Best Cardiologist in India Archives

13/Jun/2022

The topic for discussion today is Queries Regarding Your Health During Winter. And we’re extremely honored to have with us Dr. Aparna Jaswal leading senior consultant interventional Best Cardiologist In Delhi At Fortis escorts hospital daily. Thank you so much, mam. Once again for accepting our invitation to address this cause. And now I would like to hand out the session to you to guide us.

Q: What can I do to lower my risk of heart disease?

Ans: I think I have been harping about this. But yes, if you wish to lower your heart disease, you must make sure that you quit smoking. If you smoke, take alcohol and fewer amounts. If you consume take a healthy balanced diet, make time, at least some time for yourself to go out and exercise. I to you the protocol you should try and cover in 40 minutes. You should try and cover three and a half to four kilometers. That’s called brisk walking for the young. And, of course, keep yourself. Well protected. Winters have a healthy balanced diet. You do all of this. You will keep yourself protected in winter.

Q: Eating Sunflower, Pumpkin, Sesame seeds Etc. Are good For The Health?

Ans: Yes, so putting it in perspective when I say flax seeds. I’m trying to include these seeds. The seeds are very good for your health in one way or the other. You should try to combine them but most importantly, exercise regularly having something which is proven they. Without a doubt, walnuts and almonds have flax seeds. You can certainly consume the seeds, the sunflower seeds. They will always be good for you and the pumpkin seeds. But most importantly do a mix of everything for good health. Thank you so much.

Best Cardiologist in Delhi: Queries Regarding Your Health During Winter

Q: How to increase immunity?

Ans: Yeah. So how do you increase your immunity is something that the human body is so interesting and it’s an enigma rather. So all of us are born with good immunity rather it was seen in the Last covid-19. Make sure that you get yourself tested and if you have co-morbidities bring them to Bay. If you have high blood pressure, if you have diabetes look after them, if you are a smoker, you must stop smoking. You must curtail it because it is going to dampen your immunity consumption of alcohol should be contained. You must have cooked Foods in your diet, a very good diet. Helps you increase your immunity from fresh fruits and vegetable eggs as I have been repeatedly saying, Fish chicken for vegetarian people.

Q: What should be the ice blood pressure?

Ans: The ideal blood pressure for adults should be less than 130 but 80 millimeters of mercury. This is a very good point and I wish to talk about here most of us live in denial. We don’t check blood pressure. If we check our blood pressure and find it to be higher. Then you must talk to the Best Cardiologist In Delhi. Let’s understand. As we all get older in our lives blood pressure, having a higher blood pressure is a consequence of Aging if we wish to not develop high blood pressure. It’s important that when you are young and you’re on your middle-aged, you exercise. Well, you limit what you eat, take less salt, and exercise regularly.

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23/May/2022

Who have heart disease with a compromised pumping of the heart means the pumping ability of the heart is less than 35%. You must talk to the Best Cardiologist Doctor In Delhi about the need for a device that is called an implantable cardioverter-defibrillator. This is what is called an implantable cardioverter-defibrillator. And this is what it looks like. It has a small device, which is like a matchbox. This device is implanted Under the Skin. Just like we make up. We have a pocket in our Shirts, we make a little pocket under the collar bone. And we insert this device. This device with the help of one wire or a lead, as we call it. It is connected to the heart. We must remember that this device is called an implantable Cardioverter-defibrillator as the name implies is implantable and hence is called implanted.

It has a unique ability of cardioversion and defibrillation. If any of you wants to know, we can connect later, but it’s a very intelligent device. It is as if a very intelligent doctor is in your chest wall, it is as if in an emergency room, the doctor is walking with you everywhere. You feel very confident because if you were to have an episode of sudden Cardiac Arrest because you had a risk for it, the implantable defibrillator before, anybody knows diagnosis, that and treats it by treats it, by giving you a therapy, which you may not perceive, which is called anti-tachycardia pacing, or it may give a little shock therapy.

Right. So My Question Is What Is Shock Therapy

Best Cardiologist in Delhi Dr Aparna Jaswal

All you need to know is, I’m sure when you watch movies, you see that somebody when they are passing away, you see? A big machine, is brought into the hospital setting and we put two paddles in the chest wall and we give a shock therapy. So that’s what we call the shock. That is delivered from outside. So you are aware that in the hospitals. You see those big defibrillators. Obviously. Nobody can have those big things in your homes. Who will give those sharks? All of that. The little big device is compacted into this little device, which is called a defibrillator implantable.

This has been around since 1885 we have been aggressively using them. We have been advocating for them. For those of our patients who deserve them. They are battery-operated devices and these devices last approximately six to nine years. Depending upon the usage. They are battery-operated devices and these devices. Once implanted can be interrogated, externally by visiting a pacemaker Clinic, which is there in all major hospitals, and every six months, we get the devices. In fact, these devices are extremely intelligent. These devices have a unique ability today to remain connected with your doctor, and your doctor can get the information every morning when he wakes up.

So I would like to ask what is an automatic external defibrillator

If there is any abnormality that may have possibly happened in your heart and without even you, or your family member having to know, your doctor comes to know, and they further connect with you and let you know about it, right. And yeah, so I think many of you will be traveling, of course, in the last two years old, first having to travel but soon we will be in when you are at any airports. Now even in Indian airports and international airports, you see important places a small box is hanging on the wall and it is called automatic.

If you are suffering any type of heart discomfort Book an Appointment with Dr. Aparna Jaswal Top Heart Specialist Doctor in India…#fortis

13/May/2022

Sudden Cardiac Arrest as told to you is complex and heterogeneous. It is not that, it happens only to the elderly. It happens to people who are anywhere Beyond 35 years of age. It can even happen to younger people than 30. However, if we were to talk of the generation. of the people consumed by sudden Cardiac Arrest are beyond 35 years of age, up to 1 in 500 to 1000 can succumb in their living lives. Elderly. People also succumb to sudden Cardiac Arrest, but the majority happen in a younger age group, very much as you’re talking about younger people.

Being Top Cardiologist In Delhi what causes sudden cardiac arrest in younger people?

It’s a very important thing to learn. So what happens that even We Are Young in our growing years we develop blockages in our blood vessels. When we are very young. We develop the thickening of our blood vessels that thicken our blood vessels the small blockages, which happen in our blood vessels, continue to remain there. And if they are not prudent about exercise, our diet our blood pressure, those blockages continue to increase. At some time in our lives which can happen even in young adulthood that blockage bursts, when that blockage bursts. It causes a sudden Heart Attack and during that heart attack. We can have Sudden Cardiac Arrest. Also, we have to understand that younger. People can succumb to sudden Cardiac Arrest by a problem, which runs in their families. Like I told you some people have thickening of the heart muscle. Some people have a general Erotic problem, but you should not think of uncommon causes. We will always focus on the common causes. The commonality is that we must safeguard each one of ourselves and our people in the family from developing blockages in the Blood Vessels of the heart are life-threatening diseases.

So, how do we prevent anyone of ourselves or our family members? From Sudden cardiac arrest? You will be surprised that the prevention of sudden Cardiac Arrest is very simple when we are young and we are devoid of any illnesses. As suggested by Best Cardiologist In Fortis Delhi We must exercise well, we must eat healthily.

Best Cardiologist In Fortis Delhi

We must Safeguard ourselves from developing high blood pressure developing diabetes. May must take care that our cholesterol stays fine. So we must take we should not smoke. Alcohol consumption should be In small quantities, we must keep ourselves. Agile must not remain sedentary. So if we were to do all of these, that means we do good. Risk factor protection of ourselves for a good period. We will be able to ward off the blockages of the blood vessels. If you can Safeguard yourselves from developing the blockages in your blood, and vessels of the heart, there is a good chance that your likelihood of having sudden Cardiac Arrest is Diminished which is one second. If you already have heart disease and supposing, you have undergone angioplasty or bypass surgery. It’s a good idea that you must go back to your doctor routinely at least, once every year with your blood tests your echocardiogram and your doctor and your cardiologist together will identify with You are at any risk of Sudden Cardiac Arrest.

