tag:blogger.com,1999:blog-66621782838750918432024-03-12T18:26:47.238-07:00Sarwal Heart iVillage | Best Heart Specialist Surgeon in Chandigarh tricity.A BLOG BY A CARDIAC SURGEON FEATURING ALL ABOUT THE PRACTICE OF CARDIAC SURGERY....INFORMATIVE, INTERACTIVE AND SHARINGDr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.comBlogger20125tag:blogger.com,1999:blog-6662178283875091843.post-33496693471057083372022-05-15T08:05:00.002-07:002022-05-15T08:05:50.583-07:00Starting a new Cardiac Surgery set up <div>The gratification and satisfaction of starting Heart surgery program post COVID was fraught with fears, apprehension and lot of queries in mind last June,2021. The team getting together, making the new management understand the exclusivities of Cardiac Surgery, training of new inductions all posed a big challenge. Today 9 months later looking back and analysing the zero mortality (100% success) achieved so far does look an uphill task but unimaginable too. There was no morbidity too and average length of stay hovered around 5.5 days. We took acute MI Cabgs, CABG +AVRs, poor lv functions and valve replacement surgeries coming to us in failure with saturations of 82%. Whole credit goes to in depth evaluation, stabilisation preoperatively to optimise for surgery, an intense post operative care by the most experienced team. There were sleepless nights to make patients sleep well and go back home in comfort and smiles on their faces.</div><div>I always say Programs are always bigger with teams and not mere buildings. An intentness to treat life and see them as humans surpasses any other expectation and brings laurels to our specialty and the profession.</div><div>Kudos to the team and thank God for His Choicest blessings on us and all my patients who showed faith in this new setup and in challenging times. Just to add one of the patients brother-in-law law of a dear family friend had to be induced in his presence in OT as he was jumping out of table being scared though having tight left main stem Coronary artery disease. But his brother-in-law’s presence worked and today he is a confident man riding the lift alone which he was scared to do preoperatively!! </div><div>#surgery #team #training #covid #success #management #coronaryarterydisease #cabg #sarwalheartsurgery #drsarwal</div>Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-34036150570553661382022-05-15T08:05:00.001-07:002022-05-15T08:05:15.130-07:00Substandard Cardiac Surgery Centres <p dir="ltr">All hospitals including the small nursing home types like HH, MH here in tricity of Chandigarh aspire to have the most prestigious speciality services of Cardiac Surgery with them which is not only highly skill oriented but is very man power intensive if you want to save lives. This is the only speciality which gives you seconds to rescue a life in danger and help needs to be in house 24x7. Recently these over ambitious small setups have spoiled the stature of speciality in encouraging the younger generation Surgeons to work without back ups, on refurbished equipment which thankfully Govt is banning them now, cheap reused disposables just for the sake of operating and inturn earning the meager bucks not bothering whether life will be saved or not. All kinds of unscrupulous means to earn extra money underhand even from Govt schemes are adopted in the name of viability knowing Honble Courts have nothing to offer as a quick relief. Years pass on to get small redressal. <br>
This approach in highly critical and skilled speciality has destroyed the image of the speciality and the profession. Crowds gather on each mortality, police uses force still the show goes on. <br>
NABH approvals have become another farce with hired team and hired equipments to fill the forms for approval.</p>
<p dir="ltr">My question is simple: <br>
Can't the Govt ban or bar these small funny setups from operating this highly skilled speciality or makes it mandatory to provide standardised care at these hospital cum nursing homes? It will go a long way to save many bread winners of the families and save huge avoidable losses of life!<br>
<b>#team</b> <b>#nursing</b> <b>#hospital</b> <b>#hospitals</b> <b>#work</b> <b>#money</b> <b>#power</b> <b>#surgery</b> <b>#cardiacsurgery</b> <b>#heartsurgery</b> <b>#drsarwal</b> <b>#sarwalheartivillage</b> </p>Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-43114966299636624942022-03-09T20:01:00.000-08:002022-03-09T20:01:03.792-08:00End to end Heart care from comfort of patient's homes!<div>Visit us at our new Website:</div><div>www.sarwalheartivillage.com </div><div>Will soon bring to you an all new platform for end to end heart care from the comfort of patient's homes.</div>Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-86074629991315319222013-11-03T06:31:00.002-08:002013-11-03T06:31:49.185-08:0018-yr underprivileged boy from Kashmir gets new lease of life at Max Super Specialty Hospital, Mohali<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="color: red;"><strong>His free cardiac surgery was funded by Max India Foundation</strong></span><br /><strong>CHANDIGARH:</strong> Partially deaf by birth, 18-year old Asif Wani sordid tale of despair and victory is heart rending. The sixth child of a daily laborer, Abdul Azeea Wani, Asif was brought to Max Super Speciality Hospital, Mohali with complaints of breathlessness and palpitation.</h2>
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He was diagnosed with complex birth heart defects multiple conditions of Atrial septal defect, PDA and severe Pulmonary Stenosis (Congenital disorder) comprising of hole in the upper chambers of the heart, along with a flowing channel between main artery of the body and artery feeding the lungs which normally closes soon after birth. The surgery that saved the life of this innocent teenager was not only complex from the medical point of view but also gave a new lease of life to the hapless boy.<br />
Asif’s mother Zareefa Bano was speechless with gratitude as her son narrated the story of their strife to get treatment for their son. Asif had been diagnosed with the multiple congenital heart defects as early as 2 months of his birth. His parents took him to the local doctors at Srinagar but were turned away due to lack of funds. Even the best hospital in Srinagar refused free treatment to the boy. The procedure to save him, the family was told, would cost lakhs of rupees, which was impossible for the destitute daily wager to collect. Through a common acquaintance, Max India Foundation took up the case and Asif was successfully operated upon by Dr. Virendar Sarwal, Senior Consultant, Cardiology at Max Super Speciality Hospital Mohali. The 5-hour surgery involved one week of post operative care under expert supervision of critical care experts.<br />
Belonging to an obscure little village Handwara in the far reaches of Kupwara Distt about 10-12 Kms from LOC, Asif’s parents were devastated when they realized that he was suffering from congenital heart disease. Asif was advised immediate surgery. Helpless and penniless, Asif and his family were in a dilemma as to how they would bear the cost of such an expensive surgery. It was then that he was referred to Dr Sarwal, who volunteered to take up his case. Since Asif belonged to a poor family and his parents could not afford the expensive treatment, an acquaintance, who had been helping the family since last 2 years in arranging funds, approached Max India Foundation for financial assistance. Max India Foundation decided to help the young boy by bearing the entire cost of surgery and offering him world class medical treatment at Max Super Speciality Hospital.<br />
Ever since Abdul Azeea Wani, Asi’s father lost his eyesight 5-6 years back, Asif’s mother has been working as a labourer on a meager daily wage with no other source of income. We have been running from pillar to post for 2 years but all efforts to secure funds for the surgery bore no fruit. Our fellow villagers managed to gather Rs 16000 for our travel and stay once they came to know that Max Hospital was helping us, said .<br />
Dr. Sarwal said that since these were birth defects, these were high risk surgeries. Asif lungs had developed early hypertensive changes and it was a long on pump surgery because of three congenital defects. His pulmonary valve was too small for his age. Asif underwent intracardiac repair on Cardiopulmonary bypass at Max Super Speciality Hospital on October 14 and soon recuperated. He would be requiring regular medication to support his heart condition.<br />
For the past 18 years, my world was full of just pain and helplessness, said an emotional Asif, while expressing gratitude towards Max India Foundation for their support With this crippling disease, all I could do was sit or lie down on my bed and take a few faltering, painful steps to go to the toilet. It was a very depressing state of affairs for my family and me and many times I would wonder what was the point of existing like this, he remarked.<br />
Ms Mohini Daljeet Singh, Head, Max India Foundation said that living up to our social responsibility of an integral part of the core philosophy of Max India Foundation, we were very glad that we have been able to get an opportunity to serve the needy. We would continue doing so in the times to come with sincerity and passion, she asserted.<br />
It may be mentioned here that under various CSR programs like immunization, health awareness and health camps, artificial limbs camp, palliative care for cancer patients, Max India Foundation has now crossed the 1435 free and subsidized surgeries mark. Over 477147 people have benefitted from the various CSR programmes of Max India Foundation till now.<br />
Dr. Ashutosh Sood, GM operations at Max Super Speciality Hospital Mohali said that this whole package bearing cost of Rs 2 lacs, was done entirely free of cost. However, it was well worth it because today Asif presented a heartwarming sight. Having recovered very well, he was up and about, talking and playing like a normal teenager.. The joy on his face was priceless and nothing compared to the satisfaction of having helped tears turn into smiles, remarked Dr Sood.</div>
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Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-11197058588734679272013-09-08T06:10:00.000-07:002021-12-28T16:10:35.431-08:00High risk Octogenarian successfully treated for Coronary Artery Disease with Beating Heart Bypass Surgery successfully <div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><i><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">Patient presented with critically blocked and calcified heart vessels which are difficult to tackle surgically</span></i></div>
