Diseases of the heart and blood vessels, such as heart attack and stroke, are called cardiovascular diseases. Most death and disability in the present day is caused by cardiovascular diseases.
Heart attack or myocardial infarction is the most common heart disease affecting millions of people worldwide. It falls under the category ‘ischemic heart disease’ or ‘coronary heart disease’. Ischemia refers to reduced blood supply to the heart itself and coronary arteries are the blood vessels supplying oxygen and nutrients to the heart muscle (the scientific term for heart muscle is myocardium).
Heart failure is a complication of heart attack. It is increasing in incidence with the increasing numbers of heart attack survivors.
Congenital heart disease and cardiomyopathies are other less common diseases where there are structural defects in the heart.
The heart is a muscular organ that continuously pumps blood to all parts of the body. While it does this automatically, beating non-stop from womb to tomb, it requires an uninterrupted supply of oxygen to do so. Coronary heart disease occurs when the arteries that supply blood to the heart muscle, called coronary arteries, become hardened and narrowed, due to a build up of plaque on their inner walls. Plaque is the accumulation of fat, cholesterol, and other substances. As plaque continues to build up in the arteries, blood flow to the heart is reducedleading to a heart attack.
A heart attack occurs when a cholesterol-rich plaque bursts and releases its contents into the bloodstream. This causes a blood clot to form over the plaque, totally blocking blood flow through the artery and preventing vital oxygen and nutrients from getting to the heart. Another mechanism for a heart attack is sudden and total occlusion of normal coronaries(coronary spasm) whereby oxygen supply to heart cells is abruptly interrupted.
Yes. Heart attack or coronary heart disease can affect anybody. It’s a big threat to countries like India where it’s claiming lives at an unbelievable pace, leaving families and societies shocked and helpless.
Medical research in the last few decades has been focussing on understanding the causative factors, diagnosing the disease and treating patients effectively. The single most important reason for cardiovascular diseases has been identified: ‘UNHEALTHY LIFESTYLE’. The following 9 factors increase the risk of cardiovascular disease in men and women (each is an independent risk factor; the presence of several risk factors multiplies the risk of disease).
Risk factors for heart attack
• Hypertension (high blood pressure)
• Diabetes (high blood sugar)
• Dyslipidemia (abnormal cholesterol)
• Inadequate physical activity
• Unhealthy dietary habits
• Overweight and obesity
• Psychosocial factors (like chronic stress)
• Smoking (tobacco in any form)
• Excessive alcohol consumption
Awareness – this is the first step. Some ways you can become aware and knowledgeable are talking to experts, browsing reliable websites and reading about these diseases. You should know about the risk factors, early signs of disease and how to prevent it.
Action – this is the most important step. All your knowledge will bear fruit only if you put them into action. Recognizing your risk factors, including your behavioral risk factors, and taking steps to change them is key. Regular health checks are an integral part of the prevention strategy.
Achievement – this is the most rewarding step. When heart-healthy lifestyle becomes a habit, you will enjoy good health and quality of life for long.Leading a heart-healthy lifestyle not only prevents heart attack, but also keeps diabetes, hypertension, obesity, stroke, joint problems, dementia and several cancers at bay.
A cardiovascular screening test includes a routine blood test to look at blood counts and sugar and cholesterol levels, blood pressure measurement and an electrocardiogram (ECG). An X-ray chest, an echocardiogram, a treadmill test and some advanced tests will be done if necessary.
It is almost impossible even for a Cardiologist to tell the difference as both conditions mimic each other. An ECG (test done with small leads on your chest to study the electrical activity of the heart) is a very simple and useful test to diagnose a heart attack. A healthy lifestyle can be the ‘magic cure’ for both gastritis and heart disease.
A healthy balanced diet is the mantra to keep all diseases at bay. Research has shown that eating the right food, at the right time, in the right proportions and with the right mindset is a habit that won’t fail you. Dietary plans mighttell you what you can’t eat (usually your favorite foods!), but the most powerful nutrition strategies help you focus on what you should eat and how you should eat.
