Q&A - Chat with Dr. Devi Shetty, Narayana Hrudayalaya (Heart Specialist) Bangalore

The information contained in this post was received through email circulation.

Disclaimer - Contents have not been verified nor cross-checked. I do not know nor have any affiliations with the above-named Doctor. If in any doubt, please check with your own doctor.

Nonetheless, hopefully it serves as a useful reading information for those interested.

Qn: What are the thumb rules for a layman to take care of his heart?
Ans:
1. Diet - Less of carbohydrate, more of protein, less oil.
2. Exercise - Half an hour's walk, at least five days a week; avoid lifts and avoid sitting for a longtime.
3. Quit smoking.
4.. Control weight.
5. Control blood pressure and sugar.

Qn: Is eating non-veg food (fish) good for the heart?
Ans: No

Qn: It's still a grave shock to hear that some apparently healthy person gets a cardiac arrest. How do we understand it in perspective?
Ans: This is called silent attack; that is why we recommend everyone past the age of 30 to undergo routine health checkups.

Qn: Are heart diseases hereditary?
Ans: Yes

Qn: What are the ways in which the heart is stressed? What practices do you suggest to de-stress?
Ans: Change your attitude towards life. Do not look for perfection in everything in life.

Qn: Is walking better than jogging or is more intensive exercise required to keep a healthy heart?
Ans: Walking is better than jogging since jogging leads to early fatigue and injury to joints.

Qn: You have done so much for the poor and needy. What has inspired you to do so?
Ans: Mother Theresa, who was my patient.

Qn: Can people with low blood pressure suffer heart diseases?
Ans: Extremely rare

Qn: Does cholesterol accumulates right from an early age (I'm currently only 22) or do you have to worry about it only after you are above 30 years of age?
Ans: Cholesterol accumulates from childhood.

Qn: How do irregular eating habits affect the heart?
Ans: You tend to eat junk food when the habits are irregular and your body's enzyme release for digestion gets confused.

Qn: How can I control cholesterol content without using medicines?
Ans: Control diet, walk and eat walnut.

Qn: Can yoga prevent heart ailments?
Ans: Yoga helps.

Qn: Which is the best and worst food for the heart?
Ans: Fruits and vegetables are the best and the worst is oil.

Qn: Which oil is better - groundnut, sunflower, olive?
Ans: All oils are bad.

Qn: What is the routine checkup one should go through? Is there any specific test?
Ans: Routine blood test to ensure sugar, cholesterol is ok. Check BP, Treadmill test after an echo.

Qn: What are the first aid steps to be taken on a heart attack?
Ans: Help the person into a sleeping position , place an aspirin tablet under the tongue with a sorbitrate tablet if available, and rush him to a coronary care unit since the maximum casualty takes place within the first hour.

Qn: How do you differentiate between pain caused by a heart attack and that caused due to gastric trouble?
Ans: Extremely difficult without ECG.

Qn: What is the main cause of a steep increase in heart problems amongst youngsters? I see people of about 30-40 yrs of age having heart attacks and serious heart problems.
Ans: Increased awareness has increased incidents. Also, sedentary lifestyles, smoking, junk food, lack of exercise in a country where people are genetically three times more vulnerable for heart attacks than Europeans and Americans.

Qn: Is it possible for a person to have BP outside the normal range of 120/80 and yet be perfectly healthy?
Ans: Yes.

Qn: Marriages within close relatives can lead to heart problems for the child. Is it true?
Ans: Yes, co-sanguinity leads to congenital abnormalities and you may not have a software engineer as a child

Qn: Many of us have an irregular daily routine and many a times we have to stay late nights in office. Does this affect our heart ? What precautions would you recommend?
Ans: When you are young, nature protects you against all these irregularities. However, as you grow older, respect the biological clock.

Qn: Will taking anti-hypertensive drugs cause some other complications (short/long term)? Ans : Yes, most drugs have some side effects. However, modern anti-hypertensive drugs are extremely safe.

Qn: Will consuming more coffee/tea lead to heart attacks?
Ans: No.

Qn: Are asthma patients more prone to heart disease?
Ans: No.

