How To Keep Heart Healthy

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					         HOW TO KEEP HEART HEALTHY
                                                                           By Ratnajit Choudhury




                               Dr. Dipak Kr. Bhattacharyya.
                               MS, MCh (Thor) CMC, Vellore.
                            Cardio Vascular Thoracic Surgeon.

     Heart disease is increasing significantly in the world today. Besides, in India about 45
     million people are suffering from Coronary Artery Diseases (CAD) and other heart
     diseases. Further, frequent occurrence of CAD or blocks in the blood vessels of the heart
     among the Indian youths in recent times is a matter of great concern. We generally can
     not realise the impending danger of heart disease in time and sometime ignore the
     symptoms at the early stage, which subsequently lead to fatal heart attack. In this context,
     some pertinent questions were raised before Dr. Dipak Kr. Bhattacharyya, MS,
     M.Ch (Thor), an eminent heart surgeon and Assistant Professor,
     Department of Cardio-Thoracic Vascular Surgery, Gauhati Medical
     College, Guwahati, Assam, India (Former Lecturer of Christian Medical
     College & Hospital, Vellore). Dr. Bhattacharyya replied to the questions and
     suggested some valuable remedies to prevent heart diseases. The remedies as suggested
     by Dr. Bhattacharyya may be beneficial to the people of North-East those who are
     suffering from critical heart diseases.

1.   Choudhury: what is heart and how it plays important role in human body?

     Dr. Bhattacharyya: -        Heart is a very vital organ of human body which pumps blood to
     all parts of our body. It is a hollow muscular structure situated in the centre of chest. It is
     covered by a sac called pericardium. This hollow organ is consists of four chambers. All
     impure blood of the body collects in the first chamber of heart called right atrium from
                                            where blood is directed to second chamber called right
                                            ventricle through the first door called tricuspid valve.
                                            Now right ventricle pump blood through the second
                                            door called Pulmonary Valve in to lungs. In lungs
                                            impure blood gets purified (oxygen is added and
                                            carbondioxide is removed from blood). This blood
                                            collects in the third chamber of heart called left atrium
                                            from where blood is directed to fourth chamber of the
                                            heart called left ventricle through a third door called
                  Human Heart               Mitral Valve. The left ventricle pump the blood and
                                            circulate it to all parts of body including heart itself
                                            through the fourth door called Aortic Valve. Blood is
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     circulated in to heart through a system of arteries called coronary arteries. Heart pumps
     blood to all parts of human body and deliver oxygen and other nutrients to all cells of our
     body. This function is so vital to our body that temporary ceasation of its function for about
     4 to 6 minutes will cause irreversible damage to our nervous system.


2.   Choudhury: what is heart attack and what are its symptoms?

     Dr. Bhattacharyya: -        The dreadful phrase ‘heart-attack’ is not exactly a medical
     terminology and used by common people to denote sudden ceasation of heart to work
     (cardiac death) or inability of heart to work properly. This occurs predominately due to two
     conditions- (1) Myocardial Ischaemia / Infarction and (2) Heart block. Sudden severe chest
     pain, profuse sweating, difficulty in breathing, sudden loss of consciousness, a confusional
     state, a sensation of profound weakness, irregular heart beats are usual symptoms. Mere
     presence of any of the above symptoms does not mean a ‘heart-attack’ and above symptoms
     may be due to some other organ dysfunctions also. Sometimes a myocardial ischaemia may
     occur without chest pain. Hence examination by a competent person is required for its
     confirmation.


3.   Choudhury: what is Congenital Heart Disease and what are Atrial Septal Defect (ASD),
     Ventricular Septal Defect (VSD) and Patent Ductus Arterious (PDA)?

     Dr. Bhattacharyya: -       Congenital is a latin word (con-together and genitus-born) which
     means ‘present at birth’. Hence congenital heart disease indicates presence of diseases of
     heart at birth itself. But disease starts before birth when unborn child is in the womb.
     Disease may be detected during pregnancy, immediately after birth or may present latter on.
     Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), Patent Ductus Arterious
     (PDA) are example of congenital heart disease.