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<span style="font-family: Symbol; font-size: 12pt; line-height: 150%;"><span>·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><i><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;">Off Pump Coronary Artery Bypass (OPCAB) or Beating Heart Bypass Surgery is a safe and proven option for bypass surgery in elderly patients</span></i><i><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 150%;"></span></i></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt;"> </span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt;">3<sup>rd</sup> September, Mohali: Elderly patients, compared with patients of a younger age group, present for surgery with a greater burden of risk factors and reduced functional levels. Short</span><span lang="EN" style="font-size: 12pt;">‐</span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt;">term outcomes are hence poorer in them. But symptomatic relief occurs in most patients and is accompanied by excellent rates of long</span><span lang="EN" style="font-size: 12pt;">‐</span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt;">term survival and a good quality of life when treated with beating heart surgery. </span> <span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Max super speciality Hospital Mohali recently treated an 84 year old male, Ramnarayan, who had his all three major heart arteries critically blocked. Along with this complication, the major arteries going to his brain were also blocked on both sides by 90% and 60%. The main artery on the left side of the heart (called left main ) was having 90% stenosis- in such critical conditions, bypass surgery becomes an urgent requirement. Also other three arteries, two on the left and one on right side were also blocked by 90% and 99%.</span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt;">“He was very symptomatic” avers <b>Dr Virendar Sarwal, Principal Consultant and Chief of Cardiac Surgery,</b> his treating physician “Ramanarayan was offered high risk bypass surgery on beating heart at the time of angiography because of his age. In octogenarians, the risk to life becomes very high as all organs of the body are aging due to wear and tear. Reserves are substantially low which make it difficult for the body to undertake the stress of surgery.”</span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Ramnarayan decided to take some time off and went home but had to get readmitted twice in the next 10 days because of severe heart symptoms. The family accepted the high risk involved and the medical team collectively decided to work him up for surgery. “For this category of patients beating heart surgery which is now an established technique serves as very good option . </span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 12pt;">But, an individualized risk–benefit profile must be carefully constructed by clinicians, taking into account several different factors and not just age alone.</span><span style="font-family: "Arial","sans-serif"; font-size: 12pt;"></span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt;">On investigations, it was found that Ramnarayan’s both carotid arteries (supplying blood to the brain) were also critically blocked and we had to take extra care to avoid brain damage during surgery especially because of acute blood pressure variations. His CT scan had dilated lateral ventricles and cerebral atrophy. As there was no evidence of any major stroke we decided to go ahead with beating heart bypass by taking special precautions in the OT. Three grafts were given to him on beating heart by using octopus stabilizer and maintained higher blood pressure intra operatively.”</span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Ramnarayan was fully mobilized on 3rd day and discharged from the hospital on 5th day.</span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Discussing the advantages of </span><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 12pt;">off pump coronary artery bypass (OPCAB) or beating heart Bypass surgery as it is commonly called, Dr Sarwal said “ OPCAB is though technically demanding is a safe and prove option for high risk bypass surgery. Doing surgery on a beating heart eliminates the need for heart lung machine, results in fewer side effects. Some potential benefits of beating heart surgery are lower risk of stroke, fewer problems with memory loss and thinking skills, reduced injury to the heart, fewer heart rhythm problems and shorter hospital stay, less ICU stay and less usager of blood. Long term success of OPCAB includes improvement or complete relief of their symptoms and being symptom-free for several years. They may recover from surgery more quickly than those who go "on pump" and they may suffer from fewer post-operative complications.”</span></div>
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Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-74152423903632758052013-04-30T05:07:00.001-07:002021-12-28T16:11:06.667-08:00FAILURE TO THRIVE, ONE YEAR, 6 KGS POST VP SHUNT FOR HYDROCEPHALUS AND ON ANTI TUBERCULOSIS TREATMENT OPERATED FOR VSD CLOSURE on pump.<div dir="ltr" style="text-align: left;" trbidi="on">
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Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-57644883981106332002013-04-30T05:00:00.000-07:002013-04-30T05:00:40.657-07:00Max Hospital, Mohali helps save life of a critically ill Poor Patient with Life Saving Heart Surgery<div dir="ltr" style="text-align: left;" trbidi="on">
<span lang="EN-US" style="font-size: 16pt;">RP a 31years old gentleman presented to max hospital, Mohali with acute
breathlessness, vomiting for last four days. He was having this problem for the
last one years and was in the follow up of another hospital where he was
diagnosed to be having leakage of both the major valves of heart<span style="mso-spacerun: yes;"> </span>following fever and cough with expectation.
For the last four days even he was not able to lie down flat in the bed because
of severe breathlessness and heart failure. His liver was severely enlarged and
his echo cardiograph showed <span style="mso-spacerun: yes;"> </span>a dilated
heart with severe leakage of one valve and moderate leakage in the other with a
hole in the leaflet of one of the valve (aortic valve) with sign of vegetation <span style="mso-spacerun: yes;"> </span>on it. He was on medical treatment with the
other Institute before getting admitted under Dr Anurag Sharma Sr. Consultant Cardiology.
He was put on decongestive treatment and echo here showed ruptured leaflet of
aortic valve with severe leakage and liver was congested with fluid in the
lungs. After two days of his treatment he was planned for valve replacement
surgery .As he started responding to medical treatment he was shifted to the ward
from ICU but as he was poor and was not able to afford surgical treatment which
was required urgently for him, Max Hospital, Mohali decided to arrange finance
for him through Max India foundation and they very graciously <span style="mso-spacerun: yes;"> </span>arranged 1.2 lakh for him for the surgery with
further contribution from the hospital. But a day later his condition worsened
and he went into shock state because of congestive heart failure with his heart
rate dropped to 30/per mint. His urine output also dropped and he went into
renal shutdown. He was shifted back to ICU and had to be put on ventilator as
an emergency and drugs started to maintain his B.P. Next day his condition
improved and he started stabilizing under Doctor Anurag Sharma and this
team.<span style="mso-spacerun: yes;"> </span>With great efforts again he stabilized
and was removed<span style="mso-spacerun: yes;"> </span>from the ventilator<span style="mso-spacerun: yes;"> </span>but still was<span style="mso-spacerun: yes;">
</span>on medication to support his heart. After five days of aggressive
treatment he was weaned of from all drugs but his liver functions were still
deranged. As there was no other alternative he was planned for emergency
surgery requiring replacement of both the valves as his echo showed second
valve also leaking severely after this episode. <span style="mso-spacerun: yes;"> </span>The case was renewed by Dr. Virendar Sarwal,
In charge of Cardiac Surgery and his team and<span style="mso-spacerun: yes;">
</span>a request for more funds was made to Max India foundation<span style="mso-spacerun: yes;"> </span>and additional money was sanctioned for him.
After four days of more stabilization and with improvement in liver functions
he was taken for surgery with a plan to change the ruptured aortic valve and
repair of <span style="mso-spacerun: yes;"> </span>the mitral valve. On Trans
Esophageal echo cardiograph in O.T it <span style="mso-spacerun: yes;"> </span>was observed that the leakage in mitral valve
is due to jet of leakage of the aortic valve and as such mitral valve was normal.
Other factor for the leakage of this valve was dilated left chamber of<span style="mso-spacerun: yes;"> </span>the heart. So it was planned that with the
change of aortic valve the leakage of mitral will go down because the jet from
aortic valve will disappear and dilatation of chamber will also go down. Under
cardiopulmonary bypass his aortic valve was changed with a 22 sized mechanical
valve by a team composing of<span style="mso-spacerun: yes;"> </span>Dr.Virendar
Sarwal, Incharge dept. of CTVS, Dr.Ajay Sinha, Cardiac Anesthesia,</span><b><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 16pt;"> </span></b><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 16pt; mso-bidi-font-weight: bold;">Dr. Aratatran Nahak , Dr Goswami, Dr Deepak Oberoi,<span style="mso-spacerun: yes;"> </span>and Dr Rajit </span><span lang="EN-US" style="font-size: 16pt;">and after coming off CPB, TEE was done again which
showed disappearance of the leakage of the other valve.He was shifted to ICU
with moderate inotropics support and was weaned off from ventilator next day. He
progressed very well in his post operative period and was discharge on the 5<sup>th</sup>
day from the hospital in a very stable condition. On first<span style="mso-spacerun: yes;"> </span>follow up he is doing very well back to
normal life after about a month of hospitalization and stormy course which could
have been life threatening for him. Thanks to the untiring efforts of the whole
team and a big help from Max India Foundation he is alive today.<o:p></o:p></span></div>
Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-67820832501612557592013-03-29T10:49:00.002-07:002021-12-28T16:11:38.346-08:00 Adding years to your Heart….Life beyond Heart surgery<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Calibri;"><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">Heart is the most important
organ of body to sustain life….Adding life to heart means adding years to
Life!” To <span style="mso-bidi-font-weight: bold;">Add life to your Heart now
there is an Age-By-Age Guide <b><span style="mso-spacerun: yes;"> </span>which
help in bringing </b></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;">Small Changes, Big Results <o:p></o:p></span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Every 39 seconds in the United
States, someone dies from cardiovascular disease, according to the American
Heart Association (AHA). Most of those deaths are completely preventable by
working with your doctor to understand your own personal risks for heart
disease, and then making a few changes in your health habits to lower those
risks. The best health habits are those you adopt when you’re young and
continue throughout your life, but it’s never too late to make changes that can
protect your heart and help you live a happier, healthier life overall. Here,
an age-by-age guide to getting -- and keeping -- a healthy heart.</span></span></b></div>
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</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">In Your 20s: Drink Water</span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Coming out of your teens, you may regularly drink soda, sports drinks or
big glasses of juice. Switching at least one or two of these drinks a day to
water will not only save you money, it may also save your heart. These drinks
are the number one source of added sugar in the diet. The AHA recommends that
women consume no more than 100 calories (6 teaspoons) of added sugar per day,
and men no more than 150 calories (9 teaspoons). A single 12-ounce soft drink
contains 130 calories, or about 8 teaspoons. Studies show that people who get a
lot of their calories from added sugars often don’t consume enough fiber,
calcium, iron, zinc and vitamin A in their diets. What’s more, drinking your
“discretionary calories” is less satisfying than eating them, so you’re more
likely to overeat, which may put you on the path to being overweight, having
high blood pressure and being at higher risk for diabetes -- all dangers to
your heart. If plain water is just too, well, plain, squirt a lemon or lime in
it, drink seltzer or brew up some unsweetened iced tea.<o:p></o:p></span></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">In Your 20s: Find a Better Stress
Reliever</span></b></span></div>
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<b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Now is the time to switch your bad habits to good ones. If you started
smoking cigarettes as a way to fit in and look cool in your teens, and in your
20s you’re doing it to reduce stress, stopping smoking is the number one thing
you can do for your heart. “People who smoke in their 20s and continue for the
rest of their lives die on average 12 to 14 years younger than non smokers.