Qn: How would you define junk food?
Ans: Fried food like Kentucky, McDonalds, samosas, and even masala dosas.

Qn: You mentioned that Indians are three times more vulnerable. What is the reason for this, as Europeans and Americans also eat a lot of junk food?
Ans: Every race is vulnerable to some disease and unfortunately, Indians are vulnerable for the most expensive disease.

Qn: Does consuming bananas help reduce hypertension?
Ans: No.

Qn: Can a person help himself during a heart attack (Because we see a lot of forwarded emails on this)?
Ans: Yes. Lie down comfortably and put an aspirin tablet of any description under the tongue and ask someone to take you to the nearest coronary care unit without any delay and do not wait for the ambulance since most of the time, the ambulance does not turn up.

Qn: Do, in any way, low white blood cells and low hemoglobin count lead to heart problems?
Ans: No. But it is ideal to have normal hemoglobin level to increase your exercise capacity.

Qn: Sometimes, due to the hectic schedule we are not able to exercise. So, does walking while doing daily chores at home or climbing the stairs in the house, work as a substitute for exercise?
Ans: Certainly. Avoid sitting continuously for more than half an hour and even the act of getting out of the chair and going to another chair and sitting helps a lot.

Qn: Is there a relation between heart problems and blood sugar?
Ans: Yes. A strong relationship since diabetics are more vulnerable to heart attacks than non-diabetics.

Qn: What are the things one needs to take care of after a heart operation?
Ans: Diet, exercise, drugs on time, Control cholesterol, BP, weight.

Qn: Are people working on night shifts more vulnerable to heart disease when compared to day shift workers?
Ans: No.

Qn: What are the modern anti-hypertensive drugs?
Ans: There are hundreds of drugs and your doctor will chose the right combination for your problem, but my suggestion is to avoid the drugs and go for natural ways of controlling blood pressure by walk, diet to reduce weight and changing attitudes towards lifestyles.

Qn: Does dispirin/aspirin or similar headache pills increase the risk of heart attacks?
Ans: No.

Qn: Why is the rate of heart attacks more in men than in women?
Ans: Nature protects women till the age of 45.

Qn: How can one keep the heart in a good condition?
Ans: Eat a healthy diet, avoid junk food, exercise everyday, do not smoke and, go for health checkups if you are past the age of 30 (once in six months recommended).

Still a long road ahead...

Diagnosis is a start. Or in my dad's case, lucky that he decided to tell someone about his discomfort that lead him to the hospital.

The major surgery is a mere trifle compared to the long lead time for recovery. Driving is not allowed for the next two months. Healing of the chest bone will take approximately 6-9 months. In the meantime he will have to do some light exercise including one to strengthen his lungs.

Sucking in the air through the tube is much harder than blowing.

We were all relieved that he was allowed to be discharged yesterday afternoon. Definitely more comfortable resting at home, this proved by him snoring through yesterday's late evening rain and thunder storm!

More importantly I hope my mum who has been with him at the hospital for the past 12 days gets a good night sleep and rest. Nothing beats the comfort and familiarity of home ya?

As soon as I get my act together, I will post some Chinese herbal soup recipes that will aid in his recovery and total well-being.

Once again, thanks to all for your concern and well wishes.

Wound healing fish

We are on a hunt for this fish. Unfortunately, it is not a common fish sold in wet markets around our area. We are expanding our suburban search.

Have been told by many that ‘sang yue’ or ikan haruan aka snakehead, a fresh water fish is well known for wound healing, particularly for those recuperating from surgeries.

Haruan contains substantial amount of Vitamin A. The presence of heavy metals -calcium, magnesium, copper, iron, manganese, nickel, lead and zinc are very much lower than the toxic level permissible for the human body.

Haruan contains unusually high arachidonic acid content which is a precursor for prostaglandin as it initiates blood clotting and is responsible for growth.

Haruan also contains essential amino acids required for wound healing, particularly glycine which is one of the most important component of collagen in human skin. Glycine combines with aspartic and glutamic acid to form protein molecule that is crucial for growth and healing.