The Best Cardiologist In Delhi is good enough. If your heart pumping is normal, and if you have no symptoms and you have been advised, a good list of medications. There is no need to worry that you are at risk of sudden, Cardiac Arrest third. If you have had an angioplasty or a bypass surgery, but have a poor pumping of your heart. If the pumping ability of your heart would be called, ejection fraction is remised, if the pumping ability of your heart is lesser than 35%, It is a good idea that you begin to speak with your doctor, with your cardiologist to understand. If you are at risk of cardiac arrest, and if so, he may advise a treatment that is called a small device, which is called an implantable cardioverter-defibrillator.

04/May/2022

I hope we will make it worthwhile for all of you in the next couple of minutes. We choose this topic and there could have been no better opportunity. Time to be discussing this simply because of what happened last week, all of us are aware of Shane Warne. In fact, that very day. We lost two, cricketers of great Fame, and the world of cricket was completely devastated, especially with the demise of Shane Warne. Who were 52 years old and this is what we want that we all should understand and take it forward from there? So I think as the name implies sudden Cardiac Arrest is very simple. It’s a cardiac arrest, which happens suddenly to put it in. Simple terms. If anyone is going to get it, he knows it’s going to come. He would not be home.

He would be in a hospital setting or you could be in some clinic. So certainly, this is something which comes suddenly Why it is out of the blue and it is devastating and consumes alive. And the unfortunate part is it consumes a large number of lives in their productive years. So it’s important we understand and know what is it that we can do to safeguard ourselves from this entity in times to come. So that some living life around us is saved by Having learned about the nuances of Sudden Cardiac Arrest. It is extremely complex and At Regina’s, I will try and keep it as simple as we can. Right. Thanks, Dr. Aparna the Best Cardiologist In Delhi for explaining about sudden, cardiac arrest.

So just to start I would like to ask about the causes of sudden cardiac arrest. So if we were to elucidate the causes of sudden Cardiac Arrest, the most common cause of sudden Cardiac Arrest is having a blockage in the blood vessels of the heart. It’s even more intriguing. If you were to know that over 50% of people who had sudden Cardiac Arrest were not aware that they had blockages in the blood. The hawk meaning thereby. We must look after ourselves, very well, when we are young so that we do not develop the blockages in the blood vessels of our hearts.

There are some other causes that are less common. Like somebody may have a disease in the valve of the heart. Somebody may have what we call a thickening of the heart muscle called hypertrophic cardiomyopathy. Some people may have a dilatation of the heart, what is called dilated cardiomyopathy and then Some diseases which run in families, we call inherited Channel, Lupa things but to keep it very simple, the commonest cause of sudden Cardiac Arrest is a disease in the blood vessels of the heart. All right. Dr. Aparna Best Heart Specialist In Delhi

So the next question I would like to ask you is what are the signs and symptoms of Sudden Cardiac Arrest? How would someone get to know that they are responsible? Yeah. So is there any signs and symptoms of Sudden? Cardiac Arrest?

Best Cardiologist in Delhi

Well, the first and foremost, is that if you think that you have risk factors for heart, disease means, if you have diabetes, you have high cholesterol, you have high blood pressure and you smoke, or you have a family history of disease in the This is that is called ready after disease. It is time for you to go and get tested. If you have any disease in the blood vessels of your heart, that is one second. If you have any symptoms such as chest, discomfort, when you walk or chest discomfort, when you climb a flight of stairs, which comes in the center of your chest, it feels as if somebody has died or not or a band across your chest. You must seek medical advice from your local Cardiologist.

Third, if you have any symptoms such as dizziness or have had a fainting spell, it’s important that you connect with your doctor to understand if you could be at risk of any such element happening in the future. How far is the sudden cardiac arrest?

So it will be fascinating for you to learn but rather depressing. I should say if you want to know the real numbers. It is one per thousand. Per year, globally that succumb, to Sudden Cardiac Arrest, which becomes a very large number in certain geographies. We’re in the heart disease is more common like India, it is actually lesser than one per thousand means even more people. One per 500 also could succumb in their adult years. After 35, to 40 years of age Sudden Cardiac Arrest. It is that common What is there any age group for Sudden Cardiac Arrest, or has happened to only elderly people to be continued……….

25/Apr/2022

The topic for discussion today is tips for diabetes patients’ diet And exercising. And we’re extremely honored to have you with us Dr. Aparna Jaswal leading senior consultant interventional Best Cardiologist in Delhi at Fortis escorts hospital daily. Thank you so much, mam. Once again for accepting our invitation to address this cause. And now I would like to hand out the session to you to guide us further around tips for diabetes patients’ diet And exercising

Hello to you today. I wish to share some tips on Diabetes Care. I am sure all of you who are diabetics are already engaged with a good doctor, but these tips are just to enhance your life and to make sure that your diabetes steak under control. The most important element of good diabetic control is your diet and the second most important is exercise. So if you Implement these two, there is a good chance that you will be taking good care of yourself and keeping your blood sugar by control diet.

It’s important to understand that you must control your carbohydrate intake. You must limit your sugar intake, a good balanced. Diet is a diet that is full of fresh fruits, vegetable nuts, and a limited intake of refined sugars, and comp and oils.

Exercise extreme importance should be given to exercise and that should be consistent and daily. You must remember to take out at least 30 minutes for yourself and go out and exercise daily for 30 minutes and you will realize yourself. If you do these two simple steps your diabetes will be much better controlled than it was in the past.

29/Nov/2021

Are There Any Complications During Pacemaker Surgery?

Yes. So that’s I think, a very important question that when they will have any procedure done any procedure, it cannot go without saying that there can be some complications. So, whenever we implant the pacemaker surgery, at times at the local site, they can be some collection of blood, they can be an infection in one or 2% of patients in the long term. And in the acute scenario, you may injure the lungs, wherein we may have to insert a tube, they could sometimes be a collection of blood around the heart. So these are complications that are known to occur and can be tackled easily during the implant.

Many People Would Like To Know About The Types of Phases?

So we’ll keep it simple. This is what a normal pacemaker surgery looks like. These pacemakers can either be single-chamber means they have only one wire or they can be dual chambers means they have two wires. As you can see, in this we have two wires we have one wire going to the upper chamber and we have one wire going to the lower chamber in the majority of people. When a pacemaker surgery is needed for poor heart rate, we give them a dual-chamber pacemaker. In a very small minority of patients, we may consider giving Giving them a single chamber pacemaker. At times, we give them devices which are larger, which may need three-wide pacemakers surgery, which are called CRT, or they’re even called CRT DS, those devices are bigger, those devices are bigger and they may be having three wires like this, they are given in special situations. Otherwise, we either give a single chamber which is very seldom, but more often than not, we give two wide pacemakers wherein one wire goes to the upper chamber of the heart, and then in the second wire goes to the lower chamber of the heart.

Can Use MRI Done With Pacemaker Surgery?

Best Heart Specialist in Delhi

Yes, so, can an MRI be done if you have a pacemaker? In earlier years, we did not have MRI-compatible cardiac electronic devices. Today, most of the devices that we have are MRI compatible, or we call them MRI safe. When we say MRI safe or MRI conditional, we mean that when the patient has a device, at the very outset, the patient is told that you have an MRA compatible pacemaker surgery. More often than not patients opt for it because once this is put in, in use to come, if the patient needs an MRI for any reason, it becomes simpler. And if he has an MRI-compatible device, he can go in for an MRI by just informing us or informing his Best Heart Specialist In Delhi wherein we externally make a little change to the pacemaker before and after the MRI. So, these are called MRI safe or MRI conditional pacemakers.

