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Sudden Cardiac Arrest, A Silent Endemic

by Vaishali Sharma
written by Vaishali Sharma

Sudden Cardiac Arrest (SCA) is the number one killer in India, killing approximately 25 lakhs people every year. As per the data revealed by Delhi Economic Survey about 150 to 250 deaths happen in the city of Delhi every single day and out of these deaths, 25 to 45 deaths occurred due to Sudden Cardiac Arrest (SCA).

Sudden cardiac arrest (SCA) is a condition in which the heart suddenly and unexpectedly stops beating. If this happens, blood stops flowing to the brain and other vital organs. SCA usually causes death if it’s not treated within minutes.

CPR or Cardiopulmonary resuscitation is a life saving technique that helps in such condition. Medically speaking discussed about this technique and its importance with a very special panel that included: Dr. SSC. Chakra Rao, Chairperson, Indian Resuscitation Council (IRC), Dr. Rakesh Garg, Honorary Scientific Director, Indian Resuscitation Council (IRC), Dr. Aditya Kumar, Honorary Director Public Relations, Indian Resuscitation Council (IRC) and Dr. Nikki Sabhrawal, Instructor IRC.

 

What is CPR and what the common man can do really at a point of time if they are witnessing someone getting a cardiac arrest?

Dr. SSC. Chakra Rao, Chairperson, Indian Resuscitation Council (IRC): Sudden Cardiac Arrest is one of the most silent killer among all the things it is not a disease as such it is something like an incident or an event that happens to a victim I don’t call them as a patient they are victims of this sudden cardiac arrest and for a population of 1.38 billion definitely there are more than 5 crore people are suffering cardiac arrest every year and if Calculated in minutes 112 victims fall prey to this sudden cardiac arrest every minute so this is the very silent killer and we have to definitely weaken it is all reversible deaths actually so how we can prevent this to train more and more people in cardiopulmonary resuscitation the cardiopulmonary resuscitation is a very simple method and actually and all these deaths which are occurring or 80% of them of them are outside the house so there is a need to train the layman and schools  mostly and I also say that even housewives should be trained because when you are in a group of trained people only you can be saved otherwise when there is nobody who knows some training it is very difficult to say but there are five methods where we can ask them or improve the training one is improve the training for all the people not only medics and paramedics to the and people in school children and make a telephone CPR you order or inspect somebody through telephone and do a CPR improve the emergency medical system and that is more important because we have a lot of inaccessible areas and in our India because of lot of differences roads congestions and all those things the ambulance cannot reach the victim within 3 minutes so we have to improve that so probably we may have to use some drones to carry the aids and another thing is the cardiac centers also have to help cardiac arrest centers means, it is not a very special device but everywhere wherever we sit even in a cafeteria  or the cinema hauls, malls, and any place where there may be a congregation of people there should be some trained people in CPR and also there should be an availability of AED for the people then we can definitely improve the survival rate by about 50% and here one thing is any delay of even one minute with decrease this survival by 7 to 10 percent so these are method which we have to follow and the Indian Resuscitation council is trying to impress upon the people and the government to bring them all.

Dr. Garg help us understand what entails in this training?

Dr. Rakesh Garg, Honorary Scientific Director, Indian Resuscitation Council (IRC): The training is very simple for lay person it has been simplified so we can teach almost around 40 to 50 people in our time around for two hours or so it doesn’t take much and it’s scientifically evidence based. It takes around 15 – 20 minutes for a group of 40-50 and another practice of five minutes which we used to do on mannequin, mannequin is like a rubber human being on which we can show them how to compress on the chest because we’re talking about CPR. It is very doable and we have been going for last so many years now and not only in India but outside India, people are learning it so I think people should come forward to learn CPR.

 

Are you using social media platforms for this purpose? If so, how?

Dr. Aditya Kumar, Honorary Director Public Relations, Indian Resuscitation Council (IRC): Yeah, yesterday itself the chairperson Dr. Rao used Facebook Live and he addressed the youth about the information regarding this CPR. What is CPR, how can we do, what is importance of CPR; various issues he address so time we use all social media platforms. More than 80% cases of cardiac arrest happens outside the hospital. Youngsters are also approaching us time to time if they would like to have sessions in College, in their schools and universities in fact we do sessions and research time to time in colleges and schools.

Dr. Nikki, what is someone would do if they see that a person right next to them stops breathing for a few seconds with suspect that they could have a cardiac arrest or perhaps you already know someone has a history of heart disease?

Dr. Nikki Sabhrawal, Instructor IRC: The first and foremost is the creating the awareness of which we’ve been talking about, what CPR is, what is the importance, timely assistance and who can do it. So you know under the IRC we have formulated the first ever Indian guidelines for doing cardiopulmonary resuscitation and this is broken up into different parts so for the laypersons there’s a compression only life support, where only by chest compressions can they save a life. Now if our government intervenes and we make it mandatory for every citizen to learn the compression only life support, this can be a life saver. Secondly is the importance of the AED.

Because most cardiac arrests occur due to this disruption in the rhythm of the heart.

Are you in touch with policymakers are you in touch perhaps the Government of India to make it mandatory?