(source found here)

Live fresh fish is a must. The fish meat is boiled with Chinese herbs and drank as a soup.

WARNING (aesthetic reasons):
1. Must not be consumed too late post surgery.
2. Must not be consumed more than 3 times, 2 consecutive times is recommended, i.e. once in the morning and another time at night.

Reason for the above warning is that consuming too much of this soup will not allow your wound to heal nicely - keloids and hypertrophic scars may form instead.

No one likes a nasty scar especially us ladies. For men, I am sure the show-n-tell story could liven some quiet evening dinners! ;)

A pictorial tale

.....not too gory I hope.

The results after the angiogram. Also the reasons why balloon angioplasty on LHS was not advisable - it was on a major aorta and too near the 'mouth'.

Smooth and silky??
In preparation of the surgery, both legs and chest were shaved.

Does this sign make any sense?
If you were on a diet, would it motivate you?
My dad had to fast at least 6 hours before the operation.

In ICU after surgery. The surgery took 5 hours in total.

He was sleeping very peacefully when we saw him.

Lots of tubes attached to his body and arms.
Everytime I look at this, my mouth goes dry and my heart aches so deeply. It is terrible to stand around helplessly and watch your loved one going through such pain, discomfort and suffering.

The chest 'cut'! Not as long as I imagined it to be.
The sides of his chest is a little tender also as they had to use a clam to prey open the rib cage.
Lots of flam to cough out which is loosen with some medication and back pats using cup hands.

The 'cut' on the right leg where the vein was harvested for the bypass graft
Not a pretty sight especially since it is such a LONG cut. I hope it heals cleanly, well and fast.
Need to keep it slightly elevated to keep the pressure off and avoid bloating.

Some thoughts.....

The human body is a marvelous creation, perfect in every way. As with all original parts, they are the best so do try not take them for granted!!!
Even though the bypass technically gave my dad a second chance in life, we have been told that they are not as hardy and good as compared with the original ones. With careful care, medication and healthy maintenance, we hope and pray that it surpasses any expiry date.

High risk factors

With any major surgery, there is always a risk complications may occur.

It is sad to say that a family that we got to know a little better experienced bitter sweet news that their father who had been admitted for bypass more than a week ago passed away this morning.

I say ‘bitter sweet’ as he is no longer suffering, bitter that the family continues to mourn the loss of their loved one. I am totally at loss at what to say except I understand their circumstances, the close brush with death and am thankful and feel blessed.

The wife and kids have been friendly to us providing us with useful information about open heart surgery, the hospital, the doctor, surgeon, etc. As we pass each other along the corridor we would normally give each other an encouraging nod/smile, brought together by similar circumstances.

Some of the high risk factors that could complicate recovery are:
- cigarette smoking
- diabetes
- high blood pressure

I am thankful that even though my father is 70 years old, he has maintained a regular exercise regime, playing badminton twice a week. He was playing 3 times last year and only slowed down this year. His only angst is high cholesterol. In my earlier post, I revealed that my dad’s right coronary artery was completely blocked while his left side is 70% clogged. We are still amazed that somehow, he managed to continue with his weekly badminton sessions earlier that week.

God works in mysterious ways.

Life tip – exercise is important part of a healthy life.

Also, if you suffer from any chest pains no matter how minor, best to consult a doctor or inform someone, sooner rather than later. Do not let pride or stubbornness get the better of you. It could result in a life being saved.

CABG, pronounced as 'cabbage'

Information source from Wikipedia

Coronary artery bypass grafting

A type of surgery called revascularisation, used to improve blood flow to the heart in people with severe coronary artery disease (CAD).

CAD occurs when the arteries that supply blood to the heart muscle (the coronary arteries) become blocked due to the buildup of a material called plaque on the inside of the blood vessels.

CABG is one treatment for CAD. During CABG, a healthy artery (from arm or other places of the body) or vein (from leg known as saphenous vein – a long vein running along the inner side of the leg) is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, it goes around) the blocked portion of the coronary artery. This new passage routes oxygen-rich blood around the blockage to the heart muscle. Artery grafts are much less likely than vein grafts to become blocked over time.