4.   Choudhury: what are Rheumatic Heart Disease (RHD) and Ischaemic Heart Disease
     (IHD)?

     Dr. Bhattacharyya: -         Rheumatic Heart Disease (RHD) is a complication of a disease
     called Rheumatic Fever, which begin with a soar throat caused by an organism called
     Group A Streptococci. Usually heart valves are damaged by this disease and hence their
     functions are impaired. Therefore Rheumatic Heart Diseases are usually diseases of heart
     valves. The heart receives its blood supply through two arteries called Right and Left
     coronary arteries. Due to diseases of the Coronary Arteries, blood flow through it may be
     insufficient to heart resulting in an imbalance between blood supply to and demand by heart
     muscles. This imbalance is termed Ischaemic Heart Disease. Insufficiency may be so severe
     at time that it causes death to heart muscles-a condition known as myocardial infraction.


5.   Choudhury: how can a person prevent Rheumatic Heart Disease (RHD)?

     Dr. Bhattacharyya: -      Rheumatic Heart Disease (RHD), as already explained is a
     complication of Rheumatic Fever caused by streptococcal sore throat. Timely intervention
     of the soar throat by appropriate antibiotics prevents Rheumatic Fever and its complication
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     to occur. Because of this, incidence of rheumatic heart disease has come down drastically in
     western countries. People who have already got rheumatic fever should take chemo-
     prophylaxis as prescribed by a physician, which will prevent further attack of rheumatic
     fever and associate heart valve damage.


6.   Choudhury: what is Valvular Heart Disease and Coronary Artery Disease?

     Dr. Bhattacharyya: -        There are four valves in the heart. They are tricuspid valve,
     pulmonary valve, mitral valve and aortic valve. These are one-way valves allowing blood to
     flow in particular direction while preventing back flow. Any damage to these valves and
     impairment of its function is known as Valvular Heart Disease. As we have discussed
     earlier, rheumatic fever is one factor, which causes valvular heart disease.

                 Oxygenated blood is supplied to heart by two arteries called Right and Left
     coronary arteries. Narrowing of the lumen of these arteries or spasm of these arteries causes
     scarcity of blood supply to heart. As a result an imbalance is created between blood supply
     to heart and demand for blood by the heart. As we have discussed earlier, this diseased
     conditions of coronary arteries thus results in either Ischaemic Heart Disease (IHD) or
     Infraction.


7.   Choudhury: what is heart valve surgery and coronary artery bypass surgery?

     Dr. Bhattacharyya: -        When valves of the heart become damage and conservative
     treatment fails, surgery is the answer
     to restore the function of the valve.
     Surgeries undertaken are widening of
     stenosed valves, repair of regurgitant
     valves, or replacement of damaged
     valves.
                 When blood supply to a
     part of heart is hampered due to
     disease of part of a coronary artery it
     is restored by a surgery called                      Heart Valve Replacement Surgery
     Coronary Artery Bypass Surgery. In
     this surgery part of artery distal to
     diseased segment is connected to Aorta by a segment of Vein or Artery and hence blood
     supply is restored to the ischaemic area through the bypass channel.


8.   Choudhury: what is the difference between stenosis and regurgitation?

     Dr. Bhattacharyya: -      These two terms are used in relation to function of heart valves.

                Stenosis means narrowing of the opening of valve and hence proper flow of
     blood through that valve is prevented.

               Regurgitation means failure of a valve to close completely. Hence regurgitant
     valve can’t work, as an efficient one-way valve and can not prevent back flow
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9.    Choudhury: what is open heart surgery and close heart surgery and which category of
      heart surgery falls under open or close heart surgery?

      Dr. Bhattacharyya: -     During few surgeries of the heart, functions of heart and lungs
      have to be stopped and handed over to a machine called heart-lung machine. These
                                                                     surgeries are called open-
                                                                     heart surgeries. Rest of
                                                                     the surgeries can be
                                                                     performed without the
                                                                     help of heart lung
                                                                     machine      and    termed
                                                                     closed heart surgery.
                                                                     Valve         replacement,
                                                                     closure of ASD and VSD
                                                                     etc. are performed by the
                                                                     open heart procedure
                               Human Lungs
                                                                     while     closed     mitral
                                                                     valvotomy, division and
      suturing of PDA usually does not require open heart surgery.


