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Dr K K Aggarwal

Chocolate, not tea, good for the heart

By Dr K K Aggarwal
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Regular consumption of polyphenol–rich cocoa products like dark chocolate may be considered a part of dietary approaches to lower BP, provided there is no total gain in calorie intake.

Drug treatment is the basis of blood pressure control, and it should always be accompanied by lifestyle measures such as exercise and proper diet.

The recommendation is an occasional cup of cocoa but not chocolate milk, because it is high in sugar and fat.

According to a survey of medical literature by German researcher, Dr. Dirk Taubert from the University Hospital of Cologne, cocoa–rich products, and not tea, help lower high blood pressure. They covered 10 studies on cocoa that included 173 participants and five tea studies with 343 participants. The cocoa studies lasted an average of two weeks, with four out of five trials reporting a reduction in both systolic and diastolic BP.

The average reduction was 4 to 5 mm Hg in systolic pressure and 2 to 3 mm in diastolic pressure –– enough to reduce the risk of stroke by 20% and of coronary heart disease by 10%. No such reduction in blood pressure was noted in any of the tea trials, which lasted an average of four weeks. Tea and cocoa contain different kinds of polyphenols –– flavan–3–ols in tea, procyanids in cocoa.

Work-related Stress can kill

By Dr K K Aggarwal
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Job stress raises the risk of heart disease by disrupting the body’s internal systems.

The findings from a long–running study involving more than 10,000 British civil servants also suggest stress–induced biological changes may play a more direct role than previously thought.

The researchers measured stress among the civil servants by asking questions about their job demands such as how much control they had at work, how often they took breaks, and how pressed for time they were during the day.

The team conducted seven surveys over a 12–year period and found chronically stressed workers – people determined to be under severe pressure in the first two of the surveys – had a 68 percent higher risk of developing heart disease. The link was strongest among people under 50.

Stressed workers also eat unhealthy food, smoke, drink and skip exercise – all behaviors linked to heart disease.

In the study, stressed workers also had lowered heart rate variability – a sign of a poorly–functioning weak heart and higher than normal levels of cortisol, a “stress” hormone that provides a burst of energy for a fight–or–flight response.

Too much cortisol circulating in the blood stream can damage blood vessels and the heart

Precautions to stay healthy during the winter months

By Dr K K Aggarwal
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  • To prevent winter depression, one should either sit in the sunlight for long or stay in indoor spaces with illuminated light.
  • Early morning blood pressure is higher in winter than in the summer months. Therefore, people with high blood pressure should ask their doctor to increase their blood pressure medicine during the winters.
  • There are more heart attacks in the winter months than in the summer months and therefore, any chest pain especially in the morning in winter should not be ignored.
  • During the winter season, one should avoid food that is excessively sweet, sour or salty
  • Everyone should ask their doctor for pneumonia and flu vaccine.
  • Pneumonia during the winters can be deadly in very young and old people. The flu vaccine should be given to all those who are at high risk, especially, people with asthma, diabetes and heart diseases.
  • During the winters, one should avoid sleeping in closed rooms with electric gadgets like heaters on
  • One should check the earthing of all the electric devices especially the geyser
  • One should avoid using sugar while preparing sweets; instead one can use either Stevia or jaggery especially in Gajar Ka Halwa.
  • One should avoid switching from one temperature to another without giving their body time for adjustment.
  • Vitamin D is essential for good health. Each person should spend 40 minutes in the sunlight each day, especially before 10 am and after 4 pm.

Prevention is always better than cure. A little extra care can help make the holiday months, more enjoyable and heart healthy.

Difference between smile, hug and laugh

By Dr K K Aggarwal
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Smile is a sign of joy while hug is a sign of love. Laughter on the other hand is a sign of inner happiness. None of them are at the level of mind or intellect. All come from within the heart.

They are only the gradations of your expressions of your happiness.

It is said you are incomplete in your dress if you are not wearing smile on your face. Hug comes next. And laughter the last. Laughter is like an internal jogging and has benefits similar to that obtained from meditation.

But be careful… we must know when not to laugh. The most difficult is to laugh at oneself.