Number of bypasses - less or more?
The terms single bypass, double bypass, triple bypass, quadruple bypass and quintuple bypass refer to the number of coronary arteries bypassed in the procedure.

A greater number of bypasses does not imply a person is "sicker," nor does a lesser number imply a person is "healthier." A person with a large amount of CAD may receive fewer bypass grafts owing to the lack of suitable "target" vessels. A coronary artery may be unsuitable for bypass grafting if it is small (less than 1 mm or less than 1.5 mm depending on surgeon preference), heavily calcified (meaning the artery does not have a section free of CAD) or intramyocardial (the coronary artery is located within the heart muscle rather than on the surface of the heart). The surgeon will estimate the number of bypass grafts prior to surgery, but the final decision is made in the operating room upon examination of the heart.

Procedure (Simplified)
This type of surgery usually lasts 3 to 5 hours, depending on the number of arteries being bypassed.

1. Area that will be operated will be shaved. Patient will be asked to fast at least 6 hours prior to operation. Sedative given the night before to 'calm' the patient.
   
2. Patient changes to operating night gown, brought to the operating room and moved on to the operating table.
   
3. An anaesthetist places a variety of intravenous lines and injects an induction agent (usually propofol) to render the patient unconscious. During the surgery, the anesthesiologist monitors your heartbeat, blood pressure, oxygen levels, and breathing.
   
4. An endotracheal (breathing) tube is inserted through your throat and secured by the anaesthetist and mechanical ventilation is started.
   
5. An incision is made down the center of your chest (about 8 inches). The chest bone is then cut and your ribcage is opened so that the surgeon can get to your heart.
   
6. The bypass grafts are harvested - frequent conduits are the internal thoracic arteries, radial arteries and saphenous veins.
   
7. In the case of "off-pump" surgery, the surgeon places devices to stabilize the heart.
   If the case is "on-pump", the surgeon sutures cannulae into the heart and instructs the perfusionist to start cardiopulmonary bypass (CPB). Once CPB is established, the surgeon places the aortic cross-clamp across the aorta and instructs the perfusionist to deliver cardioplegia to stop the heart.
   
8. One end of each graft is sewn on to the coronary arteries beyond the blockages and the other end is attached to the aorta.
   
9. The heart is restarted; or in "off-pump" surgery, the stabilizing devices are removed. In some cases, the Aorta is partially occluded by a C-shaped clamp, the heart is restarted and suturing of the grafts to the aorta is done in this partially occluded section of the aorta while the heart is beating.
   
10. Protamine is given to reverse the effects of heparin.
    
11. The sternum is wired together. Stitches or staples to close the skin incision.
    
12. The patient is moved to the cardiac intensive care unit (ICU) to recover and monitored 24 hours. The breathing tube is removed when you’re able to breathe without it. Patient is able to eat some light food. A small pillow is recommended to be placed on the chest to counter any coughs or sneezes.
    
13. After stabilizing in the ICU (approximately 3 days), the person is transferred to the cardiac surgery ward until ready to go home (approximately 4 days thereafter).

The progress.....

My dad is stable, heavily sedated with morphin. Lots of tubes everywhere at the moment. He had a quadruple bypass - we were surprised with the additional graft as we had been told earlier it will be triple bypass.

Will update more later - thanks to all for your prayers and well wishes.

Some new words

Just a short post.

Over the last few days I have learnt some new words:

Angiogram
Aorta
Balloon angioplasty
Stent
Echo cardiogram
Coronary artery bypass

As the story normally begins....it all happened so unexpectedly and without warning. In fact, my dad was trying to enjoy a hot cuppa before I got a little anxious and impatient (after learning that my dad was experiencing some chest pains/discomfort and fainted a few hours earlier) and finally we drove him to the hospital.

My dad is having his surgery tomorrow and with lots of prayers, we hope it will be a straight forward textbook procedure.

Will blog more later.

In the meantime, will share this interesting bit of information - The left side of your heart arteries can pump sufficient blood to sustain your whole body even though your right side artery is completely blocked!