Stroke Identification and Management

What is a Stroke?

The word ‘Stroke’ can send tremors down one’s spine. However, knowing what a stroke is could well be the first step towards preventing it. A Stroke is an emergency medical condition which requires immediate attention. It occurs when the oxygen supply to a part of your brain is cut off abruptly leading to the death of brain cells.

Stokes can be fatal if not attended to immediately by an expert Neurologist.

Sagar Hospital is the best neurology hospital in Bangalore with state-of-the-art medical facilities and expert neurosurgeons with a proven track record for stroke identification and management.

What are the symptoms of a Stroke?

The most common symptoms of a stroke are,

• Feeling confused
• Difficulty in speaking or understanding what others speak
• Sudden numbness in the face, arm or leg affecting one side of the body.
• Blurred, Blackened or Double vision
• Sudden, severe headache accompanied by vomiting and dizziness
• Difficulty in walking

If any of the above symptoms are observed it is extremely important to visit your neurologist in Bangalore immediately.

What are the different types of Strokes?

Strokes can be classified into two types:

• Ischemic stroke

Very similar to a heart attack in impact, Ischemic Stroke occurs in the blood vessels of the brain. This type of stroke causes blood clots to develop in the blood vessels leading to the brain, or even in blood vessels elsewhere in the body and then travel to the brain. About 80% of all strokes are ischemic.

• Haemorrhagic stroke

It occurs due to a rupture of a blood vessel in the brain. Subsequently, the brain tissue is damaged causing the death of brain cells. The result is blood seeping into the brain tissue, causing damage to brain cells.

What can cause a Stroke?

Best Neurosurgeons in Bangalore are of the opinion that strokes can be caused due to two main factors:

Lifestyle Factors: These include,

• Obesity
• Heavy Alcohol Consumption
• Addiction to illegal drugs
• Physical Inactivity

Medical Factors: They include

• Hypertension
• Diabetes
• Sleep disorder
• Cardio-vascular diseases.

Certain other factors that can lead to stroke are the Age factor and certain hormone therapies.

What are the complications that may result from a stroke?

Some of the best consultant neurosurgeons in Bangalore have concluded that a stroke can have a large-scale impact on our body that include:

• Memory Loss
• Difficulty in moving
• Difficulty in swallowing
• Pain
• Behavioural changes

How can a Stroke be prevented?

A regular evaluation with your consultant neurologist in Bangalore can help you to know where you stand with respect to your neuro health. Additionally, following your doctor’s advice and a healthy lifestyle pattern can prevent the risk of having a stroke to a large extent.

• Monitor your blood pressure levels at regular intervals
• Monitor your blood sugar levels at regular intervals
• Quit smoking
• Limit alcohol consumption
• Maintain a healthy weight
• Include more fruits and vegetables in your daily diet
• Avoid addiction to illegal drugs
• Have a good sleep

Sagar Hospital is the most preferred Multispeciality hospital in Bangalore with excellent facilities and medical expertise to treat a wide range of neurological disorders including stroke.

Is there a relation between acidity and coughing?

If you have had a cough for a while, your first guess is probably that you have a respiratory problem. Perhaps it’s a cold, a bacterial infection of the throat, or even Covid-19. Sometimes though, a cough that lasts for more than a few days can have other causes.

Studies and experience of gastroenterologists indicate that a long-term cough may be a sign of chronic acidity, commonly known as GERD (gastrointestinal reflux disease). Acid reflux is a condition when stomach acids back up into the food pipe or the oesophagus. The acid irritates the tissue lining of the oesophagus and causes the tell-tale symptom of heartburn – a sensation of burning in the chest. This irritation from the acid reflux in the throat or breathing in the acid droplets can cause coughing.

Though heartburn is the most common symptom of GERD, coughing is also a symptom. Acid reflux that occurs more than twice a week can lead to GERD. If left untreated, GERD can cause ulcers and permanent damage to your food pipe. It also increases the risk of oesophageal cancer.

GERD and coughing

A cough that lasts longer than 8 weeks is considered chronic. Though chronic coughing is not the most typical sign of GERD, it is associated with at least 25% of cases of chronic coughing with some studies estimating the figure to be 40%.

Chronic coughing can be made worse by acid reflux as well. GERD can cause or worsen coughing in the following ways:

• As stomach acids rise in the food pipe, coughing is triggered as a reflex.
• Droplets of stomach acids can rise up the oesophagus and reach the throat or the voice box, irritating the back of your throat. This kind of reflux is known as LPR (laryngeal pharyngeal reflux). Incidentally, coughing may develop as a defence mechanism against such reflux in an attempt to keep the throat clear of such foreign particles.

Symptoms of GERD-related coughing

Some signs that indicate that your cough may be caused by GERD include:

• Coughing occurs at night or after a meal.
• Coughing occurs or increases when you are lying down.
• Coughing without asthma or post nasal drips.
• Coughing when X-rays are clear, indicating no upperrespiratory congestion.
• Chronic coughing is present when common triggers such as smoking, throat infections, or sideeffects of certain medication are absent.

