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Dr K K Aggarwal

In Paralysis, Act Fast

By Dr K K Aggarwal
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Brain attack should be tackled like a heart attack. As time is brain, a patient with suspected paralysis/stroke or brain attack should be shifted to hospital at the earliest and given a clot dissolving therapy if the CT scan is negative for brain hemorrhage. Prevention for paralysis is the same as prevention for heart attack. All patients with paralysis should be investigated for underlying heart disease and all patients with heart diseases should undergo testing to detect blockages in the neck artery, which can cause future paralysis.

Facts

  • Brain haemorrhage should be ruled out as soon as possible.
  • Obtain emergent brain imaging (with CT or MRI) and other important laboratory studies, including cardiac monitoring during the first 24 hours after the onset of ischemic stroke.
  • Check glucose and correct high or low sugar. If the blood sugar is over 180 mg/dL, start insulin.
  • Maintain normothermia for at least the first several days after an acute stroke.
  • For patients with acute ischemic stroke who are not treated with thrombolytic therapy, treat high blood pressure only if the hypertension is extreme (systolic blood pressure >220 mmHg or diastolic blood pressure >120 mmHg), or if the patient has another clear indication (active ischemic coronary disease, heart failure, aortic dissection, hypertensive encephalopathy, acute renal failure, or pre–eclampsia/eclampsia).
  • For patients with acute ischemic stroke who will receive thrombolytic therapy, antihypertensive treatment is recommended so that systolic blood pressure is 185 mmHg and diastolic blood pressure is 110 mmHg.
  • Antithrombotic therapy should be initiated within 48 hours of stroke onset.
  • For patients receiving statin therapy prior to stroke onset, it should be continued.

A woman is at risk of heart attack if:

By Dr K K Aggarwal
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  • Her father or brother below age 55 or her mother or sister below age 65 have had a heart attack, stroke, angioplasty or bypass surgery.
  • She is over 55 years old. (After age 65, the death rate increases sharply for women)
  • She smokes or is exposed to second-hand smoke every day.
  • Her blood pressure is over 135/85 mm Hg. Optimal blood pressure is 120/80 mm Hg. Drug therapy is indicated when blood pressure is >140/90 mm Hg, or an even lower blood pressure in the setting of chronic kidney disease or diabetes (> 130/90 mm Hg).
  • She does not exercise for at least 30 minutes that includes moderate–intensity physical activity, like taking a brisk walk, on most days. For weight control, women need to exercise for 60–90 minutes with moderate–intensity activity on most days.
  • She has diabetes. After age 45, diabetes affects many more women than men. If diabetic, aim to achieve glycosylated hemoglobin (HbA1c) level less than 7%.
  • Her HDL (High Density Lipoprotein or “good” cholesterol) is less than 50mg/dL.
  • LDL goals are dependent upon risk. The following levels of lipids and lipoproteins in women should be encouraged through lifestyle approaches: LDL–C <100mg/dL; HDL–C >50mg/dL; triglycerides <150mg/dL and non–HDL–C (total cholesterol minus HDL cholesterol) <130 mg/dL. If a woman is at high risk or has hypercholesterolemia, intake of saturated fat should be <7% and cholesterol intake <200 mg/d. For diabetic women, LDL should be <100. For vascular disease and very high risk women, LDL should be<70. HDL of 60 mg/dL is considered cardioprotective. One can raise HDL by taking in 2–3 tbsps of olive oil daily, quitting smoking, getting regular aerobic exercise and maintaining a healthy weight.
  • She is overweight by 20 pounds or more (More than one–third of women are more than 20 pounds overweight.)
  • Either natural or through surgery, early menopause, before the age of 40 is associated with increased risk for cardiovascular disease.
  • Taking birth control pills greatly increases risk of heart attack and stroke, especially after age 35.
  • She has a high demand/low control job with sustained high levels of stress. Stress is a normal part of life.
  • A healthy diet consists of eating fruits, vegetables and whole grain high–fiber foods (aim for 5 servings of vegetables and 2 servings of whole fruit daily); eating fish, especially oily fish, at least twice a week; limiting saturated fat to < 10% of energy, and if possible to <7%, cholesterol to <300 mg/dL. Limiting alcohol intake to no more than 1 drink per day; limiting sodium intake to <2.3 g/d (approximately 1 tsp salt) and avoiding all trans–fatty acids (listed as “hydrogenated oil” in the ingredients section)
  • Pregnant and lactating women should avoid eating fish potentially high in methylmercury.
  • Having at least three of a cluster of symptoms that are listed below put her at risk:

