Patent Ductus Arteriosus
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What is Patent Ductus Arteriosus (PDA) Defect?

Patent ductus arteriosus is a very common heart condition found in new born babies. It occurs because the ductus arteriosus blood vessel doesn’t close properly after birth.

Babies born prematurely are more likely to be affected by PDA. The risk of PDA increases the earlier the baby is born. PDA affects 10% of babies born between 30 and 37 weeks of pregnancy, 80% of babies born between 25 and 28 weeks of pregnancy and 90% of babies born earlier than 24 weeks of pregnancy.

PDA is also more commonly seen in girls than in boys.

Cause of PDA

Every baby has a ductus arteriosus, which is a foetal artery connecting the aorta and the pulmonary artery. This opening usually narrows and closes within a few days after birth. If it continues to remain open it is known as patent ductus arteriosus (PDA).

While a small PDA may not generally cause any problems, a large PDA can lead to the flow of poorly oxygenated blood in the wrong direction. This can cause heart failure and other complications such as pulmonary hypertension and blood vessel damage.

Causes of PDA include genetic disorders or a family history of the condition. Babies with neonatal respiratory distress syndrome which is a breathing problem or those born to mothers who had rubella during pregnancy are also at risk of developing PDA.

Symptoms

PDA symptoms vary according to the size of the defect. Small PDAs may not have symptoms apart from a heart murmur and may go undetected until adulthood.

Large PDAs may cause symptoms such as:

  • Persistent rapid breathing.
  • Breathlessness
  • Sweating often
  • Fatigue
  • or tiredness
  • Feeding and eating problems
  • Poor weight gain
  • Rapid heart rate

It is important to consult a doctor immediately if any of these symptoms are noticed in the baby.

Diagnosis and Treatment

PDA in premature babies and in neonates may be the cause of respiratory compromise. Many a time’s medicine is effective. In cases where medicine has failed or cannot be given due to many reasons, surgery is required. 

The paediatric cardiologist may recommend various tests such as Chest X-ray, Electrocardiogram (ECG), Echocardiogram, etc to diagnose the PDA.

A small PDA may close on its own as the child grows and may not require treatment. Doctors will prescribe the medication as required.

Large PDAs may require treatment that includes cardiac catheterization or surgery. Catheterization is a minimally invasive procedure where the doctors use a flexible tube or catheter and insert a coil through it into the heart to close the PDA. In PDA surgery an incision is made to the side of the chest and the PDA is closed with stiches or a metal clip.

Life after PDA treatment

After receiving treatment for PDA, children can lead normal, healthy lives. Activity levels, appetite, and growth will return to normal within a short duration. Periodic check-ups with the paediatric cardiologist will ensure that there are no heart or lung problems.

Acute Coronary Syndrome
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What is Acute Coronary Syndrome?

Acute coronary syndrome (ACS) refers to conditions where the blood supply to the heart muscle is suddenly blocked or severely reduced. It is a life threatening condition affecting millions of people every year and requires prompt diagnosis and care. Unstable angina and heart attack both are types of ACS.

Causes

The build-up of plaque in the arteries can block the blood flow to the heart. Plaque is a fatty substance made up of cholesterol, fat and other substances.

Gradual build-up of plaque can cause an artery to become very narrow and later completely blocked. The plaque can rupture suddenly leading to the formation of a blood clot that narrows or blocks the artery.

Symptoms

Some signs and symptoms of ACS include:

  • Chest pain or severe discomfort
  • Pain spreading from the chest to other parts of the body
  • Shortness of breath
  • Sudden, heavy sweating
  • Nausea
  • Fast or irregular heartbeat

Symptoms may vary depending on the patient’s age, sex and other medical conditions.

Risk factors

Certain risk factors increase the probability of developing ACS. People over the age of 45, those who are obese, and those who smoke are at risk.

Similarly, other conditions like high blood cholesterol, hypertension, diabetes and family history of heart disease also cause a risk of ACS.

