Why Are Indians At Higher Risk For Heart Attacks? | Dr. Nizamudeen
Table of Contents:
- Why Are Indians at Higher Risk of Heart Attack?
- Recognizing Heart Attack Symptoms in Younger Individuals
- What Exactly Is Plaque?
- Understanding the Link Between Cholesterol and Plaque
- How Can We Detect a Silent Heart Attack Early?
- Managing High Cholesterol in Young Children
- Cholesterol Treatment in Children: When to Start?
- Is Ghee Good or Bad for Cholesterol?
- The Protein Debate: A Cardiologist’s Perspective
- Belly Fat: A Hidden Risk for Your Heart
- Viral Health Hacks: Do They Really Work?
- Smartwatch Monitoring: Is More Data Always Better?
- Heart Disease Runs in the Family? Start Here.
- Are IT Professionals More Prone to Early Heart Problems?
- Heart Health Supplements: Helpful or Hype?
- Heart Attack: Warning Signs You Shouldn’t Ignore
- Gastritis or Heart Attack? Know the Difference.
- Can Lifestyle Changes Reverse Hypertension & Diabetes?
- How Does Obesity Affect Your Heart?
- Heart Health Myths: Let’s Bust Them!
- Heart Attack: Why Every Minute Matters
- Beyond Streptokinase: What Are the Treatment Options?
Dr. Hema Sathish: Hello everyone. Today we have Dr. Nizamudeen, a very well-known cardiologist. Welcome, sir.
Dr. Nizamudeen: Hi, glad to be here.
Dr. Hema Sathish: So it’s wonderful to have you here today, sir. And we are going to talk about heart attack in young individuals. It was such a burning topic, right? And I’ve heard that Indians are more prone, like we in India get heart attack earlier.
Dr. Nizamudeen: Yeah.
Dr. Hema Sathish: So could you just explain that why?
Why Are Indians at Higher Risk of Heart Attack?
Dr. Nizamudeen: India is now becoming the capital of heart attack because Indians are more prone for heart attack. And then the Southeast Asian race, we are all the rice eating population. We have a genetic tendency towards heart attack. And there is a culture of sedentary lifestyle together with the food delivery apps. And then people having poor stress management, poor sleep quality. And they have many hidden risk factors like untreated hypertension, undetected diabetes and undetected dyslipidemias. So, they all add along with the smoking, they all add to the heart attack in the young individuals.
Dr. Hema Sathish: Okay, so stress is the biggest factor or one of the factors?
Dr. Nizamudeen: I can say stress is the most important factor because when they have a genetic tendency, not all the people will manifest. Only those who are with the high stress levels, they manifest early.
Dr. Hema Sathish: Okay, okay. So that’s really sad. But you said rice eating population. But now the awareness is quite high and we tend to cut down on rice, at least the educated population. And then the northern part of India, they don’t take rice much, right? So it’s, I mean, the segregation happens there also. So southern part is more and the northern part is less.
Dr. Nizamudeen: It is not like about rice particular, the whole grains actually reduce the risk of heart attack. The American Heart Association, they all recommend whole grains, whether it is rice or wheat or any other millet, it should be as a whole grain. Because the fibre part increases, the carbohydrate, refined carbohydrate level also decreases and the ability of the body to metabolise it also increases. So, when the when it is very refined like the white rice or polished wheat or atta, they all lead to the metabolically abnormal milieu, hormonal milieu which leads to the dyslipidemia and then it leads to the heart attacks.
Dr. Hema Sathish: Oh, so there is a process to it.
Dr. Nizamudeen: Yeah.
Dr. Hema Sathish: Wow, that is really nice. So, when you are talking about like early heart attacks, this is not something everybody would be prepared or expecting, right? So, what exactly does the person come with?
Recognizing Heart Attack Symptoms in Younger Individuals
Dr. Nizamudeen: Heart attack usually comes with chest pain, that’s what we mostly think. But sometimes it may be a varied presentation of shortness of breath or palpitation or sweating. They may come with some jaw pain or throat pain or a heaviness.
Dr. Hema Sathish: So, the heaviness, I mean, what would come first?
Dr. Nizamudeen: Yeah, mostly it will be a dull aching pain and sometimes it will be burning type and compressive that is what we classically describe. But it can present it with any complaints like the most important thing is it radiates towards the back and to the neck or up to the umbilicus and then if a person tries to walk or move it will get exaggerated.
Dr. Hema Sathish: Okay. So if you have some heaviness or mild pain, and it increases if you’re increasing the activity, then you’ve got to be having your alert buttons on. That’s something which we all should keep in mind, I guess. Because I’ve heard of people who have walked up some hill or just gone trekking, and then they just collapsed with a massive heart attack. That was like shocking. And they were not very old either.
Dr. Nizamudeen: Yeah.
Dr. Hema Sathish: So, this is very common is it?
Dr. Nizamudeen: Common, yeah. So, with when they are doing unaccustomed activity, so that is a chance of the plaque destabilization. So, their coronary plaque which was silent gets destabilized and it leads to the thrombosis and leads to total occlusion. That is where they end up with fainting or unconsciousness.
Dr. Hema Sathish: So what is this plaque? Can you explain so that everybody understands what exactly a plaque is?
What Exactly Is Plaque?