Dr. SSC Rao, Chairperson, Indian Resuscitation Council (IRC): When it comes to governance, it is now part of the CBSE curriculum, and we will all take it seriously in CBSE medium schools following the succession of Covid. If there are private schools that can afford to buy mannequins, we will undoubtedly go to them and train them. We’ve already contacted the directors of CBSE schools, who will provide a list of them, and we’re asking our people to approach them and tell them about it, as well as train their teachers so that they can train the students and teach them how to perform CPR, and then we’ll form a very good network of school children who will act as your first responders. Many doctors have approached the government, and we have already made CPR training necessary in some medical universities, and we will make it mandatory for NSS and NCC camps and other similar groups, resulting in a very large number of people who have learnt the procedure.

Dr. Garg, tell us about what you are advocating to the government and policymakers of our country and what are your advice for the youth to increase the awareness about this life saving technique?

Dr. Rakesh Garg, Honorary Scientific Director, Indian Resuscitation Council (IRC): I agree if with some policies if it can be mandatory in dome schools and colleges then its absolutely fine so schools should add this in their curriculum and we have already taken an initiative where it is a part, so I think the budding students were ambitious so if they are being thought then it obviously will be helping our community on the other side even if I teach somebody the necessary things about doing CPR and give them a certification but if they see somebody collapsing on a road and it isn’t their inner feeling wants to help them by giving CPR, it’s the big issue that’s why through your channel and media like you are definitely helping us in creating awareness its just not creating awareness but also inner consciousness which should be generated that the country, community and the society has given us so many things to us so why can’t we give something back to the community, so I think this kind of inner feelings should come out for the community from our side and we should not only learn it which we are providing a platform but also be ready to help in various formats and  various platforms including the MNC from medical community including the government is working and supporting us a lot and CBSE is already taken an initiative so I think a big work is done all over and channels like you and the enthusiastic journalists are helping and supporting in this noble cause of creating awareness.

How are you trying to bridge it with people in rural areas where access to a doctor, even primarily healthcare maybe a few hours away?

Dr. Aditya Kumar, Honorary Director Public Relations, Indian Resuscitation Council (IRC): Actually the life donation is very big donation its an age old saying in Indian culture so people know all these things already so if we take the example of other countries like Europe, America, Singapore, Japan  they had included the basic CPR, in their syllabus a long time ago but now due to efforts of Indian recession council  we have get it included in CBSE and now we are trying to include it in local level and regional level because students go to school it they will learn through schools then it will impress them more rather than saying to them but other than that in recent times we are trying time to time through local newspapers or news channels or local rallies. We are trying our level best because our organization was started three years ago IRC. Afterwards on 16 October 2019 we had trained 7 lac people around the country free of cost which is a record in itself  the world bodies across the globe really appreciated it like anything, because we are trying our level best but in recent times in Covid situation we are focusing upon TOT,  that is teaching of trainees. We are making a network of trainers who will teach further to all the people when demand comes around the country but the rural divide is there so we are trying our level best through various awareness campaign and media like you.

How can someone save a life with bare hands?

Dr. SSC Rao, Chairperson, Indian Resuscitation Council (IRC): there is no need for expensive equipment. The two bare hands can save a life. When you notice a person on the ground fallen unconscious and tap on his shoulders, call for help if he doesn’t respond. You can dial 108 on your mobile and inform about your situation and place and don’t disconnect unless asked. Meanwhile, open the shirt and identify the xiphoid process that is located at the lowermost part of the sternum and measure two inches of distance with your finger. Now put your hand on the chest and interlock with the other hand. The heel of the hand should be on the sternum and then go on compressing for 120 compressions per min with 5-6 cm depth. This will definitely give the count of the blood to the brain and can save the patient. Meanwhile the AED will be brought. AED tells whether or not the patient needs to be given shocks. Henceforth, that patient can be transferred to the nearest medical facility.

Dr. Nikki would you like to add something to it?

Dr. Nikki Sabhrawal, Instructor IRC: These training programs need to be started at the school and college levels. It might be that someday your family member might be collapsing in front of you, you can do something to save their life. We have trained 1000s of individuals. If AEDs are available in Flights and malls and should be made available in schools, colleges and libraries also. If we don’t have an AED we continue with chest compression and that will help. This is my message to everyone that the training is available free of cost. People who are selling this equipment have saved many lives. We are training people, you should have the eagerness to come forward.

Should a person who has perhaps watched the videos but not sure or trained, perform a CPR?

Dr. Nikki Sabhrawal, Instructor IRC: Some effort is better than no effort at all. This process can be learned by everyone. Call for help, but continue with the chest compression till you get help.

Concluding the debate, Dr. Garg what would be your final message?

Dr. Rakesh Garg, Honorary Scientific Director, Indian Resuscitation Council (IRC): If we can save a life from sudden cardiac arrest, we have given something back to the society. I think the training program that Dr. Nikki talks about is a great initiative and I think that every individual should can get the training.

Dr. Nikki what are your concluding remarks?

Dr. Nikki Sabhrawal, Instructor IRC: Just like the principal of a school, president of RWA or the manager of a mall is responsible for running the show properly, it should be a priority to run these camps. We have done it here in Chanakyapuri, and in our hospital and trained 4-5 thousand people including the security staff and non medical people working at the hospital. Charges of these institutions should make it a part of their curriculum.