o High blood sugar >100 mg/dL after fasting

o High triglycerides, at least 150 mg/dL

o Low HDL (<50 mg/dL in women)

o Blood pressure of 130/85 or higher

o Waist >35 inches (Waist measurement of 35 inches or more or waist–to–hip ratio greater than 0.80 is a predictor of high triglycerides and low HDL levels).

Blood pressure measurement may detect vulnerability to heart attack

By Dr K K Aggarwal
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The ankle–brachial index (ABI), a simple, non–invasive 10–minute test should be incorporated into a routine physical exam to diagnose peripheral arterial disease in the middle-aged and the elderly, especially those with heart attack risk factors like smokers, diabetics and the ones with high BP or cholesterol levels. With the patient in a supine position, the doctor takes blood pressure readings from both arms; he then takes blood pressure readings from both ankles with a sphygmomanometer and Doppler device. ABI value is calculated by dividing the higher systolic pressure in each leg by the higher systolic brachial pressure.ABI scores should be interpreted as follows:

  • Greater than 0.90: Normal
  • 71 – 0.90: Mild obstruction
  • 41 – 0.70: Moderate obstruction
  • Less than 0.40: Severe obstruction
  • More than 1.30: Calcification of the vessels

Presence of peripheral arterial disease may indicate associated blockages in the heart and proneness to heart attack or paralysis.

Walk 2000 extra steps to lower your risk of heart disease

By Dr K K Aggarwal
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Walking 20 minutes at a moderate pace each day is associated with improved cardiovascular outcomes in patients with impaired glucose tolerance, according to a study published in The Lancet.

People who walked 2,000 steps more per day at baseline had a 10% lower risk of cardiovascular death, paralysis or heart attack during an average follow–up of 6 years, according to Thomas Yates, PhD, of the University of Leicester in England, and colleagues. And those who increased the amount they walked by 2,000 steps per day from baseline to 1 year had a similar reduction in risk of cardiovascular events.

The findings from NAVIGATOR trial support both the promotion of increased ambulatory activity, and the avoidance of decreased ambulatory activity irrespective of the starting level, as important targets in the prevention of chronic disease.

Donating blood reduces chances of heart attack

By Dr K K Aggarwal
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One should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion.

All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

In the current medical tourism scenario, many patients who are Jehovah’s Witnesses refuse blood transfusion on religious grounds. They do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receive the blood. They also do not accept transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation.

A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.

Relieve stress by changing the interpretation

By Dr K K Aggarwal
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Stress is the reaction of the body or the mind to the interpretation of a known situation. Stress management, therefore, involves either changing the situation, changing the interpretation or taming the body the yogic way in such a way that stress does not affect the body.

Every situation has two sides. Change of interpretation means looking at the other side of the situation. It is something like half glass of water, which can be interpreted as half empty or half full.

Studies have shown that anger, hostility and aggression are the new risk factors for heart disease. Even recall of anger has been reported to precipitate a heart attack.

Many studies have shown that when doctors talk positive in front of unconscious patients in ICU, their outcome is better than those in whose presence if doctors talk negative.

The best way to practice spiritual medicine is to experience silence in the thoughts, speech and action. Simply walking in the nature with silence in the mind and experiencing the sounds of nature can be as effective as 20 minutes of meditation. He said that 20 minutes of meditation provides the same physiological parameters as that of seven hours of deep sleep.

(Disclaimer: The views expressed in this write up are my own).

