The incidence of Covid-recovered patients suffering from Cardiac illnesses such as sudden palpitation, chest discomfort, and even heart attack has increased substantially, particularly among young people. On the occasion of World Heart Day, Medically Speaking discussed the causes of such severe heart problems, early symptoms and possible treatments with a panel of esteemed experts that included: Padma Shri Dr Mohsin Wali, Senior Consultant, Internal Medicine from Sir Gangaram Hospital; Dr Mukesh Goel, Senior Consultant, Cardiothoracic Surgery from Apollo Hospitals; Padma Shri Dr Balbir Singh, Chairman of Cardiology from MAX Hospitals and Professor Rakesh Yadav, Professor of Cardiology from AIIMS.
Here are a few excerpts from the exclusive interview:
What is the significance of talking about heart diseases in the backdrop of the Covid-19 pandemic?
Dr Mohsin Wali: COVID has proven to be a poison for the heart, particularly the smaller blood vessels which reach every organ of our body. Involvement of the cardiovascular system in covid causing complications, acute as well as delayed, has been very well understood by now. Initially we were not aware about it.
We have learnt that Covid causes severe complications and in that conditions, whole system gets affected and these are the basic effects of the covid, almost all organs are involved and heart is one of the most important organ. And on the world heart day, my first message would be that in the covid background everyday should be will be world heart day because we are taking care of hearts especially of the youngsters.
Why do we have so many young Indians of their hearts such risk at the time of the covid-19, pandemic?
Dr Balbir Singh: Two things that happen with covid in young people: one was the involvement of the heart muscle which led to a condition called Myocarditis which has been associated with heart, failure and sudden deaths. Second was formation of clots within the arteries, which lead to heart attacks and unstable angina or acute coronary syndromes, which led to deaths. We cannot take Covid lightly. Even after six months of infection, I would say that keep yourself healthy, eat well, walk and keep yourself free. Don’t exercise too much, I would advise against heavy exercise after Covid illness. This is how you can take care of yourself after Covid illness.
Many believed Covid-19 affected the oxygen levels and lungs. How is it affecting the hearts?
Dr Mukesh Goel: We have a term nowadays, which we call long Covid which has many specific symptoms, feeling tired all the time, lack of energy, loss of appetite and even some depression also. When somebody is having a real cardiac issues, those symptoms can get mixed up with those long covid or post covid syndrome and it can be neglected. So I will just say that maybe we should not ignore these symptoms thinking that this must be a long covid or post covid syndrome should take it seriously.
What is the correlation between anxiety, panic and hypertension experienced otherwise and post Covid-19 and what can a patient or his family members do?
Prof Rakesh Yadav: If you see the statistic of post covid, about 50 to 70% are going to have some neurological problems like depression, anxiety, sleeplessness, tiredness, even a memory loss is there, they are unable to concentrate. Now second important thing is we are seeing autonomous dysfunction in plenty of patient which means their blood pressure will fluctuate, either it will come down or it will shoot and they have inappropriate increase in heart rate. So you will encounter lot of patients who says that, “Doctor if I walk little, my heart rate goes to 130 140,” which is a syndrome called POTS. We have seen patients who are on 2 or 3 hypertensives post Covid which needs to be stopped after the blood pressure drops below 100. Therefore, do not be happy if we stop hypertensive, it may be an indicator of an autonomous dysfunction. There is no direct correlation of anxiety with hypertension, however, hypertension is directly related to heart diseases. There is a lot of debate over cardiac screening post Covid after 3 to 6 months but we are seeing a lot of patients.
Heart diseases are killing over 17 million people worldwide, especially at rise among youngsters. What are the probable causes for this?
Dr Mohsin Wali: We were taught as students about young Coronary Artery Disease. But now, the diet patterns have changed and youngsters are more into junk foods, disturbed sleep patterns, excessive work load, stress and smoking are on the rise. Therefore, we are seeing changed patterns of Coronary Artery Disease in India. Furthermore, cases are more complicated now. We have to regulate our diet, sleep and stress and control hypertension and sugar and overall have a healthy lifestyle.
As head of Cardiology department, do you see cases of resuscitation worsen due to lack of knowledge?
Dr. Balbir Singh: CPR and the use of an automated external defibrillator must become a practise that everyone must learn. I believe that the training class should begin in schools, and that police officers should be engaged. Every human being should be aware that if someone collapses on the road, you must provide artificial respiration and pump his heart. I know there are AEDs (automated external defibrillators) in several malls and airports, but let me tell you that none of the security personnel in the malls or airports understands how to use them. It is a waste of money to install an AED without adequate training on how to utilize it. Having an AED everywhere is good but people at local levels should know how to use it and save lives around them because there is know way you can save a person suffering a sudden cardiac arrest without the basic knowledge. Therefore people must come forward to learn it.
What sort of lifestyle changes can a person need to ensure better health overall and ensue better cardiac health most importantly?
Dr. Mukesh Goel: as far as rise in incidents of heart disease in women is concerned, we were not much aware about it earlier. In fact even medical community has become more aware about looking and treating heart disease in women only in last decade or so. It was a common perception that women do not get heart disease much often.
But now we know why one in 25 women die of breast cancer and one in two will die of heart disease. As far as lifestyle changes is concerned, there is really no gender difference. If you are a man or a woman, the guidelines are same: Regular physical activities, keep a check on your diet, smoking should be avoided by both men and women, and check your blood pressure regularly.
Many believe that ayurvedic herbs have anti-inflammatory properties and can help those living with cardio issue. Would you agree with that statement?