Dr. Aditya what is your message to the youngsters watching the show?

Dr. Aditya Kumar, Honorary Director Public Relations, Indian Resuscitation Council (IRC): Only 2% of the population is being trained for CPR in our country. If we talk about other countries, more people are aware about it because it is a part of their syllabus. So people should come forward to het the training as we are providing it free of cost. They can also visit our website which is www.cprindia.com and get registered.

In today’s times we are seeing so many people lose their lives due to Covid and it is a message to everyone that let’s not lose a life due to a cardiac arrest. As Dr. Garg said, making something mandatory is not the way. We need to realize the importance of this by ourselves. Get yourself registered at the website and save at least one life.

 

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Cardiology News

Metabolic Syndrome Is Associated With An Increased Risk Of Second Stroke And Death: A Study

by Pragati Singh
written by Pragati Singh

According to a meta-analysis, people with larger waistlines, high blood pressure, and other risk factors associated with metabolic syndrome may be more likely to have a second stroke and even die than people who do not have metabolic syndrome.

The study’s findings were published online in Neurology, the medical journal of the American Academy of Neurology.

Excess belly fat plus two or more of the following risk factors was defined as metabolic syndrome: high blood pressure, higher than normal triglycerides (a type of fat found in the blood), high blood sugar, and low high-density lipoprotein (HDL) cholesterol.

“Studies have shown conflicting results on whether metabolic syndrome, which has been linked to an increased risk of a first stroke, also increases the risk of a second stroke and death,” said study author Tian Li, MD, of the Fourth Military Medical University in Xi’an, China.

“Studies have shown conflicting results on whether metabolic syndrome, which has been tied to an increased risk of a first stroke, also increases the risk of a second stroke and death, so we wanted to analyze all of the research available,” said study author Tian Li, MD, of Fourth Military Medical University in Xi’an, China.

“These findings will help people with metabolic syndrome and their health care providers know that they should be screened for risk of recurrent stroke and given preventative treatments,” added Li.

For the risk of stroke recurrence, the meta-analysis combined results from six studies with 11,000 participants who were followed for up to five years. During that time, 1,250 people had a second stroke.

The analysis found that people with metabolic syndrome were 46 per cent more likely to have a second stroke than people who did not have the syndrome.

Looking at each component of metabolic syndrome, researchers found that having a low level of good cholesterol and having two or more components of the syndrome were associated independently with an increased risk of a second stroke.

Having excess belly fat, high blood sugar and high blood pressure were not associated with increased risk of the second stroke on their own.

For the risk of death from any cause, the meta-analysis combined eight studies with 51,613 people who were followed for up to five years. During that time, 4,210 people died.

People with metabolic syndrome were 27 per cent more likely to die during the study than people without the syndrome. None of the individual components of the syndrome was independently associated with an increased risk of death.

“These results add to the evidence that people with metabolic syndrome should take steps to modify their risk of second stroke and even death where possible, through medication, diet, exercise and other recommended lifestyle changes such as stopping smoking,” Li said.

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Cardiology News

Sudden Cardiac Arrest, a leading cause of Preventable Deaths

by Dr Siddha SC Chakra Rao
written by Dr Siddha SC Chakra Rao

Sudden Cardiac Arrest is the most leading cause of preventable deaths in India. It can occur to any person rich or poor, anywhere, even without any pre-existing cardiac diseases. Many important dignitaries of the Nation have succumbed sudden Cardiac Arrest. The incidence is more than covid-19.

 

Less than 2% of the population in India are aware of CPR. Most of the victims unattended or treated by local methods of superstitions. About 4280 people per one lakh population are prone to Sudden Cardiac Arrest every year and nearly 90% succumbed to death.  The Sudden Cardiac Arrest the cause for 59,064,000 preventable deaths in a year in India. And 161,819 per day, ie 6742people get Sudden Cardiac Arrest in an hour. India is a poor country with very meager per capita income and can’t afford an expensive training.

1.38 billion population in India. A sort of Indian guidelines and trainings is a must. Indian Resuscitation Guidelines will give confidence in all medical fraternity and among people, will save life’s, bring unity among organization. They need training in the local languages.

 

Indian Society of Anaesthesiologists has convened a meeting on 16th April 2017 at Hyderabad inviting many people involved in CPR in India. Indian Society of Anaesthesiologists, Indian society to study pain, Research society of Anaesthesiology and clinical pharmacology, Indian association of Cardiothoracic Anaesthesiologists, Indian Medical Association, Dr. NTR University of Heath Sciences, Indian Society of Critical Care Medicine, Association of Obstetric Anesthesia, UP Rural Institute of Medical University, Indian Association of Pediatric anesthesia , GVK EMRI, 108, Indian society of perinatology and reproductive biology, Indian College of Anaesthesiologists, and some members of Emergency medicine from different cities. It is resolved that India should have its own guidelines of resuscitation, as we do not have proper emergency medical system, equipped Ambulances, AEDs. We have different cultures, languages, customs, religions, inaccessible areas and superstitions. We studied the available literature available on similar circumstances around the world, less effluent countries and brought out the guidelines, and published in a PubMed Indexed journal after peer reviewing. Thus, a MAKE IN INDIA guidelines prepared to serve Indians.

