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What is Coronary Artery Disease?

Coronary artery disease (CAD) or coronary heart disease is a common type of heart disease that occurs when the arteries become hardened and narrowed. This is caused due to the cholesterol and calcium deposit or plaque in the arteries.

Coronary artery disease begins due to a condition called atherosclerosis which occurs when cholesterol and calcium collects on the inner walls of the arteries. This build-up is known as plaque which can block blood flow due to the narrowing of the arteries. If the plaque bursts it can lead to a blood clot.

Symptoms of CAD

A patient having coronary artery disease can have chest pain, breathlessness, fatigue, nausea and due to the reduced blood flow to the heart. Chest discomfort or angina is accompanied by symptoms like numbness, heaviness, aching, squeezing, etc.

Complete blockage of blood flow can also lead to heart attack.

Risk Factors

In addition to high cholesterol, other causes of damage to coronary arteries include high blood pressure, diabetes, smoking, sedentary lifestyle, etc.

Obesity, stress, unhealthy diet, irregular sleep and alcohol usage are other risk factors for coronary artery disease.

Diagnosis of CAD

The doctor reviews the patient’s symptoms, risk factors and medical history before performing a physical examination. Diagnostic tests include:

  • Electrocardiograph test: This test can detect heart attack and heart rhythm issues by recording the heart’s electrical activity.
  • Exercise stress test: This is a treadmill test that can help suspect  coronary blockages
  • Pharmacologic stress test: This test can also help detect coronary blockages through medication given to increase heart rate. This is done in patients who cannot walk on treadmill.
  • Coronary calcium scan: This can identify the amount of calcium on the walls of the coronary arteries which can give an indication of atherosclerosis.
  • Echocardiogram: This test utilizes sound waves to measure the overall functioning of the heart.
  • Blood tests: These tests are done for factors affecting arteries like cholesterol, triglycerides, lipoprotein, glucose, etc.
  • Cardiac catheterization: In this test small tubes are inserted into the blood vessels to detect the presence of coronary artery disease and also evaluate the heart function.

Prevention of CAD

According to Dr. Ramji Mehrotra who is one of India’s leading cardiologist, coronary artery disease can be prevented by adopting a healthy lifestyle to improve heart health. These include stopping smoking and limiting alcohol use, consuming a heart-healthy diet, exercising and increasing activity levels, etc.

Blood pressure, diabetes and cholesterol should be controlled. Stress management is also essential to prevent coronary artery disease.

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Life after Bypass Surgery

Coronary artery disease occurs due to the hardening of arteries supplying blood to the heart muscle. Bypass surgery is performed to restore normal blood flow to the obstructed coronary artery.

Bypass surgery helps the patients by improving the quality of life and decreasing angina and other CAD symptoms. It improves the pumping action of the heart and lowers the risk of a heart attack. Additionally it enables patients to resume a more active lifestyle.

According to Dr. Ramji Mehrotra, who is one of the Best Cardiac Surgeon in India, patients generally exhibit excellent results after bypass surgery. 85% of people have significantly reduced symptoms, with lesser risk of heart attacks in future, and a lesser chance of dying even beyond 10 years.

Recuperating after bypass surgery

Dr. Mehrotra says that patients should definitely follow the doctor’s advice regarding diet, activity and lifestyle changes, to be adopted after surgery and during recovery. They should take medication as per directions and notify the doctor immediately of any concerns like fever, pain, bleeding or problems at the incision site.

It is essential to follow the guidelines below while recovering after the bypass surgery.

Healthy diet – The patient should consume a healthy diet that is low in cholesterol and saturated and trans-fats. This can stop the build-up of plaque on artery walls.

Medications – Doctors prescribe the medications for promoting comfortable healing from the surgery and reducing the risk of future heart attacks. The medications generally prescribed include:

  • medicines to reduce cholesterol,
  • aspirin and antiplatelets to prevent blood clots,
  • ACE inhibitors and beta-blockers to regulate blood pressure, heart rate and cardiac remodelling.

Physical Activity – Physical activity should be gradually resumed by the patient and the advice of the physiotherapist may help gradual increase in exercise tolerance. For the first six weeks after surgery, the patient should not lift anything that is over 5 kg as the sternum (chest bone) will need time to heal. Walking is a good option for gradually increasing the activity level.