Dr. Nizamudeen: Plaque is a Greek word meaning a stone. Actually it is a fat like what we buy butter. So it goes inside the coronary arteries intima and goes to subintimal region. It becomes a fibrous stone like thing then later becomes calcified. Once it stabilizes it will be held by a cover thin sheet. So, this thin sheet get ruptured when they go to the unaccustomed activity or stress or sometimes heavy sports or sometimes they may hear some musical sounds in the festivals. So, because of that loud noise also they will have some flock destabilization.
Dr. Hema Sathish: That is something quite scary. So, we have to be aware of that also now. So, when you said this fat like thing inside, so is it to do directly with the cholesterol in your blood or it is just that it is some other type of fat?
Understanding the Link Between Cholesterol and Plaque
Dr. Nizamudeen: Yeah, cholesterol we have two basic two types of cholesterol; one is LDL that is a bad cholesterol and which goes to which supplies all the tissues and the HDL is a reverse cholesterol that is a good cholesterol which takes the bad cholesterol from the body and then sends it to the liver. So, it is actually needed for your living just like water is needed for the plant it is needed, but when it goes to the excess level it goes and deposits. But sometimes when it is normal level also the person if he is a genetically predisposed individual he is he is supposed to have something called stickiness. So, normal cholesterol goes and sticks at the normal levels itself. So, that is called as the small dense lipoprotein LDL. The LDL particle will be very minimal such that it penetrates intima, goes inside the intima and then deposits.
Dr. Hema Sathish: Intima is you have to explain please.
Dr. Nizamudeen: Yeah. So, intima is like the innermost lining of the arteries. We have arteries the vessels which carry the blood vessels. So, it is lined by a single layer thickness of cells that is called as intima that is innermost cell. So, cholesterol is carried by the blood vessels and then it goes in a normal rate, but LDL sometimes when it is high it naturally deposits by traversing into the cells and then goes into the innermost layer beyond that innermost layer. And if it is very high it naturally deposits but sometimes those who are genetically predisposed get their deposition even at the lower levels of cholesterol.
Dr. Hema Sathish: Okay that’s that’s very very very well explained well when you are you are talking about this symptoms that is silent heart attacks so these symptoms are very mild or very slow So, can there be something which we can do to make sure that you know someone is alerted earlier?
How Can We Detect a Silent Heart Attack Early?
Dr. Nizamudeen: So, chest pain is a very important warning sign. So, whatever chest pain the patient is presenting it should be considered as heart attack unless proved otherwise. So you have to treat any chest pain immediately. You have to take an ECG within 10 minutes. Even your previous ECG done some 2 hours back or in the morning or in the evening it is done and found to be normal. The patient is having again chest pain means you have to do an ECG again. So, and the with the background of the risk factors like you are having a strong family history of your dear ones having a heart attack and your BP is not under control or you have taken medicines for sugar, cholesterol, that is a risk factor then you should be always alert.
Dr. Hema Sathish: Now, when you say early, what is the earliest heart attack you reported in medical history?
Dr. Nizamudeen: Yeah, so it varies actually. Usual time they present to the emergency department is usual studies when they report a window period of 4 to 6 hours. But sometimes it may present within 20 minutes, 10 minutes also. I remember my senior doctor who was giving a CPR to a patient and then immediately he had some kind of muscle pain. Then he took ECG, within 10 minutes he diagnosed for himself.
Dr. Hema Sathish: Oh my god, that’s scary.
Dr. Nizamudeen: Then he got an injection shot and then went to the nearby hospital, fixed a block in this LAD territory, blood vessel, immediately he underwent a primary angioplasty. That I can say like 10 minutes also it can be found, provided if you are lucky you can have early diagnosis.
Dr. Hema Sathish: Okay, that’s quite interesting. I also want to know the age, what earliest age a person has come with a heart attack?
Dr. Nizamudeen: So, I have seen a boy studying plus one.
Dr. Hema Sathish: Oh my god!
Dr. Nizamudeen: Like 18 years, they all 17 years, 18 years they all.
Dr. Hema Sathish: Yeah, must be 16, 17 that is it. That is got some hereditary factors or some congenital deformity which is.
Dr. Nizamudeen: Congenital dyslipidemia, familial hypercholesterolemia. So, they recommend the American Heart Association recommends screening of cholesterol by young age itself. For any person it should be started within 20 years. It should be started within 20 years and those who have a family history of familial hypercholesterolemia in their father or in their siblings, they have to start a cholesterol screening by the age of 2 years.
Dr. Hema Sathish: Oh my that is that is like so tiny ok. But you know there are some children who present with high cholesterol that is hyperlipidemia. So, in that case what would you recommend?
Managing High Cholesterol in Young Children
Dr. Nizamudeen: Yeah, so for any individual the lifestyle modification is very important. You have to limit your saturated fat intake and that is very hard with the children also because their peer groups are having the lot of bakery products and processed foods. We have to educate them, we have to educate the whole family about that. So, and then activity and pores and sleep quality has to be improved. So, these are the basic things and apart from them from that we can start statins also. We can start statins and there are many drugs like Inclisiran and monoclonal antibodies. If it is not controlled with the statins, we go to the injectable forms of controlling the cholesterol also.
Dr. Hema Sathish: So, how early can you start medications? Like if you have a small child, it is so sad that you have to start them on medications for cholesterol, but how early and what kind of medications can be given?
Cholesterol Treatment in Children: When to Start?