You should choose these foods most of the time:
• Fruits and vegetables. At least half of your plate should be fruits and
• Grains. At least half of your grains should be whole grains
• Fat-free or low-fat dairy products
• Seafood, skinless poultry, lean meats, beans, egg and unsalted nuts
The goal is to achieve at least 30 minutes of moderate-intensity areobic activity on five or more days of the week. Every day is best, but doing anything is better than doing nothing at all. Try to do all four types of exercises — endurance, balance, flexibility, and strength. Try to do strength exercises for all of your major muscle groups on 2 or more days a week for 30-minute sessions each.
Certainly. Every activity counts. Climbing the stairs two steps at a time burns more calories. Likewise, walking to the street corner to buy your veggies or parking the car in the farthest parking lot to get that extra bit of walk to the supermarket are all ways of being active. Avoid sitting continuously for more than half an hour. Even the act of getting out of your chair and going to another chairand sitting helps a lot.
The idea is to engage in a sustainable and enjoyable form of activity that is both easy to pursue and can be continued for decades.Walking, swimming, cycling, and jogging are all superb forms of exercise. From the point of view of being sustainable and easy to pursue, walking is an optimal form of activity for the human body. For individuals with joint problems that limit walking, swimming is a great activity. The optimal physical activity for you should be based on what you like doing, your health condition, your age and of course your daily routine. That is why, at Cardiac Wellness Institute, we involve our clients in formulating a heart-health plan for them. And we have seen that it works better than just reeling out a list of things to follow and avoid.
Eating a nutritious diet and maintaining a healthy weight are only part of a healthy lifestyle. Regular physical activity is important to the physical and mental health of almost everyone, including the elderly. Being physically active can help you stay strong and fit to keep doing the things you enjoy and to stay independent as you age. There are men and women in their 80s, 90s and 100s who enjoy a wonderful quality of life and live life to the fullest. The lessons they have taught us are that healthy habits such as regular exercise, a balanced diet, and not smoking or consuming excessive alcohol will keep us healthy and disease-free for long.
One way to find out is to keep an activity log where you list all your daily activities. And don’t forget to list physical activities that get your body moving, such aswalking the dog, watering your plants or climbing stairs. How about weight training or an aerobics class? There are many ways to be active every day. The key is to do all four of the major types of exercises– endurance, balance, flexibility, and strengthening exercises –regularly and increase your level of effort over time.
Checking with the doc is key for sedentary people who want to begin an exercise routine or someone making a dramatic change. Getting a check-up and possibly a stress test might help prevent a heart attack or other injuries in people over 40 years. Those who have never exercised before or in those with neuropathy, kidney disease, retinopathy, diabetes, hypertension or heart complications, discussing your fitness plan with your doctor is a must. But if you're an active person looking to start a new activityor plan on starting slow by joining a walking group,you can do so without your doc's go-ahead.
Heart disease is potentially reversible with cardiac drugs and a comprehensive cardiac rehabilitation program. Together, they help reduce your metabolic risk factors like abnormal cholesterol, diabetes and hypertension and behavioral risk factors like inadequate exercise, unhealthy diet, weight issues, chronic stress, smoking and excessive alcohol intake. Several studies have shown that aggressive lowering of LDL levels below 100 mg/dl can open up blocked coronary arteries at least partially. Smoking cessation is another well-proven factor in reversing heart disease. In our own experience with treating Indian patients with coronary heart disease, we have seen that while each and every individual who participates in our program shows improvement, the chances for reversal of disease are highest in those who start early and sustain the changes for a long time.
Taking your medications as advised by your doctor, a heart-healthy diet, adequate exercise, stress management, and keeping cholesterol, BP, blood sugar and weight under control are a must after heart surgery. Quit smoking and stay away from alcohol. It is advisable to attend a cardiac rehabilitation program after heart surgery. In fact, in many western countries, it has become mandatory for Cardiologists to refer all patients with coronary heart disease for cardiac rehab.