Types of ACS

ACS includes three types of coronary artery disease that can damage heart tissue. These are:

  • Unstable angina: It comprises sudden and unexpected chest pain and is a warning sign of a heart attack.
  • NSTEMI: A Non-ST-elevation myocardial infarction (NSTEMI) is a heart attack in which the coronary arteries aren’t fully blocked.
  • STEMI: An ST-elevation myocardial infarction (STEMI) is a severe heart attack that occurs when the blood flow to the heart is fully blocked.

Diagnosis and Treatment

There are a number of tests that doctors may recommend to diagnose ACS including:

  • Electrocardiogram (ECG) – It measures the heart’s electrical activity.
  • Blood test – Blood tests such as troponin blood test can detect the cause of chest pain and the risk of a heart attack.
  • Echocardiogram – This test uses sound waves to detect if heart has been damaged or has any other problems.

Treatment for ACS may comprise medicines, surgery, or other procedures to treat the symptoms and restore blood flow to the heart. Doctors may prescribe different medicines such as aspirin, beta blockers, blood thinners, clot dissolving drugs, angiotensin converting enzyme (ACE) inhibitors, or nitroglycerin based on the patient’s condition.

Angioplasty procedure is performed to open a clogged artery using a long, thin tube known as catheter. Bypass surgery is performed to route the blood around the blocked artery.

Prevention

According to Dr Ramji Mehrotra, the risk of ACS can be reduced to a great extent by adopting a healthy lifestyle.

This includes consuming a balanced diet with plenty of whole grains, vegetables and fruits while limiting foods with high cholesterol and saturated fats. It is also important to maintain optimum weight by exercising regularly and avoiding smoking and tobacco in any form as it can damage the heart.

It is also advised to get regular preventive health screenings done and manage health conditions such as cholesterol, blood pressure and diabetes under control.

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Heart Attacks Are Becoming Common In Young People

Heart attacks, which were once called “old man’s disease”, are now occurring more frequently in younger people including women. It is increasing in people in the 20’s to 40’s age group. Presently, 1 out of every 5 heart attack patients is under the age of 40 years.

Hence, it is very important to take the required steps to protect one’s health and prevent cardiovascular disease and heart attacks.

Causes for Early Heart Attack

There are several factors that lead to heart attacks in young people. Generally, a heart attack results from a combination of factors and not just any one factor.

  • Diabetes: Diabetes is a key risk factor that can lead to blockages in coronary arteries which can cause an early heart attack. Adults with diabetes are 2 to 4 times more likely to be affected by heart disease than those without diabetes. High blood sugar can damage the blood vessels and increase the build-up of fats in the arteries thereby causing atherosclerosis.
  • Hypertension: Another major risk factor for cardiovascular disease is hypertension or high blood pressure. The occurrence of hypertension is increasing at a faster rate in the younger population than in the older people.
  • Obesity: Being obese or overweight can also increase the risk of heart attack. Excess weight not only puts a lot of strain on the heart but can lead to other health complications like diabetes, hypertension and high cholesterol which affect heart health.
  • Stress and anxiety: Stress levels are increasing rapidly in today’s youth due to various reasons. Healthy ways of dealing with stress and anxiety such as proper sleep and relaxation of the mind are not being adopted. Chronic stress is not good for the body and can lead to hypertension and obesity which affect the heart health.
  • Sedentary lifestyle: Decreased physical activity coupled with a sedentary lifestyle also leads to an increase in cardiovascular diseases in young people. Sometimes too much of exercise is also not good for the heart. Excessive exercise, in cases where there is a per-existing un-diagnosed heart condition, can lead to a heart attack.
  • Unhealthy dietary habits: Unhealthy eating is on the rise among the young population.  Consumption of saturated and trans fats, found in deep-fried and oily foods, increases the risk of heart disease and other health problems. Taking a variety of health supplements without medical advice is also harmful and can lead to health issues.

Tips for Preventing Heart Attack in Young People

Dr. Ramji Mehrotra recommends that it is important to be physically active by exercising for at least 30 minutes every day. Cardio exercises such as brisk walking, jogging, cycling and swimming keep the heart in good shape. Yoga and meditation are also very helpful in reducing stress and anxiety levels.

