Chest X-RAY helps to find out fluid accumulation in lungs, and heart enlargement.X-RAY CHESTElectrocardiogram (ECG)This test helps to detect any heart abnormality that may be associated with heart failure. Electrocardiogram(ECG).EchocardiogramUses ultrasonic waves to produce a video image of the heart,The image helps in assessment of pumping capacity of heart as well as any abnormality in heart muscle, heart valves etc.echocardiogramCoronary angiogramThis procedure is used to identify narrowing of arteries(blood vessels) which supply the heart which may be the cause of heart failure.In this procedure a thin flexible tube is inserted into the blood vessel through arm or groin which is passed to blood vessels of heart and dye is injected and the picture is obtained.Other investigations:Chest CT, Cardiac MRI, Blood tests to identify chemical markers of heart failure such as BNP.TREATMENT:Avoid smoking.Regular exercise such as walking, jogging, cycling etc.Reduce salt intake.Control blood pressureControl DiabetesControl thyroid diseases.Limit alcohol intake.Control cholesterol.DRUGSACE Inhibitors: these dilate blood vessels , improve blood flow, decrease workload on the heart.Diuretics: These group helps remove excess fluids and sodium from the body.Beta blockers: Slows heart rate and reduce blood pressure.Digitalis: Increase ability of heart muscle to contract properly.SURGERY AND MEDICAL DEVICES:CABG(Coronary artery bypass grafting) and ANGIOPLASTY  :Used to treat severely narrowed coronary arteries that contribute to heart failure.Implantable cardioverter - defibrillators(ICD).ICD monitors irregular heart rhythm and sends electrical shocks to correct this irregularity.they are implanted under the skin and attached to heart with small wires.ICDCardiac resynchronization therapy.(CRT)This is a type of pacemaker-like device which sends timed electrical signals to heart chambers allow them to pump synchronous and efficient manner.CRT DEVICEHeart pumps (left ventricular assist devices)These mechanical devices are implanted into the abdomen and attached to weakened heart to help it to pump better.HEART PUMP