 

  • Ahmed SM, Garg R, Divatia JV, Rao SC, Mishra BB, Kalandoor M V, Kapoor MC, Singh B. Compression-only life support (COLS) for cardiopulmonary resuscitation by layperson outside the hospital. Indian J Anaesth [serial online] 2017 [cited 2021 Jul 12];61:867-73. Available from: https://www.ijaweb.org/text.asp?2017/61/11/867/218099

 

  • Garg R, Ahmed SM, Kapoor MC, Mishra BB, Rao SC, Kalandoor M V, Divatia JV, Singh B. Basic cardiopulmonary life support (BCLS) for cardiopulmonary resuscitation by trained paramedics and medics outside the hospital. Indian J Anaesth [serial online] 2017 [cited 2021 Jul 12];61:874-82. Available from: https://www.ijaweb.org/text.asp?2017/61/11/874/218100

 

  • Garg R, Ahmed SM, Kapoor MC, Rao SC, Mishra BB, Kalandoor M V, Singh B, Divatia JV. Comprehensive cardiopulmonary life support (CCLS) for cardiopulmonary resuscitation by trained paramedics and medics inside the hospital. Indian J Anaesth [serial online] 2017 [cited 2021 Jul 12];61:883-94. Available from: https://www.ijaweb.org/text.asp?2017/61/11/883/218102

 

  • Singh B, Garg R, Chakra Rao S S, Ahmed SM, Divatia J V, Ramakrishnan T V, Mehdiratta L, Joshi M, Malhotra N, Bajwa SJ. Indian resuscitation council (IRC) suggested guidelines for comprehensive cardiopulmonary life support (CCLS) for suspected or confirmed coronavirus disease (COVID-19) patient. Indian J Anaesth [serial online] 2020 [cited 2021 Jul 12];64, Suppl S2:91-6. Available from: https://www.ijaweb.org/text.asp?2020/64/14/91/284914

 

The motto od Indian Resuscitation council is to make Every Citizen a Life saver

Train your neighbors and save yourself

Your two hands can save lives

We postulated the technic of Compression only Life Support (COLS) where a layperson can perform Cardiopulmonary resuscitation with his two hands outside the hospital and even useful for the Army personal.

 

 

We have many challenges ahead, to make Every Citizen A LifeSaver

13 million school children every year need to training Basic cardiopulmonary life support (BCLS)

83,000 medical students need mandatory certificate in Basic Cardiopulmonary life support and Comprehensive cardiac life support (CCLS)

200,000 nurses need of certify every year in BCLS and CCLS across nation

Only 1 % out of cardiac arrest attempt was done in India vs 40% in western countries.

 

We Indian Resuscitation Council established in 2017 participated in WRAH Day and trained school children and laymen.

Over 675,000 lay people trained in

cardiopulmonary resuscitation

worldwide — The “World Restart a Heart

(WRAH)” initiative 2018

 

Available online at www.sciencedirect.com

Resuscitation

journal homepage: www.elsevier.com/locate/resuscitation

 

The Indian Resuscitation Council, members of the Indian Society of Anaesthesiologists, and other professional, societies performed nationwide CPR training of laypeople in high schools, colleges, bus stations, railway stations, police stations, company offices, and other public places. At least 30 federal states of India participated and many

Chief Ministers and Health Ministers were actively involved. Overall, 225,000 people were trained in India for WRAH 2018.

 

Up to 206 million People Reached and Over 5.4 million Trained in Cardiopulmonary Resuscitation Worldwide: The 2019 International Liaison Committee on Resuscitation World Restart a Heart Initiative

INDIA IRC/ ISA : No trained in COLS are 500,268 , in 2019,

Vice President of India Sri Venkaiah Naidu released in BCLS manual in November 2018.

Vice President of India Sri Venkaiah Naidu released the CCLS manual in July 2019.

2020 March Covid19 has slowed down our progress.

Since 2018, IRC is attending all the bimonthly meetings of WRAH Day. Demonstrated CPR in Heritage sites, prepared songs, skits on CPR, in different languages including Urdu and Kashmiri.

 

Released 1st day envelop and stamp on the occasion of WEAH Day on 16th October 2020, by the Andhra Pradesh State Minister, Member of the Parliament and the Member of Legislative Assembly, in the virtual presence of WRAH Day, AAPI and ISA dignitaries.

COLS basic CPR guidelines are included in 12th grade nationwide school’s syllabus in July 2021

 

-Mandatory Certification of Basic cardiopulmonary life support before graduation in state of Andhra Pradesh by Dr NTR University of Health Sciences, Andhra Pradesh of 50 million population,6000 medical student graduated,

 

National Medical commission has introduced a foundation course for the newly admitted students of MBBS and they have incorporated BCLS for them

 

Establishing IRC Resuscitation Training centers in medical colleges across country

 

Training of trainers (TOT) across country is going on every two months. A separate dedicated training started for all the hospital staff with National Accreditation Board for Hospitals and Health care providers (NABH) (like joint council of hospitals). NABH certifying body of 30,000 private and thousands of govt hospital, who has mandatory certification for BCLS to all Doctors, nurse and paramedics working from front office to the high dependency areas

Providing affordable courses through IRC part of ILCOR will have more support and on international platform as health is global.