Smoking as well as alcohol and tobacco consumption must be stopped completely. Salt intake must be reduced in the diet while nutritious food including fresh vegetables, fruit and whole grains must be consumed regularly.

If a person has high blood pressure, cholesterol or diabetes, it is essential to keep them under control by consulting a doctor regularly.

By adopting all the above suggestions, the incidence of heart attack in young people can be minimized, according to Dr. Mehrotra.

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Heart Attack, Cardiac Arrest, and Stroke Symptoms

The terms Heart Attack, Cardiac Arrest, and Stroke are often used interchangeably but they are not the same. They are three different problems with different causes and treatments. Heart attack and cardiac arrest are involved with the heart, while stroke is involved with the brain. When blood flow to the part of heart muscle stops due to complete blockage in the artery which supplies blood to that part of heart muscle, the muscle dies and this is called heart attack. Cardiac arrest happens when the heart suddenly stops beating. When the blood supply to the brain is interrupted stroke occurs.

Heart Attack

A blocked artery can prevent blood from reaching the heart. This can be due to the build-up of plaque in the arteries and causes a heart attack. The blocked artery must be reopened quickly to avoid permanent damage to the heart.

The heart attack symptoms may be immediate or may also start slowly and persist for a few days or weeks before the attack. The symptoms of the heart attack can be different in both men and women. The common heart attack symptoms in men include:

  • Uncomfortable pressure, squeezing, or pain in the centre of the chest
  • Discomfort in the arms, neck, jaw, back, or stomach.
  • Shortness of breath with discomfort in the chest
  • Cold sweat, nausea, or light headedness

In women, chest pain or discomfort is the most common symptom of a heart attack.  Other symptoms include shortness of breath, back or jaw pain, nausea, and vomiting.

Cardiac Arrest

Cardiac arrest is the abrupt loss of functioning of the heart. Unlike heart attack which is a circulation problem, cardiac arrest results from a problem with the heart’s electrical system which disrupts the heart’s pumping action and stops blood flow. A heart attack is a common cause of cardiac arrest, though most heart attacks do not lead to cardiac arrest.

Sudden cardiac arrest often occurs with no warning and can lead to sudden collapse, loss of consciousness, no breathing, and no pulse. Sometimes there are symptoms observed in advance such as shortness of breath, chest discomfort, palpitations, etc.

Cardiac arrest stops the heart from beating and causes the stoppage of blood and oxygen to the brain, lungs, and other organs. If not treated immediately, cardiac arrest can lead to brain damage and also death within a few minutes. However, according to leading cardiac surgeon Dr. Ramji Mehrotra, chances of survival can be as high as 90 percent if treatment is initiated immediately with CPR and a shock with a defibrillator to jump-start the heart after sudden cardiac arrest.

Stroke

Strokes also deals with blood flow, but are not in the heart. A stroke occurs when blood supply to the brain is reduced, thereby blocking oxygen and nutrients.  The two major types of strokes are Ischemic and Haemorrhagic. When a vessel supplying blood to the brain is obstructed or clots, ischemic stroke occurs. Almost 90 percent of all strokes are ischemic strokes. Haemorrhagic stroke is caused when a weakened blood vessel or small aneurysm in brain vessel ruptures and bleeds. Uncontrolled high BP is the most common cause of haemorrhagic stroke.

Symptoms of a stroke include severe headache, sudden numbness or weakness; paralysis, difficulty with speech, loss of balance, unconsciousness etc. Risk factors that can cause stroke include smoking, high BP, high blood cholesterol, obesity, and type 2 diabetes.

Almost 75 percent of all strokes occur in people over the age of 65.

Conclusion

Dr Ramji Mehrotra says that heart attack, cardiac arrest, and stroke are all life-threatening emergencies. He is of the opinion that their risk can be minimized by getting regular check-ups, being screened for cardiovascular disease, and taking the prescribed medications and regular follow up with the doctor.. Dr. Mehrotra also highlights the importance of adopting a healthy lifestyle by quitting smoking and tobacco in any form, avoiding alcohol, exercising regularly, having a low-fat diet, keeping weight under control, managing diabetes, hypertension and other health conditions.