When should you see a doctor?

A cough associated with GERD or LPR requires attention from a doctor. If your cough persists for more than 3 weeks without improvement, consult your doctor. You should reach out to your doctor sooner if your cough gets worse with time, breathing is becoming difficult, or there is chest pain.

Diagnosis and testing

As we have mentioned earlier, coughing isn’t a typical symptom of GERD. As a result, identifying GERD as the cause of a persistent cough requires specialised tests. Your gastroenterologist may conduct tests to measure pH levels in your food pipe or an endoscopy to make the diagnosis.

Various factors related to your lifestyle may also be considered to determine the risk of GERD-induced coughing, which include:

• Smoking
• Regular consumption of foods that trigger GERD: spicy food, fried and oily food, caffeine, alcohol, garlic, and citrus fruits.
• Excess body weight

Medical treatment

Your gastroenterologist may prescribe you medication to manage episodes of acid reflux as well as to prevent them. Fewer instances of acid refluxes will protect your oesophagus from damage. These prescribed and over-the-counter medications include:

• PPI (proton pump inhibitors) to treat heartburn and ulcers by reducing the production of stomach acids.
• Antacids to manage instances of acid reflux.
• Foaming agents to prevent the contents of the stomach from backing up and causing reflux.

Preventing and improving GERD with lifestyle changes

• Eat smaller meals more frequently.
• Don’t lay down for 2 to 2.5 hours after meals.
• Maintain a healthy body weight (refer to a BMI score of 25 to calculate the appropriate weight for your height)
• Stop or don’t smoke.
• Avoid consuming alcohol.
• Limit consumption of foods that trigger acidity:
  • Spicy foods
  • Oily/ fatty/ greasy/ fried foods
  • Caffeine/ coffee/ tea
  • Citrus fruits
• Elevate the head of your bed by a few inches using inserts to create a slight downward sleeping angle.
• Avoid wearing tight-fitting belts or clothes that apply pressure around your abdomen.

A chronic cough may indicate GERD. Once diagnosed, cough from GERD can be treated easily and without further damage to your food pipe. If you suffer from GERD, you will probably display other symptoms such as hoarseness, heartburn, and trouble swallowing as well. Your doctor will conduct tests to confirm GERD and prescribe medication to manage and treat your condition. Lifestyle behaviours such as avoiding certain foods, not smoking or consuming alcohol, and maintaining a healthy weight can also help prevent GERD.To know if your chronic coughing warrants a deeper investigation and what risks you face, consult the best gastroenterologists in Bangalore at the Department of Gastroenterology and Hepatology in Sagar Hospitals.

Can hernia be treated non-surgically?

A hernia is a part of an organ or fatty tissue protruding through a weak place in the encasing muscle wall or soft connective tissue. Hernias most commonly occur in the groin or in the abdomen. Generally, hernias do not get better with time. The protrusion increases and can lead to complications. This is why doctors usually recommend surgery to push back the bulging tissue or organ inside the encasement using mesh and to keep it there.

But not all kinds of hernias need surgical intervention. Treatment varies from case to case and depends on the severity of the symptoms and the size of the protrusion.

What kinds of hernias are treated without surgery?

The following are the types of hernias that can be treated without surgery in very specific cases:

• Congenital umbilical hernias:

  The condition is monitored carefully, and unless unusually large, umbilical hernias that are present at birth usually resolve themselves by the time the child is a year old. However, if the protrusion is present at age 3 or 4 or continues to grow, surgical intervention is needed.

• Certain cases of hiatal hernias:

  If a hiatal hernia is not at risk of causing serious GERD (gastroesophageal reflux disease) or getting strangulated, non-surgical treatment may be recommended. This includes medication to:

  • Reduce acid production and neutralise excess stomach acids.
  • Strengthening the bundle of muscles that prevent stomach acids from flowing backward into the oesophagus.

  Surgery is necessary if the medication is unable to prevent further herniation or control the symptoms.

• Asymptomatic umbilical or inguinal hernias:

  This approach is recommended for patients who are at high risk from anaesthesia or surgery. If the patient has an inguinal hernia (a groin hernia that is also the most common kind of hernia) or an umbilical hernia (an abdominal hernia) that is asymptomatic and negligible in size, the gastroenterologist may want to keep monitoring the situation carefully. The doctor may attempt to massage the hernia into place if possible. If the hernia is not at risk of getting stuck in the surrounding tissue nor growing too big, close monitoring and waiting may continue with frequent follow-up tests.

What are the non-surgical treatment options for hernias?

• Waiting and monitoring closely:

  This is the most common non-surgical option to deal with hernias. The hernia is monitored with regular follow-up appointments and tests to ensure that it is not growing in size or at risk of getting incarcerated or strangulated. This option is recommended only when the hernia is small and asymptomatic.