Dr. Nizamudeen: So, we can when once the child is diagnosed to have cholesterol high levels of dyslipidemia, We have to start them, there is no other go, we have to start them on therapy which mainly includes a non-pharmacological treatment that is the diet therapy and then activity and then sleep and then weight management has to be started with the top priority. Next we go on to the drugs, then classical cholesterol drugs can be started and if it is not controlled we go to the injectable levels of drugs.
Dr. Hema Sathish: So there’s a lot of treatment available. But it’s necessary that the diagnosis is also made earlier. So when you’re talking about cholesterol, what role does ghee play in it? Because nowadays there’s so much of theory that ghee is very good, you can have ghee.
Is Ghee Good or Bad for Cholesterol?
Dr. Nizamudeen: Ghee is actually a pure form, it is a non hydrogenated fat, it is a saturated fat but the caution is you have to limit your saturated fats to less than 10 percentage of your daily calorie intake. And anything in nutrition it should be a moderation. So, it can be taken but with the caution of moderation.
Dr. Hema Sathish: Now we talk about diets. So there are so many different types of diets which have come in. So this packaged food, is the increase in packaged food intake causing the increase in the heart attacks?
Dr. Nizamudeen: Yes, definitely the food delivery culture with the packaged food has increased especially. And, in the recent times this many food delivery they carry most of the fascinated and crunchy foods. All these are all deep fried foods and they have a lot of saturated fat and lot of high sodium and the refined carbohydrates which has less fiber also. So, this adds to the biological oxidation, peroxidation this leads to the inflammation and this leads to the pro thrombotic state also.
Dr. Hema Sathish: Oh, so the whole effect just comes down.
Dr. Nizamudeen: Yeah, cascade starts.
Dr. Hema Sathish: And now what about vaping?
Dr. Nizamudeen: Vaping is also a form of nicotine addiction only. So, though it is not smoky and it does not know cause the classical smoking associated know very it is not very toxic to other people, but it is toxic to the same person. It has the same effects dangerous effects as we take in nicotine.
Dr. Hema Sathish: There were some research papers which showed that vaping had increased sudden deaths in individuals. So, this is like pushing into a heart attack?
Dr. Nizamudeen: Yes, yeah. The thing in vaping is it is pleasant for them and they take in large amounts, large amounts. It leads to the greater quantities of the nicotine. So, this may lead to the higher nicotine dependency and then harmful effects of the nicotine also.
Dr. Hema Sathish: So when we talk about stress, so stress directly increases the cortisol of course. And so is the cortisol directly going to affect the heart and cause it or it’s the other things which it does, you know, one by one knocks off every, touches every, not knocks off rather, touches every other organ and bothers it and causes lot of other complications and then leads to the heart attack.
Dr. Nizamudeen: Stress is a major risk factor for any cardiovascular disease, be it a heart attack or stroke or cardiac failure or peripheral artery disease. This is all mediated by atherosclerosis, which is accelerated by the stress. Stress leads to catecholamine release and then a lot of counter regulatory hormones which raises the heart rate and this leads to the inflammation. And this inflammation leads to the deposition of more lipid and then it becomes more sticky and the atherosclerosis process is aggravated. So, this aggravated atherosclerosis leads to the cardiovascular problems.
Dr. Hema Sathish: Can you explain for the benefit of all the audience what is atherosclerosis?
Dr. Nizamudeen: Yeah, atherosclerosis is the abnormal cholesterol deposition inside the arteries. So, this leads to the blockage of the arteries.
Dr. Hema Sathish: Now coming to diet, so if you have to, now you said rice eaters and then we said refined carbs and then we said the fiber decrease. So now there’s a big drive for protein. Now what does protein do exactly? If you ask a nephrologist, they will have too many stories to say. As a cardiologist, what do you want to say?
The Protein Debate: A Cardiologist’s Perspective
Dr. Nizamudeen: Protein is actually, it should be a good quality protein and your plate if you take it should be like, the protein should be 25 to 40% of your total calorie intake and your plate should be should be filled with more of fruits and vegetables on one side and whole wheat or whole you know grains which has a lot of husk and fibers. And a good quality protein is one which is like skinless poultry or seafood or any fish and locally you know available fish can be taken or any plant. They prefer more of plant protein than the animal protein. Actually it is you know egg you can take or plant things you know you can take nuts or legumes or lentils. So, it should be like a good quality protein and this helps to reduce your glycemic index of the food.
Dr. Hema Sathish: Glycemic index means the sugar level.
Dr. Nizamudeen: Sugar level spike you know spike is reduced so that your body metabolizes the sugar levels and excess of carbohydrate is being converted into triglycerides. So, this is where.
Dr. Hema Sathish: Triglycerides is cholesterol. Cholesterol.
Dr. Nizamudeen: So, this is where the protein comes into play. So, if you take more of proteins you will feel more you know full and your protein should be in the breakfast the breakfast protein. Helps you to prevent the craving for in the mid day or in the evening if you want to have a coffee. If you have a good quality protein in the breakfast itself, the craving for sugars reduces in the rest of the day.
Dr. Hema Sathish: That’s quite an interesting fact. That’s something which we all can follow very easily, I guess. So now when we come to screening, what age would you advise a normal person? I mean, you do not have any other history or anything. Everything is good touchwood. And then you advise, what age would you advise to screen them?
