To maintain a healthy heart, Senior Cardiologist and Head Department of Cardiology (Unit-1) JLNM Hospital, Rainawari, Dr Shahid Iqbal Takrecommends all to remember 6S. “Decrease your SALT intake to control hypertension. Control your SUGARS. Cut down you STRESS level. STOP smoking. Find SOLACE in meditation. SWIM daily or go for a brisk walk.”
In order to understand the scenario of heart diseases in Kashmir, Dr Shahid in conversation with Rising Kashmir’s senior health correspondent Mansoor Peer talks about cardiac disorders, measures to curb the disease and a way forward.
What is a heart attack?
In layman’s language, when a person feels severe chest pain with sweating and breathlessness he may be having a heart attack. Heart attack is a condition in which blood supply to a particular area of heart is compromised to such an extent that it's performance of contraction and relaxation suffers. As a result of this the blood pumping activity gets hampered.
What are the symptoms of heart attack?
The main and foremost symptom of heart attack is chest pain. Besides that some patients may present with breathlessness or loss of consciousness. Elderly patients may present with confusion and disorientation. Anybody have severe chest pain and provide sweating can have an acute heart attack.
What are the reasons behind coronary artery disease in general?
The recognized risk factors for coronary artery disease which lead to heart attack include smoking, diabetes, high blood pressure, high blood cholesterol, family history of coronary artery disease (CAD), sedentary lifestyle, obesity and stress are other likely factors. I think stress is a very potent risk factor for many diseases including CAD.
Over the years, Kashmir has witnessed rise in heart attacks cases. Why so?
The trend of heart attacks is on a rise at global level and so in Kashmir. As the lifestyle of humans is changing fast so is the scenario of non-communicable diseases (NCDs) especially heart attacks. Addiction to social media has rendered people physically handicapped. Sedentary lifestyle is not only seen in office-going class, but in children too.
Ask a child which game you like or play answer is PUBG. Similarly, bad food habits have become a part of routine life including consumption of junk and fast foods. Stress has entered every phase of life. Children adolescents, adults, middle-aged and elderly all have their own stress-related problems. Rise in diabetes, smoking, drug addiction and hypertension has added to the burden of CAD in our society.
What is the trend of cardiac diseases in Kashmir?
A variety of disorders of the heart are seen worldwide. Majority of cardiac disorders are related to coronary arteries which lead to ischemic heart disease (IHD). Then we have hypertension that causes detrimental effects on the heart and we call it hypertensive heart disease (HHD).
Similarly, we see diseases of muscle of heart named as cardiomyopathies. A good number of patients have a disease of Valves of Heart called Valvular heart disease. Similarly, cardiac conduction system diseases are also seen here.
A majority of patients have arrhythmias that come with palpitations. All such disorders are seen in Kashmir. But it is IHD and HHD that are more prevalent. A rising trend in IHD is due to rise in its risk factors like smoking, diabetes, obesity, sedentary lifestyle and pollution in both urban and rural areas.
If we will not cut down these risk factors and act at present in near future we are going to see an epidemic of cardiac diseases. Measure need to be taken at both individual and government levels.
It has been seen that some people suffer a sudden heart attack. Why?
Heart attacks usually come suddenly. It is due to the pathophysiological mechanisms involved. Yes, at times stress-full situations, that are so common in this part of the world, make its appearance dramatic.
How much is the role of stress in heart disease?
Stress leads to various changes in body physiology that can come in the form of high sympathetic drive. This high sympathetic activity can turn a stable coronary artery disease into acute myocardial infarction. There is one form of myocardial infarction called apical ballooning syndrome that usually occurs in middle-aged females due to stress. Similarly, stress can cause devastating changes in blood pressure and lead to Intracranial Hemorrhages.
Are the hospitals in Kashmir well equipped to deal with patients who suffer heart attacks?
Our hospitals are presently optimally equipped to deal with patient suffering heart attacks. In every hospital at district and sub-district level, we have facilities to treat heart attack patients by thrombolysis which is also a universally accepted standard treatment modality. Although, the best treatment modality is primary stenting, such options are available at tertiary care units only that too unlikely at odd hours.
We need dedicated chest pain units in hospitals run by simple physicians. Besides this there is a scope of improvement in treating such patients. We need to sensitize hospital staff all medical and paramedical to recognise and treat heart attacks at the earliest.
We can decentralize high-end treatment modalities by improving our peripheral health system. A cath lab and specially trained staff at all district headquarters is a need of hour.
Some hospitals aren’t well equipped with facilities to tackle the disease. What needs to be done?
We need to work on promoting primary preventive measures. We need preventive cardiology to tackle the disease. It means we have to make society aware of the risk factors for cardiac diseases and they have to act upon it. People have to change their lifestyle, abandon smoking, go for walk every day, keep body weight under control, treat hypertension and they have to keep their blood sugar and cholesterol levels under control.
