Consult with Dr. Vanita Arora - Your Trusted Cardiologist in India

1. What causes cardiovascular disease?

There are many risk factors that contribute to the development of cardiovascular disease. Some people are born with conditions that predispose them to heart disease and stroke, but most people who develop cardiovascular disease do so because of a combination of factors such as poor diet, lack of physical activity and smoking, to name just three. The more risk factors you expose yourself to, the higher the chance of developing cardiovascular disease. Many of the risk factors for cardiovascular disease cause problems because they lead to atherosclerosis. Atherosclerosis is the narrowing and thickening of arteries. Atherosclerosis develops for years without causing symptoms. It can happen in any part of the body. Around the heart, it is known as coronary artery disease, in the legs it is known as peripheral arterial disease. The narrowing and thickening of the arteries is due to the deposition of fatty material, cholesterol and other substances in the walls of blood vessels. The deposits are known as plaques. The rupture of a plaque can lead to stroke or a heart attack.

2.What is the connection between high blood pressure (hypertension) and heart disease?

Blood moving through your arteries pushes against the arterial walls; this force is measured as blood pressure. High blood pressure (hypertension) occurs when very small arteries (arterioles) tighten. Your heart has to work harder to pump blood through the smaller space and the pressure inside the vessels grows. The constant excess pressure on the artery walls weakens them making them more susceptible to atherosclerosis.

3.How is coronary heart disease diagnosed?

There are a number of ways to diagnose coronary heart disease. Your physician will probably use a number to make a definitive diagnosis. A coronary angiogram uses a dye inserted into your arteries and an x-ray to see how the blood flows through your heart. The picture taken, the angiogram, will show any atherosclerosis. Another test is an electrocardiogram. This test records the electrical activity of your heart. An electrocardiogram measures the rate and regularity of heartbeats, the size and position of the heart chambers, the presence of any damage to the heart, and the effects of drugs or devices used to regulate the heart. It is a non-invasive procedure.

4.How are smoking and heart disease linked?

Smoking damages the lining of blood vessels, increases fatty deposits in the arteries, increases blood clotting, adversely affects blood lipid levels, and promotes coronary artery spasm. Nicotine accelerates the heart rate and raises blood pressure.

5.Does diet play a part in the development of heart disease?

Diet plays a significant role in protecting or predisposing people to heart disease. Diets high in animal fat, low in fresh vegetables and fruit, and high in alcohol have been shown to increase the risk of heart disease. Adopting a diet low in fat and salt has a protective effect over the long term. This means whole grains, fruits, and vegetables.

6.How do the symptoms of heart attack differ between men and women?

The symptoms of heart attack in a man are intense chest pain, pain in the left arm or jaw and difficulty breathing. A woman may have some of the same symptoms, but her pain may be more diffuse, spreading to the shoulders, neck, arms, abdomen and even her back. A woman may experience pain more like indigestion. The pain may not be consistent. There may not be pain but unexplained anxiety, nausea, dizziness, palpitations and cold sweat. A woman’s heart attack may have been preceded by unexplained fatigue. Women also tend to have more severe first heart attacks that more frequently lead to death, compared to men.

7.Is heart disease hereditary?

Heart disease can run in some families. But even if you inherit the risks factors that predispose you to heart disease, such as high blood cholesterol, high blood pressure, diabetes, or being overweight, there are measures you can take that will help you avoid developing cardiovascular disease.

8.Are diabetics at high risk of developing heart disease?

Diabetes is treatable, but even when glucose levels are under control it greatly increases the risk of heart disease and stroke. That's because people with diabetes, particularly type 2 diabetes, often have the following conditions that contribute to their risk for developing cardiovascular disease:

High blood pressure (hypertension)
Abnormal cholesterol and high triglycerides
Obesity
Lack of physical activity
Poorly controlled blood sugars (too high) or out of normal range
Smoking

9.What treatment options are available to patients with narrow or blocked arteries?

Treatments for coronary heart disease include lifestyle changes, and, if necessary, drugs and certain medical procedures. Following a healthy diet can prevent or reduce high blood pressure and high blood cholesterol and help you maintain a healthy weight. Being physically active and managing your stress levels along with quitting smoking are some of the lifestyle changes that can be implemented. You may need medicines to treat CHD if lifestyle changes aren't enough. Medicines can reduce your heart’s workload and relieve CHD symptoms, decrease your chance of having a heart attack or dying suddenly, lower your cholesterol and blood pressure, prevent blood clots, prevent or delay the need for a procedure or surgery. You may need a procedure or surgery to treat CHD. Both angioplasty and CABG are used to treat blocked coronary arteries. You and your doctor can discuss which treatment is right for you.

10.What is an angioplasty and how are stents used?

Angioplasty is a nonsurgical procedure that opens blocked or narrowed coronary arteries. A thin, flexible tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery. Once in place, the balloon is inflated to compress the plaque against the wall of the artery. This restores blood flow through the artery. During the procedure, the doctor may put a small mesh tube called a stent in the artery The stent helps prevent blockages in the artery in the months or years after angioplasty. Stents can be classified into two categories: bare-metal stents and drug-eluting stents. Drug-eluting stents are new generation stents which are coated with medication that is slowly released (eluted) to help prevent the growth of scar tissue in the artery lining. This helps the artery remain smooth and open, ensuring good blood flow.