Dr. Nizamudeen: Yeah. For heart disease screening should be started I could say like after 30 years. After 30 years because most of the heart attack was no previously reported between 40 to 50 years. Nowadays it is reported between 30 to 40 years. So, a screening for the heart attack should be at least after 30 years, but in US they recommend for cholesterol screening it should be after 20 years also. So but for Indian rice…
Dr. Hema Sathish: I think the diet over there is very bad, right? They tend to eat lot of…
Dr. Nizamudeen: Yeah, nowadays it is very bad.
Dr. Hema Sathish: At least the common man over there is a little less health conscious.
Dr. Nizamudeen: Yeah. They have a lot of screening programs also nowadays. But in India, we can say like after 30 years, you should have your BP and your sugars and renal function tests should be done. And after 40 years, you can check with the ECG, ECHO and all the routine tests. After 50 years, you can have a screening for cancer also. And after 60 years, you can check with your eye checkup, bone checkup also.
Dr. Hema Sathish: We had ophthalmologist who said we have to start eye screening quite early. So, 60 is too late I guess. When we talk about sugary drinks, how much role these can play in your cardiac health?
Dr. Nizamudeen: Sugary drinks usually contain some salt, hidden salt.
Dr. Hema Sathish: Okay.
Dr. Nizamudeen: And they have lot of refined carbohydrates. So, they are called the empty calories means they do not have a fiber and they are called as empty calories. They just add on to the accelerated atherosclerosis problem. So, this leads to lot of cholesterol, this excess sugar is converted into cholesterol. So, this leads to the harmful effects to the heart.
Dr. Hema Sathish: Okay. And what about belly fat? I mean everybody talks about it and so what can it cause because diabetes of course they have they are at a higher risk for diabetes. How high a risk in cardiac conditions?
Belly Fat: A Hidden Risk for Your Heart
Dr. Nizamudeen: So belly fat is basically because of the visceral fat. So there are two kinds of fat in the body. One is the subcutaneous what we have below the skin and the other is around the organs. So it is called visceral fat. The belly fat is mainly because of the visceral thing which is very dangerous than the subcutaneous fat.
Dr. Hema Sathish: Okay.
Dr. Nizamudeen: So, this leads to the this visceral fat act as a separate endocrine organ, especially this endocrine organ where it secretes the chemokines like interneucine 6 and TNF alpha.
Dr. Hema Sathish: They are the inflammatory.
Dr. Nizamudeen: Inflammatory things. So, this leads to the widespread atherosclerosis and this also leads to prothrombotic effects.
Dr. Hema Sathish: So, this leads to irritation in the blood vessels.
Dr. Nizamudeen: Blood vessels. Yeah, that inflammation.
Dr. Hema Sathish: It is for the common man to understand that is all.
Dr. Nizamudeen: So, inflammation is like the injury widespread injury to the blood vessel and this blood vessel injury leads to the stenosis. And because of the this widespread inflammation they are more prone for insulin resistance and then diabetes with the high levels of triglycerides, low HDL levels and hypertension, then high sugar levels this is this you know this entire thing is called as metabolic syndrome. So, this leads to this belly fat leads to a lot of problems and this metabolic syndrome is I can say this is the main root cause for all the consequent risk factors for heart attack.
Dr. Hema Sathish: Oh my, that’s like a lot. You just see a little bit of fat and then everybody talks about it only cosmetically. And if you have to see the effects of it at a cellular level, it’s like scary. Very dangerous. So what about these viral hacks which we keep watching on the internet? There are so many, right? So let’s begin with the smaller things. Apple cider vinegar.
Viral Health Hacks: Do They Really Work?
Dr. Nizamudeen: Apple cider vinegar is found to be like it adds to the taste but it has not proven to be very useful.
Dr. Hema Sathish: Scientifically not proven.
Dr. Nizamudeen: Not proven to be useful.
Dr. Hema Sathish: What about intermittent fasting?
Dr. Nizamudeen: Intermittent fasting I can say you give rest to the gut and you are setting your body for your repair, rest and balance and then you feed because your gut cannot work 24 hours and you have to give a good window for your gut to rest. So, this intermittent fasting helps us to slow down the gut process and this helps for the body to the other cells to repair. So, this is going to be very useful especially for controlling the blood sugar and cholesterol levels it is useful for BP also.
Dr. Hema Sathish: That is like a plus plus plus then for intermittent fasting. What about the fat burning hacks?
Dr. Nizamudeen: Fat burning will be very useful especially to maintain the body weight. Just as like you have to have your numbers in control like you have to have your BP 130 or your sugar level in normal. You have to have an ideal body weight like it should be between 18.5 to 25 of BMI. So your body weight has to be maintained in such a way that it is friendly for your heart. So to maintain the body weight you have to have a normal calorie intake and you have to burn more of fat. In this, you can have regular intense physical activity scheduled as per schedule or you can have a short bus of running or swimming or vigorous physical activity also. And you can have some, you know, like you can park your car distance later also and then you can walk purposefully and you can use staircase instead of elevators.
Dr. Hema Sathish: To come from a physical activity.
Dr. Nizamudeen: Physical activity should be there.
Dr. Hema Sathish: And apart from that the diet also.
Dr. Nizamudeen: Diet also.
Dr. Hema Sathish: And the most common one everybody does detox drinks. What is your take on that?