“However, it’s easier to quit smoking in your 20s than it is later in life,
because the habit is less ingrained. Any form of exercise is a better stress
reducer than smoking, but people in their 20s might want to take advantage of
their natural flexibility and try yoga.”<o:p></o:p></span></span></b></div>
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<span style="font-family: Symbol; font-size: 14pt; line-height: 200%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: +mj-ea;">In Your 20s: Learn Your
Family History</span></b><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></b></div>
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<b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Now is the time to fill in the leaves on your family health tree. Talk
to your parents and other relatives to find out what medical conditions run in
your family. Although most people in their 20s aren’t at imminent risk of heart
attack or stroke, your risks of these conditions might be much higher if a
close relative experienced them at an early age. If your father had a heart
attack before age 55 or your mother had one before age 65, or even if a
grandparent, uncle or aunt had a heart attack or stroke at these young ages,
you may be at increased risk and need to be doing everything possible now to
protect your heart. You should also have your blood pressure checked every two
years starting at age 18<o:p></o:p></span></span></b></div>
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<span style="font-family: Symbol; font-size: 14pt; line-height: 200%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: +mj-ea;">In Your 30s: Set
Post-Pregnancy Exercise Goals</span></b><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></b></div>
<br />
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<b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">These are prime weight-gaining years, especially if you are experiencing
pregnancies. “Women get into a vicious cycle,”<span style="mso-spacerun: yes;">
</span>“They’ll have a baby, gain 40 pounds and lose five. They’ll have another
baby, gain 40 pounds and lose 10, and then by the end of their 30s, they turn
around and they’ve gained 90 pounds. The 30s are when many women start taking
care of everyone but themselves, but these are important years to keep weight
under control, and it’s easier to lose weight in your 30s than when your
metabolism starts slowing down in your 40s.” Set exercise goals to help you
lose your excess weight between pregnancies. Purchase a baby jogger and jog
every day. Set a goal to participate in a charity walk in a couple of months
and start walking every day. In other words, move more in any way you can.</span></span></b><b><span style="color: black; font-family: "Arial","sans-serif"; font-size: 32pt; line-height: 200%; mso-bidi-font-family: +mj-cs; mso-fareast-font-family: +mj-ea;"> </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">In Your 30s: Do Something You Love
Every Day</span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">“Whatever activity makes you feel really good inside, make sure you do
it for at least 15 or 20 minutes every day.”<span style="mso-spacerun: yes;">
</span>“For some people it might be meditation, for others it’s running, and for
others it may be reading. Whatever relaxes and restores you, carve out time
each day to do it and it could become a habit for life.<o:p></o:p></span></span></b></div>
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<span style="font-family: Symbol; font-size: 14pt; line-height: 200%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: +mj-ea;">In Your 30s: Know Your
Numbers</span></b><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></b></div>
<br />
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<b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">By now you should be familiar with your “three Bs”: your body mass
index, blood pressure and blood cholesterol. If any of your numbers are not in
the target ranges for heart health, talk to your doctor about changes you can
make to improve them. Here are the numbers you should aim for, according to the
AHA:<br />
-- Blood pressure: Less than 130/80 mm Hg.<br />
-- Blood cholesterol: LDL (low-density lipoproteins, or “lousy cholesterol”)
below 100 mg/dL; HDL (high-density lipoprotein, or “healthy cholesterol”) above
40 mg/dL for men and above 50 mg/dL for women;<br />
-- Triglycerides: Below 150 mg/dL.<br />
-- Body mass index: Healthy range is 18.6 to 24.9, with a waistline smaller
than 35 inches for women, 40 inches for men.</span></span></b></div>
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<span style="font-family: Symbol; font-size: 14pt; line-height: 200%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: +mj-ea;">Your 40s: Weight Train</span></b><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></b></div>
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<b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">“For women, the 40s are when your body starts losing a lot of its lean
muscle tissue and metabolism slows, making you more likely to gain
weight,”<span style="mso-spacerun: yes;"> </span>“The AHA recommends women
weight train at least two times a week, which can keep your metabolism up,
strengthen your bones and help you look and feel great as you start heading
toward menopause.”<o:p></o:p></span></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">In Your 40s: Nurture Your Relationships</span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
<br />
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<b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">“By the time you’re in your 40s, you realize how important relationships
become in helping you get through difficult times and in helping encourage you
to make healthy choices in your life.”“If you haven’t already done it, now is
the time to create and nurture that network of support around you. Research
shows that people who are isolated in their 50s and 60s have more health
problems than those who are surrounded by people who care about them.” Spend
time with people you love and care about, whether it’s your spouse, children,
siblings, friends, fellow members or other loved ones.</span></span></b></div>
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<span style="font-family: Symbol; font-size: 14pt; line-height: 200%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: +mj-ea;">In Your 40s: Add
Another Number</span></b><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></b></div>
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<b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">The
AHA recommends having your blood glucose (sugar) level checked every three
years beginning at age 45 to help monitor your risks for diabetes and heart
disease. The recommended level on a fasting blood glucose test is less than 100
mg/dL. If yours is higher, talk to your doctor about ways to lower your risk
for diabetes.<o:p></o:p></span></span></b></div>
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<span style="font-family: Symbol; font-size: 14pt; line-height: 200%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: +mj-ea;">In Your 50s: Rethink
When You Eat</span></b><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></b></div>
<br />
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<b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">The often-repeated advice to eat breakfast like a king, lunch like a
prince and dinner like a pauper is especially true as you age into your 50s and
beyond. “Most people need to eat fewer calories overall when they hit their
50s, and it’s best to eat most of your calories earlier in the day and not be
locked into the idea that you need three big meals a day.” “You need calories
early in the day to rev up your metabolism and give you energy for the things
you need to do, and it’s fine to have a good-sized meal at lunchtime, but
eating a lot in the evening may interfere with your sleep as your body works to
digest the food. Most people in their 50s </span></span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">don’t need a lot of calories for the activities they do at night. Those
extra calories that aren’t burned off just contribute to weight gain.”<o:p></o:p></span></span></b></div>
<br />
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<span style="font-family: Symbol; font-size: 14pt; line-height: 200%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: +mj-ea;">In Your 50s: Volunteer</span></b><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></b></div>
<br />
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<b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">In your 20s and 30s, there tends to be a lot to be excited about --
marriage, babies being born, careers taking off. By the time you reach your
50s, those big life events may be in your past, and you may instead be facing
an empty nest, parents who are dying or already gone and the denouement of your
career. “Volunteering is a great way to bring more positives into your life.”
“Whether it’s by starting a new group related to a cause you care about or
helping out someone in your community, having something that you’re committed
to can have a very positive impact on your life.”<o:p></o:p></span></span></b></div>
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<span style="font-family: Symbol; font-size: 14pt; line-height: 200%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: +mj-ea;">In Your 50s: Get
Screened</span></b><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></b></div>
<br />
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<b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">The National Osteoporosis Foundation recommends a bone mineral density
test after age 50 if you have risk factors such as being menopausal or having a
family history of osteoporosis. Although not directly related to your heart,
“conditions that predispose to osteoporosis also predispose to </span></span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">heart disease -- namely, inactivity and poor diet,”<span style="mso-spacerun: yes;"> </span>A bone mineral density test may pick up
thinning bone problems that could predispose you to falls. If you fall, you may
not be able to exercise for a while, which could set you up for weight gain and
health problems. Strong bones help you have a strong heart.<o:p></o:p></span></span></b></div>
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<span style="font-family: Symbol; font-size: 14pt; line-height: 200%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: +mj-ea;">In Your 60s and Over:
Adjust Your Exercise to Accommodate Your Body</span></b><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></b></div>
<br />
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<b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">It’s important to maintain the momentum that you built up in your 30s,
40s and 50s. If you continue to be active into your senior years, your heart
will look and act younger. In their 60s, some people start experiencing issues
like arthritis and back pain, and you may have to switch from running to
walking or from tennis to water aerobics. Find what works for you and keep
doing it. Continue strength training twice a week, too. It will help you to
maintain your lean body mass.</span></span></b><b><span style="color: black; font-family: "Arial","sans-serif"; font-size: 44pt; line-height: 200%; mso-bidi-font-family: +mj-cs; mso-fareast-font-family: +mj-ea;"> <span lang="EN-US"><o:p></o:p></span></span></b></div>
<br />
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<span style="font-family: Symbol; font-size: 14pt; line-height: 200%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: +mj-ea;">In Your 60s and Over:
Take Up Yoga</span></b><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></b></div>
<br />
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<b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Studies show that yoga not only helps you de-stress, it helps to prevent
balance problems that can lead to falls in your later years. It also helps </span></span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">reduce pain if you have any chronic conditions, and improves sleep, all
of which are good for your heart,”<o:p></o:p></span></span></b></div>
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<span style="font-family: Symbol; font-size: 14pt; line-height: 200%; mso-bidi-font-family: Symbol; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: +mj-ea;">In Your 60s and Over:
Get Talking</span></b><b><span style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 12.0pt;"><o:p></o:p></span></b></div>
<br />
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<b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Call
your doctor at the first sign of any unusual symptom, even if you don’t think
it’s serious. “In terms of heart disease, symptoms including chest pressure,
tightness in your jaw, profound fatigue and shortness of breath with activity
all may indicate heart problems.”<span style="mso-spacerun: yes;"> </span>Your
doctor may recommend more detailed screening to assess your risks, and, if
necessary, treatment to help you live a longer, healthier life<o:p></o:p></span></span></b></div>
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<b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Add
Years to Your Life by new ways to protect against heart disease:<o:p></o:p></span></span></b></div>
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</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Spice Up Your Meals..Indian
masalas are full of antioxidants<o:p></o:p></span></span></b></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Eat a Handful of Nuts Daily<o:p></o:p></span></span></b></div>
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</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Eat Fruit -- Especially Kiwis
The kiwi’s lutein -- a plant compound that helps artery walls stay relaxed --
keeps your blood pressure down even when your stress levels climb.</span></span></b></div>
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</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Hang Out with a Friend.. The
Cleveland Clinic research suggests that nurturing a couple of solid friendships
can cut your risk of heart disease by 40 percent…But No FB<o:p></o:p></span></span></b></div>
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</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Eat Your Snack Mid-Afternoon..