  While your condition is being monitored:

  • Avoid lifting heavy weights to avoid triggering abdominal pain.
  • Try to maintain a healthy body weight and strengthen your abdominal muscles with exercise for your core.
  • Avoid the risk of constipation by consuming a diet rich in fibre and fluids. Being constipated can make you strain in the bathroom, adding additional pressure on the herniated tissues.

  As long as the hernia is not getting strangulated, or incarcerated, or there is hope that the hernia can be pushed behind the damaged muscular wall, surgery can wait.

• Using hernia binders, trusses, and corsets:

  Wearing a binder, truss, or corset can keep the hernia in place and prevent further sagging by providing additional support to the damaged muscle walls. It is important to note that this treatment option is effective only if the hernia is completely reducible and can be pushed backthrough the muscle wall back in its proper place. The truss has to be worn and remain in place during all normal physical activities. Consequently, this is not an ideal solution and one that can cause skin irritation and infection. However, this treatment option may be recommended for elderly patients for whom undergoing surgery may be high risk.

When is surgery necessary to treat a hernia?

Surgery is recommended for hernia treatment if:

• The hernia (hernia sac) cannot be pushed back in place behind the damaged surrounding muscle.
• Incarceration: This happens if tissue or organ (such as the intestine) gets trapped in the muscle wall and cannot be pushed back into its respective cavity.Prompt intervention is needed to avoid complications such as strangulation.
• Strangulation: This happens if the incarcerated hernia is left untreated and blood and oxygen supply to the tissue gets blocked, leading to organ death. A strangulated hernia requires immediate surgical treatment.

Seek immediate medical help if your hernia turns dark, red, or purple or if you experience sudden pain that keeps getting worse. This may be accompanied by fever or nausea.

Though a hernia can cause significant inconvenience and discomfort, the outlook for hernia treatment is encouraging and positive. Small and asymptomatic hernias can be treated without surgery if they pose no further risk of incarceration. At the Department of Gastroenterology and Hepatology, our expert gastroenterologists have extensive experience in treating hernias without surgery as well as with surgical treatment for hernias of all kinds. If you feel that your symptoms warrant a deeper investigation andwant to discuss comprehensive treatment options available to you, consult the best gastroenterologists in Bangalore at the Department of Gastroenterology and Hepatology in Sagar Hospitals.

Bacterial stomach infections – how to treat and protect yourself

Bacterial gastroenteritis, or digestive problem caused by bacteria, is fairly common in India.It is also commonly called food poisoning. You can get bacterial gastroenteritis after consuming contaminated food or water. Unhygienic and improper handling, storage, and cooking of food items can make foodunsafe for consumption.

People can get bacteria on their hands by handling contaminated food or water and, consequently, bacterial infections of the stomach have a tendency to spread from person to person quickly. Harmful bacteria are also present in the stools of infected people and can get transmitted to others if proper handhygiene is not practised.

Symptoms of bacterial stomach infections

The symptoms of bacterial gastroenteritis depend on the kind of infection, and may include:

• Diarrhoea
• Abdominal pain and cramping
• Nausea and vomiting
• Fever
• Loss of appetite
• Blood in the stool (extreme cases)

When should you see a doctor?

Often, bacterial gastroenteritis will clear up on its own with some rest and by drinking plenty of fluids. However, seek help from your doctor if your symptoms do not improve even after 5 days. In the case of children, contact your doctor if symptoms do not improve after 2 days or if vomiting continues after 12 hours. If an infant younger than 3 months has diarrhoea or vomiting, call your doctor without delay.

Causes of stomach bacterial infections

The different kinds of bacteria that cause bacterial gastroenteritis include:

• E. Coli: Occurs in unwashed fruits, vegetables, and undercooked meats, especially beef.
• Shigella: Occurs in contaminated water (including swimming pools) and raw foods.
• Salmonella and staphylococcus (staph): Present in raw or undercooked meats, dairy products, and eggs.
• H. Pylori: A particularly antibiotic-resistant infection, this is commonly found in contaminated water and food. It also spreads via contact with saliva, vomit, and faecal matter from contaminated people.
• Campylobacter: Occurs in undercooked or raw poultry and dairy products.
• Yersinia: Found in raw or undercooked pork.

Home treatment for mild cases

Milder cases of stomach bacterial infections can be treated at home by following measures that include:

• Avoid eating:
  • Fatty/ oily/ fried foods
  • Dairy, raw fruits or vegetables, or high fibre foods.
  • Heavy meals
• Consume:
  • Lots of water and fluids
  • More frequent, smaller meals
  • Foods and drinks with potassium, such as bananas and fruit juices
  • Electrolyte drinks, especially after diarrhoea and vomiting.

Medical treatment

Medication is meant to keep you hydrated and avoid complications. Some points of note:

• Do not take OTC (over-the-counter) medication unless prescribed by your doctor or gastroenterologist.
• Your doctor may prescribe you antibiotics for your treatment. Be mindful of the dosage and complete the entire course of medication in a timely manner.
• Follow the measures listed for home treatment also.
• If you are unable to keep any fluids down, go to a hospital.

