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Dr K K Aggarwal

Can blood pressure be higher in one arm?

By Dr K K Aggarwal
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A small difference in blood pressure readings between arms is normal. However, a difference of more than 20 mmHg for systolic pressure (top number) or more than 10 mmHg for diastolic pressure (bottom number) can be a sign of an underlying narrowing of the main arteries to that arm.

A difference of 10 to 15 mmHg for upper systolic pressure that shows up repeatedly is a risk marker for vascular disease and future heart attacks.

Always have your doctor check blood pressure in both your arms and use that arm, with higher reading, for future blood pressure readings.

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.

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.

Kidney patients more at risk for future heart attacks

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , | | Comments Off on Kidney patients more at risk for future heart attacks

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.

Blood pressure drugs should be taken at night

By Dr K K Aggarwal
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Uncontrolled blood pressure can lead to heart attacks, paralysis and heart failure. Most such attacks occur in the early morning hours. Pulse, blood pressure and thickening of platelets are all higher in the early morning hours.  Controlling early morning blood pressure can reduce cardiovascular mortality. According to a study published in the Journal of the American Society of Nephrology, among patients with chronic kidney disease and high blood pressure, taking at least one antihypertensive drug at bedtime significantly improves blood pressure control, with an associated decrease in risk for cardiovascular events.  The study included 661 patients with chronic kidney disease who were randomly assigned either to take all prescribed anti BP drugs on awakening or to take at least one of them at bedtime. Patients were followed for a median of 5.4 years; during that time, patients who took at least 1 BP–lowering drug at bedtime had approximately one third of the cardiac risk compared with those who took all medications on awakening. A similar significant reduction in cardiac deaths, heart attacks and paralysis was noted with bedtime dosing. Patients taking their medications at bedtime also had a significantly lower mean BP while sleeping. For each 5 mmHg decrease in mean sleep–time systolic upper BP, there was a 14% reduction in the risk for cardiovascular events during follow–up. Potential explanation for the benefit of night time treatment may be associated with the effect of night time treatment on urinary albumin excretion levels. Urinary albumin excretion is significantly reduced after bedtime, but not morning, treatment.

Can blood pressure be higher in one arm?

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , , | | Comments Off on Can blood pressure be higher in one arm?

A small difference in blood pressure readings between arms is normal. However, a difference of more than 20 mm Hg for systolic pressure (top number) or more than 10 mm Hg for diastolic pressure (bottom number) can be a sign of an underlying narrowing of the main arteries to that arm.

A difference of 10 to 15 mm Hg for upper systolic pressure that shows up repeatedly is a risk marker for vascular disease and future heart attacks.

Always have your doctor check both your arms for blood pressure and which of the two is higher, use that arm for future blood pressure readings.

Blood pressure drugs should be taken at night

By Dr K K Aggarwal
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Uncontrolled blood pressure can lead to heart attacks paralysis and heart failure. Most such attacks occur in the early morning hours. Pulse blood pressure and thickening of platelets are all higher in the early morning hours. Controlling early morning blood pressure can reduce cardiovascular mortality. According to a study published in the Journal of the American Society of Nephrology among patients with chronic kidney disease and high blood pressure taking at least one antihypertensive drug at bedtime significantly improves blood pressure control with an associated decrease in risk for cardiovascular events. The study included 661 patients with chronic kidney disease who were randomly assigned either to take all prescribed anti BP drugs on awakening or to take at least one of them at bedtime. Patients were followed for a median of 5.4 years during that time patients who took at least 1 BP lowering drug at bedtime had approximately one third of the cardiac risk compared with those who took all medications on awakening. A similar significant reduction in cardiac deaths heart attacks and paralysis was noted with bedtime dosing. Patients taking their medications at bedtime also had a significantly lower mean BP while sleeping. For each 5 mmHg decrease in mean sleep time systolic upper BP there was a 14 reduction in the risk for cardiovascular events during follow up. Potential explanation for the benefit of night time treatment may be associated with the effect of night time treatment on urinary albumin excretion levels. Urinary albumin excretion is significantly reduced after bedtime but not morning treatment.

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.

