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.

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.

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.

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.

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.