Are There Any Disadvantages Associated With Pacemakers Like Having A Pacemaker?

So, any procedure when you do you have to earn the procedure, you have to be worthy of getting the procedure if you need a procedure, you have to pick up the risks or dangers attached along with which are very few as I just told you, if I may say the disadvantage can only be sometimes you may develop a local infection, you may develop local blood collection, you may sometimes get some injuries along. So these are the complications attached along within the long term. The pacemakers are supposed to heal you, they allow you to perform better in a very small number of patients. When we give the pacemakers in the subset of them, the pumping may come down. So when the Pacemakers are implanted, we always do an echocardiogram before we implant the pacemaker surgery. So we are sure of what kind of a pacemaker and index patient needs.

So How Long Does It Take For Recovery?

Yeah, so as I told you, the procedure is typically done under local anesthesia. We do these procedures under general anesthesia if we have very small children or very elderly patients who are unable to lie on the cap table. Patient after the procedures and systems local anesthesia goes into the ICU, the patient stays in the ICU for one day. Subsequently, the patient is shifted to the room where he stays for a day. And he’s walking the very next day he goes back home walking, he comes back to us every 48 hours for the local sight healing, we do the dressing, it takes about one week for a wound to heal. And after a week the patient is allowed to do all activities. routinely in his house. We allow the patients with pacemakers to resume their driving in about four to six weeks, we allow them to go out for walks in two to three weeks, we allow them to lift their arms in about two weeks. When the pacemaker surgery is when the patient for the pacemaker is discharged, we tell them that you must allow your arm to increase at 90 degrees, this 90 degrees as soon as one day is over. Remember, if you do not move your arms there you result in a frozen shoulder, a frozen shoulder can become a very difficult situation. So you should avoid a frozen shoulder for which you must remember that you must continuously give arm exercises after the first 24 hours to bring it 90 degrees. And after two weeks, raise your arms above. How Do I Take Care Of A Pacemaker?

I Have Got Many People Saying That They Will Not Use Microwaves or Plants Appliances When Implanted. Is it True?

Yeah, I think this is the most pertinent question that once I have a pacemaker implanted in my chest Wall, what is it that I cannot do? The first thing you should remember is when you use a mobile phone, you should use the mobile phone from the other ear. Remember, there are magnetic fields, and you should not want to come with your phone close the pacemaker by six inches. So we always tell our patients to use the mobile phone from the other year, all electrical appliances at home, meaning if it were your mixer, a washing machine, it could be a microwave or television remote, you can use all electrical appliances at home. If you have an MRI-compatible pacemaker, you can go in for an MRI, CT scan, and X-rays and ultrasounds are not a contraindication you can have all these procedures done. One thing that you should remember is if you have any problem and you want to visit a physiotherapist, we tell them that we do not want any electrical stimulation, because a pacemaker may unnecessarily see electrical stimuli. Outside of that, you can do everything you can also walk through when you go to a mall, there are electrical surveillance, you can walk through them do not stand there.

Pacemaker Surgery in Delhi

But what you should remember is those places where there are very huge electrical transformers, we tell our patients not to hang around them very long, which typically we don’t. So by and large, once you have a pacemaker in, you can do most activities of daily living. The Apple Watch, yes, you can use all electronic watches, Apple, I watch, you can do everything. However, one thing we tell does not to keep your phone in your pocket. On the left side, I told you that your devices should be six inches away. So we don’t want you to keep any of your phones, iPhones in the pocket of your shirt, which could potentially interact with your pacemaker.

So alcohol is something that often comes up because of the interest of the patients. But what we need to understand is that alcohol taken in moderation as prescribed 30 to 60 ML is no contraindication for a pacemaker implant. But remember what I said 30 to 60 ML, we must remember that alcohol is to be consumed only in moderation. It is not a contraindication. But when you have a pacemaker implanted, maybe you can wait for about a week or 10 days before you resume having alcohol.

So We Have A Band With Our Questions And We Have Some Questions For You in the Comment Section. So I’ll Read It To You. What is What Hardware is A Pacemaker Need?

Yes. So there is no number, at what heart is a pacemaker surgery need. For some people, we may want to implant a pacemaker at a heart rate of 50, while others may sustain a good quality of life even at a rate of 45. So what is important when we implant a pacemaker is there has to be symptomatic documented low heart rate, meaning the patient says I feel uncomfortable even at 50 I feel dizzy. It’s a reason enough to implant a pacemaker. If a patient is 48 heart rate and says I’m absolutely fine. I can go for my walk, I don’t need I don’t have any problem. We don’t need to implant the pacemaker. So there is no one magical number. But every patient is different and we have to deal differently with each patient.

Any Information Regarding The Microchip?

Yes, so the micro pacemaker, or as it is called a lidless pacemaker. I just mentioned to you that these pacemakers are like capsules, these capsules are inserted from the leg into the heart. So these capsules stay inside the heart without leads. Hence they’re called lead list pacemakers. It is a newer technology, it is catching up very fast. It is very expensive for now, but in a given subset of patients who do not have sites to enter from here, or are on dialysis, or have undergone implants and have infections in the past, we do recommend having a leadless pacemaker is the other option for the prolonged holder. Yes. So I told you that whenever our patients complain of low pulse rate, we have to document it. How do we document that you take an ECG and ECG is 12-second documentation, so it’s diagnostic yield is not very good? So the next thing we depend upon is a halter holder, the 24 hour ECG recording, which is a very good tool to pick up slow heartbeats, yet it may not be sufficient in every patient. For then, we consider doing extended holders it is called extended loop recorders or external loop recorders. They can record your heartbeats for as many as seven days, 14 days, 30 days, and that is stuck to your chest wall. They’re called external loop recorders. However, in some patients, we need longer monitoring. And that’s when the rule roll of these devices comes in. These little devices are called insertable loop recorders, they come mounted on a syringe, and we insert them under the skin. As you can see, they are so slick. As you can see, they are so slick, they are on a syringe, and we give a little nick one-centimeter neck inserted under the skin, right here on the left side, give one suture. Now this little device is called insertable Loop Recorder, it can record your heartbeat for up to three years, it is MRI compatible, and when the patient says that he has an abnormal rhythm or had a fainting spell, the patient comes back to us, we interrogate this device and we get to know immediately what was the cause of the patient’s fainting spell, if it tells us it was because of low heartbeat, we know it needs a pacemaker. If there is some other reason we treat the patient accordingly you have shown us so Is it my surgery or it can be implanted.

So, this is a very simple procedure, it is although done in the wizard it can be done in the OPD setting, it is a small neck, on the skin just on the skin one centimeter, and it is inserted under the skin over the surface over the heart side area. And this picks up the ECG of the heart just like a normal ECG recording and it records up to three years. Hence, it makes it very simple for us to know what our patient has a problem if the patient faints during the insertable Loop Recorder.

Another Question From Our Viewer is If The Heart Rate is High, Then In That Scenario Also Pacemaker is Acquired.

So in a very rare situation for high heartbeats, we may want to give a pacemaker they could be special devices and a pacemaker is given for patients who have a very high heart beating wherein we go inside the heart we may burn the no AV nodal area and subsequently to treat the fast heart beating we have to give a pacemaker. So there are situations

Pacemaker And ICD The Same?

Pacemaker icd

Splendid. So pacemaker and ICD are not the same now that you have asked this question, I will have to show this device to you, which I was using for other reasons. Let me try and show it to you. Okay, so I just showed you the pacemaker. This is what a pacemaker looks like. And if I were to show you what an ICD looks like, this is what an ICD looks like. So surely, the ICD or CRT D is larger than a pacemaker. You can see even from the side, it is larger than a pacemaker. But the implantation procedure of a pacemaker and defibrillator or a CRT is much the same. They are larger, they are more complex devices. Technically, they are more challenging, and the implantation of these devices is also more challenging.

