The human heart is a complex and chief organ for survival. In our attempt to understand the importance of heart better, we spoke to Dr. Niraj Gupta. He is currently practising as an Associate Director of Interventional Cardiology at Medanta Hospital Gurgaon.
Ques 1. How is interventional cardiology different from other subspecialties? What are the indications that a patient requires a catheter-based procedure?
The difference between interventional cardiology and other branches of cardiology is that it is very demanding. We, as interventional cardiologists, have to work 24✕7 and 365 days. It is because cardiac emergencies can affect a patient at any time. So we have to be on our toes always.
The other thing about interventional cardiology is that the results are very gratifying. For example, if somebody suffers from an acute heart emergency and his pulse rate and blood pressure are very low, then we would immediately take the patient to the cath lab to do an angiography. We would open up the heart vessels by angioplasty or push a temporary pacemaker immediately to save his life. So, this aspect gives a sense of satisfaction to the doctor himself that he has saved a life even at 2 am or 10 pm in the night. It is different from other specialities in the way that it gives instantaneous results. But for such results, we have to work hard and have full expertise to handle complex situations also.
Now, talking about the indications for the catheter-based procedure like angiography. One indication is that the patient may be having chest pain or acute coronary syndrome, then their ECG changes and troponin levels in the blood tests are elevated. In these conditions, you have to do the coronary angiography immediately without wasting any minute. We have to be very fast in acting and making a decision.
The other indication is unstable angina, where the troponin level is fine but then the doctor is suspecting something odd. Apart from acute conditions, there may be some chronic conditions also in which coronary angiography should be done. Like the patient gets angina on minimal exertion or that the severity of angina has increased despite optimal medical management. Also, if the stress tests and other tests are strongly positive and a large amount of muscles is involved, then this procedure is conducted.
Ques 2. Vascular closure devices are well in use in the field of cardiology. Can you elaborate on its uses and benefits?
Vascular closure devices are available in the market for the past few years. Initially, what we used to do is that after doing an angiography or angioplasty, we used to compress it. Or if we had to do certain procedures in which the catheter is very wide, then we had to make a surgical cut-down. But nowadays with the introduction of different vascular closure devices, we can use it post- angioplasty also.
If we put the vascular closure device, then the patient does not have to keep his leg or arm straight for 4-6 hours. Hence, the patient can be mobilized early.
There may be some patients with spine problems who may not be able to lie for a long period after a procedure. In such cases, vascular closure devices are very essential and good. Also, in older patients who have difficulty in passing urine while lying down or patients in whom there is an enlarged prostate, we can put a vascular closure device for the ease of the patient.
Ques 3. Studies have shown that air pollution increases the risk of heart diseases in men and women. Curbing air pollution is a tough battle to fight but heart diseases can be prevented. What are your suggestions and views on this issue?
I agree that air pollution can cause heart diseases along with respiratory diseases. Some epidemiological studies on this subject have been conducted which have shown a correlation between the level of air pollution and heart diseases. There also have been publications in several cardiovascular textbooks.
Alveoli is the part of the lung through which aeration takes place. It is that part from where the oxygen comes in and the carbon dioxide comes out. There are different levels of air pollution. Suppose the PM level is above 10, these particulate matters are bigger particles. So they don’t reach the alveoli.
The particles which are less than PM 2.5 can cross the alveoli and enter our bloodstream. Or they can be stagnant in the alveoli itself. If these small particles cross the alveoli and enter our bloodstream, they can cause inflammation. Once they cause inflammation, the lungs also get damaged and the patient suffers from some breathing problems. These can also cause oxidative stress in the body and atherosclerosis. Atherosclerosis means deposition of cholesterol in the blood vessels of the body.
So as a result of this deposition, the blood vessels start narrowing gradually. Another thing is that these particles can cause hypertension. So once you are hypertensive and you have atherosclerosis, there are more chances of heart attack and stroke. So these are the side-effects of a high level of air pollution on our body, which should be contained as soon as possible.
Ques 4. What obstacles do you face while performing a procedure under interventional cardiology?