10.   Choudhury: what are the main risk factors for Coronary Artery Disease (CAD) and how
      can it be prevented?

      Dr. Bhattacharyya: -       The main risk factors for Coronary Artery Diseases are family
      history, obesity, cigarette smoking, high blood pressure (hypertension), diabetes melitus,
      high blood cholesterol level, sedentary life styles, tension and anxiety.
                 Prevention can be achieved by controlling many of the risk factors. High blood
      pressure, diabetes melitus and high blood cholesterol level should be treated properly.
      Cigarette smoking should be stopped. Life style should be modified to reduce tension and
      anxiety. Regular exercise, yoga and meditation will prevent excess deposit of fat and help
      in weight reduction.


11.   Choudhury: what is Coronary
      Angioplasty?

      Dr. Bhattacharyya: -       Coronary
      Angioplasty is an interventional
      procedure in which diseased
      narrow segment of coronary
      arteries are dilated by passing and                        Balloon Angioplasty
      inflating miniature ballons at the tip
      of small catheters into the              diseased   part      of    the     coronary   arteries.




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12.   Choudhury: what is coronary angiography and cardiac catherization?

      Dr. Bhattacharyya: -     Coronary angiography is an invasive diagnostic procedure in
      which Coronary Arteries, which supply blood to heart, are visualised by injection of dye in
      to Coronary Arteries.

              Cardiac catherization is another invasive diagnostic procedure in which structure
      (anatomy) and function (physiology) of heart is studied by injecting dye in to heart and
      measuring pressures inside heart by specially designed small tubes called catheter passing
      in to chambers of heart.


13.   Choudhury: what is electrocardiography and
      echocardiography?

      Dr. Bhattacharyya: -        Electrocardiography
      (ECG) is a non-invasive technique in which
      electrical activity (potential) generated by heart
      is recorded graphically.

                 Echocardiography is another non-
      invasive technique to visualize structure of
      heart and study its function by means of                         Electrocardiograph

      ultrasound waves.


14.   Choudhury: what is a pacemaker and what is the difference between permanent and
      temporary pacemaker?

      Dr. Bhattacharyya: -               The human heart beats on average 73 times per minute
      and this result in circulation of blood in human body. A specific area of heart called S A
      node generates electrical stimuli which spread into whole heart and cause it to beat. Due to
      some disease this automatic production of electrical stimuli of heart and its distribution into
      heart may be disturbed, endangering the life of a person. Here medical science comes to
      rescue by delivering electrical stimuli from specially devised external electrical energy
      source. This device is known as PACEMAKER.

                 When a person becomes totally dependant on a pacemaker, a specially designed
      machine is permanently implanted in to body and such a machine is called permanent
      pacemaker. When pacing is required for a transient period or in case of emergency when
      immediate placement of permanent pacemaker is not possible, electrical stimuli are
      delivered to heart from a pacemaker kept outside the body. Such pacemakers are called
      temporary pacemakers.


15.   Choudhury: what is robotic heart surgery and heart transplantation, now a day both the
      procedure done in India?

      Dr. Bhattacharyya: -       When a heart surgery is performed with robotic assistance, it is
      called robotic heart surgery while replacement of an end stage diseased heart with a healthy
                                               5
      heart obtained from a cadaver donor is called heart transplantation. While robotic heart
      surgery has been performed recently in Escorts Heart Institute & Research Centre, New
      Delhi heart transplantation procedure is going on for last few years in selected cardiac
      centers of India.


16.   Choudhury: what is vascular disease and vascular surgery and what is Peripheral
      arterial occlusive disease (PAOD) and Buerger’s disease?

      Dr. Bhattacharyya: -      Any diseases of the blood vessels of our body (arteries, veins and
      lyumphaties) are termed as vascular diseases. It can affect any part of the human body.
      When surgery is required for these diseases, Cardio-thoracic Surgeons perform surgery of
      the blood vessels of heart, Neuro-Surgeons perform surgery of the blood vessels of brain
      and surgery of the blood vessels of rest parts of the body is looked after by a new but
      established group of surgeons termed as Vascular Surgeons. Vascular diseases of the body
      dealt with by Vascular Surgeons are now know under a specific heading called Peripheral
      Vascular disease or PVD. Examples of Peripheral Vascular diseases are Peripheral Arterial
      occlusive disease (PAOD), Buerger’s diseases etc.


17.   Choudhury: what is bacterial endocarditis and pericarditis as we heard most of the
      patient often suffer from above problem after surgery?