Just trimming your waistline so it measures 34 inches or less -- even if you’re
nowhere near your goal weight -- will cut your risk of heart disease by 72
percent. “Other fat stores -- like the stuff that gives people curvy hips and
thighs -- just take up space, but belly fat produces a steady stream of
heart-damaging inflammation,”<o:p></o:p></span></span></b></div>
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</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Take Fish Oil Daily..Hundreds
of studies document fish oil’s heart-protecting powers: Its omega-3 fats lower
your liver’s production of triglycerides .<o:p></o:p></span></span></b></div>
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</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Eat a Hearty Breakfast…Recent
research shows moving most of your daily fat into your morning meal (and saving
carbs for later in the day) reduces your production of artery-clogging
triglycerides and prevents blood sugar surges -- two huge risk factors for
heart disease. Eating fat first thing in the morning switches on your body’s
natural ability to properly burn and </span></span></b><span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;"><span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">use all types of food -- so
that far less of it ends up clogging your arteries and damaging your heart.<o:p></o:p></span></span></b></div>
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</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Consider an Air Purifier..If
you struggle with bad allergies to dust, mold or dander, getting your symptoms
under control could cut your risk of heart disease by 30 percent or more.<o:p></o:p></span></span></b></div>
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</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Tidy Up Your Home..Staying fit
by getting roughly 30 minutes of light exercise daily can cut your risk of
heart disease in half because exercise raises your production of
artery-clearing HDL cholesterol by 10 percent or more. And you don’t have to
lace up your sneakers to get this great health perk. In a surprising new study,
the fittest women weren’t the ones exercising outdoors -- they were the ones
with the cleanest houses!<o:p></o:p></span></span></b></div>
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</span></span></span><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Sip Green Tea/Hibiscus Tea..When
folks with heart-damaging high blood pressure sip 24 ounces of Green/Hibiscus
tea daily, their pressure readings can plunge 13 points in six weeks. That
makes this flavorful brew as powerful as ACE Inhibitors, a class of
prescription drugs used to lower blood pressure</span></span></b></div>
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<b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;"><span style="font-family: Calibri;">Another
important factor is Stress as a risk factor towards heart disease. How One Can
Make Intensive Changes to Manage Stress?<o:p></o:p></span></span></b></div>
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</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">Try directed breathing. Practice
inhaling slowly and filling your belly, then exhaling and drawing your belly
button toward your spine. You can also learn three-part breathing. Take in air
smoothly, as a flowing inhalation from your abdomen, then your chest, and then
your throat. Reverse the process as you exhale. </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">Meditate. If you meditate daily,
you will learn to focus on the present moment. Most people who meditate do so
twice a day. When you concentrate on your breath or on a candle flame, for
example, you clear your mind of thoughts and feelings that may get in the way
of relaxation. </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">Pray. Prayer allows you to turn
your problems over to a higher power. When you trust in your faith, you realize
that you may be guided by something bigger than yourself. This belief may help
you to stick with your intensive lifestyle changes. </span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">Try progressive muscle relaxation.
This is a series of exercises that teach you to first tense and then relax your
muscle groups. Starting with your toes and feet, work your way up, stopping at
each body part. First tighten them, then relax them. </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">Stretch. You may do any activity
that gently extends the range of your muscles, tendons, and ligaments. You can
start with these three moves. Raise your arms way above your head. Bend over,
with your knees slightly bent, and reach for the ground so you feel a gentle
stretch from your neck to your heels. Shrug your shoulders. </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">Use visualization. This technique
teaches you how to use your imagination to help reduce stress. You focus on a
positive experience you have had or would like to have. For instance, visualize
yourself on a beach. See the sun, hear the waves, feel the salty air on your
skin. Or pick any time or place where you were truly relaxed and your breathing
was calm. You can use this mental experience to achieve a new kind of peace. </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">Try yoga. This ancient Indian
practice involves breathing, relaxation, and stretching in a series of
postures. </span></b></span></div>
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<span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">If
you have heart disease, a program of rehabilitation that is supervised by
healthcare providers may help you do the following: </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">increase your ability to engage in
activity </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">decrease your symptoms, such as
chest pain, breathlessness, and fatigue </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">improve your blood cholesterol
levels </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">get help to quit smoking, if you
smoke </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">reduce stress </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">improve your psychological outlook </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">reduce your risk of death from
heart disease </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">Our
country is slowly witnessing a <span style="mso-spacerun: yes;"> </span>cardiac
rehabilitation program which is a program designed to support you. Rehab staff
work with you to: </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">improve your diet </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">increase your exercise </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">change other habits that affect
your heart </span></b></span></div>
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<span style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt; mso-bidi-font-weight: bold; mso-fareast-font-family: "Times New Roman";"><span style="mso-list: Ignore;">•<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><span style="font-family: Calibri;"><b><span lang="EN-US" style="font-size: 14pt; line-height: 200%; mso-bidi-font-size: 11.0pt;">Healthcare providers trained to
help you in these areas supervise the program. Cardiac rehab is meant to help
you recover faster and return to a full, active life. This is true whether you
have had a heart attack or heart surgery. It can also help if you've had
another procedure, such as bypass surgery. </span></b><b><span style="font-size: 14pt; line-height: 200%; mso-ansi-language: EN-IN; mso-bidi-font-size: 11.0pt;"><o:p></o:p></span></b></span></div>
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Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-69435921308264011272013-01-22T10:54:00.000-08:002013-01-22T10:56:52.514-08:00Affordable healthcare only possible with value based medicine<div dir="ltr" style="text-align: left;" trbidi="on">
<span class="desc2"> </span>India is a developing country and 80 per cent of the population of our country cannot afford expensive healthcare. The facilities provided by the government are miniscule in front of the giant problem. Shortage of doctors, basic infrastructure, paramedical staff and expensive medicines makes healthcare even more out of reach for a common man. That is the reason we are still struggling with the certain communicable diseases and now added to that is the burden of non-communicable diseases.<span id="more-15865"></span><br />
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<div class="wp-caption alignright" style="width: 210px;">
<img alt="" height="400" src="http://www.aalatimes.com/wp-content/uploads/2012/10/Dr-Virendar-Sarwal.jpg" title="Dr Virendar Sarwal" width="200" /><br />
<div class="wp-caption-text">
Dr Virendar Sarwal</div>
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India is going to be the world capital for heart disease in 2030 as per the WHO report. Diabetes is rampant and there is total lack of awareness about prevention, lifestyle management, hygiene levels, sanitation and the healthy living with the result that we have huge load of patients whether it is communicable or non-communicable disease. Added to it is the shortage of manpower to treat these patients.<br />
As per one study, our country has only 20 doctors per 10,000 people as compared to 650/10,000 in US. The budgetary provisions for healthcare are so low that even the primary healthcare cannot be delivered efficiently with the result the rural population is the worst sufferers. That is how there is mushrooming of quacks and invaluable lives are at risk.<br />
In such a dismal scenario only alternative to improve upon the services and make each step in healthcare delivery more justified and economical, if we look at an evolving healthcare delivery system all over the world and even in developed countries like US, is Valve Based Medicine. So far, we have been practicing Evidence Based Medicine where in based on the evidence of the disease, we treat it with the costliest way of treatment. It ignores the logic of benefit vs cost ratio whether it is concerned with writing costly medicines or adopting the costliest intervention.<br />
The value based medicine concept is different from the evidence based medicine concept in the sense that we are treating human beings and not symptoms. The treatment plan has to be based on the effective control of the disease with respect to the perception of the patient and his family in terms of benefit as compared to the cost involved in it.<br />
Let’s say in heart disease a patient having coronary artery disease in two or three vessels can be treated with bypass surgery as well as ballooning and stenting. Now, whereas stents will cost him a big money and will also not be durable so bypass surgery becomes more economical and more durable. What the patient wants here is effective quality of life improvement with an economical and durable procedure. So, of course, bypass surgery is the best answer here. Similarly, a sore throat can be effectively treated with low-end antibiotic treatment and supportive therapy instead of expensive and high-end antibiotics.<br />
Value based medicine is a means to compare all healthcare interventions on the same scale and a measure that can be combined with the cost of an intervention to arrive at a cost utility ratio. It provides most effective assessment of the patient perceived worth of an intervention. It also measures quality of life and/or length of life. The irony of healthcare industry is that it is one of the few industries where purchasers or the patients are unable to measure the valve of what they purchase.<br />
So, value based medicine allows highest quality care, maximization of healthcare rupee and incorporation of patient based perception of quality of life. The goal of value based medicine is to promote what is best for the most important people in healthcare i.e. patients. It provides transparency backed by scientific opinion, communication by personal attention, no scare or fear by involving empathy, economics and 24×7 availability.<br />
Similarly, if we come to procedures, the beating heart surgery is value based medicine. Minimal invasive surgery goes a step further in that direction as it makes the patient up and about early and the patient does not lose productive days of earning and is back to work at the earliest with less stress on the body. Also, in terms of logistics there is less ICU stay, less hospital stay, less use of blood products. Value based medicine also incorporates all the forthcoming evidence which is percolated to the patient level and helps in decision making for the patients.<br />