Preventing bacterial stomach infections

Preventing an outbreak of bacterial gastroenteritis is a matter of following hygienic routines. You should adhere to the following as a rule of thumb to avoid not just bacterial, but most stomach infections:

• Cleanliness:
  • Keep your kitchen and bathrooms clean.
  • Use a separate cutting board for raw meats.
  • Wash vegetables and fruits thoroughly before eating them.
  • Wash the cutting board every time after use.
  • Though not a measure related to cleanliness, avoid close contact with people who are suspected to have gastroenteritis.
• Wash your hands::
  • After using the bathroom
  • Before handling food
  • After handling any raw meats
  • After touching pets/ animals
• Water:
  • Avoid drinking water from unknown sources unless you are sure it is clean.
  • Drink water at home that has been RO or UV treatments, or boiled.
  • While travelling, drink water carried from home or bottled water only.
• Food:
  • Avoid consuming raw or undercooked meats.
  • Avoid drinking unpasteurised milk.
  • Refrigerate perishable foods such as raw meats, vegetables, fruits, and cooked food.
  • Store foods with shelf life in closed or sealed containers.
  • Avoid street food.
  • Avoid food at restaurants that do not seem hygienic.
  • Do not eat food that has been kept out for long.

Many bacterial stomach infections result from food that makes its way from the grocery stores to your plate. Contaminated water is also a major source and can cause infections by contact or consumption. Avoid certain foods such as dairy, oily/ fatty foods, and raw vegetables and fruits. Keep yourself hydrated especially if you have diarrhoea or vomiting. Most cases of bacterial gastroenteritis are not dangerous and are treated completely with home remedies and antibiotics. If left untreated, complications may occur and you may have to seek care at a hospital. You should seek treatment as soon as you see symptoms of stomach problems for timely treatment and to prevent the infection from spreading to others. If youare experiencing any symptoms related to digestion that warrant a visitto a specialist, or want to know more about the risks and treatments relatedto bacterial gastroenteritis, consult the best gastroenterologists in Bangalore at the Department of Gastroenterology and Hepatology in Sagar Hospitals.

What are the diseases of the heart valves?

Your heart consists of 4 chambers – 2 upper chambers (atria) and 2 lower chambers (ventricles). The four valves of your heart are the mitral, tricuspid, pulmonary, and aortic valves.

Blood passes from one heart chamber to the other through valves. Each of these valves has flap-like leaflets that open and close once per heartbeat, maintaining blood flow in the right direction. In short, a valve acts as a one-way outlet anda one-way inlet on either side of a chamber, preventing the backflow of blood.If any of these valves fail to close or open properly, the flow of blood through your heart and to the rest of your body is disrupted.

What are the signs of heart valve problems?

When heart valves begin to fail, the heart has to beat harder to maintain proper blood flow. Over time, the condition may deteriorate to a point that you start noticing symptoms. They include:

• Increasing instances of shortness of breath
• Weakness or dizziness
• Swelling in the feet, ankles, or the abdomen (edema)
• Chest pain and discomfort
• Rapid weight gain
• Fluttering or pounding heartbeats (palpitations)

Types of heart valve diseases

Heart valve problems can be acquired with age through heart conditions and infections. They can also be congenital (present at birth). They include:

• Acquired heart valve diseases:
  • Regurgitation: The valve leaflets (flaps) don’t close properly, causing a backward leakage of blood into the heart. This usually occurs due to prolapse, a condition when the leaflets bulge backward or become stretchy.
  • Stenosis: The valve flaps become stiff, thicken, or even fuse together, creating a narrowed valve opening through which the blood flow is restricted and make the heart work harder.
  • Endocarditis: A bacterial infection enters the bloodstream and infects the valve, creating holes, scarring, or harmful growths.
• Congenital heart valve diseases:
  • Atresia: The valve is not properly formed, and instead of flaps that open, solid tissue blocks the flow of blood between the heart chambers.
  • Valves, such as the pulmonary or the aortic valves, may be improperly formed, be of an improper size, or be improperly attached to their base.
  • Bicuspid aortic valve disease: The aortic valve in this condition has only 2 leaflets instead of 3, and is leaky because the valve cannot close or open completely.

What are the risk factors to develop valvular heart diseases?

The factors that increase your risk of developing heart valve diseases include:

• Heart valve infection
• Changes in the structure of the heart valve with ageing.
• Heart disease/ coronary artery disease
• History of heart attack
• High cholesterol, hypertension, diabetes, and other cardiovascular disease risk factors
• Congenital heart disease (heart conditions present at birth) such as myxomatous degeneration
• Syphilis

Can there be complications?

Heart valve diseases can create life-threatening complications such as:

• Heart failure
• Blood clots
• Stroke
• Irregular heart rhythms
• Death

How is heart valve disease diagnosed?