Generally, we face a lot of obstacles in interventional cardiology while performing procedures. I think one of the biggest factors that cause these obstacles is the financial problems in India. Everybody in the country may not be able to afford angiography, angioplasty, pacemakers or TAVI procedure. Even though the Indian government has come up with multiple schemes, this problem persists.
Another problem is the myths surfacing in society. Imagine somebody has suffered a heart attack and needs urgent intervention as a life-saving procedure. But their family would have heard of certain myths to avoid angioplasty. The family may believe that they could control this disease or prevent the heart attack with other kinds of medications.
When somebody comes with a heart attack, there are two options – either we give blood-thinning agents or we do primary angioplasty. The best modality is to do angioplasty urgently. Everywhere in the world, urgent angioplasty is being conducted.
The third factor is that people are half-educated through the internet. People read something on the internet but they do not have full knowledge about that subject. It is difficult to explain to them what is going to happen. They come with information that is now in their minds. The challenge is that we have to educate them completely so that they understand the disease process, history, treatment options and henceforth. All the crucial time is consumed in this and delays the procedure, leading to damage to the heart muscles. This condition can further be life-threatening to the patient, in both, the short and long term.
Ques 5. Most people lead a sedentary lifestyle these days. What advice would you like to give to the elderly, working-class and children for maintaining better heart health?
For better heart health, two-three things are very important. The first thing is healthy living. Healthy living means a healthy and proper diet that includes less fatty foods, fewer carbs and less sugar. These days sugar and salt are known as white tobacco. So everybody should try to avoid them.
Kids should avoid junk food. Parents should persuade their kids to eat healthy foods instead. These days, many children in the school are hypertensive and obese without knowing it. It is a very alarming situation in India. Kids are obese because they are not involved in enough physical activities. They concentrate on playing video games on their computers or mobile phones. Also, they are eating a variety of junk food. Regular blood pressure checks should be done by the school for the kids. They should aim to control the weight of the kids. Students should play outdoor games to have a healthy life.
For middle-aged people – Regular heart checkups should be done. At Medanta Hospital, Gurgaon, we offer different health packages. With the use of these checkups, you can determine which risk factors can develop into heart disease in the future.
Hypertension’s nickname is the Silent Killer. You don’t know about it until you realize that you have certain problems. But by the time you realize these problems, the disease may have progressed. It may affect the brain, the eyes, the heart, the kidneys and the nerves. So regular heart checkups should be done, along with eating healthy and regular exercise. I recommend minimum 30-40 minutes of moderate exercise, at least 5 days a week. It has been proven that exercises decrease weight, controls cholesterol levels, hypertension, diabetes, and gives a sense of well-being to the person. It also controls depression because good hormones are being secreted by your brain, like endorphins, which improves your overall musculoskeletal system.
For elderly people – Again, regular checkups for elder people are suggested. The people in this age group usually develop high levels of hypertension, diabetes, and cholesterol levels. Patients with high blood pressure should take their medicines without fail.
People generally believe that if they take medicines and notice a controlled blood pressure, they can then stop their medications. This should never be done. A hypertensive patient should never skip taking their medicines since their blood pressure is controlled because of the medicines. Once you stop the medicines, the blood pressure will shoot up and they will have rebound hypertension. So before making any changes to your medicines, you should consult with your doctor.
Besides this, tests like echo, TMT, stress and all should be done regularly. People of all age groups should exercise. The best exercise for elderly people is brisk walking.
About The Doctor
Dr Niraj Gupta is a famous Cardiologist and Associate Director of Interventional Cardiology, Heart Institute at Medanta – The Medicity, Gurgaon. He has over 19-year clinical experience in his field. He has completed his MBBS from Pt. B.D. Sharma PGIMS Rohtak, MD – General Medicine from Pt. B.D. Sharma PGIMS, Rohtak in 1999 and DNB – Cardiology from Escorts Heart Institute & Research Centre, New Delhi in 2006. Previously he was associated with Apollo Hospital, New Delhi and has also served as a Cardiologist at Escorts Heart Institute And Research Centre, New Delhi.
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