What facilities are being provided at JLNM hospital for such patients?
We have a good non-invasive cardiac setup which is at par with any center in this country. We have huge OPDs for cardiac patients. Although we do not have a dedicated cath lab we use a flouro in surgical theatre to implant cardiac pacemakers in needy patients. We badly need a dedicated cath lab to help more and more patients.
Are cardiology disorders more prevalent among males or females?
Hormonal systems of males and females are different thence are diseases. Males have more tendency to get heart attacks although this difference comes down in postmenopausal females.
Does it mean that every household has a heart patient?
Yes, cardiac diseases are a universal problem. You will definitely find some in a family at least with hypertension or heart failure or IHD.
Are there any heart diseases specific to pregnant women?
Yes, women can suffer specifically from heart diseases during and after pregnancy wherein functions of the heart are reduced. This disease is called Peripartum Cardiomyopathy. Most of such cases are reversible however should consult their cardiologist before planning for next pregnancy.
Can drug addicts suffer heart attacks?
Drug addiction is a risk factor as well as a precipitating factor for heart attacks. A good example is heart attacks in cocaine users. There are some particular drugs which affect heart, one such drug that is cocaine. Cocaine also is known as coke, is a strong stimulant mostly used as a recreational drug. Cocaine and heart attacks have a relationship with each other but we have not seen such cases in Kashmir. The drug users can suffer sudden heart attacks and their blood pressure gets high and it can cause death. There is a possibility of such cases in Kashmir also but they might be hiding their history.
Can exercise help to maintain a healthy heart? What do you suggest?
Yes 45-minute brisk walk every day is now recommended for every healthy person to maintain his cardiac health.
Suggest some control measures that such patients can do at individual level?
I will recommend all to remember “6 S”. Decrease your SALT intake to control hypertension. Control your SUGARS. Cut down you STRESS level. STOP smoking. Find SOLACE in meditation. SWIM daily or go for a brisk walk.
How can young people prevent themselves from falling prey to heart attack?
Coronary artery disease is a lifestyle disease. Fully 70% of it can be prevented by lifestyle modification. This includes staying smoke free, eating a healthy diet, regular exercise, maintaining ideal body weight, stress reduction and controlling risk factors like diabetes, higher blood pressure, hypothyroidism etc.
In winter, there are more heart attack cases due to severe cold. How can people prevent it?
When temperature drops, heart attacks go up. Prevention is through avoiding exposure to excess cold, using warm clothes and avoiding exertion. It is especially important for older people to be careful.
Is COVID-19 a contributing factor for heart attacks?
Covid-19 is a novel disease unfolding its dimensions each day. One of its complications is coagulopathy that can lead to heart attacks even in patients with normal coronary arterial.
How can people avoid heart attacks?
Heart attacks can be avoided by adopting healthy life style and keeping in check diabetes and hypertension. Heart attacks can be adequately treated by early recognition and seeking medical aid at the earliest.
What if a person suffers hearth attack at home?
Remember, for treatment of heart attacks, first hour of chest pain is the golden hour when one gets maximum benefit. Do wait for chest pain to settle. As soon as a middle aged male or female experiences retrosternal pain radiating to left arm he should rush to the nearest health facility and an ambulance should be called at the earliest.
What is the role of aspirin tablet? How should people use it?
Aspirin is a blood thinner which is a primary drug for treatment of heart attacks. It is recommended that any medical facility should have blood thinners like aspirin and Clopidrogel and a statin like Atorvastatin easily available for patients of heart attacks.
Anybody having a heart attack should receive Aspirin 300 mg, Clopidrogel 300 mg and Atorvastatin 40 mg immediately. Aspirin should be chewed and rest of the drugs swallowed. These medicines can be given by any first medical contact.
Is treatment affordable in our hospitals?
Yes in our hospitals treatment for heart attacks is affordable
What is the role PMJAY scheme in easing peoples’ burden?
Pradhan Mantri Jan Arogya Yojana is a national public health insurance fund of the Government of India that aims to provide free access to health insurance coverage for low income earners in the country. The scheme is boon for such patients.
It has helped all class of patient and particularly patients having cardiac ailments where costs are usually beyond the affordability of poor people. I think PMJAY is a great move by the GoI to help patients. In my career, I have for the first time seen costly treatment modalities being given to the poorest of the poor.
People as well as the medical fraternity need to be thankful to Prime minister of India, for launching and continuing such a wonderful scheme.
Please tell us something about postoperative care in cardiology and its importance?
Basically in interventional cardiology, we need a coronary care unit where patients following stenting are observed for few hours. Usually, if everything goes fine patients are discharged after 24 to 48 hours of any percutaneous cardiac procedure.