Cardiac Rehabilitation – Through Cardiac rehabilitation or rehab the patient can take up exercise under the supervision of a medical professional. It also involves psychological counselling, nutritional counselling, etc.

Diabetes Management – Patients with diabetes need to carefully manage their recovery in coordination with their doctors as diabetes contributes to cardiovascular disease.

Stress Management – Chronic stress is a risk factor leading to heart disease and hence must be managed carefully with a healthy lifestyle.

Improvement in Life – Improvement in quality of life after bypass gives the patient positive reinforcement towards life and patients are more receptive towards life style changes. Many quit smoking, alcohol and sedentary life style and start exercises and healthy dietary habits. 

Conclusion

As a leading arterial bypass Surgeon based in Delhi, Dr. Ramji Mehrotra is of the opinion that long-term recovery from bypass surgery involves managing the risk factors contributing to the cardiovascular disease. Though some risk factors like family history cannot be changed, others like healthy diet, medications, physical activity, and other lifestyle changes must be adopted for faster recovery and maintenance of good health.

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Signs and Symptoms of Omicron XE

The XE variant of Covid-19 is a mutation of Omicron BA.1 and BA.2 strains. It is a recombinant where two related parent viruses exchange genetic material to create offspring with genes from both parents.

XE variant was first discovered in the United Kingdom in January 2022. It is more highly transmissible when compared to other variants. Mumbai is the first city in India to report cases of the Omicron XE variant. Subsequently cases have been reported in other places including NCR, Gujarat, etc.

XE variant is 10 times more infectious than BA.2 variant. BA.2 reports the highest number of cases in the world currently and is called the stealth variant as it is not easy to detect.

Symptoms of Omicron XE

The new variant is exhibiting similar symptoms as those of the original Omicron. These include fever, cold and cough, sore throat, skin irritation, gastric trouble, etc. Loss of smell, shortness of breath, exhaustion, body ache, loss of appetite, and diarrhoea are the other symptoms. The symptoms are generally milder and not very severe.

Generally, people afflicted with XE variant also experience a loss of smell and taste. Severely affected people may experience heart trouble, palpitation and nerve issues as well.

Omicron XE is observed to be thrice as contagious as the Delta variant. However, the risk of hospitalisation is lower in XE than was observed in the earlier Covid variants. It is also reported to be less severe than the Delta variant in children less than five years old.

According to doctors, the XE variant may prove to be more dangerous for people who are already suffering from serious ailments. It is recommended to seek medical advice immediately if any of the symptoms become visible.

Potential Fourth Wave

The XE variant is causing concerns about a potential fourth wave of Covid-19 in India. Though it comprises only a small proportion of total sequenced cases, there is evidence of community transmission.

According to the National Technical Advisory Group on Immunisation (NTAGI) there is “nothing to panic” as the cases reported have not caused many serious infections.

The World Health Organisation (WHO) has said that it will not classify XE as a variant of concern separate from Omicron until major differences in disease transmission or severity are observed.

Conclusion

Health experts are advising the continuation of public health precautions such as physical distancing, wearing masks, practising proper sanitation, and staying home when sick. According to them, vaccinations is the best protection and is very effective in preventing any complications because of the XE virus.

The central and state governments are also keeping a close eye on the situation and are issuing directives to the health authorities as and when required.

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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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How Depression and Heart Disease are interlinked?

Depression and heart disease are two widespread diseases observed among the general public today. They often occur simultaneously within the same person. Many patients have been affected by depression after a heart attack, though they had no prior history of depression. Similarly, people with depression have been observed to develop heart diseases at a higher rate than normal persons.

It is natural for a patient to feel sad or depressed temporarily after a heart attack or cardiac surgery. The feelings of sadness generally go away after a few weeks as the patients adjust to a normal routine after recovery. However, if the depressed mood persists for a longer duration along with other symptoms it is necessary to take treatment.