Dr. Nizamudeen: Yeah. Detox drinks are especially useful to improve the gut quality. So, like the apple, beetroot and carrot drinks and then you can have chia seeds, flax seeds. So, these all help your gut to know process normally, it avoids constipation. Thereby promotes your you know gut brain access health. So, if your brain and gut are active and healthy it indirectly reduces your stress. It reduces the whole body inflammation. So, whereby the inflammation induced heart disease will be reduced.
Dr. Hema Sathish: That’s quite a chain of things.
Dr. Nizamudeen: Interconnected.
Dr. Hema Sathish: And so connected, right? Well, let’s talk about some smart watches. So everybody seems to wear some smart watch, like some wearable’s. And so, there are so many reports now. They see, you know, night I slept so many hours, deep sleep was so much, my heart rate was so much at this hour. So, so much of monitoring goes on. So, do you think that is a healthy practice?
Smartwatch Monitoring: Is More Data Always Better?
Dr. Nizamudeen: Yes, actually it should be taken with a like a pinch of salt. So, you should have a wearable devices. It is a form of awareness and it helps the patient to know seek a doctor early if they have any abnormal warning signals. For example, people wear it to monitor their heart rate, to monitor their footsteps, to monitor their oxygen level, sometimes they can see the ECG’s also. Sometimes it is no useful for BP detection also. So, if it gives an alarm the patient should not omit it and become should not become panicky also. So, it is a form of you know remainder for the patient to seek a medical help. It is not equal to medical diagnosis, but it should be taken as a form of increasing the awareness and motivation.
Dr. Hema Sathish: So it works both ways. So it’s up to us to decide how well we use it. So don’t get just carried away by wearing a smartwatch and thinking that, you know, whatever it says is right. Neither ignore it. So you should know the fine balance. Because once I was talking to a doctor about smartwatches and he said, don’t go by that. That tells a lot of things. So it’s necessary to know, but it’s not necessary to react, I guess. When the familial history of heart problems are there, so what would you advise them to do in the household? So it’s not possible for them, you know, every member of the family runs to the hospital, sees a doctor and takes some kind of a help or something until it is warranted. But then what kind of things they should do at home so that, you know, they are kept under check and when the necessity comes, then they go to the doctor.
Heart Disease Runs in the Family? Start Here.
Dr. Nizamudeen: Yeah. So your heart disease no care for the heart disease prevents no starts with the prevention so the it we should aim to prevent the heart disease rather than to treat it.
Dr. Hema Sathish: Okay.
Dr. Nizamudeen: So like how do you prevent the heart disease in the home means we have to have a common family schedule for a heart healthy heart friendly healthy schedule should start with the discussion among the family members that they should eat on time, they should eat the balanced food, they should limit the salt intake, they should limit the refined carbohydrate intake, they should have a habit of walking in the morning and evening, they should go to bed early. So, this is all the daily routines and once in a week they should all sit together and then watch their BPs. Watch their sugar level and once in a month they should check all the you know blood parameters like advanced lipid levels also or they can have a monthly once common month for example, November all will come and then they will take move to the doctor, they will take all their files. Once in a year they should have a periodic routine checkup. So, this is how they can you know prevent the heart attack.
Dr. Hema Sathish: Okay, so that’s quite interesting. So if you have a familial history, then by following this, at least the other problems would be taken care of, I guess. I don’t want to talk about it like attacks or anything, but then the serious problems can be handled well. So there is a talk always that you know, IT professionals are more prone to heart attacks at a younger age. I mean, would you like to second that?
Are IT Professionals More Prone to Early Heart Problems?
Dr. Nizamudeen: It is true actually. We are seeing lot of young people with heart attack and most of them have you know IT work and their work is actually stress with a lot of you know sleepless nights.
Dr. Hema Sathish: Okay.
Dr. Nizamudeen: And they are having shift duty so that the they are not having a proper quality sleep. So that is the major thing I can say. And because of the stress and improper eating pattern, they all have no outside food which they can’t afford to have home food also. So they have a lot of harmful foods. This leads to the added to that they have a physical inactivity also.
Dr. Hema Sathish: Yeah, they are quite sedentary.
Dr. Nizamudeen: Yes, quite sedentary because their sleep cycle is disturbed. They can’t go for a regular exercise schedule also. So that leads to the heart attack.
Dr. Hema Sathish: So this is very much true.
Dr. Nizamudeen: Yeah, true. Very much true.
Dr. Hema Sathish: So I think IT professionals should take this very seriously and try to do some kind of a lifestyle change to make sure that you don’t end up with scary things. Well, when we look at vitamins and supplements, there are so many in the market, right? And then there are many which say that, you know, for good heart or heart health. So what multivitamins or supplements do you think is a good heart supplement?
Heart Health Supplements: Helpful or Hype?
Dr. Nizamudeen: So as of now, to lower the cholesterol levels and triglyceride levels, we can take omega-3 fatty acids. These are all scientifically proven and approved by American Heart Association. Other than that, lot of products are there like Coenzyme Q, Lycopene and many other products also which are not known to have good scientific support. So, what I would say is the omega-3 and vitamin D, they are all known to protect heart.
Dr. Hema Sathish: Okay, okay. That’s quite interesting. So if you want to take some multivitamins for the heart, there are some available. You can try them for sure, I guess. They say your body warns you a few days or months ahead that you’re going to have a problem. So what are those warning signs which we can look for?
Heart Attack: Warning Signs You Shouldn’t Ignore
Dr. Nizamudeen: Warning sign is usually a form of breathlessness and on your usual activity you get tired or fatigue or may have a discomfort on exercise or fainting when you bend down and then get up you have a blackout. So, these are all the warning signs.