Energy drinks may put heart at risk for sudden death

By Dr K K Aggarwal
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Energy drinks may raise blood pressure and prolong QT interval increasing the risk of sudden cardiac death. In a meta–analysis by Sachin A. Shah at University of the Pacific in Stockton, Calif, with a pooled analysis of 93 people who consumed energy drinks, the QT interval on an ECG was significantly prolonged by 10 ms. The threshold level of regulatory concern is around 5 ms. In another pooled analysis of 132 people by the same group, researchers found a significant increase in systolic blood pressure by 3.5 mmHg that was associated with the consumption of energy drinks.
Doctors are generally concerned if patients experience an additional 30 ms in their QT interval from baseline. QT prolongation is associated with life–threatening arrhythmias. Most energy drinks have caffeine. Drinks such as Monster, Red Bull, Rockstar, Full Throttle and AMP have three times the amount of caffeine as colas. A 16–oz. can of Monster Energy, for example, contains 160 mg of caffeine, which is almost as much as 5 cans of soda.

Confession

By Dr K K Aggarwal
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Confession is one of the many ways of detoxifying the mind. It has its roots in Hindu mythology but today it is mainly practiced in Christian religion as a hardcore ritual where one usually goes to a Church and confesses to the Bishop without disclosing his or her identity. In Hindu mythology, confession is a routine spiritual practice. People can confess to their Guru, to their God in the temple or their mentor. Confession can also be done to a plant (Peepal tree), an animal (dog or a cat) or the birds. It is a common saying that taking a dip in Yamuna or Ganga removes all your sins. The dip in water involves a ritual of confessing guilt every time we make a dip. Giving food to birds is also a way of confession where one makes a confession with each offering.

The easiest way to confess is 3 minutes of free writing, which can be done every night. One can tear off the paper after writing. This involves writing from the heart and not giving time to the mind to think. Earlier people used to confess and de–stress their emotions by writing in a diary or making a folder in the computer and writing. But, the best confession is to meditate, which is equivalent to reformatting the hard disk and removing viruses and corrupt files from our body computer. Meditating with intent to get rid of guilt washes them over a period of time. Confession involves the process of forgiving and forgetting. Forgiving is at the level of mind and forgetting is at the level of heart.

Group Singing is good for the heart

By Dr K K Aggarwal
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Melody Synchronizes Choir Members’ Heart Rate

When people sing in a choir their heart beats are synchronized and the pulse of choir members tends to increase and decrease in unison.

A study published in Frontiers in Neuroscience from Sahlgrenska Academy at University of Gothenburg has shown that music in biological terms, affects our body and our health and can be used for medical purposes, primarily within rehabilitation and preventive care.

In December 2012, Bjorn Vickhoff and group brought together fifteen 18–year–olds at Hvitfeltska High School in Gothenburg and arranged for them to perform three different choral exercises: monotone humming, singing the well–known Swedish hymn “HÃrlig Ãr Jorden” (Lovely is the Earth) as well as the chanting of a slow mantra. The heart rhythm of the choir members was registered as they performed in each case.

The results showed that the music’s melody had a direct link to the cardiac activity of the individual choir member. To sing in unison had a synchronizing effect so that the heart rate of the singers increased and decreased at the same time.

Singing regulates activity of vagus nerve, which is involved in our emotional life and our communication with others and affects our vocal timbre.

Songs with long or short phrases achieve the same effect as if breathing slow or fast in yoga. In other words, through song we can exercise a certain control over mental states. Singing leads to a calm and regular breathing pattern, which has a dramatic effect on heart rate variability.

During normal breathing, both the heart rate and pulse decreases when breathing out and increases when breathing in.

Breathing out activates the vagus nerve that lowers the heart rate.

The vagus breathing connection is more pronounced with young people in good physical condition and not subject to stress.

For example, singing a song with long phrases will reduce respiratory rate and in turn the heart rate and vice versa with singing small phrases.

In Vedic knowledge it is well described that people who chant together influence even the people who are not chanting and the health effects in people who chant together are higher than when they chant alone. If one percent of the society meditates together, the health effects are on the whole society.



Chocolate, not tea, good for the heart

By Dr K K Aggarwal
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Regular consumption of polyphenol–rich cocoa products like dark chocolate may be considered a part of dietary approaches to lower BP, provided there is no total gain in calorie intake. Drug treatment is the basis of blood pressure control, and it should always be accompanied by lifestyle measures such as exercise and proper diet. The recommendation is an occasional cup of cocoa but not chocolate milk, because it is high in sugar and fat. According to a survey of medical literature by German researcher, Dr. Dirk Taubert from the University Hospital of Cologne, cocoa–rich products, and not tea, help lower high blood pressure. They covered 10 studies on cocoa that included 173 participants and five tea studies with 343 participants. The cocoa studies lasted an average of two weeks, with four out of five trials reporting a reduction in both systolic and diastolic BP. The average reduction was 4 to 5 mm Hg in systolic pressure and 2 to 3 mm in diastolic pressure –– enough to reduce the risk of stroke by 20% and of coronary heart disease by 10%. No such reduction in blood pressure was noted in any of the tea trials, which lasted an average of four weeks. Tea and cocoa contain different kinds of polyphenols –– flavan–3–ols in tea, procyanids in cocoa.