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Cardiology News

Learn CPR and Save Life- Must for every citizen

by Vaishali Sharma
written by Vaishali Sharma

Feature by:

  • Mr Aditya Kumar, Honorary Director Public Relations, Indian Resuscitation Council.
  • Dr Rakesh Garg Honorary Scientific Director, Indian Resuscitation Council.

Every year, about 4,280 out of one lakh victims of sudden cardiac arrest (SCA) die in India. Sudden cardiac arrest is a condition where the heart stops its function of pumping blood to the whole body leading to the cessation of heartbeat and breathing. The terms cardiac arrest and heart attack are often used interchangeably, but these are two different conditions. A heart attack occurs when an artery is blocked due to fat and cholesterol deposition and prevents blood from reaching the heart muscle causing severe chest pain and breathing difficulty. Whereas cardiac arrest often occurs suddenly without any warning due to disturbance in the electrical activity of the heart that causes an irregular heartbeat (arrhythmia) which disrupts the heart’s ability to pump blood to the brain, lungs, and other vital organs. Disturbance in the electrical activity of the heart leading to cardiac arrest can be due to any of the following reasons: diabetes, hypertension, lungs, liver and kidneys diseases, etc. However, it can happen to anybody at any point in time.  Within few minutes of cardiac arrest, the victim becomes unconscious and death occurs within minutes if the victim didn’t receive treatment. It has been observed that “ Every minute’s delay in the resuscitation of the cardiac arrest victim reduces the chance of survival by 7-10%”. So a prompt action can save the person’s life with cardiac arrest.

 

India is a vast country with lots of diversity, differences in culture, language, religions, customs, atmosphere, socio-economic issues, and differences in terrain. The environment and the infrastructure for resuscitation of a person with sudden cardiac arrest vary from place to place. So there was a need for a structured guideline to be followed for resuscitation of cardiac arrested victims. Moreover, the approach should be such that it is applicable at all scenarios and remains scientifically valid. There is a large body of evidence to show that it is possible to save the victims of SCA with immediate high-quality bystander hands-only cardiopulmonary resuscitation (CPR) – Compression only life support (COLS)

Compression only life support (COLS) are the guidelines developed by the Indian Resuscitation Council for providing only chest compressions in a stepwise algorithmic approach by a layperson for the cardiac arrest victims till the time medical help arrives

The timely management of the victim with cardiopulmonary arrest is paramount. It may not be possible to provide immediate medical care by the trained person when the victim is outside the hospital. The inclusion of common man after their proper training would be beneficial to improve the outcome of the victim. However, the medical steps to be taught to a layperson should be kept simple and easy to follow, and yet evidence-based.

Learning the skill of saving one’s life is may not be easy. But it is equally not easy to ignore someone dying unattended. The Compression only Life Support (COLS) provides an easy, algorithmic stepwise approach for resuscitation of the victim with cardiopulmonary arrest by the lay person. To save one’s life, we should know various steps of  COLS-Compression Only Life Support.

 

  1. Ensure Scene safety
  2. Victim’s response check
  3. Call for help and emergency medical system
  4. Early and effective chest compression
  5. Transfer to the health facility

The main activity of Compression-Only Life Support (COLS) is effective chest compression which should be performed continuously till help arrives. The chest compressions are performed at the rate of 120 per minute and the depth of each chest compressions should be around 5-6 cms.

To enhance the outcomes in cardiac arrests we need high-quality adult resuscitation education and Hands-on Training to maximum citizens. To achieve this, we first need to create the awareness and creating confidence among laypersons, that their contribution is equally important for the survival of a sudden cardiac arrested victim outside the hospital.

The main motto of any project related to layperson training in CPR is to bring out wide popularity for resuscitation, impart training to as many laymen including school children so that every citizen becomes a lifesaver. The IRC aims to train at least one person in the family to save the life from sudden cardiac arrest.

So, remember, Each of one us can save a life. Your two hands can save a life. Your timely help with compression-only CPR (COLS), in this emergency, may save somebody’s life. This victim could be your family member, friend, or a stranger on the street! Let us take a pledge on this National CPR day to learn CPR.

 

 

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AI tool measures fat around the heart to predict a patient’s risk of diabetes

by Vaishali Sharma
written by Vaishali Sharma

A team led by researchers from Queen Mary University of London has developed a new artificial intelligence (AI) tool that is able to automatically measure the amount of fat around the heart from MRI scan images.

Using the new tool, the team was able to show that a larger amount of fat around the heart is associated with significantly greater odds of diabetes, independent of a person’s age, sex, and body mass index.

The research is published in the journal Frontiers in Cardiovascular Medicine and is the result of funding from the CAP-AI programme, which is led by Barts Life Sciences, a research and innovation partnership between Queen Mary University of London and Barts Health NHS Trust.

The distribution of fat in the body can influence a person’s risk of developing various diseases. The commonly used measure of body mass index (BMI) mostly reflects fat accumulation under the skin, rather than around the internal organs. In particular, there are suggestions that fat accumulation around the heart may be a predictor of heart disease, and has been linked to a range of conditions, including atrial fibrillation, diabetes, and coronary artery disease.

Unfortunately, manual measurement of the amount of fat around the heart is challenging and time-consuming. For this reason, to date, no-one has been able to investigate this thoroughly in studies of large groups of people.