You should limit saturated fats, trans fats, cholesterol and salt (sodium). These fats are found in foods such as pizza, ice cream, fried chicken and other non-vegetarian foods, many cakes and cookies, baked foods, fried foods, and burgers.
Cholesterol is an essential component of the animal kingdom (human beings also need cholesterol to maintain cell structure).Our dietary sources of cholesterol are meat, eggs and dairy products (such as whole milk, ice cream, butter, cheese, full-fat yogurt). Plant cells, on the contrary, do not have cholesterol in them. Hence, all plant-based foods such as fruits, vegetables, grains, oils of plant origin, seeds and nuts are devoid of cholesterol. However, you have to remember that varying combinations of saturated and unsaturated fatty acids are present in plant foods as well and get converted to cholesterol by our liver if in excess.
Salt in the diet can cause an increase in blood pressure for some patients. For that reason it is usually recommended that salt intake be restricted to moderate levels. It is particularly important to watch your salt intake if you have high blood pressure or if you have a condition called heart failure where the heart is functioning poorly. Many foods, such as pickles, dried fish, potato chips, peanuts, roasted nuts and ready-made meals, have very high salt content. Removing the salt-shaker from the dining area, using very small amounts of low-sodium salt while cooking and substituting salt with other flavors like pepper and lime juice might help you make this health change.
Excessive consumption of alcohol or alcohol abuse is a major social problem faced by our country. People who drink alcohol are at increased risk of suffering from stroke, high blood pressure, cirrhosis of the liver, abnormal heart rhythm, heart attack and heart failure.
Alcohol is high in calories and may lead to weight gain and obesity. Abdominal obesity (also called a paunch in men) is common in habitual drinkers and leaves them at a high risk for heart attack. Binge drinking, on the other hand, can cause severe hypertension. Patients on cardiac medications should definitely avoid alcohol as it can alter the effect of the drugs and can also lead to serious side effects.
People who exercise regularly are definitely less likely to experience a heart attack than those who do not exercise. However, heart attacks are normally a result of multiple risk factors and taking care of a single risk factor will not automatically control your overall risk. Also, exercise needs to be prescribed in patients with heart disease in order that they get full benefit from it. Medically supervised exercise programs tailored to the individual’s needs are offered at Cardiac Wellness Institute. Patients with certain health problems can be at increased risk during exercise and should discuss this with their physicians prior to embarking on an exercise program.
Love and companionship are positive emotions that contribute to mental and physical health. Studies have shown that regular sexual activity in married couples is good for the heart.
Individuals who have suffered a heart attack should refrain from vigorous physical and emotional activity including sexual activity during the period of recovery. They may resume normal sexual activities with appropriate counselling and advice. In our own experience, we have observed that couples (where either partner has had a heart disease or procedure) are often reluctant to discuss the issue of resuming sexual activity. They however appreciate the guidance given by the healthcare team on this aspect as it helps in clarifying their doubts and fears and improves their quality of life.
Cardiac rehabilitation (rehab) is a medically supervised program that helps improve the health and well-being of people who have heart problems. Cardiac rehab programs include exercise training, education on heart-healthy living and balanced nutrition, and psychosocial counselling to help you manage your emotions better.The aim of the rehab program is tohelp you and your family understand the disease and to enable you to return to a normal life safely and confidently. Cardiac Wellness Institute provides highly professional and personalized cardiac rehab programs for patients.
Cardiac rehabilitation is recommended for individuals with the following conditions:
• Heart attack or myocardial infarction
• Any heart condition such as coronary artery disease, angina (chest pain) or heart failure
• Heart procedure or surgery such as coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention (PCI), including coronary angioplasty (balloon angioplasty) and stenting, valve replacement, pacemakeror implantable cardioverter defibrillator (ICD) implantation.
• Grown-up congenital heart disease
There are some conditions like unstable angina, uncontrolled/severe heart failure and very high blood pressure which should be treated first before providing cardiac rehab.
