Pioneer in the field of heart failure management, the head of department of Advanced Cardiac Centre at PGIMER, Prof Yash Paul Sharma, speaks to Chandigarh Newsline about increasing cases of cardiac diseases in winters and precautions one should take
Why are people more prone to heart attacks during winter?
The winter — from November to February — is the time when there is a surge in the number of patients with cardiac diseases. There is an increase of 30 to 40 per cent cases of angina, heart attack and heart failure at the Advanced Cardiac Centre of PGIMER.
In winters, the peripheral blood vessels of the heart get narrow. Basically, there is constriction and the load on functioning of heart increases. There is increase in Systemic Vascular Resistance (SVR) so the heart has to pump the blood with extra force to overcome that peripheral resistance. The demand for oxygen supply to the heart increases which leads to mismatch in the blood supply and demand. That is why mostly heart attacks, angina and heart failure get precipitated in the winter months.
Not only those with any kind of obstruction in the heart — artery blockage — or who face breathlessness have to be extra cautious, but also people with less blockade and with minor plaque get prone to clot in the coronaries since the viscosity of blood increases. The blood gets viscous and the tendency to have a clot also increases. That is why heart attack occurs during this season, even in the young people.
What precautions one should take to avoid getting heart ailments in this season?
There is a sudden surge in Mean Arterial Pressure (MAP) in the morning, the time when already the oxygen is less. The mean arterial pressure is minimal when patient is sleeping and it increases within first two hours of waking up. The difference between maximum pressure and the least pressure which is during one’s sleep should be less.
So, the most important factor which I have been emphasising is that blood pressure medicines in the morning should be taken as early as possible after waking up because there is a morning surge in the Mean Arterial Pressure. If we take the medicine early, the pressure of the blood gets controlled and thus no pressure on the vessels too. This significantly reduces the chances of angina or heart attack. Proper monitoring of blood pressure should be got done during this winter period.
And particularly for elderly?
Elderly people must ensure that they wear layers of clothes in winters. Head, neck and chest must be completely covered. Morning walks should be done only after sunrise. During fog, when the oxygen is really less, walks should be delayed. Usually elderly are in the habit of waking up early, so I advise that at least during these months, they should not move out and can carry out any kind of physical activity in their house until the sun rises. Salt intake should be reduced and infections should be avoided.
Adequate sleep and heavy meals at night must not be taken. As it is said if elderly take precautions during winters, it adds year by year to their life.
What has been the overall number of heart patients at PGI in the last three years? Are there young patients too?
Overall, if we see there has been an increase in heart patients in the city and around. In 2015, there were 3,500 cardiovascular patients at PGI while the figure rose to 3,600 in 2016 and it was 5,400 in 2017. On a daily basis, 30 to 40 patients on average are being admitted to the CCU.
There are around 10 per cent of patients who are below 30 and about 15 patients are between 30 and 40 years of age. Hypertension, stress, lack of physical activity, long working hours and no proper balanced diet are the reasons for the increasing heart problems. People should ensure that they carry out their regular walks, consume less salt, take fruits, vegetables and salads more and control their sugar levels.
You have been the head of department (HOD) since 2011. What improvements have been made at the Advanced Cardiac Centre?
We consistently aimed at reducing the mortality in the heart patients with new innovative approach and theories. Just this month, our study has been presented in the Cardiology Society of India which states that we had the least mortality rate in the globe, that is 35 per cent in the patients having acute coronary syndrome with cardiogenic shock. It has been accepted by the Indian Heart Journal and will be published soon. Mortality rates in literature range up to 60 per cent in cardiogenic shock patients while ours was the least — 35 per cent — creating a history in the medical literature.
Cardiogenic shock (CS) is a severe situation after heart attack in which the heart fails to pump blood to the body and is the leading cause of death in heart patients. Mean age of the patients taken for the study was 58 years which was almost a decade younger than the western counterparts. These patients had multiple comorbidities or multiple chronic situations like diabetes, anaemia, renal dysfunction and sepsis. In 100 patients of ACS, around eight patients have CS. Out of these eight patients, through conventional treatment, five to six patients had mortality. But with new innovative, integrated patient-specific approach and with continuous monitoring, multi-modality treatment mortality reduced to two to three patients. All these augment a better future for coronary artery disease.
What factors lead to decreasing mortality?
Role of treating anaemia, strict monitoring and judicious correction of intravascular volume (volume of blood), albumin and treating these patients with precision in cardiac treatment have contributed to the decrease in the mortality. I have been emphasising that the role of treating anaemia to the normal value of 14 to 17 HB plays an important role in heart patients. Heart patients must ensure that their haemoglobin is normal.
What has been the overall mortality rate, both in CCU and ward?
For the last seven to eight years, there is an improving trend in patient care and outcome. All these efforts and achievements were appreciated by the union health secretary as well. We have shown overall decreasing mortality trends in CCU, in consecutive years from 2015 to 2017 — approximately 10.2 per cent to 8.2 per cent, which is a heartening sign. Also, our mortality is around 3 per cent when total indoor admissions are considered (CCU and ward).
What new techniques are we bringing in at the cardiac centre?
We are trying to get the robotics angioplasty soon. Partly, the functions while carrying out angioplasty are done manually while partly it is done by the robotics. The angioplasty is remote-controlled and robotic-assisted. It allows controlled, robotic-assisted placement of stents, balloons and coronary guide-wires.