11.What are the various tests doctors use to diagnose a heart disease?

When making a diagnosis, your doctor will ask about your symptoms, medical history and risk factors. Based on this information, your doctor may give you tests to see how healthy your arteries are. The most common tests include:

ECG
ECHO
Stress Test
Angiogram
CT Scan
Magnetic Resonance Angiography (MRA)

12.Is Sudden Cardiac Arrest & Heart Attack the same?

Often mistaken for one sudden cardiac arrest (SCA) is not a heart attack but can occur in a person who has survived a heart attack. Heart Attack stems from a circulation or plumbing problem of the heart. It is caused by blockage in one or more of the arteries, preventing the heart from receiving enough oxygen-rich blood. If the oxygen in the blood cannot reach the heart muscle, it becomes damaged. The risk factors for a heart attack are high cholesterol, high blood pressure, obesity, smoking, diabetes, family history of heart attack. Heart attack is likely to be accompanied by pressure in the chest, sweating, pain radiating to the arms, shortness of breath, nausea. Sudden Cardiac Arrest (SCA) on the other hand is an electrical problem with the heart that triggers a dangerously fast heart rhythm. It is caused by the electrical malfunction of the heart that results in no blood flow to the body and brain. The risk factors for sudden cardiac arrest are a low ejection fraction, heart failure, previous heart attack or family history of SCA. Sudden cardiac arrest often occurs with no warning. Sometimes other signs and symptoms precede sudden cardiac arrest. These may include fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations or vomiting.

13.Can someone know before-hand if he/she is about to suffer a SCA?

One cannot know about an impeding SCA however thanks to advancement in medical technology, people at risk of SCA can be prepared and well protected against it. One of the top killers worldwide, sudden cardiac arrest, claims more lives than breast cancer, AIDS, or lung cancer. It’s a silent killer and occurs mostly without symptoms. If not treated within initial 10 -15 mins the chances of survival is close to zero. This is the reason that 95% of patients do not survive the first episode of sudden cardiac arrest.

14.What is Ejection Fraction or EF?

EF stands for Ejection Fraction. It is the percentage of blood that is pumped out of the heart with each heartbeat. Your doctor determines how well the heart is pumping based on your EF number. Since your EF number can change over time, it is recommended that you check your EF regularly. People with low Ejection Fraction, i.e. 35% or below, are at a higher risk of Sudden Cardiac Arrest. A healthy heart has an EF between 50% and 75%. This indicates that the heart is pumping well and is able to supply enough blood to the body and brain. The most common method of measuring EF is with an echocardiogram

15.What are the treatment options for SCA?

ICD is a small device that's placed in the chest below the collar bone. An ICD is designed to monitor your heart rhythm 24 hours a day. If your heart is beating too fast or irregularly, the device will first send small painless electrical signals to correct your heart rate. If the fast heart rate continues, the defibrillator will deliver a shock to restore your heart to a normal rate. The ICD is like an emergency room in the chest preventing sudden cardiac death due to fast rates

16.Any technological advancement in the field of cardiological devices which is beneficial to patients?

Recently cardiac devices industry has yielded an interesting innovation with regard to pacemakers and ICDs which has increased its use in clinical practice phenomenally. These devices are embedded with new technology that allows for full-body MRI scans among patients with these devices. It is estimated that as many as 63 % of patients will need an MRI within 10 years of receiving a device. Furthermore, 85 percent of all pacemaker patients have one or more comorbidities, making comprehensive multi-specialty care, including access to MRI, important in today’s environment. Until the availability of MR-Conditional pacemaker and ICD systems, patients with devices have been contraindicated from receiving MRI scans because of potential interactions between the MRI and device function, which in turn affects the diagnosis and treatment.

17.How many patients have benefitted from the MRI compatible ICD in India and globally?

ICD is commonly used device worldwide to prevent sudden cardiac arrest in high risk patients like survivor of sudden cardiac arrest and those who had treated for ventricular tachycardia with underlying severe heart disease. This device is also implanted as primary prevention of SCA, in patients who carry high risk for sudden cardiac arrest. Since last couple of years many ICD recommended patients are choosing MRI Compatible device globally as well as in India because of MRI scan might be required any time in their life. Every year approximately 400 devices are implanted in India to prevent sudden cardiac arrest

18.What is heart valve disease and it’s prevalence in India?

In India, large numbers of people suffer heart valve damage as a result of rheumatic heart disease. There are aprox 56L patient living with rheumatic heart disease. Heart valve disease occurs if one or more of your heart valves don't work well.*
Source (Circulation. 2009;119:e211-e219.), another india paper states at 43.5 %, JAPI paper attached.

19.What are the treatments available for heart valve disease?

There are three goals of treatment for heart valve disease: protecting your valve from further damage; lessening symptoms; and repairing or replacing valves.Your doctor may recommend repairing or replacing your heart valve(s), even if your heart valve disease isn't causing symptoms. Repairing or replacing a valve can prevent lasting damage to your heart and sudden death.Having heart valve repair or replacement depends on many factors, including:

The severity of your valve disease.
Your age and general health.
Valve repair preserves the strength and function of the heart muscle.