The benefits of cardiac rehab to individuals with heart disease and their families have been proven beyond doubt. While almost every district and county in USA, Australia, UK and other European countries have a cardiac rehab set-up, very few centres in India are currently offering cardiac rehab programs. Cardiac Wellness Institute is proud to be the first-of-its-kind fully integrated cardiac rehab facility in Chennai.
No. Cardiac rehab goes hand-in-hand with medical and surgical management of heart disease. It is not a substitute for drugs. In fact, a cardiac rehab program helps you understand the importance of the various drugs you’ve been prescribed. What a cardiac rehab program might help with is reducing the dosage and number of drugs as you begin to control your risk factors with lifestyle changes. There will be an ongoing communication between the cardiac rehab team and your Cardiologistto help achieve the best results.
A bypass surgery restores the blood flow to the heart muscle and should be done if you have severe blockage of your coronaries. However, it will not alter the disease process or prevent future complications. You can halt your disease from worsening and in fact reverse your disease by taking your medications regularly and by following a cardiac rehab program, even after surgery and stenting.
You can get more info from our website (www.cardiacwellnessinstitute.com) or by contacting us by phone or email.
You indeed have a strong family history of diabetes. However, diabetes, hypertension, obesity, heart attack and stroke are all multifactorial diseases with both genes and lifestyle playing a causative role. Offsprings of affected individuals are at higher risk of disease than those of unaffected individuals. But the good news is you can care for your heart and blood vessels and prevent/control diabetes (and other lifestyle diseases) by following a few simple steps:
• Take your medicines/insulin regularly
• Keep a close watch on your blood sugar levels (fasting blood sugar, postprandial blood sugar and HbA1C should be within normal limits)
• Eat a healthy balanced diet with plenty of fruits, vegetables and whole grains every day. Avoid processed, sweetened, salty and fatty foods as much as possible
• Exercise regularly. Do some aerobic exercise like walking (swimming, cycling, jogging) for at least 30 minutes on five or more days a week, and muscle strengthening exercises twice a week. Avoid using lifts and avoid sitting at a desk for a long time if you can
• Quit smoking and avoid excessive use of alcohol
• Control your weight, blood pressure and cholesterol
• Learn to manage your stress better
• Get yourself screened for other risk factors of heart disease every year
Your doctor/dietitian will design a meal plan that works for you. A meal plan is a guide that tells you what kinds of food to eat at meals and for snacks. The plan also tells you how much food to have. For most people who have diabetes a healthy diet consists of 40% to 60% of calories from carbohydrates, 20% from protein and 30% or less from fat. It should be low in cholesterol, low in salt and nil/very low in added sugar.
Unrefined or complex carbohydrates are better; it’s found in wholegrains/cereals, beans, and green/yellow vegetables. It takes longer for the digestive system to break these foods down. Blood sugar levels go up slowly and peak at lower levels.
What you eat is closely connected to the amount of sugar in your blood. The right food choices will help you control your blood sugar level better. In fact, your physical activity levels and your emotional status also have a close connection with your body’s ability to utilize sugar.
It is a myth that fruits are bad for diabetic people. Sufficient dietary intake of fruits and vegetables (at least 5 portions per day) and a balanced diet are a must for everyone including those with diabetes. You should know the glycemic index of the foods you normally eat so that you can better mix and match your diet without compromising on blood sugar.
Some fruits like mango, chikoo (sapotta), jackfruit and custard apple have a high glycemic index and should be had sparingly. All other fruits can be included in the diet; whole fruits are preferred to fruit juices.
When you work up a sweat, your body first uses all of the glucose stored in your muscles for energy. And then it draws glucose from your blood, thus lowering the levels. Exercise also helps you use the insulin circulating in your system more effectively. Physical activity acts like a separate dose of insulin because it redirects glucose from the blood into the muscles. Depending on the type of exercise (a light walk versus a vigorous 10-kmbike ride) and how long you're active, the effect of exercise on insulin and glucose metabolism can last anywhere from a couple of hours to a few days.