Dr. Hema Sathish: So, how early can these begin?
Dr. Nizamudeen: It can be quite varying from months to weeks also. But we have to pick it up. The thing is people usually they neglect their symptoms due to varied reasons because they try natural medications and they try with the community healers. They have some the accessibility issues. Sometimes they will be preoccupied with their own responsibilities in the families. And they neglect all the symptoms and end up in a complication later. The thing is you have to pay attention to what your body says like you are feeling tired and they have a problem and go get checked earlier your BP and your ECG. If it is normal you can know jolly well do your routine works.
Dr. Hema Sathish: Many a times patients complain of gastritis but at times it could be a cardiac problem right especially the inferior wall infarct can present that’s a lower wall heart attack so can present like gastritis so how do you differentiate that and or when do you say it’s gastritis?
Gastritis or Heart Attack? Know the Difference.
Dr. Nizamudeen: It is just a gray zone we can say like heart attack induced chest pain and gastritis induced chest pain are close mimic symptoms. Because this is because of the referred pain when we are in the embryo stage we have a common nerve origin. So when you have a stomach pain it closely mimics a heart attack pain or if you have a heart attack pain sometimes it may radiate to the stomach and you will feel like it is gastritis only. So the point of differentiation will be like if you are having your gut as in the good condition, you are eating on time, you are avoiding tea and you are not exposed to very chilly foods and you are under medication for gastritis, you have done your gastroscopy, everything and it is clear. In spite of that you are getting some problem in you have to you will be alert. So, this is one way. The other thing is you have any form of you know chest pain or any suspicion you go to the doctor and then get it get the ECG done cleared and make sure that it is not a heart pain.
Dr. Hema Sathish: Present very gently also, but nevertheless it is a scary thing. So, what can be done about this? How do you know how to pick?
Dr. Nizamudeen: Yeah, as you correctly said, all the heart attacks need not be in a like, no one shot, it will be like sometimes it will be having a they’ll be having a slow form of pain. And it will be for from hours to sometimes days also. So, when it comes you know when the patient feels like it his pain is increasing severity or it is radiating pain and it is not bearable they should seek the doctor immediately.
Dr. Hema Sathish: So there are some people who say that, you know, if you go the natural way, so you take natural things, natural food, everything. So you can revert this lifestyle diseases that would include hypertension and diabetes. What’s your take on that?
Can Lifestyle Changes Reverse Hypertension & Diabetes?
Dr. Nizamudeen: Yeah. Diabetes and hypertension, dyslipidemia, when it is because of the reversible factors, it can be reversed easily by a proper lifestyle changes. Like your sleep is good and your diet is healthy and your excess weight is being reduced. Definitely there is a reversal, but it is not a one stop thing. Sometimes it will be reduced for a while and then later it can manifest as IBP or high cholesterol also. So it is not a remission, it is not gone forever. It can remit but you have to be very careful.
Dr. Hema Sathish: So there is a good chance but depends on how you manage it well. Okay. Talk about belly fat. Could you just elaborate some more on if a person is obese, general obesity, so how will that affect the heart?
How Does Obesity Affect Your Heart?
Dr. Nizamudeen: Obesity is a strong risk factor for heart disease in the sense it affects multi system like previously they say diabetes is the thing which leads to the multi system disorder. Obesity is well known to cause problems in all the systems. It causes the atherosclerosis, heart attack and stroke and then the COPD. Then kidney diseases, lot of diseases. All this derangement of all the problems in all the organs leads to the heart problem. This leads to this subcutaneous fat and visceral fat, this leads to the incipient heart failure. So, the unrecognized heart failure sets in and the patient suddenly goes for the severe LV systolic dysfunction. And then.
Dr. Hema Sathish: Can you explain a little on that LV systolic?
Dr. Nizamudeen: LV systolic dysfunction your left ventricle is the major part of the heart. This muscle goes for the silent failure. So, this because of the improper contraction that is systolic failure. As well as the relaxation your diastolic also your ability of the heart to stretch to receive more blood from the upper chambers that is also restricted because of the ongoing inflammation in your body fat that indirectly affects your heart muscle also that leads to the heart failure and accelerated atherosclerosis that is the building up of the plaques in your coronary arteries And this leads to the multi system like when you get affected with stroke, the quality of life reduces, your intake alters and this indirectly affects your heart also. And your kidney is affected, you should have a salt restriction and this indirectly affects your heart also. So, obesity leads to lot of problems. What I would say is the most under recognized problem in obesity is their sleep issues. The partner complains of snoring and then they have a silent hypertension which is not detected. So, when you ask the partner he or she will say like he used to have a snoring and when we take BP invariably it will be high. So, this leads to the silent heart attack and silent heart failure and lot of multi-system problems also.
Dr. Hema Sathish: So, obesity is a big killer. Well, there is something like you know when we see that the person who is younger gets a heart attack. So, you think that age, that number which you put on them that is enough or it is the biological age which actually matters?