To address this problem, we’ve invented an AI tool that can be applied to standard heart MRI scans to obtain a measure of the fat around the heart automatically and quickly, in under three seconds. This tool can be used by future researchers to discover more about the links between the fat around the heart and disease risk, but also potentially in the future, as part of a patient’s standard care in hospital.”

Dr Zahra Raisi-Estabragh, Lead Researcher, Queen Mary University of London

The research team tested the AI algorithm’s ability to interpret images from heart MRI scans of more than 45,000 people, including participants in the UK Biobank, a database of health information from over half a million participants from across the UK. The team found that the AI tool was accurately able to determine the amount of fat around the heart in those images, and it was also able to calculate a patient’s risk of diabetes.

Dr Andrew Bard from Queen Mary University of London, who led the technical development, added: “The AI tool also includes an in-built method for calculating uncertainty of its own results, so you could say it has an impressive ability to mark its own homework.”

Professor Steffen Petersen from Queen Mary University of London, who supervised the project, said: “This novel tool has high utility for future research and, if clinical utility is demonstrated, may be applied in clinical practice to improve patient care. This work highlights the value of cross-disciplinary collaborations in medical research, particularly within cardiovascular imaging.”

CAP-AI is led by Capital Enterprise in partnership with Barts Health NHS Trust and Digital Catapult and The Alan Turing Institute and is funded by the European Regional Development Fund and Barts Charity.

Source: Queen Mary University of London

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Cardiology News

Transient pacemaker harmlessly dissolves in body

by Vaishali Sharma
written by Vaishali Sharma

Researchers at Northwestern and George Washington (GW) universities have developed the first-ever transient pacemaker — a wireless, battery-free, fully implantable pacing device that disappears after it’s no longer needed.

The thin, flexible, lightweight device could be used in patients who need temporary pacing after cardiac surgery or while waiting for a permanent pacemaker. All components of the pacemaker are biocompatible and naturally absorb into the body’s biofluids over the course of five to seven weeks, without needing surgical extraction.

The device wirelessly harvests energy from an external, remote antenna using near-field communication protocols — the same technology used in smartphones for electronic payments and in RFID tags. This eliminates the need for bulky batteries and rigid hardware, including wires (or leads). Not only can leads introduce infections, they also can become enveloped in scar tissue, causing further damage when removed.

The study will be published June 28 in the journal Nature Biotechnology. The paper demonstrates the device’s efficacy across a series of large and small animal models.

“Hardware placed in or near the heart creates risks for infection and other complications,” said Northwestern’s John A. Rogers, who led the device’s development. “Our wireless, transient pacemakers overcome key disadvantages of traditional temporary devices by eliminating the need for percutaneous leads for surgical extraction procedures — thereby offering the potential for reduced costs and improved outcomes in patient care. This unusual type of device could represent the future of temporary pacing technology.”

“Sometimes patients only need pacemakers temporarily, perhaps after an open heart surgery, heart attack or drug overdose,” said Dr. Rishi Arora, a cardiologist at Northwestern Medicine who co-led the study. “After the patient’s heart is stabilized, we can remove the pacemaker. The current standard of care involves inserting a wire, which stays in place for three to seven days. These have potential to become infected or dislodged.”

“The transient electronics platform opens an entirely new chapter in medicine and biomedical research,” said GW’s Igor Efimov, who co-led the study with Rogers and Arora. “The bioresorbable materials at the foundation of this technology make it possible to create whole host of diagnostic and therapeutic transient devices for monitoring progression of diseases and therapies, delivering electrical, pharmacological, cell therapies, gene reprogramming and more.”

Rogers is the Louis Simpson and Kimberly Querrey Professor of Materials Science and Engineering, Biomedical Engineering and Neurological Surgery in the McCormick School of Engineering and Feinberg School of Medicine and the director of the Querrey Simpson Institute for Bioelectronics. Arora is a professor of medicine at Feinberg and co-director of the Center for Arrhythmia Research. Efimov is the Alisann and Terry Collins Professor of Biomedical Engineering at GW.

Ditching restrictive, risky leads

Currently, to set up a temporary pacing after open heart surgery, surgeons must sew on temporary pacemaker electrodes on the heart muscle during surgery. These have leads that exit the front of a patient’s chest, connecting to an external pacing box that delivers a current to control the heart’s rhythm.

When the temporary pacemaker is no longer needed, physicians remove the pacemaker electrodes. Although uncommon, potential complications of implanted temporary pacemakers include infection, dislodgement, torn or damaged tissues, bleeding and blood clots.

With Northwestern and GW’s transient pacemaker, surgeons and patients can sidestep this potentially risky procedure. The fully implantable device is light and thin — 250 microns thick and weighing less than half a gram. Soft and flexible, it encapsulates electrodes that softly laminate onto the heart’s surface to deliver an electrical pulse.

“Instead of using wires that can get infected and dislodged, we can implant this leadless biocompatible pacemaker,” Arora said. “The circuitry is implanted directly on the surface of the heart, and we can activate it remotely. Over a period of weeks, this new type of pacemaker ‘dissolves’ or degrades on its own, thereby avoiding the need for physical removal of the pacemaker electrodes. This is potentially a major victory for post-operative patients.