The preliminary test that your cardiologist will perform if he/ she/ they suspect valvular heart disease is to check for any abnormal sounds in the heart with a stethoscope. These characteristic sounds due to the turbulent flow of blood in the heart are known as heart murmurs.

To further diagnose the precise kind of valve disorder and the extent of the problem, the following tests may be conducted:

• Electrocardiogram (ECG)
• Echocardiogram (echo)
• Transoesophageal echocardiogram (TEE)
• Chest X-ray.
• Cardiac catheterization.
• Magnetic resonance imaging (MRI)

How is heart valve disease treated?

Depending on the type and severity of the valvular heart disease, treatment may include:

• Medication: Medicines are not a cure for heart valve disease, but their use can help relieve symptoms.
  • Beta-blockers and calcium channel blockers help control the heart rate and prevent abnormal heart rhythms.
  • Medicines such as vasodilators relax the blood vessels and reduce blood pressure to reduce the force with the heart must pump blood.
• Surgery: Malfunctioning valves may need to be repaired or replaced with surgery.
  • Heart valve repair: Abnormal heart valve tissue may be remodelled for proper function. A dilated valve may also be narrowed by inserting prosthetic rings.
  • Heart valve replacement: Severely dysfunctional or malformed valves may need to be replaced. These replacement valves may be biological valves (valves from animals or donated organs) or mechanical valves (made of metals, plastics, and other materials).

If you suspect heart disease or heart valve disease, you should call your doctor before your symptoms become too severe or frequent. Following diagnosis, you will need to schedule follow-up appointments with your cardiologist to make sure that your heart valves are functioning properly to avoid complications. Sagar Heart and Vascular Institute has the best cardiologists in Bangalore and specialises in the treatment of heart valve disease.To know more about the risks of heart valve disease and the latest treatment plans, book an appointment with our consultants.

Obesity and Heart Disease

Though middle-income countries like India have traditionally been counted among nations with an underweight population, India has recently broken into the ranks of the top 5 obese countries in the world. According to the latest National Family Health Survey 5 (NFHS-5), nearly 24% of women and 23% of men are overweight or obese (BMI of 25 or more).

So why is this a cause of worry in the medical community and for us in general? According to WHO,excess weight has contributed to over 2.8 million deaths in 2021 from non-communicable diseases that include cardiovascular/ heart disease, diabetes, respiratory disorders, and cancer among others.

We’ll discuss here how obesity and heart disease are linked in particular.

What causes excessive weight gain or obesity?

• Poor dietary choices and consumption of processed and “junk foods.”
• Lack of regular exercise
• Sugar and fat content of everyday food
• Genetic predisposition: Asians and Indians, in particular, are prone to fat collection around the belly. Collection of belly fat is more dangerous than weight anywhere else in the body. This is why Indians, and other people prone to central obesity, should consider using a BMI point of 23 instead of 25 to measure obesity.
• Stress
• Lack of good-quality sleep
• Misleading food labelling that market unhealthy foods as healthy or at least harmless food.

The weight-heart disease connection

Excess body fat, especially around the waist/ belly, is risky for your health. Most people tend to worry about visible fat, the fat that sits under the skin (subcutaneous fat). The bigger health risk comes from the fat that sits around our internal organs such as the heart and liver – visceral fat.

Visceral fat significantly increases risk factors that are closely associated with heart/ cardiovascular and circulatory diseases.

There are three major ways in which being overweight/ obese is dangerous for your heart:

1. Obesity increases the risk of coronary artery disease, heart attack, and stroke

Excess weight increases cholesterol levels in the blood, especially the harmful kind known as LDL cholesterol. When you are overweight, there is a tendency for cholesterol (plaque) to build up in your arteries and clog them. This can cause your arteries to become blocked and damaged, restricting proper blood flow to your heart. This condition is known as coronary artery disease.

This relationship is direct – obesity increases the risk of heart disease by 28%. A blockage in your arteries can cause a heart attack unexpectedly. If this blockage occurs in an artery going to your brain, you can suffer from a stroke or vascular dementia.

2. Obesity is the leading risk factor for type-2 diabetes

Carrying weight around your middle makes it harder for your body to use insulin and control glucose (sugar) levels in your blood. High sugar levels in your blood can damage arteries and significantly increase the risk of heart and circulatory diseases. In fact, obesity accounts for 80-85% of the risk of developing type-2 diabetes.

Type-2 diabetes, in turn, increases the risk of heart disease by two to four times. If you have diabetes but have not yet been diagnosed with heart disease, it is very important that you begin to control your weight immediately.

3. Obesity can cause high blood pressure

As your body weight increases, so can your blood pressure. Overweight people need a greater blood supply to provide oxygen and nutrients to parts of the body, increasing the risk of high blood pressure (hypertension). High blood pressure or hypertension is a common cause of heart attacks, which are more common in overweight people.

Lowering your weight and heart risk

You should be concerned about excess weight even if you have not been diagnosed with hypertension or diabetes. There may be “silent” heart damage at play that is simply not symptomatic yet.