Dr. Nizamudeen: So the biological age is what your cells are undergoing wear and tear. So, your if your body is like 30 years by your chronological age, but if your cells are working more than your age like sometimes a person may be 30 years. But the cells are working very heavily such that the age of the cells become more to the extent of 60 years also. So, that is with their repeated working on the inflammation exposure, there is something called as the genetical change because of the biological oxidation, lipid peroxidation and this leads to the DNA methylation also. So, DNA methylase activity is measured, this is one of the promising factor for the cellular ageing. So, if the DNA methylation according to the Tufts University studies they have conducted and they have found to have if a DNA methylation your cellular ageing is high there is more risk of developing atherosclerosis and there be heart attack also.
Heart Health Myths: Let’s Bust Them!
Dr. Hema Sathish: Oh, so let us bust some myths now. So, coming to the very common myths that I go to the gym regularly, so I cannot get a heart attack.
Dr. Nizamudeen: Yeah, you are going to gym is a good habit actually. This now helps you to balance your weight according to your height. But the thing is it should be consistent. And that consistency is very important because your heart is consistently working for you every minute and every day. So, your care for the heart should be like you know in a consistent pattern. So, it is not the thing you are going to the gym alone is not you know important and you know exercise along with your diet and good sleep is also very important.
Dr. Hema Sathish: So, only overweight people get heart disease.
Dr. Nizamudeen: Yeah, heart attack is also common in the thin individuals also. Suppose the he is a thin individual, but he is having diabetes or he is having smoking issues or nicotine dependence or having improper sleep pattern still not even though he is not overweight still he is possible to have a heart disease.
Dr. Hema Sathish: Oh, heart attacks always happen suddenly.
Dr. Nizamudeen: Yeah, it is not true actually. It can happen, you know, in a slow process also. The patient may complain of pain and breathlessness or sometimes fainting, angina equivalence like thing and you know for days together or week also.
Dr. Hema Sathish: If you get a chest pain and if it goes away after some time, then it is nothing to worry.
Dr. Nizamudeen: False not always actually even if your chest pain goes away there may be some serious problem also. So, at that moment your blocked coronary arteries may having a revascularization by self what we call as aborted MI also. So, the myocardial infarction sets in the thrombus clogs the arteries sometimes it will recanalize by itself then again it will start blocking. So, it may be a normal phenomenon to have their chest pain completely reduced to the normal levels and it will be in an intermittent fashion also.
Dr. Hema Sathish: So, that is something which you have to be aware of.
Dr. Nizamudeen: Yeah.
Dr. Hema Sathish: Otherwise, you never know that such a thing could happen. So, if I am a very active person, then I do not require to do health check-ups.
Dr. Nizamudeen: Health checkup report being normal is not a guarantee that no you will not have future heart attack. It is just a snapshot of no continuous process your heart is undergoing or your metabolic parameters are undergoing. So your BP may be normal at this point and it may anytime it may be elevated. Your sugars may be normal at this point. Maybe in a future span of 2-3 months if you get more stress your sugar may go high. So one stop your BP or your reports are normal. It does not guarantee that you will not have heart attack in future.
Dr. Hema Sathish: There is a belief that only men get heart attack.
Dr. Nizamudeen: Yeah. So in young men there is less protection by estrogen as we have in women. So young women have the protection by their hormonal patterns like estrogen. That is why the older women after menopause when the estrogen effect is lost they will have heart attack. Young women also can have with this culture of having eating, not eating properly, not eating healthy, not moving much and sedentary lifestyle, having a family history, even young women are also at risk of heart attack.
Dr. Hema Sathish: So, stress is just mental, it does not affect you physically.
Dr. Nizamudeen: It is false actually. Stress actually it is considered to be a mental thing, but the form of the manifestation of stress is varied. It affects your heart, your internal organs also, it affects your blood flow, it affects your heart rate, it affects the blood pressure, even the cholesterol levels. Everything is affected by stress. If you control the stress, you can stop many diseases.
Dr. Hema Sathish: That’s so true. But so difficult to control stress. So, a protein heavy diet is very healthy for the heart.
Dr. Nizamudeen: It is not it is false actually. So, protein should be taken in the right proportion like 25 to 40 percentage of your diet should be protein and it should be a quality protein like the skinless poultry or fish and the seafood’s or the vegetable proteins, good proteins like beans, peas, lentils they have to be taken in the right proportion especially with low salt and low fat. The preparation of protein is very important.
Dr. Hema Sathish: Only smokers end up with blocked arteries.
Dr. Nizamudeen: Yeah, blocked arteries can occur in non-smokers also because of the varied uncontrolled and undetected diabetes. Uncontrolled blood pressure, undetected cholesterol levels, so and improper sleep and inactivity they all lead to atherosclerosis and hence blocked arteries are common even with non-smokers also.
Dr. Hema Sathish: So a single normal heart report means my heart is healthy.
Dr. Nizamudeen: It is false actually. Normal heart report may be normal at this moment. Your heart is okay for now. It doesn’t guarantee that you will not have heart attack in future.
Dr. Hema Sathish: If you are young and if you have hypertension, so do you think all physical activities are fine with them?
Dr. Nizamudeen: Yeah, your physical activity recommendation is actually 150 minutes of moderate physical activity. Like walking you know a casual walk this should be like 150 minutes of walking moderate activity for a week. It should be spread throughout the week. It should not be like a two days a week and then take rest for five days or a vigorous physical activity of 75 minutes like running or jumping a rope or swimming or cycling. This should be like 75 minutes. It should also be spread throughout the week. It should be continuous and there should not be a gap of three days or going to the activity and three days not going to the activity. And, it should be a combination of it can be a combination of both the moderate physical activity as well as intense physical activity. So, physical activity in the sense it should be accompanied with the strength training also. Strength training is also a part of the physical activity. So, other exercises will be like balancing exercises and stretching exercises and this can this should also be combined and endurance exercises also. This should also be you know combined with the physical activity.