All diabetics must get an eye check up done

By Dr K K Aggarwal
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The vast majority of diabetic patients who develop diabetic retinopathy (eye involvement) have no symptoms until the very late stages (by which time it may be too late for effective treatment). Because the rate of progression may be rapid, therapy can be beneficial for both symptom amelioration as well as reduction in the rate of disease progression, it is important to screen patients with diabetes regularly for the development of retinal disease. The eyes carry important early clues to heart disease, signaling damage to tiny blood vessels long before symptoms start to show elsewhere. Diabetic people with retinopathy are more likely to die of heart disease over the next 12 years than those without it. As per a study from the University of Sydney and the University of Melbourne in Australia and the National University of Singapore, people with retinopathy are nearly twice as likely to die of heart disease as people without it. People with these changes in the eyes may be getting a first warning that damage is occurring in their arteries, and work to lower cholesterol and blood pressure. Patients with retinopathy have a greater risk of incident cardiovascular disease (CVD) events, including heart attack, stroke, revascularization, and CVD death, compared with those without retinopathy.

Donating blood reduces chances of heart attack

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Donating blood reduces chances of heart attack

One should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion.

All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

In the current medical tourism scenario, many patients who are Jehovah’s Witnesses refuse blood transfusion on religious grounds. They do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receive the blood. They also do not accept transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation.

A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.

Donating blood reduces chances of heart attack

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on Donating blood reduces chances of heart attack

 

One should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion.

All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

In the current medical tourism scenario, many patients who are Jehovah’s Witnesses refuse blood transfusion on religious grounds. They do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receive the blood. They also do not accept transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation.

A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.

The woman is at risk if

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on The woman is at risk if

  1. Her father or brother below age 55 or her mother or sister below age 65 have had a heart attack, stroke, angioplasty or bypass surgery.
  2. She is over 55 years old. (After age 65, the death rate increases sharply for women)
  3. She smokes or is exposed to second-hand smoke every day.
  4. Her blood pressure is over 135/85 mm Hg. Optimal blood pressure is 120/80 mm Hg. Drug therapy is indicated when blood pressure is >140/90 mm Hg, or an even lower blood pressure in the setting of chronic kidney disease or diabetes (> 130/90 mm Hg).
  5. She does not exercise for at least 30 minutes that includes moderate–intensity physical activity, like taking a brisk walk, on most days. For weight control, women need to exercise for 60–90 minutes with moderate–intensity activity on most days.
  6. She has diabetes. After age 45, diabetes affects many more women than men. If diabetic, aim to achieve glycosylated hemoglobin (HbA1c) level less than 7%.
  7. Her HDL (High Density Lipoprotein or “good” cholesterol) is less than 50mg/dL.
  8. LDL goals are dependent upon risk. The following levels of lipids and lipoproteins in women should be encouraged through lifestyle approaches: LDL–C <100mg/dL; HDL–C >50mg/dL; triglycerides <150mg/dL and non–HDL–C (total cholesterol minus HDL cholesterol) <130 mg/dL. If a woman is at high risk or has hypercholesterolemia, intake of saturated fat should be <7% and cholesterol intake <200 mg/d. For diabetic women, LDL should be <100. For vascular disease and very high risk women, LDL should be<70. HDL of 60 mg/dL is considered cardioprotective. One can raise HDL by taking in 2–3 tbsps of olive oil daily, quitting smoking, getting regular aerobic exercise and maintaining a healthy weight.
  9. She is overweight by 20 pounds or more (More than one–third of women are more than 20 pounds overweight.)
  10. Either natural or through surgery, early menopause, before the age of 40 is associated with increased risk for cardiovascular disease.
  11. Taking birth control pills greatly increases risk of heart attack and stroke, especially after age 35.
  12. She has a high demand/low control job with sustained high levels of stress. Stress is a normal part of life.
  13. A healthy diet consists of eating fruits, vegetables and whole grain high–fiber foods (aim for 5 servings of vegetables and 2 servings of whole fruit daily); eating fish, especially oily fish, at least twice a week; limiting saturated fat to < 10% of energy, and if possible to <7%, cholesterol to <300 mg/dL. Limiting alcohol intake to no more than 1 drink per day; limiting sodium intake to <2.3 g/d (approximately 1 tsp salt) and avoiding all trans–fatty acids (listed as “hydrogenated oil” in the ingredients section)
  14. Pregnant and lactating women should avoid eating fish potentially high in methylmercury.
  15. Having at least three of a cluster of symptoms that are listed below put her at risk:
  1. High blood sugar >100 mg/dL after fasting
  2. High triglycerides, at least 150 mg/dL
  3. Low HDL (<50 mg/dL in women)
  4. Blood pressure of 130/85 or higher
  5. Waist >35 inches (Waist measurement of 35 inches or more or waist–to–hip ratio greater than 0.80 is a predictor of high triglycerides and low HDL levels).