Now, coming to stent vs surgery, two major trials — one in 2009 Syntax trial and the other in November 2012 Freedom trail — have clearly established and concluded that in multi-vessel disease and diabetes, bypass surgery scores over drug coated stents in terms of death, second heart attack and second or repeat intervention. So, all patients with multi-vessel disease should be offered bypass surgery as the first option for durable economical treatment.<br />
In this scenario, value based medicine (VBM) stipulates that when it come to coronary artery disease each and every patient should meet the surgeon with his angiography report to reach to a conclusion whether he needs to go for stents or surgery. The other thing, which our country needs to incorporate into VBM is the availability of cost effective medicines, disposables and equipment. Most of the equipments, disposables used in high-end surgeries is still being imported and thereby making huge loss and leading to escalation of prices of these essentials.<br />
The government has to encourage use of generic drugs, which should be free and easily available and encourage manufacture of disposables and equipments in our own country. It will do away the huge profit margin taken by the multinational companies when the middlemen and dealers add to the cost. There are very innovative products available in India and effort should be done to produce them at mass level and promote them at all levels. In fact, all hospitals should be told to use them as the first priority.<br />
The infrastructural resources for the primary, secondary and tertiary healthcare delivery are very less so a policy needs to be made wherein the government and the private sectors should join hands in making the total available infrastructure at the disposal of all the patient population group. There should not be any differentiation and all available beds should be utilized to the maximum by one and all. It will help in reducing the waiting list and huge queues seen in government hospitals today. All it needs is rationalization of compensation to the private sector.<br />
Today also many government agencies are utilizing the private resources for tertiary care by reimbursing them the subsidized cost of treatment. Why can’t it be applied to the primary and secondary care? The public private partnership (PPP) is another good concept of upgrading and bringing secondary and tertiary care in all cities and rural areas.<br />
To promote healthcare delivery in rural areas the doctor should be encouraged by arranging for them good housing and transport facility and good schooling for their children. In fact, the concept of rural dispensaries should be abandoned and what we need is a good primary/secondary healthcare centre within a radius of 20 kilometres and that area on daily basis should be covered for OPD service by mobile vans with fixed hours backed by strong ambulance service which most states have already adopted. This will help getting the medical and paramedical manpower stationed at these centres as they will get basic facility and necessities of life for themselves and their family and doctors will be able to deliver better healthcare with better facility in terms of equipment and beds in an upgraded hospital environment. It will also help in running the various preventive healthcare programmes in true earnest.<br />
These primary/secondary healthcare centres should be backed by tertiary care centres whether in private or government sectors at treatment cost rationalized by a committee of experts consisting of knowledgeable people from the government and the private sectors.<br />
We need to understand that health is the ultimate necessity of life and is very important for the economic growth of this country. If we get developed this concept of value based medicine, it will see us through in building a healthy and capable society which in turn will produce a workforce which will work hard to take this country forward and will make it a world leader.</div>
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Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-40803388491323456142012-09-09T10:36:00.000-07:002012-09-09T10:41:51.028-07:00CROSSED 100 MARK IN CARDIAC SURGERIES AT MAX HOSPITAL,MOHALI WITH 99.2% SUCCESS RATE<div dir="ltr" style="text-align: left;" trbidi="on">
Crossed the 100 mark in cardiac surgeries at Max Superspeciality Hospital, Mohali. The profile of patients varied from one year to 80 years. CABG included the highest risk situations tackled successfully. Started the paediatric cardiac surgery program with a complex blue baby who was corrected fully.<br />
GREAT TEAM WORK WITH GREAT INFRASTRUCTURE COUPLED WITH VERY QUALITY ORIENTED ETHICAL APPROACH.</div>
Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-50233882935928634712012-08-14T23:47:00.001-07:002012-08-14T23:48:05.582-07:00A MIXED FEELING AND DEEP SATISFACTION ON TREATING A FAILURE TO THRIVE 7.5KGS AT 2.5YRS BABY WITH COMPLEX BLUE BABY SYNDROME WITH TOTAL CORRECTION.<div dir="ltr" style="text-align: left;" trbidi="on">
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Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-14395347905768529862012-07-13T10:58:00.000-07:002021-06-13T09:11:33.140-07:00High Risk End stage Coronary Artery Disease treated successfully with Beating Heart Surgery<div dir="ltr" style="text-align: left;" trbidi="on">
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<b style="mso-bidi-font-weight: normal;"><u><span style="font-size: 16pt; line-height: 115%;"><span style="font-family: Calibri;">High Risk End stage
Coronary Artery Disease treated successfully with Beating Heart Surgery<o:p></o:p></span></span></u></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;">Recently
we operated upon a 63 yrs old male who had CAD since last 10years and was very
symptomatic as he had myocardial infarction or heart attack couple of times
with the result his heart function went down to bare 15%. He was refused
intervention every where in view if the high risk involved in it. Even his one
of relatives in USA is a cardiologist and he also advised very high risk for
surgery. He went into heart <span style="mso-spacerun: yes;"> </span>failure a
number of times and was treated at local hospitals for that. Looking at the
heart function he was refused surgery but treated medically or was suggested
PTCA in one of arteries with doubtful benefit..<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="mso-spacerun: yes;">
</span>He came to us again and on ECHO his ejection fraction was only 15%, dilated
heart and muscle looked to be thin. His angiography done in NCR showed severe
triple vessel disease. Dilated heart with low heart function makes it very high
risk surgery. His “Euro score” a criteria to assess risk of surgery based on
the clinical and investigative parameters was 14 indicating a mortality of 40%.We
decided to do a further work up and went for PET scan(positron emission
tomography) which gives us a very good idea that whether the heart muscle is viable
or not and can it be revived by revascularization. Luckily for him PET showed
good muscle with reasonably good viability in most of areas except two areas. Based
on this we came to a conclusion that he will benefit if preoperatively he
tolerates the procedure. We decided to offer him a beating heart surgery a new
technique adopted with us for last 10years where you avoid heart lung machine
and its side effects which is very crucial in such cases for good recovery.
Intra-operatively we used special gadgets to monitor functioning of the heart
continuously with continuous cardiac output catheter. Adequate preparation i.e.
decongestion and putting intra-aortic balloon pump (IABP) preoperatively was
done which helps heart in giving more blood. After 24hrs we took him for OPCAB(beating
heart surgery) and did three by- passes on his heart. His lung pressures were
very high which were manipulated with drugs and they settled down after the
grafting. He sustained the procedure well and in the post operative period did
very well. IABP was removed on 3rd day and all drugs to help heart were off by
5<sup>th</sup> post operative day. He was mobilised and shifted to HDU to see
his early mobilization under close supervision. He was very comfortable in
walking around extensively with normal parameters and was discharged on 9<sup>th</sup>
day. Before discharge his heart function came up to 30% from 15% a massive
improvement. It will further improve but slowly. These patients are ideally
suitable only for heart transplant but facilities for this in our country are
few and too expensive to maintain it also. If left untreated the prognosis is
not very good as low output state and repeated heart failure damages the other
organs like kidneys, liver and they succumb to multi-organ failure. Careful
planning and extra care with new technologies help saving such lives and gives
them quality of life also.<o:p></o:p></span></b></div>
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<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt; line-height: 115%;"><span style="mso-spacerun: yes;"> </span>Thus
“Time is muscle and do not lose it in waiting.” By- pass surgery done at appropriate
time in stable condition is the best thing to happen to heart and it increases
your quality of life and prevents further set- backs to heart muscle. He was
operated by a team headed by Dr Virendar Sarwal, In charge Dept. Of CTVS Max
hospital, Dr Ajay Sinha, Dr Arat Nahak, Dr Srinivas, Dr Goswami, Dr Shailender
at Max Superspeciality Hospital, Mohali.<o:p></o:p></span></b></div>
</div>Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-37848762639403513252012-04-22T11:19:00.001-07:002021-06-13T09:12:20.166-07:00Invited to present a paper at Heart Valve Society of America in New York<div dir="ltr" style="text-align: left;" trbidi="on">
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Invited to present a paper at Heart Valve Society of America in New York on End Stage Valvular Heart Disease. Got good appreciation of the work. Pictures from conference Venue at Hotel Marriot Marquis, New York.</div>Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-26420062534456644302012-02-19T10:54:00.000-08:002012-02-19T10:54:58.772-08:00Self CPR<div dir="ltr" style="text-align: left;" trbidi="on">What are you to do if you have a heart attackWhile you are alone.<br />
If you've already received this,<br />
It means people care about you.<br />
The Johnson CityMedicalCenter staff actually<br />
Discovered this and did an in-depth study<br />
On it in our ICU.<br />
The two individuals that discovered this then did<br />
An article on it, had it published and have had it incorporated into ACLS and CPR classes.<br />
It is very true and has and does work.<br />
It is called Cough CPR.<br />
A cardiologist says it's the truth,<br />
If everyone who gets this sends it to 10 people,<br />
You can bet that we'll save at least one life.<br />
It could save your life!<br />
Let's say it's 6:15 p.m. And you're driving home<br />
(alone of course), after an usually hard day on the job.<br />
You're really tired, upset and frustrated.<br />
Suddenly you start experiencing severe pain<br />
In your chest that starts to radiate out<br />
Into your arm and up into your jaw.<br />
You are only about five miles from the hospital<br />
Nearest your home.<br />
Unfortunately you don't know if you'll be<br />
Able to make it that far.<br />
What can you do?<br />
You've been trained in CPR<br />
But the guy that taught the course didn't tell<br />
You what to do if it happened to yourself.<br />
Since many people are alone when they suffer a heart attack, this article seemed to be in order.<br />
Without help, the person whose heart is beating improperly and who begins to feel faint,<br />
Has only about 10 seconds left before losing consciousness.<br />
However, these victims can help themselves by coughing repeatedly and very vigorously.<br />
A deep breath should be taken before each<br />
Cough, and the cough must be deep<br />
And prolonged, as when producing sputum<br />
From deep inside the chest.<br />
A breath and a cough must be repeated<br />
About every two seconds without let up<br />
Until help arrives, or until the heart is felt to be beating normally again.<br />
Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and<br />
Keep the blood circulating.<br />