The following can help you lower your heart risk:

• Control or lose weight if you are overweight (BMI > 25). Reducing excess weight is the best long-term strategy to reduce heart risk or risk of heart failure.
• Regularly test and monitor your key heart-risk indicators such as BMI, blood sugar, blood pressure, and cholesterol (HDL, LDL, and total).
• If you are obese, watch out for signs typical of heart failure. These symptoms include fatigue, shortness of breath, and irregular heart rhythms (heartbeats that you can feel).
• Every gram of weight loss helps. For every 5-point increase in your BMI points, the risk of heart failure increases by 32%.

The link between excess weight and heart health is direct – obesity increases the risk of heart disease significantly. Though you may find the medical advice to eat healthy, exercise, and lose weight an overused trope, it is sound advice when it comes to the health of your heart. Your doctors understand that it is not easy to lose weight with the trappings of our modern, mostly sedentary lives. However, you must know that every bit of weight you lose reduces your risk of developing heart disease. The Sagar Heart and Vascular Institute has the best cardiologists in Bangalore. Consult our experts to know more about how obesity can affect your cardiovascular weight and how to control your heart risk.

Dealing with Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a genetic condition that causes thickening of the heart muscle (myocardium) and consequently impairs heart function. This muscular thickening most commonly occurs at the septum, the wall separating the lower left and right chambers of the heart (ventricles).

The thickened septum can create problems in two ways:

• The thickened walls can become stiff, reducing the amount of blood that the ventricle can hold and pump out of the heart with every heartbeat. This is known as nonobstructive hypertrophic cardiomyopathy.
• The thickened septum can create a narrowing that can reduce or block blood flow from the left ventricle to the aorta. This can cause the ventricles to pump much harder to overcome the narrowing or blockage. This is known as obstructive hypertrophic cardiomyopathy.

Symptoms

Some people do not show any symptoms of HCM until diagnosed or until they feel its effects after exercise or exertion. Out of these, the majority have obstructive hypertrophic cardiomyopathy, and the rest havenonobstructive hypertrophic cardiomyopathy.

Signs and symptoms of hypertrophic cardiomyopathy include:

• Shortness of breath, particularly during exercise/ exertion.
• Chest pain, particularly during exercise/ exertion.
• Abnormal heartbeats or palpitations (heartbeats that you can feel).
• Dizziness or light-headedness, particularly during exercise/ exertion.
• Fatigue

Risks and complications

Hypertrophic cardiomyopathy is the most common kind of genetic heart disease and is largely passed down the generations. Having a parent who suffers from HCM increases your chances of having inherited the condition by 50%. Parents, siblings, and children of people with diagnosed hypertrophic cardiomyopathy should be screened at the earliest.

Unless the heart is put under stress, patients of hypertrophic cardiomyopathy don’t have major health issues to worry about. However, complications listed below can occur:

• Atrial fibrillation: This can affect the heart’s electrical system and cause irregular heartbeats. It can also increase the chances of blood clots and stroke.
• Blocked flow of blood
• Problems with the mitral valve: This can cause blood being pumped out of the heart to leak back in, worsening symptoms.
• Dilated cardiomyopathy: The pumping ability of the heart becomes weaker.
• Heart failure: The ability of the heart to perform its function is compromised and worsens over time.
• Sudden cardiac arrest

Diagnosis and tests

Since HCM is an inherited disease, your doctor will perform several investigations to diagnose the condition correctly. These include:

• Family and medical history: Your doctor will check and ask questions about your family history to spot patterns of cardiac events such as cardiac arrests, family history of HCM, and heart failure.
• Physical examination to check and listen for problems with blood flow.
• Echocardiogram: This test is most commonly used to diagnose HCM and find signs of muscle thickening. This may be done along a treadmill test to check how well your heart is pumping blood in the form of an exercise stress test.
• Electrocardiogram: This test is conducted with electrodes/ sensors placed on your chest to check for abnormal heart rhythms and signs of muscular thickening in the heart.
• Cardiac MRI

Treatment

The primary focus of HCM treatment is to reduce the risk of sudden cardiac arrest and to relieve symptoms of the condition.

• Medication

Medication helps reduce the strain on your heart to pump blood and how strongly the heart muscle must squeeze to perform its function. These include:

• Beta-blockers to reduce blood pressure.
• Heart rhythm drugs to reduce irregular heartbeats.
• Blood thinners to prevent blood clots.
• Calcium channel blockers to reduce strong contractions in the heart and arteries.
• Surgical procedures

Several surgical interventions are available to treat hypertrophic cardiomyopathy and its symptoms. They include:

• Septal myectomy: The open-heart surgery is performed to remove the thickened and overgrown septum separating the two heart chambers.
• Septal ablation: Alcohol is injected with a catheter to kill the overgrown heart tissue and reduce muscle thickening.
• Implantable cardioverter-defibrillator (ICD): The ICD is a small device that is implanted in your chest to continuously monitor the heartbeat. In case an abnormal heart rhythm occurs, calibrated electric shocks are provided to the heart to restore regular heart rhythm and prevent sudden cardiac arrest.