We Have is Life Normal With Pacemaker? Or Will There Be Any Changes in The Life

once you have a pacemaker implanted and your local site is healed, you should forget about the pacemaker and you will lead a life as normal as any other patient any other individual in your vicinity or in your neighborhood. All you need to remember is every six months, you need to revisit your implanting doctor so he can know how your pacemaker surgery is behaving. I told you these are battery-operated devices. These devices need to be continued into interrogation, which can be done either remotely or from our clinic. You can also have these devices monitored remotely from the comfort of your home. Or you must come here into our pacemaker clinics every six months because these batteries last roughly around eight to 12 years.

Thank you so very much now. We have completed the questions from our comment section. For any heart, emergency call us:+91 9818797594 and fix your appointment with the Best Cardiologist Doctor In India Dr. Aparna Jaswal Director Cardiologist And Electrophysiologist at Fortis, Okhla.

09/Oct/2021

The topic for discussion today is myth versus reality heart disease, inflammation. And we’re extremely honored to have with us Dr. Aparna Jaswal leading senior consulatant interventional Best Cardiologist in Delhi at Fortis escorts hospital daily. Thank you so much, mam. Once again for accepting our invitation to address this cause. And now I would like to hand out the session to you to guide us further around heart disease in women.

Thank you very much. At the outset, I would like to thank you, Ben, for giving me this opportunity to be amongst your there could be no better opportune day and moments than today, considering today is the world heart day. And we are seeing a lot of activity and buzz around this day in media, today’s newspapers all around. And I think it’s vital. We discussed this because heart diseases continue to remain a very big burden of disease across the globe.

Even more so in India, there could be no better day than today to be discussing heart disease in women. I think a lot of attention in 2021 is being given to heart disease in women in general. And today is a special day. So I think I would like to take you along with me trying to understand why we need to discuss this. The reason the most important reason is that people have this myth that heart disease is generally a man’s disease. It was always believed that women do not die of heart diseases. However, the glaring reality and unfortunate one is that heart disease continues to remain the leading cause of death in women. It is important to remember that women develop cardiovascular disease about a decade later than men. But the outcomes for women are often worse. Women do not remember themselves, that heart disease is the number one killer in them.

Top Heart Specialist in Delhi

This brings us to the point to discuss today that awareness is lacking. We can only achieve what we wish to if we are aware of the problem. So I will make an attempt to take you through to understand why we need to remember that heart disease in women is a big burden. Women carry the traditional as well as non-traditional risk factors. The traditional risk factors being what we see in men, diabetes, smoking, obesity, sedentary lifestyle, hypertension, and abnormal cholesterol. However, in women, they should be aware that women undergo hormonal, emotional, the drug problem that they undergo with hemodynamics when they are pregnant, all these together become even more troublesome for women. As you can see, there are issues around delivery time during the pregnancy, hypertensive disorders, diabetes during the pregnancy, there is something called autoimmune disorders, breast cancer, and of course depression. Hyper hypertension, high blood pressure is a leading cause of cardiovascular disease worldwide. This is to be remembered that women have higher mortality than men when they are hypertensive. under the age of 45, men are more likely, however, as women get older women to develop hypertension more than men. And it’s important to remember this only 1/3 of elderly women have adequate blood pressure control. Often patients come to us and ask us, doctor, will I have to take the pill every day? Well, we must understand and remember, if you have high blood pressure, it’s important to keep your blood pressure under control. Because blood pressure is a silent killer and it destroys our other organs. And the most dramatic and devastating complication of high blood pressure is stroke. Diabetes confers a greater cardiovascular risk for women than men.

Diabetic women have a higher incidence of heart disease as well as stroke. Thus, diabetes correlates most strongly with Cardiovascular Disease mortality in women than men. High cholesterol, dyslipidemia, as it is called, has the highest population-adjusted risk among women, compared with all other known risk factors for heart disease, obesity. Now, this is a problem that is more specific to low and middle-income nations, there is double the amount of obesity in women than in men, the reason being the low and middle-income nations. Because the diet, the diet is rich in carbohydrates. As a result, it makes people obese. Hence, it is important that we control obesity as a risk factor for women in the developing world. Physical inactivity, we have to remember that we must get out of our beds and hit the box and walk for at least 30 to 45 minutes every day, we must take a pledge upon ourselves as women that we must take out that much time for our own activity. pregnancy. This is something that is unique to women. And it is important that we must assess the pregnancy history for women of all ages.

The problem of pregnancy is that during the pregnancy, they can develop high blood pressure, they can develop diabetes, they can be preterm delivery, all of these put the woman at a higher risk of heart disease, depression. I think depression is something that is a universal phenomenon that can affect men and women. But surely, women have more psychosocial problems. As a result, they are more inclined to go into depression. Depression is associated with increased cardiovascular mortality, because people will not exercise, they will eat unhealthily, they will eat out of time hence there is a problem. And why do women tend to delay care? This is important. They misinterpret their symptoms. They believe that I cannot have heart disease, there is a state of denial, minimizing the perception of risk. Competing obligations don’t want to impose their problem on the family and sometimes can be embarrassed about their symptoms. Thus, it’s important that women know their symptoms. Women don’t experience heart disease the same way as men do. They have less angina, they can present very differently. What is Heart Attack: Symptoms, Warning, and Treatments. Have heart attacks among women usually are more sudden and come on with less warning. As a result, women are less likely to take that they’re having a heart attack and to seek medical care. So what are the unusual symptoms? So typical symptoms one must remember is chest pain in the center, which is constricting as somebody has kept awake and paying and go to the job or to the shoulders, at least in our arms. But women can come even differently. They can be unusual upper body discomfort, they can be shortness of breath, break out of a cold sweat, unexplained fatigue, lightheadedness, or nausea. If you have any of these symptoms, and you have risk factors you must not ignore and you must seek medical care. It is time to tell the women that we must be increasingly aware and we must remain ready to be screened so that they have knowledge of lowering the chances of getting heart disease. Rule number one look before you eat. Eat a variety of fruits and vegetables every day. Eat a variety of great products. Choose nonfat and low-fat products, less fat meats, more chicken fish, and lean guts. Switch to fat-free and skimmed milk. Dietary Guidelines as I told you, you must limit the number of carbohydrates you must limit the number of calories you must not try to drink too much of soft drinks, candies and junk food, saturated fats trans fats and this is what comes in your pizzas, burgers, pastries, cakes, chips, so this is some more sauce. This is what is saturated and trans fats. You must remember you must eat less than six grams of salt today means a small teaspoon is five grams. It should be less than that all your day. exercises. Rule number two, maintain a level of physical activity exercises daily for 30 minutes. This is extremely important. It reduces your risk of obesity increases your good cholesterol, lowers your bad cholesterol helps keep lifestyle diseases such as diabetes and hypertension at bay. Walking for a healthy heart. It has been known that those people who walk live the longest and amongst all the exercises daily walk is one exercise which has shown to last the longest. So it is a good thing if you can go to the go to gym and do it every day. However, walking is something all middle-aged women must adapt because it lasts the longest stress management manage your stress well. A very good way to do that is by doing yoga. Take a daily sleep of seven to nine hours, but must attempt to sleep on time and wake up on time. Know your numbers. This is important when we deal with cholesterol. Total cholesterol should be less than 200. LDL should be less than 100 and HDL should be more than 40 triglycerides less than 200. Get these levels tested routinely after especially once you achieve middle-aged and keep them under control. They are not difficult to get under control. If you exercise well. eat healthily seek the help of your doctor and take the right medications. Benefits of reducing cholesterol. But 10% reduction of blood cholesterol produces a 20 to 30% decline in deaths because of heart disease. So you must remember that if you are an adult, get your levels tested 20 years and above, get it tested five years later again get it tested, one must not worry about drugs, one must not worry about the result, one must test it and get it treated. Control your blood pressure. We must try to achieve a blood pressure in the majority of the time to be between 120 and 80.