Kidney patients more at risk for future heart attacks

By Dr K K Aggarwal
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Chronic kidney disease patients with kidney function less than 60% are included in the list of criteria for defining people at highest risk for future heart attacks.

In a large cohort Canadian study published in The Lancet led by Dr Marcello Tonelli at University of Alberta, patients with only chronic kidney disease had a significantly higher rate of heart attacks than those who only had diabetes. Those who had already had a heart attack had the highest overall rate of heart attacks.

Chronic kidney disease should be regarded as a coronary heart disease risk equivalent, similar to diabetes, as patients with the condition have high rates of cardiovascular events, particularly when they also have proteinuria. When chronic kidney disease was defined more stringently with kidney function less than 45% and increased proteinuria, the rate of first heart attack was higher in those with both chronic kidney disease and diabetes than in those with either disorder alone.

Air pollution can raise blood pressure

By Dr K K Aggarwal
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Breathing polluted air for even 2 hours can increase blood pressure, potentially raising the risk of cardiovascular disease in those exposed to smog.

In susceptible patients this small increase may actually be able to trigger a heart attack or stroke. In a study, which appeared in the journal Hypertension, researchers tested 83 people as they breathed levels of air pollution similar to those in an urban city near a roadway. The air pollution caused diastolic pressure (lower number in a blood pressure reading) to rise within 2 hours. Blood vessels were impaired for as long as 24 hours. Tests showed that microscopic particles in the air, rather than ozone gases, caused the rise in blood pressure and impaired blood vessel function. If air pollution levels are forecasted to be high, those with heart disease, diabetes or lung disease should avoid unnecessary outdoor activity.

Blood vessels were impaired for as long as 24 hours. Tests showed that microscopic particles in the air, rather than ozone gases, caused the rise in blood pressure and impaired blood vessel function. If air pollution levels are forecasted to be high, those with heart disease, diabetes or lung disease should avoid unnecessary outdoor activity.

Lifestyle tips from HCFI

By Dr K K Aggarwal
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  1. Quit smoking and drinking as they are two major factors in causing damage to the heart.
  2. Manage your cholesterol levels as any imbalance in this can lead to a heart attack or stroke.
  3. Keep a check on vitals such as blood pressure and blood sugar. Any fluctuations in these can directly impact the heart in the longer term.
  4. Ensure that you get at least 30 minutes of physical activity every day.
  5. Achieve and maintain a healthy weight
  6. Eat a variety of healthy food including fruits, vegetables, and whole grains.

Heart Patients Beware of Eating Cakes

By Dr K K Aggarwal
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Food of animal in origin and saturated foods contain cholesterol. 1% rise in cholesterol raises the chances of heart attack by 2. Heart patients should therefore avoid eating cakes during the Christmas and New Year Season. They should distribute fruits & dry fruits instead of cakes. Beware of the term Low or High Cholesterol on the labels

  1. Cholesterol Free means less than 2 mg cholesterol and 2 grams or less fat.
  2. “Low Cholesterol” means 20 mgs or less cholesterol and 2 grams or less saturated fat.
  3. “Fat Free” means less than ½ gram fat;
  4. “Low Fat” means 3 grams or less fat;
  5. “Reduced Fat” means at least 25% less fat than other brands of same food.

Caffeine�Alcohol combination in paralysis

By Dr K K Aggarwal
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A drug caffeinol containing caffeine and alcohol may help stroke patients recover.

In a small study at Texas Health Science Center in Houston, 60% of stroke patients who were given the drug, had no or minimal disability when they were discharged from the hospital. In contrast, only 26% of stroke survivors given standard therapy with tissue plasminogen activator, or tPA, fared that well.

Caffeinol contains about as much caffeine as 5 to 7 cups of good, strong New Orleans coffee and the equivalent of two shots of alcohol.

The study involved 100 people who had suffered an ischemic stroke. All received intravenous tPA; 10 were also given an infusion of caffeinol. Caffeinol allows cells to tolerate reduced blood flow longer, thereby giving tPA a longer opportunity to do its action.

Will these findings be applicable to heart attack? Only time will tell as heart attack treatment is also done with tPA.