      Dr. Bhattacharyya: -       The inner side of chambers of the heart are covered by a thin
      layer of cells called endocardium. Infection of this layer with bacteria is called bacterial
      endocarditis. This infection occurring to a postoperative patient is a very serious problem
      and needs aggressive management. Seriousness increases manifold in case of heart valve
      replacement. During and after surgery special care is taken to prevent it.

                 Heart is covered by a sac called pericardium and inflammation of this sac is
      called pericarditis. This condition may occur frequently after surgery and patient may
      become symptomatic. Usually patient responds to medications and recovers early.


18.   Choudhury: what are the affects of smoking? Is it tough for heart and lungs?

      Dr. Bhattacharyya: -      Smoking is so harmful that approximately 40% of smokers die
      premature. It affects almost all parts of our body including lungs and heart. In lung
      development of cancer and chronic airway obstructive diseases are main danger. In
      cardiovascular system, diseases of blood vessels are the main manifestations. This results in
      peripheral vascular diseases, hypertension and ischaemic heart disease. Cessation of
      smoking may reverse or slow down progress of many of these pathological changes.


19.   Choudhury: is heart disease hereditary?

      Dr. Bhattacharyya: -      Yes, few heart diseases are hereditary.




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20.     Choudhury: what is your suggestion to the patient already underwent heart surgery like
        Valve Replacement, Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), Patent
        Ductus Arterious (PDA) and Coronary Artery Bypass Surgery (CABG) for keeping their
        heart healthy?

        Dr. Bhattacharyya: -       All post operative patients are given instructions regarding drugs,
        diet, exercise and follow up at the time of discharge from the hospital which should be
        followed religiously. Patients should not hesitate to consult their operating surgeon in case
        of any concern or doubts. Active participation of the patients in health care makes the post
        operative management easier, free communication with the surgeon relieves the patient of
        many avoidable anxiety and will help early detection and treatment of any post operative
        problem.


21.     Choudhury: finally, what are the best ways to keep heart healthy?

        Dr. Bhattacharyya: - ♥    Don’t insult your heart,
                             ♥    Stop smoking,
                             ♥    Do regular exercise,
                             ♥    Consult doctor in case of any symptoms,
                             ♥    Treat hypertension, diabetes mellitus, high cholesterol level,
                             ♥    Follow advices of doctor,
                             ♥    Add yoga and meditation to your regular life for keeping heart
                                  healthy.



        PROFILES OF DOCTOR BHATTACHARYYA

1) Dr. Dipak Kumar Bhattacharyya is the first and only surgeon from entire
North-East who qualified in Magister of Chrurgerie (M.Ch) in Thoracic Surgery
from Christian Medical College & Hospital, Vellore in the year 1996. The
Christian Medical College & Hospital, Vellore is credited with conducting India’s
first successful open heart surgery as well as first kidney and liver transplants.
M.Ch in Thoracic Surgery degree started in CMC Hospital, Vellore in the year
1961 and since then till 2004 i.e. last 43 years only 100 persons have been
qualified in M.Ch degree in Thoracic Surgery and Dr. Bhattacharyya is one of
them.




                                                7
2) He resigned from the post of Lecturer in the Department of Cardio Vascular
Thoracic Surgery, Christian Medical College & Hospital, Vellore in the year 1999
and decided to settle down at Guwahati and came back for helping to the needy
patients those who can’t afford to go outside North-East for treatment of various
heart ailments.


3) He was one of the favourite students of Dr. Roy John Karula, Professor &
Head of the Department of Cardio Vascular Thoracic Surgery, Christian Medical
College & Hospital, Vellore as commented by Dr. Roy John Korula.


4) He has excellent records in the fields of cardio-thoracic surgeries.


Incase of any query or any suggestions may contact                            to
DR. DIPAK KR. BHATTACHRYYA through the followings: -
By mailing: -
                Dr. Dipak Kr. Bhattacharyya, MS, M.Ch (Thor)
                Assistant Professor,
                Cardio-thoracic Department,
                Gauhati Medical College,
                Guwahati, Assam, India.

By E-mail: -
                drdipak@sify.com

Over phone: -
                0-94351-03148 (Cell)

Interviewed by: -
              RATNAJIT CHOUDHURY.




                  ♥♥♥♥♥
           Take care of your heart!
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