Lifestyle changes to manage hypertrophic cardiomyopathy

Your doctor may suggest certain lifestyle changes or guidelines to reduce the risk of complications of HCM and manage its symptoms. These include:

• Exercise as recommended and with caution (avoid high-intensity sports)
• Eat a heart-friendly and balanced diet
• Maintain healthy body weight.
• Control diabetes
• Limit your alcohol consumption
• Stop or don’t start smoking
• Monitor your blood pressure regularly
• Manage stress whenever possible

Overall, most people with hypertrophic cardiomyopathy (HCM) live long and normal lives without serious complications or disruptions to their regular lifestyles. However, people with serious symptoms and who are at risk of heart complications such as sudden cardiac arrest and heart failure must manage the condition carefully and a treatment plan must be made by their cardiologists. It is very important that your health care providers identify any risks in time and provide preventive treatment. If you are worried about the risks of HCM, have developed symptoms, or have been diagnosed recently, reach out to the best cardiologists in Bangalore at the Sagar Heart and Vascular Institute to improve your quality of life and take control of your heart health.

What is the difference between a heart attack and a sudden cardiac arrest?

Often, the terms heart attack and cardiac arrest are used synonymously. However, these are two different things. A heart attack, in short, happens when the flow of blood to the heart is blocked. A sudden cardiac arrest, on the other hand, occurs when the heart malfunctions and suddenly stops beating.

To understand these two conditions better, let’s take a closer look at them: their symptoms, and what you should do if you find a person suffering from either of these emergency conditions.

HeartAttack

A person suffers from a heart attack when the flow of blood to the heart is blocked. The most common cause for this blockage is a blood clot or a build-up of plaque in the coronary arteries. Oxygen is vital for the heart muscle. When the flow of oxygen-rich blood is blocked, the muscle begins to die if the condition is left untreated. The longer the condition goes untreated, the greater the damage to the heart. This is why someone suffering from a heart attack needs to be taken into surgery as fast as possible to remove the obstruction and restore blood flow.

The symptoms leading up to the actual attack may begin much earlier, growing gradually over hours, days, or weeks. The heart may continue to beat but deteriorate further due to the reduced flow of oxygen-rich blood from arterial blockage.

The symptoms of a heart attack include:

• Chest pain: Tightness in the centre of the chest that persists even after resting.
• Shortness of breath
• The chest pain spreading to other parts of the body, including the jaw, neck, back, arms, and abdomen.
• Sweating
• Feeling anxious
• Coughing
• Weakness and light-headedness
• Palpitations

Sudden Cardiac Arrest

While in a heart attack the heart may continue beating, though disrupted and in reduced function, in a sudden cardiac arrest the heart suddenly stops beating entirely.

A sudden cardiac arrest happens suddenly and usually without any warning. An electrical malfunction in the heart triggers an arrythmia, an irregular heartbeat. With the heart not pumping blood,blood flow to the brain, lungs, and other vital organs stops. A person suffering a sudden cardiac arrest loses consciousness within seconds and soon has no pulse. Unless treatment is received within minutes, the victim generally suffers death.

The symptoms suffered by a person during a cardiac arrest are alarmingly straightforward:

• No breathing
• No pulse

However, there may be a few warning signs leading up to a sudden cardiac arrest. These symptoms include:

• Shortness of breath
• Chest pain
• Weakness and dizziness
• Palpitations

Are these two conditions related?

While there is no definite cause and effect relationship between a heart attack and sudden cardiac arrest, there definitely is strong correlation. Most heart attacks do not cause cardiac arrests. But when cardiac arrests do occur, they are often preceded by heart attacks. A sudden cardiac arrest can happen after a heart attack or during the recovery period.

Cardiac arrest can occur due to other cardiac conditions such as heart failure, cardiomyopathy, and arrhythmia.

What you should do: Heart Attack

• Call an ambulance immediately. The patient must be taken into surgery as fast as possible for the arterial blockage to be removed.
• If the person is conscious, have him/ her chew aspirin immediately.
• If the patient is an existing heart patient, nitroglycerine tablets should be administered sublingually.
• If the person is unconscious, perform CPR. If there is an automatic defibrillator (AED) available, start following the instructions on the device.

What you should do: Sudden Cardiac Arrest

• A person can be rescued from a sudden cardiac arrest if it is treated within a few minutes. Therefore, call an ambulance immediately.
• Begin CPR and continue till professional emergency personnel arrive. In the absence of an AED, CPR can double or triple the chances of a person’s survival.
• If there is an automatic defibrillator (AED) available, start following the instructions on the device.