Snoring how boring

By Dr K K Aggarwal
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When this irritating sound blasts through the quietness of the night it can drive the sanest of people insane – well almost! There are many couples who have divorced on this ground. It’s no joke to be accused of snoring – neither for the snorers nor for the sufferers who have to endure sleepless nights! Even the fair sex is not immune to this malady howsoever they might deny it. The cause of snoring is air flowing through the open mouth and causing the soft palate (side area around the back of the tongue and the tonsils) to vibrate. This results in the production of sound – the snore! Medically, snorers are found to be more prone to heart attacks and sudden death. Certain conditions can predispose to snoring. These are: • Enlarged tonsils or adenoids • Congestion in the nasal sinuses • Deviated nasal septum • Loose dentures • Nasal polyps • Sleeping on your back (causes the tongue to fall back and block the windpipe partially) • Aging causes the throat muscles to become flabby. This is also caused by alcohol, and certain drugs – tranquilizers, pain killers, or sedatives, all of which depress the brain and cause the muscles to be loose. Practical remedies for this malady • Find the cause and treat it if snoring is due to any of the above conditions. Corrective measures should be undertaken ant it may stop snoring. • Sleeping on the side: The tongue does not block the airway and hence helps to prevent snoring. For this purpose a ball is stitched on the back of the night suit shirt to remind the person to sleep on the side. • A special anti-snoring pillow can be made in which the portion under the neck is higher than the one under the head, hence extending the neck this prevents snoring. • Lose weight if you are overweight, especially around the belly. • Stop smoking as smoke irritates the nasal mucosa and the throat. • Sleep without dentures if you use them. • For the sufferers, one last line: Stuffing your ears with cotton wool (or your partner’s mouth) or sleeping in another room may be the best answer to the solution. If nothing helps – just pray to God for endurance.

Use painkillers with caution in the elderly

By Dr K K Aggarwal
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Painkillers can cause stroke via irregular heart rhythm. Non selective non–steroidal anti–inflammatory drugs (NSAIDs) and new generation selective COX–2 inhibitors commonly used to treat inflammation are now linked to an increased risk of irregular heart rhythm called atrial fibrillation (AF), as per a Danish Research of 32602 patients led by Professor Henrik Toft Sorensen at Aarhus University Hospital in Denmark.

These drugs are already linked to increased risk of heart attacks and strokes. And now through AF, the risk gets intensified for stroke and new risk added of heart failure and death.

In the study, compared with non users, new users (first drug within 60 days of diagnosis) showed 40% increased risk of AF with non–selective NSAIDS and 70% increased risk with COX–2 inhibitors. This means four extra cases of AF per year per 1000 new users of non–selective NSAIDS and seven extra cases of AF per 1000 new users of COX–2 inhibitors.

The risk was highest in the elderly, patients with chronic kidney disease or rheumatoid arthritis especially on COX–2 inhibitors. NSAIDs should be used very cautiously in older patients with a history of hypertension or heart failure

Neck artery wall plaques suggest vulnerability to heart attacks

By Dr K K Aggarwal
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Presence of plaques in the neck artery wall is highly suggestive of underlying plaques and blockages in the heart arteries. If a patient with acute coronary syndrome, who presents with chest pain is found to have an ultrasound detected echolucent neck artery plaque in the emergency room, it is highly suggestive of a high risk patient with increased chances of heart attack and sudden death. A calcification in the plaque is highly predictive of underlying heart diseases compared to a plaque with no calcification. An artery thickness of more than 1 mm is called as a plaque. Some define a plaque as to when the thickness is more than 1.5 mm. In a patient with diffuse neck artery thickness, any focal additional thickening of 0.5 mm or more than 50% of the neck artery thickness is classified as a plaque. If a patient has plaques in both neck and the leg arteries, he/she will invariably also have plaque in the heart artery. Patients who demonstrate a plaque of more than 1.5mm have a very high history of premature heart-related deaths in the family. In the presence of plaques, risk of acute coronary syndrome is 6.7 times more than in a person with no plaques in the neck artery.

Snorers at risk of sudden death

By Dr K K Aggarwal
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The interrupted night time breathing of sleep apnea increases the risk of dying. Sleep apnea is a common problem in which one has pauses in breathing or shallow breaths during sleep.

Studies have linked sleep apnea during snoring to increased risk for death. Most studies were done in sleep centers rather than in the general community. A study published in the journal Sleep has suggested that the risk is present among all people with obstructive sleep apnea. The size of the increased mortality risk was found to be surprisingly large.

The study showed a six–fold increase, which means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who does not have sleep apnea.

For the study, the researchers collected data on 380 men and women, 40 to 65 years old, who participated in the Busselton Health Study. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow–up, about 33 percent of those with moderate to severe sleep apnea died, compared with 6.5 percent of those with mild sleep apnea and 7.7 percent of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly tied to the condition.

People who have, or suspect that they have, sleep apnea should consult their physicians about diagnosis and treatment options.

Another study by researchers from the University of Wisconsin has also shown that severe sleep apnea was associated with a three–fold increased risk of dying. In addition, for those with moderate to mild sleep apnea, the risk of death was increased 50 percent compared with people without sleep apnea. Sleep apnea is also linked to future heart attacks and with thickened wall thickness of the neck artery.

Science behind Shiva the Neelkanth

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The blue neck Shiva called Neelkanth symbolizes that one should neither take out the vices or negative emotions nor suppress them. Instead one should alter or modify them.

The blue colour in mythology symbolizes slow poison that includes attachments, anger, greed, desires and ego. Blue neck means to hold on the negative emotions temporarily so that it can be neutralized at appropriate time.

Suppressed anger releases chemicals which can lead to acidity, asthma, angina, future heart attacks and diarrhea etc. Similarly expressed anger can cause social unhealthiness and acute heart disease.

The only way to mange anger is to take the right and not the convenient action. One should neutralize anger by willful cultivation of opposite, positive of different thoughts.