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If your blood pressure is more than 130 by 90, you are labeled as hypertensive, so you must try to achieve optimal levels. How can you keep your blood pressure at bay if you don’t want to eat medicine is diet, exercise solid restriction controlling your weight? And if you need medication as per your doctor, you must take the blood pressure medications. Do not stop your medications without consulting your doctor. Do not think that I’ll have to eat for a lifetime. Because most important is to keep your blood pressure controlled. Control your blood sugar. You must remember a fasting blood sugar has to be less than 100. Post means less than 140. modify your lifestyle, diet, exercise, and weight. These are the most important things. Do not stop your medications for diabetes without consulting your doctor. Remember, if you’re a diabetic once, you will need medications for blood pressure control. You can reduce your doctor can reduce your blood pressure medications. If you exercise well eat healthily and control your weight.

I think I would like to conclude here and open the house for the discussion. And I will be happy to take some questions. Yeah, thank you so much, man, for such an informative session. We have a few questions in the chatbox man. Would you like to take those questions first?

How Can I Keep My Cholesterol Levels in Check?

Well, the most important thing is if you’re an adult, you’re more than 30 it’s a good idea to at least get your blood cholesterol checked once. If your cholesterol is on the higher side. The simplest thing is to exercise to eat healthily. If these don’t work, you may need a pill to discuss with your Best Heart Specialist in India or your physician. And if they think it is important, you must take a pill, exercise, and die. Bring your levels down. The doctor may think that you can stop your pill. That’s how you do it. The next is our pregnant women are at risk of heart disease. It’s not that pregnant women are at risk of heart disease.

How can I keep my cholesterol levels in check

It is the hemodynamic the autonomic, the hormonal, the emotional imbalances which come with pregnancy, which can put you at risk. You can develop gestational diabetes, you can develop hypertension. So hence you can be at risk. So does my menopause have anything to do with heart disease? Yes, menopause in women has a lot to do with heart disease. When you achieve, you know, cause you are now at risk of heart disease just as your male counterparts. So if you are in a menopausal age group, you must work aggressively to take care that you don’t develop high blood pressure. You do not develop diabetes, you take care of your cholesterol levels, you work aggressively on them because now your risk of heart disease is as much as men because the protection offered by the hormones when you were pre-menopausal has gone away.

So The Next Question is My Father Aad A Heart Attack A Few Years Back, Am I At Equal Risk To Get it?

This is a very good question. Strong family history puts you at risk of developing heart disease. So you should remember that if you have a family history, you need to work over zealously over aggressively to make sure that your risk factors are very well controlled.

The Risk Factors Are High Blood Pressure

Diabetes, smoking, cholesterol levels, and exercise. If you take care of these five things, you can push your genetics and make sure that even your genetics do not allow you to develop heart disease. The lifestyle measures that you need to adapt to avoid heart attack on exercise every day. I often tell my patients that exercise nine days a week, it implies on some days, do twice a day, eat healthily, do not have transplants, have less salt, make sure your diet is not cholesterol-rich, do not have trans fats. So if you look into these things, do not smoke. I think that’s important. Do good stress management, sleep well do not remain essentially, these are the measures that are very simple and should be incorporated in our daily lifestyle, which can keep you healthy. Are women more vulnerable in heart disease as they lack vigorous exercise? Yes. So after menopause, if women don’t look after themselves, they will be at Risk of Sudden Cardiac Arrest, because as I told you, postmenopausal women are at equal risk as men. So to think in our homes, we have our mothers, we have our grandmothers who think that they will not develop heart disease, because they’re protected by hormones, is a bit postmenopausal, they must look after themselves, too. Young hypertension, has young hypertension become more common and women when hypertension has stepped into our lifestyles, and we are seeing more and more of high blood pressure, even in school-going children. What is the reason is inactivity. So being on the computers, being on their mobile phones, not going out to exercise, eating unhealthy foods, eating junk foods, all of these, remember the food that you get from outside, a very high inside preservatives, saturated fats, and trans fats. All these things together, combined with lack of exercise, push us to develop heart diseases. So it’s a combination of all of these factors, which pushes us to develop heart disease.

Right, thank you so much, ma’am. I think we have Thank you so much, first of all, for pretty much covering all the questions which our audience has asked. And this session has been really wonderful for us. We got to know a lot of facts about heart disease in women which is really a pressing need to understand at this point in time. We would like to thank you once again for sparing your valuable time to address this noble cause of heart disease in women thank you so much from local India. And that’s it from our side.

Thank you very much. I think it is it is activities such as these that will actually bring around awareness and all of us will make a concerted effort for a healthy life in this world hearty Thank you very much.

21/Sep/2021

So what do you suggest like what would be the main assessment indicator for sudden cardiac arrest? Like someone gets to know that he had a Risk of Sudden Cardiac Arrest What would be the next step?

Right. So in the community, I think it is unfortunate that India is the capital of diabetes. And also we have a very high penetration of hypertension, as much as one out of four adults has hypertension and of course, diabetes. Our country is the diabetic capital. So to keep it very simple, those adults who have diabetes and hypertension must work aggressively on risk factor lowering, so that they do not develop heart disease. If they have developed heart disease, and their heart pumping is normal. It’s important they address their heart disease with their Best Cardiologists in Delhi. Even if it means just medical management. Some of them may need stents. Some of them may need bypass surgery, all of those should be done and subsequently should have should be on good medications to minimize your risk of sudden cardiac arrest. We must remember, in a subset of patients who have these problems, their heart pumping, which is seen on an echocardiogram may come down with what you call an ejection fraction. If the patient’s ejection fraction is compromised, that is E F, which is noted on an echocardiogram. If the ejection fraction is compromised and is less than 30 to 25%. It is important that the patients understand they may need a device which is called a defibrillator. So a defibrillator is a simple device. And these defibrillators come in these types. These defibrillators are implanted below your collarbone on the left side in the majority of the cases. So this defibrillator is called an ICD implantable cardioverter defibrillator. It is of utility to those patients whose ejection fraction is lesser than 30 to 35%. Irrespective of the cause. It’s important to discuss with your cardiologist that if you need one if your cardiologist thinks you must consider having an ICD implanted because this device is indeed a medical Marvel for those patients who are at risk of sudden cardiac death. This disease ICD minimizes your risk of sudden cardiac arrest is a device that is implanted under the skin. And it is as if you have a very intelligent doctor sitting inside your chest while this defibrillator watches every beating of the heart. when it seems that your heart is behaving abnormally, that means I told you already that it should be 60 to 100 times a minute. And if your heart begins to beat abnormally fast, the ICD is trained to deliver therapy, such that your heartbeat comes back to normal meaning thereby that you could be saved from the sudden cardiac arrest episode by the intervention of the defibrillator. The defibrillator may sometimes give shocks which you should understand and discuss with your cardiologist before you go in for implantation. So you know what your info is when you have the device implanted,

right? So ICD seems to be very useful for the patient connects some very basic questions from the list of patients that what basically the hospital do when they In the case of severe cardiac arrest, and someone goes, secondary dies. Yeah. So if what I understand is…

If The Patient Comes Into The Emergency Room With The Risk Of Sudden Cardiac Arrest, What Do We Do?

So the most important point here is that we have to work very aggressively, we have to be really quick in addressing the problem, because the chances of survival, minimize by the minute, as the patient has a sudden cardiac arrest. So as soon as the patient comes into the emergency room, and if we see that the patient is having a very fast beating of the heart, we immediately put the patient on a defibrillator, which is a large device, which you would have seen in hospitals and clinics. And some of you may have seen in movies, we attach the patient to a defibrillator, and we give an external therapy with the help of paddles, we revive the patient immediately. Sometimes we may have to give artificial ventilation, where the tube is put inside the mouth, and the revive the patient of the patient comes up comes back to normal life. But the most important message here is that we have to work really quickly to salvage the patient because every minute the chances of patients surviving come down by 10%. So that’s why we have to act really quickly to save the patient. Another very common question is…what is the difference between sudden cardiac arrest? I think that’s a very important point to address…

What Is The Difference Between Sudden Cardiac Arrest And A Heart Attack?