Factors leading to depression

Depression is a medical illness that negatively affects how a patient feels, thinks, and behaves. It is caused by a combination of many factors like genetic, environmental, and psychological. Some of the major symptoms of depression include:

  • Feelings of sadness and hopelessness
  • Irritability over small matters
  • Sleep disturbances
  • Tiredness and lack of energy
  • Reduced appetite and weight loss
  • Anxiety and restlessness
  • Trouble in thinking, concentrating, and remembering

However, with proper diagnosis and treatment, it is possible to recover from depression and lead a normal life. Over a period of time, it can help to improve the patient’s overall health and decrease the risk of heart disease.

Effect of depression in patients with CVDs

Studies have shown that around 15 percent of patients with cardiovascular diseases experience depression. If not managed properly stress can lead to high blood pressure, damage to arteries and irregular heart rhythms. It can also increase adrenergic drive and other humoral changes  which are risk factors for cardiovascular disease. In many cases, depression leads to negative lifestyle habits like smoking, consumption of alcohol and poor diet, all of which could interfere with the heart disease treatment.

According to Dr Ramji Mehrotra, in patients with heart disease if depression is left untreated, it because of reasons enumerated above can increase the risk of heart attack and blood clots. 

Managing depression and heart disease

It is very important to take the right steps for managing depression and consequently reduce the risk of heart disease. Some of the lifestyle changes that can help to manage both depression and heart disease include:

  • Consume healthy foods: A balanced diet improves the health of the heart and reduces the risk of heart disease.
  • Regular exercise: Exercise helps significantly in improving the health of people with depression. It also improves heart health.
  • Avoid alcohol: Alcohol is a depressant and lowers the serotonin levels in the brain thereby causing depression to worsen. It can also increase the blood pressure and increase the risk of heart attack or stroke.
  • Quit smoking: Many depressed people take up smoking which is a major risk factor in developing heart disease. By not smoking the chances of developing heart disease can be lowered significantly.

A few other techniques to lower stress levels and prevent depression include:

  • Doing meditation and deep breathing exercises
  • Using visualization and recollecting positive memories
  • Getting adequate sleep and rest
  • Sharing feelings with others or writing them down

Conclusion

Dr. Mehrotra says that early detection of depression and treatment are crucial to not only improve a patient’s quality of life but also reduce the probability of heart disease. If not treated in time, depression can increase the risk of a heart attack. Patients with depression should not be stigmatized and must be helped to recover by providing them with the right treatment and support.

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Effect of a Positive Mental State on Heart

Mental health is an important component of the overall health of an individual. It involves a combination of psychological, emotional, and social well-being. Benefits of good mental health include reduction in stress and anxiety, clearer thinking, improvement in moods and inner peace, reduced chances of depression, etc.

Relation between Mental Health and Heart

Research has shown that mental health is related to the health of the heart. According to Dr Ramji Mehrotra, cardiovascular health is negatively affected by negative psychological factors and mental health disorders, while positive attributes make a positive impact and can lower the risk of cardiovascular disease and death.

Negative psychological conditions like chronic stress, anxiety, and depression can cause harmful biological responses such as irregularities of heart rate, increased blood pressure, and reduced blood flow to the heart. Smoking, unhealthy diet, obesity, lower levels of physical activity, etc. all negatively impact psychological health apart from directly influencing the heart negatively which in turn is connected to heart disease. To improve mental and psychological health, stress reduction therapy, meditation and exercise are recommended.

On the other hand, people with positive psychological health are likely to have lower blood pressure and lower cholesterol. Consequently, they are at a lower risk of developing cardiovascular disease. Health behavior that is likely to increase positive psychological health includes consuming healthy food, physical activity, regular health screening, and check-ups, etc. apart from stress reduction therapy including meditation.

Adopting a Healthier Lifestyle for Healthy Mind and Heart

While the risk of developing cardiovascular and heart diseases is high if a person has a mental health condition, the positive news is that it can be reduced with appropriate changes to one’s lifestyle. These steps towards improving both the body and mind include:

  • Be physically active: Physical activity boosts mental health by releasing chemicals into the brain that reduces depression and anxiety. It also ensures better sleep, less stress, and higher energy levels, etc.
  • Consume a healthy balanced diet: Eating a balanced and healthy diet is essential for mental health along with physical health. A healthy diet controls not only weight but also BP and cholesterol levels which reduce the risk of heart disease.
  • Stop smoking: Though smokers may think that smoking reduces their stress, in reality it increases stress, tension, and anxiety. It also leads to a high risk of lung cancer and all other cancers as well as heart and circulatory diseases. Hence, it is essential to cut down on smoking and eventually stop it altogether. Infect tobacco in any form is injurious and should be avoided.
  • Reduce alcohol: Alcohol is a depressant and affects the mood and mental state of a person. People consuming large amounts of alcohol lose control of their feelings and can become angry, aggressive, anxious and depressed. It can also cause several other health issues.
  • Other activities: Mental health can also be improved by taking up several activities such as adopting spirituality and meditation, improving social relationships, expressing gratitude, practicing kindness, cultivating optimism, etc.