The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a hospital.</div>Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-70051233569955934472012-02-08T10:20:00.000-08:002021-12-28T16:12:18.408-08:00Advantages of Off Pump Surgery or Beating Heart Surgery. <div dir="ltr" style="text-align: left;" trbidi="on"><h3>What are the Advantages of Off-Pump Coronary Bypass Surgery (OPCAB)?</h3>An alternative to traditional CABG is off-pump or beating heart surgery, where surgeons don't use the heart-lung machine. The procedure is also called OPCAB (Off-Pump Coronary Artery Bypass). The surgeons sew the bypasses onto the heart while it continues beating. Various types of heart stabilizers are used to restrain the heart one section at a time so the surgeon can operate on it. The chest is opened through a midline sternotomy incision. After the target coronary vessel is exposed and stabilized, it is occluded and opened. A bridging plastic tube -- which allows blood flow during suturing -- may be placed. The bypass graft is then sutured to the coronary artery. <br />
The potential benefits/advantages of off-pump surgery may include the following: <br />
<ul><li>Reduced need for blood transfusions </li>
<li> Reduced risk of bleeding, stroke and kidney failure</li>
<li>Potential for reduced psychomotor and cognitive problems</li>
</ul>High-risk patients with additional diseases like lung disease, kidney failure and peripheral vascular disease may benefit from this kind of operation<br />
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<img align="right" alt="Off-Pump Surgery" class="floatnoborder" height="905" src="http://www.umm.edu/heart/images/pump2.jpg" width="215" /><br />
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</div>Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-21437074677089377032011-10-15T10:15:00.000-07:002011-10-15T10:16:32.085-07:00Joined Max Superspeciality Hospital, MohaliIt is great priviledge for me to announce that I have joined Max Superspeciality Hospital ,Mohali in the Dept. of Cardiac Sciences now as Senior Consultant and Incharge of CTVS. This hospital is part of one of the largest chain of hospitals in India known for best infrastructure, quality care and utmost ethics in healthcare. A large rapidly expanding group focussed on providing best possible care to all.Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-7267171609061592282011-08-10T10:58:00.000-07:002021-12-28T16:08:06.168-08:00End Stage Valvular heart disease treated successfully with Double Valve Replacement on CPB<div dir="ltr" style="text-align: left;" trbidi="on"><strong></strong> 29 yr old male presented with severe breathlessness, palpitation and giddiness. On examination he was found to be having severe leakage of both Aortic and Mitral valve. He was in heart failure with enlargement of liver and fluid collection in the lungs. His lower blood pressure was very low, & it was unable to nourish the heart. On investigations his echocardiography, his heart was grossly dilated and added to that his aorta was dilated grossly to 5.7cm and left side chamber was 8.4cm. All this made him a very high risk for routine surgery and only alternative available to him was heart transplant which again was not very feasible. In last 4-5yrs he went to Bangalore, Delhi and other hospitals in Chandigarh but did not get a definitive answer for surgery. We decided to investigate him in detail and stabilize him by decongestion and prepare his heart for surgery. In view of his dilated heart changing the aorta along with mitral valve was a very challenging procedure which was the ideal treatment. On admission he had chest pain in night and his heart stopped. He was put on a ventilator and started on drugs to maintain his blood pressure. Luckily he responded and was extubated and underwent CT scan. We examined the CT scan very thoroughly and found that aorta at the place where our clamp was to come was 4.7cm, which was comfortable for this procedure. <br>
So we decided to change the plan to more conservative in the form of simple double valve replacement and save the aorta if its wall was well preserved. We planned to preserve heart muscle by perfusing blood cardioplegia with higher frequency. The plan paid off and he tolerated the procedure and in the post operative period he recovered slowly, but well, under the very strict supervision of our expert critical care team. He was discharged from hospital on 9th day and his echocardiography after one month showed marked improvement. His heart size has come down to 7.1cm from 8.4cm and aorta to 3.8cm from 5.7cm. He wants to ride a bicycle now, whereas he was barely able walk earlier.<br>
The challenge in these cases is that since left side of heart has got dilated so much that it is difficult to preserve it during surgery as reserves of the muscle are very limited. One needs to devise special techniques to do that and one is to perfuse cold blood with additives to keep the heart arrested very frequently (every 15 minutes) and this gives the heart the required oxygen and nutrition to maintain cell metabolism. Other is to keep the heart totally empty and not to allow it to get distended. These are few of the techniques, coupled with making the procedure as short as possible. This was the real challenge and if one goes by bookish conclusion he required replacement of the whole aorta along with mitral valve replacement , a very extensive procedure and probably he would have not survived this procedure. Hence it was reduced to only replacement of both valves.</div><br>
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Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-25423840375642841762011-08-03T02:28:00.000-07:002021-12-28T16:09:51.722-08:00Badly Damaged Heart Requiring Heart Transplant Treated Successfully With Beating Heart Surgery on IABP<div dir="ltr" style="text-align: left;" trbidi="on"><br>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US">Every heart attack leaves the heart muscle damaged and more the number of attacks, more the damage. After bypass surgery some part of its gets revived and some part remains damaged only. But major risk of damaged heat is whether it will be able to bear the stress of surgery and beyond a certain limit which is judged by echocardiography in terms of Ejection Fraction the risk is very high. These patients with Ejection fraction of 20% and below are generally the candidates for heart transplant which is itself is not very easy to go through because of shortage of donors especially in Indian setting and also because of life long <span style="mso-spacerun: yes;"> </span>heavy expenditure on drugs. World wide in view of this there is an effort to salvage a few patients<b style="mso-bidi-font-weight: normal;"> </b>by offering their bypass surgery though mortality for these kinds of patients is very high but otherwise also it is same if nothing is offered to them. </span></div><br>
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<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US">Beating heart surgery has proved a blessing to such patients as success rates of bypass surgery in this class of patients has improved a lot. These patients but definitely require extensive investigation to see the benefit and <b style="mso-bidi-font-weight: normal;">thorough</b> stabilization and planning. Sometimes before surgery they are supported with intra aortic balloon pump to reduce the load on the heart as well as improve the blood supply to heart muscle to some extent so that heart improves a bit to tolerate bypass surgery. </span></div><br>
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<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US">Recently, we at <st1:place w:st="on"><st1:placename w:st="on">Alchemist</st1:placename> <st1:placetype w:st="on">Hospital</st1:placetype></st1:place>, Panchkula operated upon one such patient Mr. Tara Chand 50yrs Male. Dr. V. Sarwal, Head, Deptt. of Cardiovascular and Thoracic surgery along with his team Dr. Mubeen Mohammed, Dr. Ajay Sinha, Dr. Amit Ahuja, Dr. Dheeraj Dumir, Dr. Srinivas and Mr. Des Raj operated upon him successfully.</span></div><br>
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<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US">He came to OPD for an opinion for his heart disease and his condition was getting worse. Earlier, he had shown at many places even had angiography done at <st1:city w:st="on"><st1:place w:st="on">Bangalore</st1:place></st1:city> but some how could not get operated and as per his previous record his ejection fraction was 30%. He was advised fresh angiography followed by pass surgery. On the night before his scheduled day of angiography his condition deteriorated, had chest pain, breathlessness and went into heart failure. He was admitted in the night itself and angiography showed disease had progressed and other investigations revealed a fresh heart attack. He tolerated angiography but his blood pressure was low and required drugs to support it. Echocardiography revealed further damage to heart and ejection fraction fell down to 12%. It was decided to insert IABP (Intra-aortic balloon pump) to support the heart and then stabilize him with medications for next 48-72 his before planning for surgery. </span></div><br>
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<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US">Angiography showed two arteries 100% blocked and third one was 85% in the proximal part and after that 100% blocked so all three arteries were completely blocked and he was surviving on 2-3 small branches of these main arteries. </span></div><br>
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<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US">Review of all investigations showed that he was ideally a candidate of heart transplant and bypass was quite risky but this was an option only theoretically. His Trop –I levels a marker for fresh heart attack was high so we stabilized him with drugs to take out water from lungs. Supported him on IABP for 3 days and when Trop – I level came down we decided to go for beating heart bypass surgery. Only positive thing on the whole scenario was that he was admitted with chest pain along with breathlessness which in itself on indirect indication of revivable heart muscles.</span></div><br>
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<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US">He was taken to Operation Room for surgery after 3 days and three grafts were put on him on beating heart. His vessels had quite a diffuse disease and one of the vessels had to be thoroughly cleaned (Endarterectomy) before putting up the grafts. He tolerated the procedure with moderate drug support and ventilator was removed on next day and IABP on 4<sup>th</sup> POD. Slowly his drug support was reduced, de-lined and mobilized and discharged on 12<sup>th</sup> Post op day in very stable condition. </span></div><br>
<div class="MsoNormal" style="margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US">His echocardiography showed marked improvement on his second follow-up and EF has come up to 30% now. His recovery is very good and his normal routine has started now. Beating heart bypass surgery is also quite risky in such conditions but is much better and helpful than conventional bypass surgery done on heart lung machine. This single technique has made quite a bit of difference in the outcome of such patients and our center is expert in this technique and has offered successfully this to very high risk and elderly patients even above 80yrs of age</span></div><br>
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</div></div>Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-35353310081609997472011-08-03T02:23:00.000-07:002021-12-28T16:09:14.587-08:00STENT OR SURGERY… its not a DIELEMMA any more. Surgery scores in durability and event free years.<div dir="ltr" style="text-align: left;" trbidi="on"><br>
<div class="MsoBodyText" style="margin: 0cm 0cm 0pt;"><span lang="EN-US"><span style="font-family: Arial;">Heart Disease or Coronary Artery Disease is the largest single killer in our society. The changing life style and added to that the stresses and strains of life have made this disease an almost epidemic. In India it is fast growing and soon we will be the number one country with patients of Coronary Artery Disease. The WHO report is scaring and it points towards a total disaster. Keeping this in new we all need to take preventive steps to lessen the burden of this disease. First and foremost step towards this will be to have an organized lifestyle, regular exercise and diet control. But the next more important step will be to go for preventive check ups. The incidence of this disease is rising now in younger population so it will be advisable that anybody who is above 35 years should have all his investigations carried out from heart point of view at least once a year so that if there is any alarming sign it is tackled well in time. This particularly holds good in those persons who have a strong family history. </span></span></div><br>