What Is The Difference Between Sudden Cardiac Arrest And A Heart Attack?

So What is a Heart Attack? a heart attack is when a patient complains of sudden tearing pain in the center of his chest as if somebody has died a band or somebody is sitting on his chest, and the pain from here can radiate to the top of his shoulders can also go along the inner side of the arm. This is called a heart attack. a heart attack is because of sudden occlusion or blockage of the blood vessel of the heart. That is a heart attack. Why sudden cardiac arrest, as I told you in the very beginning, is an electrical problem of the heart, the heart begins to beat and normally fast, it is supposed to normally be between 60 to 100 times a minute, but when there is a sudden cardiac arrest, it can be as much as 250 to 300 times a minute, meaning there is ineffectual contraction, that is a distinction between a heart attack and a sudden cardiac arrest. Unfortunately, there always remains confusion and the public is unable to understand the distinction between the two, we must be very clear heart attack means blockage of the blood vessels of the heart. But during a heart attack, a patient is susceptible to sudden cardiac arrest. Hence, you must immediately be rushed to a hospital when you suspect that you may have a heart attack. Why did a sudden cardiac arrest, it can come out of the blue, it can present itself without just discomfort. sudden cardiac arrest can present itself for the very first time with the patient falling down on the ground. Hence, those of us in the community who are at a high risk of lifestyle diseases of developing heart disease must address our lifestyle diseases aggressively. Keep your blood pressure under control. Keep your diabetes under control. Remember to exercise regularly. Do not smoke, look after your lifestyle in terms of go for regular exercises. Look after your diet. If you work on all these elements aggressively, you minimize your risk of sudden cardiac arrest.

From the viewers, we have one question from today was asking people who already have the ice with them.

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Can we also be working? sanitary? Correct? Yes. So what does an ICD do? an ICD is an implantable cardioverter-defibrillator and ICD is implanted under the skin under the collarbone. What does this ICD do this ICD watches every beating of the heart as soon as it sees that there is abnormal beating means that the patient is actually having a sudden cardiac arrest. Before the patient fades or falls, this ICD delivers therapy. The ICD can deliver therapy either by quickly giving shock impulses to the heart and break that rhythm. But sometimes it may have to give a shock, just like you see that the patients get an external shock.

This ICD is a very small device but it is a medical Marvel. It has the capacity to deliver shock therapy to the heart and revive the heart. So it gives a shock internally when it For the device, the heart needs a shock and brings the back brings back the heart to a normal beating of 6200 times a minute. So, another question from when happened to anyone. So we must remember that sudden cardiac death is common. I already said that it comes one 4000 globally, in a year. So it’s a common occurrence. Whom does it affect? It typically affects younger adults young means those who are beyond 35 years of age. It typically affects those who have disease in the blood vessels of the heart, but they may not know for sure that they have disease in the blood vessels of the heart. It typically affects those who have lifestyle diseases means if you have the risk factors for heart disease, or you already have heart disease and have poor pumping of the heart, you have a higher chance of sudden cardiac arrest. To put it very simply. The risk is largest for those patients who already have heart disease and poor pumping of the heart. There they are at the highest risk have those who have heart disease and the ejection fraction is less than 30 to 35%. The next subgroup is those people who already have heart disease with lifestyle diseases. The third group is those who are who have lifestyle diseases but do not know that they have heart disease, must remember that those of us who have no lifestyle diseases also are at minimal risk of having sudden cardiac arrest means we all must tend to our heart, we must look after it, we must look after our diet, we must exercise every day we must eat healthily, we must not smoke. So these are very simple pointers, which can protect us from sudden cardiac arrest and get sober we have many questions in our comment section. And I think we have covered all of them. So do you have any take-home messages for your viewers?

Yes, in my take-home messages, we must understand first, that sudden cardiac arrest is common. We must understand that sudden cardiac arrest will not just happen to our neighbors. sudden cardiac arrest can affect any of us or our family members. It is our duty to learn basic life support and cardiopulmonary resuscitation so that if any of our loved ones suffer a sudden cardiac arrest, we can come to the rescue. We must recognize that there are certain risk factors that put us at risk of sudden cardiac arrest. The risk factors are if you have diabetes, if you have high blood pressure, if you are smoking, you accidentally consume large amounts of alcohol, or have a high family history of developing heart disease. It is not difficult to act on these risk factors and minimize your risk of sudden cardiac arrest. Those of us who have family members who have already suffered from heart disease, and have a poor pumping of the heart ejection fraction less than 30 to 35%. It is a good idea that you address this to your doctor by asking them if your patient needs the implantable cardioverter-defibrillator. Thank you so much Dr. Aparna Jaswal (Best Cardiologist in India) for being with us. And we will see you shortly with some other topic on another day. Thank you so much. Goodbye.

10/Sep/2021

So hello, everyone, good afternoon, I hope you all are keeping safe at your places. And we all know that COVID is not over yet. And we need to be very careful about COVID. And we should not be careless about it. So we need to take good care of ourselves for preventing ourselves from COVID. So for today, we have a very interesting topic of sudden cardiac arrest with none other than our favorite Dr. Aparna Jaswal just Live, who is the Best Cardiologist Doctor In Delhi and also the Director of cardiologists and electrophysiologist at Fortis Escorts Heart Institute Okhla. So with this, I would like to invite Dr. abundances file for the session of the day.

A topic of discussion for today was that those of us who are engaged in watching sports do realize what happened in euro 2021, with the captain of the Denmark team, Christian Eriksen. And that was scary, those of us who are watching it live. And it is not something which is unusual. And we all talk about it. We all fear it. But it’s a good point that we understand that can I as an individual, understand what happens in sudden cardiac arrest? And can I prevent it? So the format for today that we’ve kept is that Miss Jaya is going to help us with questions that have been posted to her from the viewers. And she’s going to throw those questions at me. And I will try and justify and answer them in the next couple of minutes. So all of us can understand. Should you have any more questions, please feel free to push your questions and we will try and accommodate to our best. And let’s see how it goes on. So hang on, bear with us. And let’s take it forward is jam. Right. So I would like to know what actually the Sudden Cardiac Death is. So if I were to answer what is sudden cardiac arrest, as the name implies, it is a sudden stopping of all biological functions. And what happens is, it stops the heart from beating along with the patient stops breathing and loses consciousness. Now, all of this happened. So suddenly, that it could happen in any sequence, that is the patient could be anywhere out of his boom, obviously, if the patient knew that something like this is going to happen, he would either be in a patient doctor’s clinic or he would be in a hospital. So it is not it does not happen inside the hospitals. We see certain cardiac arrests happening even inside the hospitals, but sudden cardiac arrest is the sudden stopping of the heart function, breathing, and consciousness. That is what encompasses sudden cardiac arrest. And remember, it happens suddenly, it is a bolt out of the blue, it comes unexpectedly. That’s why does a little thing happen.

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Yeah, so what leads to sudden cardiac arrest, as the name implies, is something that is happening Suddenly, there is a sudden change in the electrical function of the heart. As we all know, the heart pumps 6200 times a minute, and we can feel that by our pulse rate. So what is sudden cardiac arrest in sudden cardiac arrest, the heart begins to beat abnormally fast and that is called ventricular fibrillation? Why in the normal sinus rhythm, it was to beat 60 to 100 times a minute. When the patient has a sudden cardiac arrest, the heart beats as much as 250 or more. As a result, the heart is unable to make any effective contraction. Because there is effectual contraction, there is no circulation of blood to the heart, to the brain, to the vital organs of the body, and the individual collapses. So what happened in sudden cardiac arrest is very fast, abnormal B of the heart, which results in ventricular fibrillation and inadequate blood supply to the entire body. Right.