Physical activity helps your body use insulin more efficiently and reduces the amount of glucose in your blood. Plus, the result of being active - bigger muscles - allows your body extra storage space for glucose. So, to avoid hypoglycaemia during and after exercise, it may be necessary to cut down your insulin. For instance, if you plan to work out after lunch, you may need to reduce the insulin you take with your meal. People who are more active tend to use less insulin. You might have a decrease in insulin requirements after a few weeks of regular exercise. But remember, what works for one person may not work for another, so discuss with your physician before embarking on a new fitness regime.
Blood pressure is the force of blood pushing against the blood vessel walls. The heart pumps blood into the arteries (blood vessels) that carry the blood throughout the body. High blood pressure, also called hypertension, means the pressure in your arteries is above the normal range (normal is 120/80 mmHg). Several factors such as diet, exercise, stress, genetic predisposition, age, gender and race play a role in causing hypertension.
Simple and often small lifestyle changes can help prevent/control high blood pressure:
• Maintain a healthy weight
• Be physically active
• Follow a healthy eating plan
• Reduce salt and unhealthy fat in your diet
• Manage your stress appropriately
• Take your medicines regularly
• Avoid complications by regular health checks
Eat plenty of fruits and vegetables and foods low in fat, salt, and calories.Use spices and herbs, vinegar, lemon or fruit juices instead of salt. Use less oil, butter and ghee in your cooking.
The American Heart Association recommends limiting daily sodium intake to no more than 1.5 grams (a teaspoon of salt has about 2.4grams of sodium). Studies have shown that Indians consume about 5-10 grams of sodium everyday which is way above the recommended daily allowance. The high incidence of heart diseases and obesity is also closely linked to our salt intake. We have to steeply cut sown our salt intake.
Depending on your blood pressure and other clinical parameters, you will be advised to make specific lifestyle changes and take medication regularly. Borderline or pre-hypertension normally responds to simple things like reducingsalt in the diet, increasing intake of fruits, vegetables and whole grains, and regular exercise, keeping full blown hypertension at bay.Even those taking treatment for hypertension will benefit from changes to their lifestyle. They can reduce the number of drugs and their dosage and also prevent damage to organs like heart, kidneys and blood vessels. However, every individual is different and so, we at Cardiac Wellness Institute, thoroughly assess all the relevant parameters before treating our clients with drugs and lifestyle intervention. Bringing blood pressure to normal range as soon as possible should be the treatment goal in order to prevent serious complications.
• Low density lipoproteins (LDL or bad cholesterol) should be less than 100mg/dl (ideally should not be more than 70mg/dl)
• High density lipoproteins (HDL or good cholesterol) should be more than 45 mg/dl (ideally should be more than 50 mg/dl for women and more than 45 mg/dl for men)
• Triglyceride levels should be less than150 mg/dl(ideally should not be more than 100mg/dl)
• Total cholesterol levels should be less than 200 mg/dl(ideally should not be more than 200mg/dl)
Making gradual and permanent changes in your diet and lifestyle will help to lower yourcholesterol levels.
• Reduce fat and cholesterol in diet (whole milk products, organ meat, egg yolk,bakery foods and fried items etc)
• Eat more natural foods such as fruits, vegetables, and whole grains
• Increase your level of physical activity
• Maintain a healthy body weight
Eating too much saturated fat (red meat and full-fat dairy products) and trans fat is the main cause of abnormal cholesterol. Trans fat is formed through an industrial process, whereby hydrogen is added to vegetable oil tosolidify the oil at room temperature. This process of adding hydrogen to vegetable oil produces partially hydrogenated oil.Foods prepared with this oil are less likely to spoil and have a longer shelf life. Restaurants commonly use partially hydrogenated vegetable oil to prepare dishes because it doesn't have to be changed as often as do other oils. Trans fats have to be totally avoided as they not only increase the bad cholesterol but also decrease the good cholesterol levels in our blood.
Statins are the most commonly used drugs for abnormal cholesterol and you are likely taking a statin medication. The drug helps to lowerthe cholesterol levels but you should start taking steps to a healthy lifestyle so that the medication can be reduced and stopped with your doctor’s advice. However, if you have had a heart attack or are being treated for coronary artery disease (block in the arteries), statins should be continued for a longer time.