<div class="MsoBodyText" style="margin: 0cm 0cm 0pt;"><span lang="EN-US"><span style="font-family: Arial;">This is one scenario and the other is that someone is having coronary artery disease, which is significant enough to produce symptoms, and requires some treatment. In this second scenario one has to act immediately. Rather than have a wishful thinking that symptoms are not related to heart and may be due to gastric trouble or muscular pain one should immediately go for stress test and if it is positive then to see how much exactly the disease is, one undergoes angiography which is the only gold standard test to quantify this disease. </span></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Arial","sans-serif";"><span style="mso-tab-count: 1;"> </span>The real dilemma starts when one is found to be having significant coronary artery disease, which requires interventional treatment. As of now two types of interventions are available (both are invasive and require hospitalization). <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Arial","sans-serif";"><span style="mso-tab-count: 1;"> </span>Angioplasty and Bypass Surgery there can be situations where both can be offered as treatment of coronary artery disease and of course Bypass Surgery can be applied and is the solution in any type of situation. Angioplasty means that the diseased area of coronary artery is repaired by dilating the diseased porition with a balloon catheter and these days to support the weak dilated wall of the artery a stent is put in place for better long term patency rates.<o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Arial","sans-serif";"><span style="mso-tab-count: 1;"> </span>Bypass Surgery is where surgically the disease part is bypassed with a new route of blood supply via a graft taken from the human body only in the form of vein or an artery. These days we used more and more of arterial grafts either the Internal Mammary Artery that runs at the beck of sternum or radial artery, which runs in the arms.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Arial","sans-serif";"><span style="mso-tab-count: 1;"> </span>Angioplasty is less invasive than surgery in terms of that it is done under local anaesthesia and there are no major incisions. Bypass Surgery has also become less invasive in terms that it is being done on beating heart and no longer the heart is arrested to carry out these grafts. So the stressful effect of heart lung machine on the body is gone now and recovery is much faster. Bypass surgery is beyond doubt the long term, time tested solution which improves quality of life, prevents sudden heart attacks and freedom from second procedure is great. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Arial","sans-serif";"><span style="mso-tab-count: 1;"> </span>In case of Angioplasty with stents also improves quality of life but the other two factors do not hold good. If the stent fails or blocks again it will lead to a fresh heart attack and also the chances of blockages second time are more with stents where a second procedure may be required early. The earlier stents had high re-blockage rate but the new generation of medicated or drug coated stents have better durability and patency rates but still they have above 9% re-blockage rate during the first year only. The procedure is beneficial only in short-term basis, in terms of no major incision, less or shorter stay in hospital and no general anaesthesia but at the cost of durability. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Arial","sans-serif";"><span style="mso-tab-count: 1;"> </span>Bypass surgery is a proven durable treatment for coronary artery disease but when a patient is detected to have this disease there are certain situations where both the treatments can be applied and there the dilemma starts. If you look at human psyche anybody and everybody in the world will want a less traumatic treatment where angioplasty comes in mind but at the same time no one wants to suffer again and again and one wants a long term solution to the disease or to that effect eradication of disease (which though is not possible) but something close to that is possible with bypass surgery. As new route of blood flow is create via grafts, which are disease free, bypassing the diseased part of artery, which means in an indirect sense removing the diseased path from the route of blood supply to the heart. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Arial","sans-serif";"><span style="mso-tab-count: 1;"> </span>Whenever a particular form of treatment is adopted it is backed by lot of research first in animal models and then in human beings as clinical trials. Then only it is offered to public en mass. Even after the procedure is accepted it is constantly evaluated by further trials and also it is compared to the already existing procedures or other newer procedure so that the best form of therapy can be chosen for the patient population. In this direction lot of trials were conducted on cardiology front about 15 major ones and some were compared with surgical arm. Even with the advent of drug eluting stents, bypass surgery scored over angioplasty with stents in terms of better long term results i.e. event free years and less chances of second procedure. Patients in the angioplasty arm had more incidence of major adverse coronary events after the first procedure. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Arial","sans-serif";"><span style="mso-tab-count: 1;"> </span>What are the issues here lets have a look ! Agreed any patient will choose a less invasive treatment out of two available treatments. But here is a catch; these two terms of treatments have to be equally effective in terms of their results. In case of angioplasty vs surgery key issues are:<o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l1 level1 lfo1; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">Is angioplasty in multi-vessel disease evidence based?<o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l1 level1 lfo1; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">Are the limitations of angioplasty known to the patient?<o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l1 level1 lfo1; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">Is it economical in multi-vessel disease as compared to surgery? <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify; text-indent: 18pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif";">There is another major flaw. The trials on which we base our treatment are conducted on western population, which is genetically different than Asian or Indian population. In the sense that in western population the size of coronary arteries is much bigger than the Asian population like it is 4-6mm as compared to 2-4mm in Asians. So treatment applied there cannot hold good here. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Arial","sans-serif";"><span style="mso-tab-count: 1;"> </span>As such if we look at Angioplasty vs CABG the two forms of treatment are not equivalent in terms of:<o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l2 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">Bypass Surgery not only tackles culprit lesion but also deals with future lesions as it is done distal to the diseased part. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l2 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">In certain situations angioplasty carries very high mortality like Left Main Disease. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l2 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">Even the repeat revascularization or second procedure requirement is higher with angioplasty in multi-vessel disease or left main disease. As per two latest trials even in western population Arterial Revascularization Therapy Study (ARTS), Stent or Surgery (SOS) trials the incidence of second procedure in angioplasty group is 3 times higher than patients treated with surgery. Also the risk of death in both the trials with surgery is very low 1.2% in ARTS trial and 0.8% in SOS trial. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l2 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">4.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">The trials included only simpler form of disease like single or double vessel but the results are being applied to multi-vessel group. The need for re-intervention in ARTS trial was 30% as compared to 9% in surgical group. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l2 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">5.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">Again in diabetes the bypass surgery scores over angioplasty in terms of long term benefits as in ARTS trial it was 43% in angioplasty as compared to 10% in surgery patients.<o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l2 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">6.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">Surgery offers more complete revascularization with better durability especially arterial grafts.<o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l2 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">7.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">Left main disease is a very serious situation, which requires urgent intervention and bypass surgery so far has been the best form of treatment. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l2 level1 lfo2; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">8.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">Another major disadvantage with drug coated stents is what we call “Late Stent Thrombosis” or sudden occlusion of the stent after a year or so when the blood thinners or antiplatelets are withdrawn or reduced and infact FDA in USA has issued a warning to all these companies for this dreaded complication. <o:p></o:p></span></div><br>
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<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif";">Other myths about angioplasty safety have also been proven wrong. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l3 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">Risk of heart attack during angioplasty is 10%<o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l3 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">Risk of restenosis with in first year is 10% to 30%.<o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l3 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">There is no reduction in neurological complications with this.<o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l3 level1 lfo3; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">4.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">Even in trials including drug coated stents multi-vessel disease, small vessels, long lesions, diabetes and restenosis patients have been excluded but in practice they are applied in even these subset of patients also. <o:p></o:p></span></div><br>
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<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify; text-indent: 36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif";">Recently a lot of studies have come in the reputed International Journals, two of which I quote here which have proven beyond doubt that CABG or Bypass Surgery is much superior to angioplasty in multi-vessel and left main disease and these subset of patients should only be treated with surgery for long term benefits and economics. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l0 level1 lfo4; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">One paper was published in Annals of Thoracic Surgery Dec. 2006 entitled, “Coronary Artery Bypass Grafting is still the best treatment for Multivessel and Left Main Disease… But patients need to Know” by Dr. David P Taggart from John Radcliffe Hospital, University of Oxford, United Kingdom. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt 54pt; mso-list: l0 level1 lfo4; tab-stops: list 54.0pt; text-align: justify; text-indent: -36pt;"><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">2.<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";"> </span></span></span><span lang="EN-US" style="font-family: "Arial","sans-serif";">Does off pump or minimal invasive coronary artery bypass reduce mortality, morbidity and resource utilization when compared with percutaneous coronary Intervention? A Meta analysis of randomized trials. …In Journal of Thoracic and Cardiovascular Surgery March 2007 by David Bainbridge & Colleagues from Canada. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Arial","sans-serif";"><span style="mso-tab-count: 1;"> </span>Both these papers have detailed about pros and cons of two procedures. In Lancet in Jan. 2006, the headline cover stated, “In view of the survival benefits shown for CABG the real controversy is why patients with symptoms and anatomy known to benefit from surgery are still submitted to angioplasty”. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Arial","sans-serif";"><span style="mso-tab-count: 1;"> </span>Again the dilemma is summarized by Dr. Califf, Head of Interventional Cardiology at Duke University, “Stenting or Surgery” in Journal of American College of Cardiology”. It is likely that most people undergoing Coronary Angioplasty are not told the entire story when a decision is made about undergoing angioplasty. He attributes this to conflicts of self-referral and financial incentives and concludes, “Without Surgical Opinion the patient is in no position to have a rational input into the decision.” <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Arial","sans-serif";"><span style="mso-tab-count: 1;"> </span>The great father of interventional cardiology, Andreas Gruntizg, who died prematurely in a plane crash at age of 46 stated in 1979, “We estimate that only about 10-15% of candidates for bypass, surgery have lesions suitable for angioplasty. A perspective randomized trial will be necessary to evaluate the usefulness in comparison with surgical and medical management”. <o:p></o:p></span></div><br>