What do you think like, what can be the risk factors of sudden cardiac arrest like can lifestyle reason for this?

So I think that’s a very important question that she brings up that why do people have a sudden cardiac arrest, it is known that it is a very common occurrence. And we must discuss and talk about it, learn about it because we can prevent it, it is as common as one per 1000 per year in the world to have a sudden cardiac arrest. So that’s a very common occurrence. So what is it that causes it in most of the cases, and as much as 80 to 90% of the cases, the cause of sudden cardiac arrest is a disease of the blood vessels of the heart, what we call coronary artery disease or ischemic heart disease. So remember, those of us who have diabetes, have hypertension, or smoking, have a strong family history, lead an identity lifestyle, consume large amounts of salt, and alcohol and five, push ourselves to be at risk of sudden cardiac arrest. Because in those patients, the Meenu is perfect to develop a disease in the blood vessels of the heart. That is called coronary artery disease. So those of us who have risk factors, if we work on our risk factors, we minimize the risk of sudden cardiac arrest. So those are the risk factors that you should remember, if we want to minimize our risk of sudden cardiac arrest, we must act upon the risk factors that we all as adults carry within our bodies, are high blood pressure, high blood sugar, smoking, access, alcohol, sedentary lifestyle, and poor food habits, work on each of these elements in your lifetime, you can minimize your risk of sudden cardiac arrest.

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Thank you have any information. The next question we have for you is like how can someone recognize that he had a sudden cardiac arrest?

So the question is, how can someone recognize that he has had a sudden cardiac arrest? So I think more before we reach them, we have to understand how can one recognize that he is at risk of sudden cardiac arrest? So those of us who are adults, that means not 18? But yes, in the group of those beyond 25 years, and those of us who have risk factors for heart disease, such as hypertension, diabetes, smoking, we know we have disease in the blood vessels of the heart. This is the group that has a risk of sudden cardiac arrest. So we must work aggressively in controlling our risk factors. Coming back to the question that she posed to me, that how can I recognize that I’ve had a sudden cardiac arrest? Well, if we have lifestyle disorders, and if you ever feel that you are going to faint, or you have fainted, and you have revived yourself, it’s a good idea to meet your Doctor Aparna Jaswal Best Heart Specialist In Delhi, let you talk to decide, let your doctor put you through certain tests. And they will tell us that are you at risk of having heart disease? Or if you have heart disease? Are you at risk of sudden cardiac arrest? So the take-home message for this question would be it’s pertinent that you address your lifestyle diseases, connect with your Best Cardiologist Doctor In Delhi and get the tests done, as your doctor advises?

Right? Thank you. Another question we have for you is Can someone recover from sudden particles like it seems a qualifying would like you to know the probability of survival?

Yes. So, at the very outset, you must distinguish that there is sudden cardiac arrest and sudden cardiac death. So when we say that somebody had sudden cardiac arrest, we imply that the individual has actually survived it. If somebody does not survive and dies, it is called sudden cardiac death. To give you a very simple example. And to put it in perspective, those of us who watched Christian Eriksen watching during the match of Denmark, fell down on the ground, and that is what is called sudden cardiac arrest. He lay unconscious, and suddenly, all the medical help came in and revived him. With a shock, he was given a defibrillator shock from a CD, an Automatic External Defibrillator, and he goes revived. So that is called sudden cardiac arrest, but not many have been so fortunate. For example, one name which hits my mind immediately is Mr. Abdul Kalam, all of us are aware that he wasn’t dice and addressing a group of students, and he fainted. He had a sudden cardiac arrest on the dice. However, he was not as lucky and he could not be revived. And that sudden cardiac arrest, because it did not intervene and he could not be revived, it landed up in Sudden Cardiac Death, meaning thereby that when a patient falls unconscious, and if, if it is one of your relatives, and you know that he’s a higher risk candidate means he has diabetes, hypertension is smoker, he already has a certain amount of cardiac illness, it’s a good idea that we all understand that the patient could be at risk of sudden cardiac arrest, and we do the needful. Also, I think our society has come to a point that all of us together, must engage in learning basic life support, if we know the basic life support, if we know what CPR is, we will be able to save several lives by a code by attending to the patient and giving basic life support. Here’s a great article.

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07/Aug/2021

Cardiac Resynchronization Therapy by Best Cardiologist Doctor In Delhi: So your clinical practice, what is the percentage of patients you monitor remotely as far as the heart devices are concerned? So institutionally, between heart failure physicians and the electrophysiologist, I would say it’s about 90% 90 to 95%, are monitored. The challenge across most institutions in the United States is actually trying to determine who’s actually going to follow the data, right. And so there are actually some. So there are some quirks to the billing associated with interrogation of these devices. And so whether we interrogate devices remotely for electrophysiologic parameters, versus hurt failure parameters, those can actually build differently, I see. And they can be actually billed on a monthly basis. And so if one is looking for heart failure parameters that can be billed more frequently, which can be challenging in a healthcare environment, like in the United States, where there are challenges to costs. And I’d imagine more so here, where patients are going to be, you know, I don’t know if their charges are for remote interrogation or how that works domestically.

So It’s a bit complicated here. I would completely agree with you on that. And my question, which I think is very dear to implanting physicians who implant CRT is to reduce the burden of non-responders. So I want to hear from you about three implants post-implant, what is your strategy to reduce the percentage of non-responders, I think the most important thing with regards to non-response with CRT is to pick the right patients. And so truly following the guidelines for patients with optimal guideline-directed therapy for three months, with class two heart failure symptoms, at least, if they have a left bundle and a QRS duration of greater than 150. Those people I usually can say, with some confidence, you’re likely to have a good response to this therapy. For patients whose QRS duration is still with a left bundle is between 120 and 150. I usually will counsel those patients that you may not have a greater response. And particularly with right bundles, I say to them, you know, this is really a decision that you would need to make and we should make that together. So if I can stop you here for continuation in your practice.

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What is the percentage who should have a QRS of more than 150? With IBBB? What is the other?

Yeah, that’s so the ideal patient for CRT implant is a diamond in the rough these days, if they’re very hard to find, typically, most of our patients will end up falling in the 120 to 150 range. And those are, those are difficult conversations to have. Typically, when we talk about CRT implants, we’re hoping most patients are not. They’re interested in extending their lives, but most of what they want is an improvement in quality of life. And so to counsel people on how much benefit they’ll derive from CRT therapy can be quite challenging. And those patients end up being the bulk of our patients. So, we discuss pre-implant Yeah, so pre-implantation, we will discuss with the patient you know, look, this may not be the perfect EKG, you may have some response you may not. And how to assess that response can be challenging as well. Patients. So I’ve had one patient who had several prior attempts at Lv lead implantation, all of which failed, had recurrent hospital heart failure hospitalizations, and was referred for another attempt. So we were able to find a position and when I saw that patient’s back post-implant, he said, You know, I don’t really feel better. But I told you you haven’t been in the hospital in three years. Right. And so how do we temper that perception of what response is right. And so he actually had quite a successful response to, to ob pacing, but didn’t perceive it that way. And so I think part of what we also need to do in speaking with patients has to lead them to expect and what to expect, you know if we start off telling people, you’re going to, you know, three-quarters of the time, you’re going to feel better. That isn’t always, you know, people expect, oh, I’m going to be able to get up and run around, when in fact, that’s not likely to be the case, we may improve somebody from 100, you know, heart failure, class three to two, well, we’re certainly not going to take somebody from three to one. So, and explaining that to patients, having them understand that gain some insight prior to the implant, I think can be very, very helpful. Again, particularly here, where patients are going to be guided by, you know, I have to pay for this device, potentially, knowing which device might benefit them more, and what they’re seeking, in terms of quality of life versus quantity of life, can be potentially very helpful, right? So, in your post-implant.