“With further modifications, it eventually may be possible to implant such bioresorbable pacemakers through a vein in the leg or arm,” he added. “In this instance, it also may be possible to provide temporary pacing to patients who have suffered a heart attack or to patients undergoing catheter-based procedures, such as trans-catheter aortic valve replacement.”

Prioritizing patient comfort

Northwestern Medicine cardiac surgeon Dr. Duc Thinh Pham, who was not involved with the research, imagines a transient pacemaker undoubtedly would make his patients more comfortable. With current pacemakers, patients often feel discomfort for days after the leads are inserted. Then, they must limit their movements and activities in order to prevent the leads from dislodging.

“This transient pacemaker is brilliant,” said Pham, who has performed more than 2,000 cardiac surgeries throughout his career. “In addition to addressing the primary issue of occasional post-cardiac surgery patients needing temporary pacing due to blockages or arrhythmias, the device addresses the secondary issue of patient comfort, ability to move freely and rehabilitate. If successful, this device will greatly improve a patient’s post-operative course.”

Disappearing act

This is the second example of bioresorbable electronic medicine from the Rogers lab, which has been studying transient electronics for over a decade. In 2018, Rogers and colleagues demonstrated the world’s first bioresorbable electronic device — a biodegradable implant that speeds nerve regeneration. The team’s bioresorbable devices are completely harmless — similar to absorbable stitches. After fully degrading, the devices completely disappear through the body’s natural biological processes.

“There is clearly a need for better temporary cardiac pacemakers,” said Dr. Bradley Knight, the Chester C. and Deborah M. Cooley Distinguished Professor of Cardiology at Feinberg and coauthor of the study. “When I first learned about the bioresorbable nerve stimulator, I contacted Professor Rogers to explore the possibility of using this technology to pace the heart. He had already started working with Dr. Efimov to develop a small version of a bioresorbable pacemaker as a proof of concept. We then worked with both teams to develop a larger version of a bioresorbable, leadless, cardiac pacemaker that could be effective on a human scale. It’s a great example of what we can create at Northwestern by bridging the expertise in engineering and medicine.”

Depending on the patient, a temporary pacemaker might be needed anywhere from a couple days to several weeks. By varying the composition and thickness of the materials in the device, Rogers’ team can control the precise number of days it remains functional before dissolving.

“We build these devices out of different types of safe, bioresorbable materials and in optimized architectures to ensure stable operation over a time period somewhat longer than is clinically necessary,” Rogers said. “We can tailor the devices to address a broad spectrum of relevant lifetimes. Transient technologies, in general, could someday provide therapy or treatment for a wide variety of medical conditions — serving, in a sense, as an engineering form of medicine.”

Source: Northwestern University

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Cardiology News

AED – A Possible Prevention for Sudden Cardiac Death

by Vaishali Sharma
written by Vaishali Sharma

Sudden Cardiac Arrest (SCA) is the number one killer in India, killing approximately 25 lakhs people every year. As per the data revealed by Delhi Economic Survey about 150 to 250 deaths happen in the city of Delhi every single day and out of these deaths, 25 to 45 deaths occurred due to Sudden Cardiac Arrest (SCA).

Every now and then, cases are being reported of a young person, previously hale and hearty, dying suddenly, due to ‘Sudden Cardiac Death” (SCD). One such case was experienced by Dr Nishith Chandra, DM Cardiology and Director of Fortis Escorts Hospital, Delhi. He saw a young man of his society die due to Sudden Cardiac Arrest.

According to World Health Organization, nearly 5.8 lakh people are dying due to heart attack in the world in a year. Nearly 1.15 lakh people die due to cardiac arrest every day in the world.

The most common cause of this is Ventricular Fibrillation. This is a medical term denoting, chaotic, very fast and ineffective cardiac activity, leading to cessation of blood flow to the vital organs, including brain, and if not restored in next 5 – 8 minutes, leads to irreversible brain damage and ultimately death.

“So, what could be done in 5 minutes, in a residential tower on 7th floor with nearest heart hospital at least 2kms away. If we wait for an ambulance or a doctor to arrive it takes at least 30 minutes, even if you are very near to a hospital. With each passing minute after a cardiac arrest, the chance of survival goes down by 10%. That means after 10 minutes of cardiac arrest, there are negligible chances of survival,” said Dr Chandra.

Dr Chandra then pointed out the significant role of technology that came up as a possible solution to avoid such situations. A device known as AED (Automated External Defibrillator) can be used by a layperson/bystander, to jumpstart the heart from the cardiac arrest.

He further answered certain queries that may arise upon the use of AED:

1.So, what actually is an AED:

AED are small portable battery powered devices, which are designed to detect a ventricular fibrillation (Cardiac Arrest), and are able to deliver a shock, to correct it. AED uses sophisticated software to analyze the victim’s heart rhythm and determine if a shock is required to restart the heart. The electrodes which attach to the victim’s chest relay information to a computer inside the AED that analyzes whether a shock is necessary. A shock is only delivered by the AED if deemed to be needed (a sudden cardiac arrest event is detected) and the “shock” button is pressed by the rescuer.  The electrodes will deliver a shock to the body which stun the heart allowing it to reset to a normal heart rhythm. It’s important to back away from the victim if the AED indicates it’s about to deliver a shock. Receiving this shock to restart the heart is essential to survival as there is only a 3–5-minute window before most individuals begin to experience brain damage.