Anger is a known risk factor for heart blockages.  Anger can evoke physiological responses that are potentially life threatening in the setting of underlying heart blockages. It has a dominant influence on the severity, frequency, and treatment of angina.

This Vedic message of Shiva is being validated by many western scientists.

Anger has many phases

  1. Anger Expression Inventory
  2. Assesses anger frequency (trait anger)
  3. Anger intensity
  4. Anger expression (anger-out)
  5. Anger suppression (anger-in)
  6. Anger recall.

Both anger-in and anger-out are associated with heart blockades.

  1. Dr. C. Noel Bairey Merz, from Women’s Health at Cedars-Sinai Medical Center has shown women who outwardly express anger (anger-out) are at increased risk especially if they also have other risk factors like age, diabetes and high cholesterol levels. The findings are a part of Women’s Ischemia Syndrome Evaluation Study, a multi-center, long-term investigation sponsored by the National Heart, Lung and Blood Institute.
  2. Anger-in is also related to severity of blockages. Dr. TM Dembroski in 1985 has shown that potential for Hostility and Anger-In are significantly and positively associated with the heart blockages disease severity, including angina symptoms and number of heart attacks. Suppressed anger is also associated with increased carotid arterial stiffness in older adults, a condition making them prone to future heart attacks and paralysis.
  3.  In univariate correlational analysis byAndersonDEfrom National Institute on Aging,Baltimore,Marylandin 2006 has shown a significant positive association of anger-in with artery stiffness.
  4.  Suppressed anger has also been shown to increase blood pressure by Thomas and group fromUniversityofTennessee.
  5.  Recall of suppressed anger has been shown by Dr D Jain in 2001 from Yale University to be associated with angina, heart LV dysfunction and rise in upper blood pressure.
  6. G Ironson and colleagues from Department of Psychology,University of Miamiin 1992 has shown that anger recall produces more stress than the actual stress in a treadmill. Intensity of anger was associated with severity of angina. In the study vasoconstriction only occurred with high levels of anger. There also showed that there was no narrowing of non-narrowed arteries indicating that anger recall produce coronary vasoconstriction in previously narrowed coronary arteries.

Snorers at Risk of Sudden Death

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The interrupted night time breathing of sleep apnea increases the risk of dying. Sleep apnea is a common problem in which one has pauses in breathing or shallow breaths during sleep.

Studies have linked sleep apnea during snoring to increased risk for death. Most studies were done in sleep centers rather than in the general community. A study published in the journal Sleep has suggested that the risk is present among all people with obstructive sleep apnea. The size of the increased mortality risk was found to be surprisingly large.

The study showed a six-fold increase, which means that having significant sleep apnea at age 40 gives you about the same mortality risk as somebody aged 57 who does not have sleep apnea.

For the study, the researchers collected data on 380 men and women, 40 to 65 years old, who participated in the Busselton Health Study. Among these people, three had severe obstructive sleep apnea, 18 had moderate sleep apnea, and 77 had mild sleep apnea. The remaining 285 people did not suffer from the condition. During 14 years of follow-up, about 33 percent of those with moderate to severe sleep apnea died, compared with 6.5 percent of those with mild sleep apnea and 7.7 percent of those without the condition. For patients with mild sleep apnea, the risk of death was not significant and could not be directly tied to the condition.

People who have, or suspect that they have, sleep apnea should consult their physicians about diagnosis and treatment options.

Another study by researchers from the University of Wisconsinhas also shown that severe sleep apnea was associated with a three-fold increased risk of dying. In addition, for those with moderate to mild sleep apnea, the risk of death was increased 50 percent compared with people without sleep apnea. Sleep apnea is also linked to future heart attacks and with thickened wall thickness of the neck artery.

Heart Checkup camp at Dept. of Science & Technology

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Heart Care Foundation of India organized a Heart Checkup camp for the employees and staff of Dept. of Science & Technology, Government of India. Over 200 employees and staff availed of this opportunity.

Speaking on the occasion, Padma Shri & Dr. B C Roy National Awardee, Dr. KK Aggarwal, President, Heart Care Foundation of India, said that all those who have a history of high blood pressure and abdominal circumference of more than 90 cm in men and more than 80 cm in women should have their lipid profile, blood sugar and blood pressure checkup done as they may be candidates for metabolic syndrome, which is responsible for future heart attacks and paralysis.

Dr. Aggarwal further said that maximum heart attacks occur in early morning in winter. All patients with heart disease, high blood pressure and/or diabetes should have their medication doses adjusted during winter.

Both aspirin and cholesterol drugs (Statins) can prevent heart attacks during winter and one should ask his or her doctor about the same.

 Winter Guidelines

· Keep doses of your drugs adjusted during winter.

·  Ask your doctor for aspirin and statin, if you are not taking them.

·  Say no to smoking. Early morning smoking with a cup of tea/coffee can be fatal.

· Do not consume alcohol to relieve winter cold.

· Take your flu vaccination.