Overweight and obesity are the result of several factors including dietary habits, emotional status, exercise behavior, sociocultural practices and your genes. Sometimes, undiagnosed hormonal imbalance can underlie weight problems. A positive energy balance – that is, a long term excess of energy intake, is a common cause that we see in everyday practice.
Obesity increases a person's risk for heart disease, type 2 diabetes, high blood pressure, stroke, gallbladder disease, joint pains, breathing problems, infertility and certain types of cancer.
Obesity brings with it an increased risk of chronic back pain, sleep apnea, and osteoarthritis, the types of chronic conditions that can make it difficult to climb stairs, get enough exercise, and get a good night's sleep. The emotional and mental effects of obesity are also significant and can lead to low self-esteem, depression, anxiety and isolation.
For individuals with morbid obesity (body mass index, BMI, above 40 kg/m2) and for those with serious health problems linked to obesity, weight loss surgery (bariatric surgery) may be advised. However, surgery has complications and is reserved only for the severely affected patients. After careful preliminary evaluation, Cardiac Wellness Institute will refer you to an expert bariatric surgery unit. After surgery, you will participate in a program at Cardiac Wellness Institute and adhere to the healthy lifestyle measures to prevent gaining excessive weight again.
Many individuals who have lost a substantial amount of weight did so while walking 60 minutes daily at a moderate pace (that doesn’t mean that other types of exercise cannot be employed or that exercise of a shorter duration is not helpful). Exercise that can be sustained for a long term is an important factor.
Any amount of aerobic exercise has some beneficial training effect compared to not exercising and simply sitting in a chair or lying in bed. Walking 10 minutes per day, irrespective of the heart rate achieved, leads to a training effect substantially better than no activity.
No, it is not generally necessary. Many individuals, however, find that keeping track of their heart rate is useful for gauging the intensity of the physical activity. Cardiac patients are taught to keep track of their heart rate in order to prevent developing a heart rate above the highest prudent heart rate which is safe for them.
People of all ages benefit from these types of exercises as they improve strength and enable you to perform advanced endurance activities. Yoga and tai-chi are good examples of mind body techniques and are great stress relievers.
Any exercise which strengthens core body muscles as well as extremities will decrease falls and increase mobility in the elderly. Falls often lead to a further substantial decrease in physical activity, as well as bone fractures. Activity enhances health and inactivity leads to disability and depression. Hence, these activities are particularly valuable for the health of the elderly. We incorporate all these forms of exercise in the programs at Cardiac Wellness Institute.
About Cardiac Wellness Institute
On your first visit here, you should bring all your medical records for us to go through. You will be asked some medically relevant questions to help us understand your health condition better. You are likely to meet the physician, dietitian, physiotherapist and counselor and undergo a clinical examination, nutritional assessment and assessment of exercise capacity. When you contact us for an appointment, you will be briefed on what to expect as well.
• Cardiac rehabilitation program – for those with heart diseases
• Cardiac prevention programs – for those with risk factors but without previous heart condition
We provide out-patient programs ranging from 6 weeks to 6 months in duration based on the medical requirement of the individual. Each session may last 1.5 to 2 hours, 1-3 times per week and has exercise and education components.
We have several clients residing in other parts of the state and all over India. After the initial evaluation, we can suggest modified programs to help you attain your health goals.
We highly recommend discussing with your doctor about lifestyle changes and cardiac rehab and their benefits for you. The team at Cardiac Wellness Institute will also establish communication with your doctor to inform them of the progress you make during your program. We believe in cooperating and collaborating for the overall health and wellbeing of our clients.
We fully understand that unexpected circumstances may arise and will take all efforts to help and support you during that time. Session dates can always be adjusted, provided there is a valid reason. However, for best results, close adherence to the prescribed program is recommended.
We charge a consultation fee of INR 500. The cost of the program will depend on the length of the program, your risk profile and certain other factors.