Cardiac Resynchronization Therapy

What is your Practice in Programming The device? Do You Have The RV Pacing on? Or Do You Like To Do It With Pacing off

I’d like your input on that. So typically, particularly with the current generation Medtronic devices, which will do adaptive pacing, in people who have a normal PR interval, and a prolonged QRS, those devices can be very, very effective in avoiding RV pacing, which as we know, can be deleterious to heart function, and precipitate as much heart failure as, as not pacing or as not, not by V pacing. And so typically, in those devices, I’m very happy to see how much Lv pacing or lb only pacing they’re having, we won’t typically turn off RV pacing. We’ll keep it on for the adaptive element of that. But in other device companies, we tend to have more fusion pacing, more RV and Lv pacing combined. So I think there are some distinct advantages to that, you know, based upon the studies that we’ve seen, there does appear to be a distinct benefit to avoiding RV pacing, but I don’t typically turn off RV pacing in those. So in St. Jude devices or habit devices, they’ll actually sense Lv and sense RV, so one could program those devices, but they don’t have the predictive nature that the adaptive CRT does to track the AV delay and appropriately pace said there’s a fusion between intrinsic RV activation and then the Lv fusion. So that ends up being quite limited to just one device manufacturer, at least for us. Another question, which I’d like to ask you is for the responder rate to increase, would you do an echo-guided optimization for every patient that you implant? Or is it something that is reserved for the subset which does not respond?

So typically, we reserve echo optimization to non-responders. The data on echo optimization is the challenge is just the dynamic nature of people, right? We’re up and moving about. We do eco optimization while people are recumbent. And so it can be quite challenging, but those are usually reserved in our institution for people who will not respond. We are, you know, we’re a research institution where we’re doing pre-procedural MRIs in order to determine both optimal, it helps us determine both the venous anatomy pre-implantation, as well as areas of scar in areas of delayed activation in order to determine what the best size of implant may be. So perhaps that leads to some better responder rates than perhaps otherwise. But in general, we still reserve echo optimization to the non-responder.

Is there any rule of coming back to his bundle? Do you ever think there is a rule of seeing the QRS duration when you do your pacing? Because of what we began to do in our centers, few of us are supposed to be given the dual chamber and we are giving his bundle. Would you like to consider the thickness of the QRS duration at various sites? And then go ahead and do the PC? Yeah,

so the data on that still, there really just isn’t enough data to suggest that pacing in multiple sites is going to be helpful in terms of long-term outcomes. The challenge ends up being that just in terms of doing eco optimization for CRT, you can also do QRS optimization for CRT. And there really isn’t good data for one versus the other and in the same way There isn’t necessarily good data for shorter QRS duration based on pacing, right? So I think the one exception to that ends up being direct is per kanji pacing, right. So if we get into the conduction system when we pace, then that may have long term, long-term benefits. But beyond that, you know, having the QRS look more narrow doesn’t mean that there’s not going to be dyssynchrony. And so I think that ends up being one of the challenges. The other issue ends up being that just because the QRS is narrow, doesn’t mean that depolarization of the ventricle is done in a more synchronous, synchronous fashion, as though it was going through his Purkinje system, there’s lots of evidence to suggest that fibrosis within the ventricle can lead to disparate conduction and disparate and dyssynchrony. And so just because the QRS looks narrow doesn’t mean that lvd polarization or RV depolarization is synchronous. And so I think that makes us feel better. But there’s no evidence to suggest that there’s a long-term benefit to that.

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In the post danish era, how has your practice changed? The reality ends up being I think, for most of us, we still are practicing, you know, in a pre-Danish area. I do for most of my patients, we talk about the advantages of CRT P versus CRT D. And so particularly now the in about February of this year, the US Medicare changed its guidelines, and actually mandated that we have documented shared decision making now or my practice has always been to do a degree of shared decision making with my patients talking about the risks of implant and post, post-implant management of the device and risks of complications. But now we talk a lot more about the benefits of crop versus CRT D and the time differential in terms of longevity between those two, on average, instead of these being just months. Right. So I see.

So I think you would like to speak on AF ablation a bit? We’ll just touch on one subject. One question. Yeah, I think

earlier in the CRT discussion that we had had, there was a lot of we talked specifically about AF ablation in the setting of heart failure. And I think, you know, with the recent publication of castle AF and how that impacts how we manage heart failure in the setting of atrial fibrillation, you know, the challenges with AF ablation in an environment where we’re where we are doing a lot of it. The success rates are not always what we perceive them to be or what we’d hoped they would be. And in particular, in patients with heart failure, those results can be more can be poor. And so I think we still have to approach those patients as long as they have an understanding that I’m going to get a procedure to manage heart failure, and to help me symptomatically that may fail after some period of time, as long as they understand that and are have eyes wide open about that. I think that’s a very reasonable approach. And I’ll be seeing a 30-year-old man with heart failure, he’s developing an F to talk about ablation, in, I think, on Tuesday when I get back to the clinic. And so they’re very, patients are very aware of the fact that the outcomes of ablation are not always perfect. But when you take a young patient who develops a fib and if they’ve been induced cardiomyopathy, for example, those patients would much prefer to manage afib with an invasive approach, rather than putting in a long-term device. And so I think a lot of that depends, so the patient I’ll be seeing next week already has a device implanted device. I’m thinking of another patient who is in his 50s woke up one morning with severe heart failure, was hospitalized for two weeks, and was cardioverted to maintain sinus rhythm, but then his AF was all attacking induced cardiomyopathy. And so he underwent ablation and has been doing quite well. But now anytime his heart rate doesn’t feel quite right to him, he’s quite anxious about the potential for recurrence, particularly of heart failure.

So I think my last question to you would be about left atrial appendage closure devices. So understand that in your clinical practice, how often do you find a patient who cannot offer an old C, and deserves to undergo a left atrial appendage closure.

So the challenges with that are actually quite deep. So just last week in the hospital, I was taking care of a patient that I’d done an appendage closure on two weeks prior that patient had had a bilateral lung transplant, developed atrial fibrillation post lung transplant, which one would think would be quite uncommon, but it happens a fair amount. We implanted the device knowing that she’d had prior bleeding episodes. And we discussed you may bleed after we put this device in because we put people on anticoagulation. And so I was seeing her in the hospital because she’d bled quite a bit. And we talked about what to do. She had an upper examination, a lower examination with no source identified, and she left the hospital on aspirin alone, not ideal anticoagulation. But these patients are not a perfect population. We don’t have good answers for them with anticoagulants with regards to anticoagulation, because almost all of the patients that I’m implanting these devices in have bled already. Yes. And so I discussed with all of them, you know, how are we going to approach anticoagulation post-implantation? And what you know, what do we do if there is recurrent bleeding? So they all understand that there are limitations, there is no perfect, there is no perfect patient for this device. The studies all show that often, patients had more issues with bleeding post-implantation than they may have beforehand until they get off of the anticoagulation. and manage that risk in the long term. determining how best to regulate people, I think is going to be a big problem until we’re doing so ASAP. To is a study that’s being done to evaluate the safety of anticoagulation and what approach should be taken. So we’re that that’s a very important trial, but it’s very, very difficult to enroll patients in the randomization to either continue therapy with current anticoagulation, whatever strategy that may be, or device implantation. Most patients aren’t willing to be randomized to no end or no intervention. They’re not willing to enroll in that study. So the company has had a very difficult time enrolling patients. So but again, I think part of the way to manage that is to have patients understand what is going to happen to them afterward, and what the risks are. So as long as they understand that, you know, as long as we have a therapeutic relationship, I think that it ends up being helpful to them.

So I’d like to thank you very much, Dr. Roy, for being here with us. And look at the book, look forward to meeting you. The next upcoming CSI is in the coming years. Thank you very much, very much.

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