Non obstructive heart blockages not benign

By Dr K K Aggarwal
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In a retrospective study of patients undergoing elective coronary angiography, non-obstructive coronary artery disease (heart blockages), compared with no apparent coronary artery disease (no blockages), was associated with a significantly greater 1-year risk of heart attack and all-cause mortality.

After risk adjustment, there was no significant association between 1- or 2-vessel non-obstructive coronary artery disease (blockages in one or two arteries) and mortality, but there were significant associations with mortality for 3-vessel non-obstructive coronary artery disease (blockages in all three arteries).

Veterans with evidence of non-obstructive CAD on elective coronary angiography had a 2- to 4.5-fold greater risk for heart attack compared with those with no evidence of blockages and 1-year heart attack risk was found to increase progressively by the extent of blockages, rather than increasing abruptly when blockages became obstructive. The results of this study are published in Nov. 5 issue of JAMA.

Never tell your patients “that your coronaries are fine and they have nothing to worry about.” Instead, one should say “There is evidence of atherosclerosis and while there is no need to panic, we need to address it.”

Remember there is nothing like “mild coronary artery disease.” Up to 1 in 4 angiograms show minimal plaque or blockages.

Non-obstructive blockages mean presence of atherosclerotic plaque revealed during coronary angioplasty or angiography that does not appear to obstruct blood flow or result in angina symptoms.

These non-obstructive lesions occur in about 10-25% of patients undergoing elective angiography, and their presence has historically been characterized as “insignificant” or “no significant blockages in the medical literature even though multiple studies have shown plaque ruptures leading to heart attack commonly come from non-obstructive plaques.

Extreme exercise may not pose danger to heart

By Dr K K Aggarwal
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Extreme exercise may not pose danger to heart: The Wall Street Journal reported that a study of Tour de France cyclists found that they had longer lives than the general population and were less likely to die from heart troubles.

Faster heart attack care has not led to better in–hospital survival: USA Today reported that research published in the New England Journal of Medicine indicates that while hospitals have “shaved 16 minutes off the time it takes to get heart attack patients into treatment from 2005–2006 to 2008–2009, reducing that time from 83 minutes to 67 minutes,” investigators “found that the percentage of heart attack patients who die while in the hospital, about 5%, hasn’t changed.”

Gut bacteria may play role in determining weight: The investigators found that mice who received bacteria from the obese twin became fat, while the mice who received bacteria from lean individuals remained lean.

CDC: One in four deaths from cardiovascular disease preventable: USA Today reported currently, there are approximately 800,000 deaths annually in the US from cardiovascular disease, but about 200,000 of these deaths “could be prevented if people made healthy changes including stopping smoking, maintaining a healthy weight, doing more physical activity, eating less salt and managing their high blood pressure, high cholesterol and diabetes.

To screen or not to screen all young athletes with ECG to discover problems hiding within the heart

By Dr K K Aggarwal
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Guidelines from the American Heart Association (AHA) (endorsed by the American College of Cardiology) and the European Society of Cardiology (ESC), both recommend a screening before sports participation, but the Americans favor a detailed medical history combined with a physical examination only, while the Europeans favor the addition of the 12–lead ECG.

The controversy was evident in the results of a poll conducted during a debate session at the AHA meeting last year, which were published this week in the New England Journal of Medicine by James Colbert, MD, of Harvard Medical School.

Of the audience members who voted –– an unscientific sample, to be sure –– 70% favored some type of screening for cardiac disease in young athletes. And in a scenario where screening was already a foregone conclusion, 60% said it should include an ECG. A similar online poll on the NEJM website was even more informative, showing that the differences in opinion exist on both sides of the Atlantic.

Of the 1,266 people who voted on the site –– again, not a scientific sample –– 18% didn’t want any mandatory screening, 24% wanted screening with a medical history and physical exam, and 58% favored screening that included an ECG. The percentage of voters who endorsed an ECG was higher among Europeans than among Americans (66% versus 45%), but that still indicates a substantial amount of controversy regardless of geography.


Dark Chocolate good for the heart

By Dr K K Aggarwal
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Dark chocolate thought to promote relaxed arteries, also have biochemical effects that may discourage atherosclerosis suggests a report published in the March 2014 issue of the FASEB Journal.

