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Let the heart breathe!

To mark World Heart Day, Dr Naresh Trehan, CMD of Medanta – The Medicity and Delhi’s top cardiologist, answers questions about cardiac disease, its prevention and cure

A recent report suggests that exposure to even low levels of traffic pollution can lead to heart damage. Do you agree with this finding?
Yes, pollution damages the lungs as well as the heart vessels just as smoking does. In medical terms, it leads to endothelial dysfunction; there is a buildup of arterial plaque.

We still find politicians and rich people going abroad for heart surgery. Do Indian hospitals lack in anything?
No, everything is available in India, we have the same technology and expertise and at a significantly lower cost. Thirty years ago, when we started doing coronary artery bypass surgery on a large scale in India, the cost of the procedure was about one lakh rupees. Over three decades, the cost has only grown organically. This is the minimum price one has to pay for world class quality, including expertise, equipment and consumables.

We read that the life of a 46-year-old was saved in Medanta with the heart of an 18-year-old who died in Indore with the help of a flying ambulance. Was any procedure done in the air?
On April 28, 2016, a heart retrieved from 18-year-old Deepak Dhaketa began beating inside Delhi resident Anita Verma, 47, within 4 hours and 3 minutes of Deepak being declared brain dead, at the Sri Aurobindo Institute of Medical Sciences, Indore. The aorta, the main artery supplying oxygenated blood to the body, was clamped to help retrieve the heart, at 10:53 am in Indore. At 3:56 pm the transplantation surgery in Delhi was complete.

This was made possible through the massive effort to transport the heart to Madhya Pradesh, Delhi and Haryana, creating green corridors on the ground and in the air.

Also do tell us about the robotic arm that conducts/assists in angiography (Artis-Zeego) at Medanta.
The Artis-Zeego Endo-vascular Surgical Cath Lab (Artis-Zeego) is a cath lab and an operating room combined into one room. It provides the ability to perform both minimally invasive, catheter-based procedures and conventional open surgery simultaneously in the same room.

The Artis-Zeego available at Medanta is the first system in angiography that is equipped with a multi-axis robotic arm that provides unmatched flexibility and helps the patients to be in that position which fits best to procedural needs. This hybrid OT embodies the collaborative ‘Heart Team’ concept of Medanta by allowing cardiac surgeons and interventional cardiologists to work together, simultaneously, in the same room to provide the most technologically advanced care available.

Is the ‘Heart Team’ approach unique to cardiology?
This cohort-driven approach is typical to Medanta wherein specialists collaborate to recommend the best treatment to patients across specialties. Treatment for heart diseases should be customised as per the patient’s condition. At Medanta, the Heart Team comprising of cardiologists, interventionalists and surgeons discuss and prescribe the best treatment for a patient.

Are there any new medications/treatment for dealing with heart blockage?
There have been technological advancements in every aspect of cardiac care. An example of this is an angiogram where we have the FFR technology (Fractional Floor Reserve Wire) through which a wire is put through the blockage and gives an index reading. This reading determines the course of the patient’s treatment.

Are pacemakers still being installed or is that technology obsolete?
Pacemakers are still installed but newer implantable devices are gaining popularity because of their small size.

What advice would you give a patient who is advised stents? Are stents being overused when not strictly necessary?
A 70% blockage detected in the arteries can be treated medically. In case it exceeds 70%, stents are a good option. Whenever in doubt, one should get a second opinion. This should be an institution or expert whom you are confident will guide you in the right direction.

Is it true that people with diabetes mellitus are at a higher risk of cardio-vascular diseased (CVDs)? If yes, how can this be prevented?
Diabetes is another fast-growing condition across the country, and our lifestyle choices have a part to play here. Modifications in eating behaviour is one of the biggest challenges that Indians are currently facing in diabetes management. Therefore, healthy eating habits should be inculcated from childhood for better prevention.

Heart diseases now result in 28% of deaths in India, mostly affecting people below 70 years of age. What are the major risk factors that have contributed to this rise, specific to Indian diets and habits?
Apart from non-modifiable factors like age, gender and genetics, the risk factors for CVDs include high blood pressure, diabetes, deranged blood lipids, smoking, physical inactivity, obesity and stress, among others. Even though people are aware of the risk factors, most of them are ignored till their condition worsens.

What do you feel about ghee? A whole generation had stopped taking it and now we are being encouraged to take it.
Anybody with an established cardiac history, diabetes or other risk factors should not take ghee. In the growing up years, a child can take upto two teaspoons per day of pure home-made ghee provided he/she is physically active. Most adults cannot burn that amount of fat.

At what age and under what circumstances should a person go for a routine heart check-up? If there is a heredity factor, should the age of check-up be advanced?
It is important to know your genes (family history). For example, if either of an individual’s parents is suffering from heart disease, it increases the risk of the individual by 15-20% and in case both parents are affected, the risk increases by 30-40%. Screening can begin as early as 25 years of age.

What are the healthy habits that can be adopted from childhood or adolescence to prevent the risk factors?
CVDs can be reversed with lifestyle changes. Making simple changes in what you eat, how often you exercise, how much you weigh and how you best manage stress can help put the brakes on the disease. One should learn not to give in to the temptation to consume oily, sugary and junk food items, especially after the age of 40.

Yoga and exercise are being advocated for all and sundry. Do you feel that when a cardiologist talks about it, the patient gets serious?
Cardiovascular diseases can be reversed with lifestyle changes especially through physical activity. Exercise at least 45 minutes a day — you can do brisk walking, running, cycling or any other form of physical activity. Yoga can also help in reversing the adverse effects to a significant extent.

Dr Reshma is an advocate of wellness, prevention and holistic health. Instagram handle: dr.reshmakhattarbhagat