2.Do I need training to use an AED?

AED is designed to be used by a lay person. A very short training of only 10-15 minutes, only which is required to use an AED. Even a 5th class student can learn to use AED, and it is safe. Most AEDs give a voice-based step by step instructions on

3.I know CPR – that’s enough.

CPR is very important, but CPR alone is not enough. The odds of survival reduce by as much as 10% every minute the heart is not beating after a sudden cardiac arrest or cardiac event. The use of an AED along with CPR actually increases a person’s chances of survival by 75%. After 10 minutes without defibrillation, very few people survive. EVERY MINUTE COUNTS!

4: How safe is to use AED. Could I get a shock?

AEDs are designed to be very safe. There are zero chances of getting a shock while using it. An AED cannot shock a person whose heart is in normal rhythm. Most AEDs will clearly tell you something along the lines of: “Stay clear of the patient” and will warn you not to touch the patient before pressing the shock button and administering the shock.

Should you happen to have a hand on the patient while a shock is administered, you may feel a slight tingle. Proper placement of AED pads are unlikely to cause any harm. All you have to do is follow the prompts and you will be safe. If a person does not have a “shockable” rhythm, the AED will not allow the delivery of a shock.

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Cardiology News

A simple surgery saves patients with heart arrhythmia from often-lethal strokes, says a study led by McMaster University

by Vaishali Sharma
written by Vaishali Sharma

Researchers found that removing the left atrial appendage — an unused, finger-like tissue that can trap blood in the heart chamber and increase the risk of clots — cuts the risk of strokes by more than one-third in patients with atrial fibrillation.

Even better, the reduced clotting risk comes on top of any other benefits conferred by blood-thinner medications patients with this condition are usually prescribed.

“If you have atrial fibrillation and are undergoing heart surgery, the surgeon should be removing your left atrial appendage, because it is a set-up for forming clots. Our trial has shown this to be both safe and effective for stroke prevention,” said Richard Whitlock, first author of the study.

“This is going to have a positive impact on tens of thousands of patients globally.”

Whitlock is a scientist at the Population Health Research Institute (PHRI), a joint institute of McMaster University and Hamilton Health Sciences (HHS); a professor of surgery at McMaster, the Canada Research Chair in cardiovascular surgical trials, a cardiac surgeon for HHS, and is supported by a Heart and Stroke Foundation career award.

The co-principal investigator of the study is Stuart Connolly who has also advanced this field by establishing the efficacy and safety of newer blood thinners. He is a professor emeritus of medicine at McMaster, a PHRI senior scientist and a HHS cardiologist.

“The results of this study will change practice right away because this procedure is simple, quick and safe for the 15 per cent of heart surgery patients who have atrial fibrillation. This will prevent a great burden of suffering due to stroke,” Connolly said.

The study results were fast tracked into publication by The New England Journal of Medicine and presented at the American College of Cardiology conference today.

The study tracked 4,811 people in 27 countries who are living with atrial fibrillation and taking blood thinners. Consenting patients undertaking cardiopulmonary bypass surgery were randomly selected for the additional left atrial appendage occlusion surgery; their outcomes compared with those who only took medicine. They were all followed for a median of four years.

Whitlock said it was suspected since the 1940s that blood clots can form in the left atrial appendage in patients with atrial fibrillation, and it made sense to cut this useless structure off if the heart was exposed for other surgery. This is now proven to be true.

Atrial fibrillation is common in elderly people and is responsible for about 25 per cent of ischemic strokes which are caused when blood clots block arteries supplying parts of the brain. The average age of patients in the study was 71.

“In the past all we had was medicine. Now we can treat atrial fibrillation with both medicines and surgery to ensure a much better outcome,” said Whitlock.

He said that the current study tested the procedure during cardiac surgery being undertaken for other reasons, but the procedure can also be done through less invasive methods for patients not having heart surgery. He added that future studies to examine that approach will be important.

Whitlock said the left atrial appendage is a leftover from how a person’s heart forms as an embryo and it has little function later in life.

“This is an inexpensive procedure that is safe, without any long-term adverse effects, and the impact is long-term.”

External funding for the study came from the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada.

Source: McMaster University

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broken heart stressed brain
Cardiology NewsNeurology News

Researchers reveal stressed brain is associated to broken heart

by Vaishali Sharma
written by Vaishali Sharma

Heightened activities in the brain, caused by stressful events, is linked to the risk of developing a rare and sometimes fatal heart condition called Takotsubo syndrome (TTS), also known as ‘broken heart’ syndrome , according to new research drove by European Society of Cardiology.

TTS, also known as “broken heart” syndrome, is characterised by a sudden temporary weakening of the heart muscles that causes the left ventricle of the heart to balloon out at the bottom while the neck remains narrow, creating a shape resembling a Japanese octopus trap, from which it gets its name.

Evidence has suggested that it is typically triggered by episodes of severe emotional distress, such as grief, anger or fear, or reactions to happy or joyful events. Patients develop chest pains and breathlessness, and it can lead to heart attacks and death. TTS is more common in women with only 10% of cases occurring in men.

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