Though seemingly similar, heart attacks and sudden cardiac arrests in different in terms of lethality.As per a multinational coronary disease study, about 8%-17% of heart attacks are fatal.The fatality rates of sudden cardiac arrests, however, are very high – 95%. Most people who suffer a heart attack or a sudden cardiac arrest survive if they receive help very quickly. Most fatalities occur because the person is alone, the people around did not know CPR or call emergency medical help, or if the emergency medical help does not arrive within the 10 minutes to avoid brain death. Though such statistics may seem discouraging, a healthy lifestyle with regular exercise, a balanced diet with low sugar and oil, and avoiding habits such as smoking and drinking go a long way in preventing heart disease and cutting the risks of heart attacks and sudden cardiac arrests. For more information regarding your heart health and risks of heart attacks or sudden cardiac disorders, book an appointment with the best cardiologists in Bangalore at the Sagar Hospitals.

What are stents and when are they used?

To understand what stents are and for what purpose they are used in surgical procedures, we first must understand what coronary artery disease and atherosclerosis are.

What is coronary artery disease?

Coronary artery disease develops when the arteries supplying blood to your heart (coronary arteries) become clogged, damaged, or diseased due to the build-up of cholesterol (plaque) and calcium deposits. Build-up of plaque causes the passageway of your arteries to narrow and block over time, reducing the blood flow to the heart muscles. This condition of coronary arteries hardening from cholesterol or plaque deposits in the inner walls is called atherosclerosis.

Symptoms

A cardiologist may suspect atherosclerosis if the patient suffers from symptoms similar to a heart attack or angina. These include:

• Crushing chest pain or a burning sensation in the chest
• Shortness of breath
• Pain in the shoulder or arms
• Sweating
• Neck or jaw pain (in women)

Surgical procedures to restore and improve blood flow

The first line of treatment for atherosclerosis or coronary artery disease is attempted through medication. However, more aggressive treatment may be required in cases when patients suffer from serious symptoms. They include:

• Coronary artery bypass surgery:

  The surgeon creates a graft from another blood vessel in the body to bypass the blocked coronary artery. Stitching the blood vessel above and below the narrowed or blocked artery allows blood to flow around it. This open-heart surgery is reserved for patients with multiple blocked coronary arteries.

• Angioplasty and stent placement (percutaneous coronary revascularisation):

  For the elderly or patients with other health conditions who cannot bear the strain of open-heart surgery, the minimally-invasive procedure known as percutaneous coronary revascularisation (PCI) or, simply, angioplasty with stents is employed. We will discuss this procedure in greater detail below.

What is angioplasty with stents and how is it used?

During a PCI or an angioplasty with stent placement procedure, the heart surgeon inserts a long, narrow tube (a catheter) into the blocked artery. Here, a metal mesh, also known as a stent, is passed along the tube with a deflated balloon to the blocked or narrowed area of the artery. The balloon is then inflated, pushing open the metal coil into the inner walls of the blocked artery. This pushes out the plaque causing the blockage against the inner walls and opens up the artery. In time, arterial tissue grows around the stent, keeping it in place.

Stenting technology is advancing continually, and now medicated stents are employed that release medication into the arteries that prevent the stent from narrowing and clogging from scar tissue at the site of the stent application.

When is stenting used?

A number of factors decide when stenting is to be used for a patient with coronary artery disease. They include:

• To improve blood flow immediately following a heart attack.
• Unlike coronary artery bypass surgery, stenting is ideal when there are just 1 or 2 blockages and they are minor.
• If the blockage is in one or more of the 3 major coronary arteries, stenting is not an option and a bypass surgery must be performed.
• For the elderly, stenting is recommended if medication is ineffective. Coronary artery bypass is generally not advised for elderly patients as they cannot bear the strain of the surgery.
• Stenting is not recommended for patients suffering from comorbidities such as diabetes, heart valve disease, kidney disease, peripheral arterial disease, a prior incident of heart attack, or stroke. For them, a coronary artery bypass is the best option.
• Patients with a weak heart or those in a frail condition cannot bear the strain of open-heart surgery. For them, a coronary artery bypass is not an option, and stenting is recommended.

Post-procedural care

To mitigate the increased risk of clotting in the operated artery after stenting, treatment with anti-platelet/ anti-clotting drugs and blood thinners is needed for a prescribed period. It is important that the patient understands the dosage and duration of the medication and that medication is not altered or stopped without consulting the cardiologist.

Do stents cure coronary artery disease?

Stents are not a cure for coronary artery disease and do not reduce its risks. The stent will simply prevent the blocked or narrowed artery from restricting blood flow to the heart for a certain period after the procedure.

To control coronary artery disease, risks such as smoking, hypertension, and high bad cholesterol (LDL) must be controlled. Lifestyle changes that include being physically active, maintaining a healthy diet and body weight, and not smoking can prevent plaque from building up in your arteries.

Recovery from an angioplasty with stents is usually quick and most patients can resume normal activities within days. Some patients may experience bruising, but that is temporary. Sagar Heart and Vascular Institute has the best cardiologists in Bangalore. Consult our cardiologists to have a clear understanding of the benefits and risks of stent implementation.