Prof Rakesh Yadav: Any herb proven by science is accepted, but until that, I will not comment on it. Secondly, believe it or not, all our scientific medicines come from ancient herbs, may it be for diabetes or hypertension. So I’ll never blame Ayurveda for nothing. I know what will happen if I take an excessive dose of, let’s say an allopathic medicine for diabetes. I will suffer from hypoglycemia. Same goes with Ayurvedic medicines where people suffer from organ dysfunction due to excessive intake of Kadhas.
How do regular heart checkups reduce the risk of cardiovascular diseases?
Dr Mohsin Wali: Any checkup on a regular basis is beneficial. Routine checkup should be a part of everyone above the age of 25 which includes ECG, Electro-Cardiography, Sugar Screening, Blood Pressure Screening, Kidney Function, etc. After the age of 35, regular cardio checkup should be made mandatory. If one is a smoker, overweight or diabetic, these checkups must be taken frequently, at least once a year. Sometimes, diabetic patients do not have warning symptoms like chest pain so they are not aware about it. Dr Balbir Singh treats a lot of patients with Arrhythmias, which is also a cause of sudden death and is common among youngsters. Most importantly, if you have an abnormal symptom, like excessive sweating or even exhaustion, one should go for a cardiac checkup.
Many of the symptoms of cardiac issues are quite generic. What are the basic ones to watch out for?
Dr Balbir Singh: Foremost reason for such conditions is denial. For example if a person is facing difficulty with climbing stairs, they excuse it as weakness and think they cannot have a cardiac problem. This is a psychological problem that happens with everyone. These symptoms are so generic that these could be nothing or can be a serious heart ailment. The only way to distinguish is to get yourself tested without which you won’t be able to know. An ECG and a blood test will be sufficient to test it.
What are the alarming and more specific signs for these?
Dr Balbir Singh: There are two or three risk factors one should take care of. If one is a smoker, obese of diabetic, or has a family history of heart disease, one is under risk and should not take gas or acidity lightly, and ask for medical help. If 9 out of 10 get no signs of heart risks after tests, it is better than not getting tested at all.
Now let’s come to treatment which takes us to the real developments, which are happening when it comes to saving people’s lives. Of course, there was a time when major surgeries required stands, and of course, they were extremely expensive, but now things have changed completely. What’s the most recent news on the subject?
Dr Mohsin Wali: Things have improved. We used to treat cardiac attacks with morphine injection and giving oxygen. We can now map the diseased portion of the heart by doing echocardiograms, even by ECG’s. We were taught to map the area of the heart disease affected and then visualise it physically, by doing angiography. Beyond that, we have progressed to cardiac MRIs.
So these are the recent things we can implant: cardio, vascular, defibrillator, Walter devices, and very compact things like pacemakers. Initially we used to have only pacemakers, now we have defibrillators with portable, small and implantable cardioverters. So these are all the recent changes in the cardiac transplants that are extreme.
So maybe certain things we can do beyond that. Even if we can cut like a carpenter, that is a Rotablation. In one word, coronary revascularization. Heart muscle has tremendous capacity to recover, and that is why the doctors who treat the heart become very famous because they have to apply their minds to revive the muscle. Heart is an organ of the body that doesn’t go on leave. It beats from the last four months of intrauterine life until the last breath. It functions even when you are sleeping, driving, or having any activity. God made this muscle so strong and we poison it with sugar, smoking, alcohol and so many other stressful things. But we have to really save the heart and that us what the World Heart Day is for.
Take us to the latest investments in the Technological Sector that have been made in India and ehat more cam be invested in? How can our infrastructure be better prepared for a greater influx of patients?
Dr Balbir Singh: Covid has taught us many lessons about patients, their families, and doctors. So the doctors have taught us how to work hard and try to save more lives. It also taught us that if we work hard with the patients, we can get results. It has taught us in cardiology that innovations are helping patients. The one good thing that happened with COVID-19 was the media coverage. It brought the hospital into the view of people, who now realise how important hospital and medical health is. I used to give an example that a person will go to a restaurant and spend 5000 rupees, but he will not spend that 5,000 on getting his health check-up, which is a major disaster. So what has happened is that we have seen a 200% increase in health insurance following the Covid. That means people are now serious. The second thing that has happened is that these devices that have been just talked about are expensive. They are not cheap. Fortunately, we have not invested. India has not invested into making this technology. It is a difficult technology. We will have to ultimately get into this piece and build on who we are. These are important things, and we spend a lot of money on getting these devices, which means that we have to get to that level where we get our devices, which would be cheaper and more affordable for the world population.
What are the basic devices one can keep at home for regular home checkup as coming to hospital might be a risk for people? What would you say about their feasibility?
Dr Mukesh Goel: So basic devices that everyone should have at home is a blood pressure monitor, a blood sugar monitor, and earlier it was basically, I would not have recommended it, but now it has a pulse oximeter. So these three devices must be at everyone’s home. And if one is not hypertensive, and sugar is normal, I still recommend a weekly check of blood pressure, as well as a monthly check of blood sugar apart from the formal annual health check-up in a medical setting. That should be the minimum.
What would be your word of advise?
Prof Rakesh Yadav: If you want to make your heart healthy, make it happy too, because it is a happy and healthy heart that makes a good person. The second important thing is how to monitor your heart’s health. If you are asymptomatic, at least in your childhood, you should have one blood pressure check. After 20 years, you should have your blood pressure, sugar, and lipid profile checked. Then after 40 years, you get these three blood pressures, sugars, and lipid profile. If it is normal, repeat it after 5 years, and after 50, repeat it every two years. And after 60, repeat it every year. And after 70, every six months, if it is normal, it is good. But if it is abnormal, kindly seek advice from your doctor. Don’t ignore all of that. Don’t ignore your blood sugar. If you are hypertensive, by your blood pressure estimate, take your blood pressure at home. As doctor Goel suggests, if you are a diabetic, you must monitor your blood sugar levels on a regular basis. That is the most important thing to mention.