Conclusion

It has been observed that people with mental health issues like stress, anxiety, and depression may experience physiological effects like increased cardiac activity and reduced blood flow to the heart. This may lead to abnormal calcium build-up in the arteries and heart disease. Hence, it is very important to maintain positive mental health by adopting a healthy lifestyle with physical activity, proper diet, stress reducing activities, meditation, cultivating hobbies, feeling good and avoiding smoking, tobacco etc.

Dr. Mehrotra’ says that along with taking care of physical conditions such as blood pressure, diabetes, cholesterol levels, etc., the negative aspects of mental health must be monitored and addressed regularly to reduce the incidence of heart disease in patients.

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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.

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Dr Ramji Mehrotra – A Cardiac Surgeon par Excellence

Dr. Ramji Mehrotra is a renowned cardiac surgeon based in Delhi. He is one of the leading names in the field of Cardio Thoracic and Vascular Surgery in India. He is presently working as a Principal Director & Chief in Cardio Thoracic and Vascular Surgery (CTVS) Department at BLK Super Speciality Hospital, New Delhi.

Highly Qualified Practitioner

Dr. Mehrotra is a highly qualified practitioner having been educated in and associated with very prestigious medical institutions like BHU, AIIMS and Harvard Medical School. His qualifications include: MBBS, MS – General Surgery, MCh – Cardio Thoracic Vascular Surgery, Fellowships in Cardiac Surgery.

Specialization 

Dr Ramji Mehrotra is a versatile surgeon. His forte lies in operating CABG on Beating Heart, Total Arterial CABG, Minimal Access Mitral and Aortic Valve repair and replacement.

Surgeries:

  • Cardiac Surgery
  • Cardio Thoracic Surgery
  • Cardiovascular Surgery
  • Beating Heart CABG,
  • Total Arterial CABG
  • Minimal Access Mitral Surgery
  • Aortic Valve Surgery
  • Valve repair surgeries.

Achievements

Dr. Mehrotra is credited to have performed the first successful arterial switch operation in Mumbai, India. He has the credit for setting up the pediatric Cardiac Surgery facility at Asian Heart Institute, Mumbai.

Dr Ramji Mehrotra has performed the first total arterial revascularization and first total arterial revascularization using bilateral mammary arteries at Indraprastha Apollo Hospital. New Delhi. He is also the one to perform a total arterial CABG on the youngest patient in India aged 10 years.

Dr. Mehrotra has presided over and presented many papers in national and international conferences.

Patient Testimonials

  • Dr. Mehrotra is admired by all his patients for his dedicated efforts in restoring them to good health. His patients often send personal thank you notes to express their gratitude.
  • Neeti Rawat, who is a staff member at Fortis Escorts Heart Institute, has said that Dr. Mehrotra has a unique way of caring for his patients and is a unique clinician. She added that his patients are given as less trouble as possible with minimum incisions during the surgery. She called him an “angel in disguise.”
  • Vijay Sen, whose mother was treated by Dr Ramji Mehrotra, has said that he has the magical power of healing touch towards the patients. He thanked Dr. Mehrotra for the care, support and motivation given to his mother during her bypass surgery. He said that Dr. Mehrotra used to positively respond to her when she called despite his busy schedule.
  • Niharika Verma said that Dr. Mehrotra is a very experienced and skilled surgeon who gave her husband Nishith Verma a new life.  She said that the operation was successful and they are thoroughly satisfied by his work.
  • Anoop Chitkara said that Dr. Mehrotra is a thorough professional and personally supervises the treatment right from the admission till discharge and post operation follow up. He added that Dr. Mehrotra is an amazing cardiologist and a very skilled heart surgeon.

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