<div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0pt; text-align: justify;"><span lang="EN-US" style="font-family: "Arial","sans-serif";"><span style="mso-tab-count: 1;"> </span>So to conclude stent or surgery is not/should not be a physician’s choice. It should depend on what disease demands keeping in view the long term benefits and the economics. Pros and Cons of both the procedures should be made aware to patient in detail. Durability of treatment rather than short stay should be the goal and important factor for deciding treatment.<o:p></o:p></span></div><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 12pt; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><span style="mso-tab-count: 1;"> </span>In the end I think the best way to remove this dilemma is have multidisciplinary team consisting of a physician, a cardiologist and a cardiac surgeon to decide about the treatment plan for coronary artery disease in a particular patient on individualized basis</span></div><br>
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Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0tag:blogger.com,1999:blog-6662178283875091843.post-26509343546269117282011-08-03T01:53:00.000-07:002011-08-14T11:38:13.630-07:00YOUNG PATIENT SALVAGED WITH HEART SURGERY FOR TERMINAL STAGE BY- BIRTH DEFECT<div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="http://3.bp.blogspot.com/-3HDyu8Pojs0/TjkMHbwIdUI/AAAAAAAAAAM/SRN8NSvDj4I/s1600/Photograph+2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="http://3.bp.blogspot.com/-3HDyu8Pojs0/TjkMHbwIdUI/AAAAAAAAAAM/SRN8NSvDj4I/s320/Photograph+2.jpg" width="289" /></a></div><br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%; mso-bidi-font-size: 11.0pt;">Atrial septal defect is an abnormality present in a person from birth where there is a hole in the partition between the upper chambers of the heart called the atria. As a rule many times if it is small it can close on its own by 2yrs of age beyond <a href="http://www.blogger.com/" style="mso-comment-date: 20110803T1411; mso-comment-reference: a_1;">that</a></span><span class="MsoCommentReference"><span lang="EN-US" style="font-size: 8pt; line-height: 115%;"><a class="msocomanchor" href="http://www.blogger.com/post-create.g?blogID=6662178283875091843#_msocom_1" id="_anchor_1" language="JavaScript" name="_msoanchor_1"><span style="font-family: Calibri;">[a1]</span></a><span style="mso-special-character: comment;"><span style="font-family: Calibri;"> </span></span></span></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%; mso-bidi-font-size: 11.0pt;"> if it is of simple nature then one comes to know of it only in second decade. If the type of this defect is atypical which is called Sinus Venosus <span style="mso-spacerun: yes;"> </span>type of defect then symptoms happen <b style="mso-bidi-font-weight: normal;">earlier</b> and needs early intervention also. Here most of times one vein carrying pure blood from lungs which was to drain into left upper chamber is opening into right upper chamber this increasing the flow to lungs. Or some time all veins from right lung are opening into the superior Vena Cava (Vein draining impure blood from upper parts of body to right upper chamber) along with large gap in the partition between the two upper chamber. In such a situation the flow to the lung increases markedly and permanent damaging changes start setting in and a stage comes when resistance of lung vasculature increases so much that blood flow direction reverses. Normally it is left to right but then it becomes right to left and patient start becoming blue also. This is a stage where surgery is not possible and patient become in-operable. Otherwise if heart surgery for this carried out at the right age and time is suitable and patient becomes absolutely normal for rest of his /her life. <o:p></o:p></span></div><br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%; mso-bidi-font-size: 11.0pt;">Recently a 21yrs female who had given birth to a child 4 months back presented to us at Alchemist Hospital, Panchkula with severe breathlessness and palpitation. On <a href="http://www.blogger.com/" style="mso-comment-date: 20110803T1411; mso-comment-parent: 12; mso-comment-reference: a_13;"></a><a href="http://www.blogger.com/" style="mso-comment-date: 20110803T1411; mso-comment-parent: 11; mso-comment-reference: a_12;"></a><a href="http://www.blogger.com/" style="mso-comment-date: 20110803T1411; mso-comment-parent: 10; mso-comment-reference: a_11;"></a><a href="http://www.blogger.com/" style="mso-comment-date: 20110803T1411; mso-comment-parent: 9; mso-comment-reference: a_10;"></a><a href="http://www.blogger.com/" style="mso-comment-date: 20110803T1411; mso-comment-parent: 8; mso-comment-reference: a_9;"></a><a href="http://www.blogger.com/" style="mso-comment-date: 20110803T1411; mso-comment-parent: 7; mso-comment-reference: a_8;"></a><a href="http://www.blogger.com/" style="mso-comment-date: 20110803T1411; mso-comment-parent: 6; mso-comment-reference: a_7;"></a><a href="http://www.blogger.com/" style="mso-comment-date: 20110803T1411; mso-comment-parent: 5; mso-comment-reference: a_6;"></a><a href="http://www.blogger.com/" style="mso-comment-date: 20110803T1411; mso-comment-parent: 4; mso-comment-reference: a_5;"></a><a href="http://www.blogger.com/" style="mso-comment-date: 20110803T1411; mso-comment-parent: 3; mso-comment-reference: a_4;"></a><a href="http://www.blogger.com/" style="mso-comment-date: 20110803T1411; mso-comment-parent: 2; mso-comment-reference: a_3;"></a><a href="http://www.blogger.com/" style="mso-comment-date: 20110803T1411; mso-comment-reference: a_2;"><span style="mso-comment-continuation: 3;"><span style="mso-comment-continuation: 4;"><span style="mso-comment-continuation: 5;"><span style="mso-comment-continuation: 6;"><span style="mso-comment-continuation: 7;"><span style="mso-comment-continuation: 8;"><span style="mso-comment-continuation: 9;"><span style="mso-comment-continuation: 10;"><span style="mso-comment-continuation: 11;"><span style="mso-comment-continuation: 12;"><span style="mso-comment-continuation: 13;">examining</span></span></span></span></span></span></span></span></span></span></span></a></span><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%; mso-bidi-font-size: 11.0pt;"> we found her to be having a hole in the heart in both the upper chamber and investigating her with echo-cardiography and going through her previous record we found that she had atypical sinus venous type of atrial septal defect which manifested after child birth but along with her pressure in the lung vasculature had become very high almost equal to the body’s blood pressure. In view of this outside other peripheral <span style="mso-spacerun: yes;"> </span>hospitals had denied her surgery in view of very high risk including the risk to life. Infact she was sent Delhi for <span style="mso-spacerun: yes;"> </span>opinion.<o:p></o:p></span></div><br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%; mso-bidi-font-size: 11.0pt;">When she presented to us we also felt the same way but then we decided to further investigate looking at her young age. The only chance for correction or treatment through surgery was now and otherwise it could be fatal. We admitted her and did a cath study on her. The lung pressures had peaked to 110mmHg which was equal or slightly more than her own blood pressure and shunt across the defect got reduced to 1.3:1 (normal criteria for surgery is shunt more than 1.5:1 or 2.1). The pulmonary vascular resistance came out to be 12 wood units, close to the terminal<span style="mso-spacerun: yes;"> </span>limits, where one becomes in- operable. Only positive finding in the study was that she was still maintaining almost normal oxygen levels in left side of upper chamber i.e left atrium about 97% that was a sign that she was not de-saturating but other parameters pointed towards non-operability.<o:p></o:p></span></div><br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%; mso-bidi-font-size: 11.0pt;">We decided to plan her treatment and give her a chance. We started her on certain newer drugs to lower her lung pressure before surgery, talked to the family of high risk involved and total picture and need to prepare her for about a week before surgery by drugs including lungs pressure lowering drugs, to flush out extra fluid from body and to give rest to right heart and also some thing to improve the contractions of right heart.<o:p></o:p></span></div><br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%; mso-bidi-font-size: 11.0pt;">Looking at the literature again she was in that rare group where surgery was not possible. After nine days of preparation we decided to do a repeat echocardiography and she did responded to medication but<span style="mso-spacerun: yes;"> </span>marginally and also there was no bluish discoloration involved, so we felt that changes were not irreversible. On 17.06.2011 she was operated for open heart surgery and her hole was closed with a patch made out of the outer layer of heart called pericardium, diverting all the right lung veins which were connecting to lower part of superior Vena <span style="mso-spacerun: yes;"> </span>Cava <span style="mso-spacerun: yes;"> </span>to the left. We did one more innovation in creating a flap- valve type of patch in her case. The idea of this is that incase after surgery the right heart pressure increases the flap valve allows the right chamber to dicompresss by opening up. Heart <span style="mso-spacerun: yes;"> </span>muscle <span style="mso-spacerun: yes;"> </span>was<span style="mso-spacerun: yes;"> </span>protected well during surgery with various newer Techniques. She responded well to treatment and surgery and her lung pressure came down to 50% of arterial pressure in the immediate post- op period. They further were controlled with the new drugs which we had started earlier in the pre- op period. Over all she responded very well and lung pressure almost came to normal range. <o:p></o:p></span></div><br />
<div class="MsoNormal" style="margin: 0cm 0cm 10pt; text-align: justify;"><span lang="EN-US" style="font-family: "Times New Roman","serif"; font-size: 14pt; line-height: 115%; mso-bidi-font-size: 11.0pt;">She was discharged on 8<sup>th</sup> day with detailed explanation about the medications and precaution and on her follow up visit<span style="mso-spacerun: yes;"> </span>on 1<sup>st</sup> June it was very heartening to see her healthy and progressing well. Well thought of strategy and extra effort in treatment goes a long way in saving these high risk patients along with a good and skilled infrastructure and highly experienced team of doctors. 6 Senior doctors were involved in her care on day to day basis and it was very satisfying for all of us to save this young life. She was operated by a team headed by Dr Varinder Sarwal, Head- Dept. of CTVS, Alchemist hospital, Panchkula, Dr Arath Nahak, Dr Ajay Sinha, Dr Deepak Oberoi, Dr N Srivastava and Dr Dheer<o:p></o:p></span></div><br />
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Dr. Virendar Sarwalhttp://www.blogger.com/profile/13168725909699293934noreply@blogger.com0Chandigarh, India30.731345 76.77538500000002830.666502 76.696795000000023 30.796188 76.853975000000034