Dr. Hema Sathish: Now, for instance if a person has got a heart attack which is not like very severe maybe or they you know there are no drugs to reverse it if it is early detected like within 4 to 5 hours. So, in that case what kind of activity would you suggest for them?
Dr. Nizamudeen: So, a person who have heart attacks, so their heart should be brought back to the normal level with the graded physical activity recommended for the heart, the you know ailing, the ill heart. It has to be brought to the normal level by graded physical activity. So, it should be this is called as cardiac rehabilitation, it should start from the ICU itself and when the patient moves to the step down ward, it should be a kind of activity and when the patient is discharged, they should be prescribed with some exercise. Just as we prescribe the medicines and diet, their exercise should also be prescribed depending upon their performance in the ward. So when they are in the ICU we will adjust we will ask them to move their foot and they will ask them to take a breathing exercise and then to move around the cot in the ICU. Then when they are brought to the step down they should sit in the chair and then they should go to the bed they should move around frequently. When they are in the ward level, they will be asked to go to the walk in the veranda and then do breathing exercises. When they go home, they can have a free weight training like just one kg dumbbell, just for biceps, triceps.
Dr. Hema Sathish: They can do it within how many weeks?
Dr. Nizamudeen: They can do after 2 weeks. 2 weeks. Minimal activity and walking is always the best exercise for any cardiac patient after and after a episode of heart attack they can walk for 15 to 20 minutes after 1 month say for example. And after their functional capacity improves, they can improve the walking speed, walking time by 5 minutes later, then say 20 minutes, then 30 minutes. So, half an hour walk per day can be slowly brought in their lifestyle in a span of 3 to 6 months.
Dr. Hema Sathish: Oh, wonderful. So, that is something really interesting, right? Because you have a heart attack and so you do not end up doing anything is also not again good for your system. There’s one more thing. We were talking so much about, you know, how to detect a heart attack and how you can, you know, prevent it also and how you should know what needs to be done. So, but now when you pick that now, you know, okay, there is probably, you know, you’ve been picked with a heart attack. So, now we’ve taken to the hospital. So, how early should you go? Because we’re talking about all these things. So, that early intervention is the best thing to do, right? So, can you just tell the timelines of how early the patient can be helped in the best possible way?
Heart Attack: Why Every Minute Matters
Dr. Nizamudeen: So, this is a great question actually. So, this is based whole thing the crux is based on your heart muscle no damage is irreversible. So, the early you intervene every muscle is saved actually. So, what we say is time is muscle. So, your cardiac muscle goes on for necrosis every 10 minutes it starts losing its number means there no the cardiac failure chances and the rate of death and increases and your quality of life also reduces if you are brought late to the hospital. So, the diagnosis of the myocardial infarction heart attack rest mainly on ECG. So, ECG should be taken for any chest pain patient within 10 minutes. That we call as the first medical contact to diagnosis as 10 minutes. And if they are diagnosed to have the heart attack and we give the blood clot remover that is called the streptokinase injection or Ritiplase or Tenecteplase whatever it may be that injection is given by a needle. So, we call as the door to needle time. So, this in the injection if at all it is prescribed it should be given very early. So, they will explain to the attenders and the attenders will take like they will call somebody, they will know they take some time to do actually because of logistical reasons.
Dr. Hema Sathish: So, you said like you know within the first 30 minutes only you can administer the streptokinase. So, in case if the patient is brought in a little later or they are not a very ideal candidate for the streptokinase, what else can you do?
Beyond Streptokinase: What Are the Treatment Options?
Dr. Nizamudeen: Yeah. So, if the patient is not suitable for giving this injection. We have to take the patient directly for intervention. So do an angiogram and balloon and then stent the patient. This all process should be done within 90 minutes. So this we call as door to balloon time. This should be done within 90 minutes.
Dr. Hema Sathish: And if the patient comes later than that, I mean they have taken few hours to find out and then going to the hospital. So what would be the procedure for them?
Dr. Nizamudeen: So if they, most of the patients come very late only. So what we prescribe is, you know, it should be done within 90 minutes of the first medical contact. And if they come late also we have to do the same thing. So with that presentation it should be done for 10 minutes ECG diagnosis, 30 minutes the streptokinase injection. Within 90 minutes we have to stent the patient.
Dr. Hema Sathish: Okay. This was a wonderful conversation and we heard so much from you Dr. Nizamudeen. Thanks a lot for everything. But I want you to give some pearls to the audience who are watching it. So what would be your advice to them? Like you know something you would have felt that if everybody knew they could do this then we could you know save so many patients. So what’s your advice for them?
Dr. Nizamudeen: So what I would say is life’s essential eight that is being suggested by American Heart Association. These eight steps if you follow, you can surely protect your heart. So one is eat well and eat more sensibly, eat healthy. Second is sleep well. With have a quality sleep and third is you maintain your blood pressure maintain the sugar levels maintain the cholesterol levels and have a proper balanced diet and then avoid smoking manage your stress well and manage your weight.
Dr. Hema Sathish: Thanks a lot thank you doctor thank you wonderful having you.
Dr. Nizamudeen: Thank you.