In a randomized, double–blind study, eating dark chocolate—acutely and over weeks—not only improved objective measures of endovascular function, it also improved biochemical markers that reflect leukocyte activation, inflammation, and other signs of atherogenesis.

Changes in endothelial function were reflected in improved flow–mediated dilation (FMD), blood pressure, and augmentation index (AIX), while “changes in leukocyte–cell counts, plasma cytokines, and leukocyte adherence markers after chocolate consumption point toward a less–activated state of cellular adherence and, hence, a less atherogenic milieu, according to the authors, led by Dr Diederik Esser (Top Institute Food and Nutrition and Wageningen University, the Netherlands).

Heart Patients Beware of summer

By Dr K K Aggarwal
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Dehydration can precipitate heart attack in susceptible individuals. The normal fluid requirement is 30 ml per kg weight, but the same needs to be increased in the summer because of the loss of fluid from sweating. Apart from water, sodium or salt is also lost. A person, therefore, needs to take more fruits during summer period.

Not passing urine in eight hours, dry armpits, feeling exhausted or feeling weak are suggestive of underlying dehydration. Dehydration can make the blood thick and precipitate heart attack in patients with uncontrolled blood pressure or diabetes.

Walking is a necessity for heart patients and the same should be continued even during peak summer but the timing should be so chosen that peak heat periods are avoided. One can walk early in the morning or late in the evening. People taking anti–allergic pills should take special precautions as they are more likely to get heat stroke.

Heat stroke is a medical emergency leading to charring of organs because of extreme internal heat. A person’s temperature may be more than 105°F.

Energy drinks may put heart at risk for sudden death

By Dr K K Aggarwal
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Energy drinks may raise blood pressure and prolong QT interval increasing the risk of sudden cardiac death.

In a meta–analysis by Sachin A. Shah at University of the Pacific in Stockton, Calif, with a pooled analysis of 93 people who consumed energy drinks, the QT interval on an ECG was significantly prolonged by 10 ms. The threshold level of regulatory concern is around 5 ms.

In another pooled analysis of 132 people by the same group, researchers found a significant increase in systolic blood pressure by 3.5 mmHg that was associated with the consumption of energy drinks.

Doctors are generally concerned if patients experience an additional 30 ms in their QT interval from baseline. QT prolongation is associated with life–threatening arrhythmias.

Most energy drinks have caffeine. Drinks such as Monster, Red Bull, Rockstar, Full Throttle and AMP have three times the amount of caffeine as colas. A 16–oz. can of Monster Energy, for example, contains 160 mg of caffeine, which is almost as much as 5 cans of soda.

Children should be screened for the heart before playing any sports

By Dr K K Aggarwal
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Sudden cardiac death amongst athletes is a rare but a devastating event. Most victims are usually young and, apparently, healthy but many have underlying undiagnosed heart disease.

As per American Heart Association Guidelines, children and adolescents undergoing athletic training need medical clearance. Majority of sudden deaths amongst athletes are due to malignant irregularities in the heart rhythm such as ventricular tachycardia and ventricular fibrillation. The precipitating factors can be prolonged physical training or unaccustomed athletic activities.

In athletes under the age of 35, the most common cause of death is underlying congenital heart disease and for those above the age of 35, it is the presence of blockages of the coronary arteries.

As per Heart Care Foundation of India, in every school/college, the attached doctor should evaluate all students with a 12 step history and examination to rule out high risk cases that need further evaluation.

The Foundation, along the lines of European Society of Cardiology, also recommends an additional standard 12–lead ECG before a medical clearance is given for both competitive as well as recreational athletic activities.

Master athletes who are above the age of 35 will need an additional exercise testing before they can be given a clearance for athletic activity.

Diagnostic echocardiography is indicated when clinical, historical and physical findings suggest possibility of structural heart diseases. Athletes on pacemakers should not engage in sports as bodily collision may damage the pacemaker system.

The 12–element AHA recommendations for pre participation cardiovascular screening of competitive athletes are as follows:

  1. Exertional chest pain/discomfort
  2. Unexplained syncope/near–syncope
  3. Excessive exertional and unexplained dyspnea/fatigue, associated with exercise
  4. Prior recognition of a heart murmur
  5. Elevated systemic blood pressure
  6. Premature death (sudden and unexpected, or otherwise) before age 50 years due to heart disease, in one relative
  7. Disability from heart disease in a close relative <50 years of age
  8. Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long–QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias
  9. Heart murmur
  10. Femoral pulses examination to exclude aortic coarctation
  11. Physical features of Marfan syndrome
  12. Brachial artery blood pressure (sitting position, both arms)