Month: April 2019

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Yes it is proven: Blocks can disappear

One or more blocks in the blood vessels supplying the heart muscle is known as coronary artery disease. Severe coronary artery disease is the culprit in the majority of heart attacks. It is a combination of cholesterol deposits and blood clots in the inner lining of the blood vessels that usually prevents blood flow and causes heart muscle damage. As soon as someone is diagnosed with a heart attack, the emergency medical team rushes to give intravenous medications to stop the blood clot from growing and takes immediate steps to restore the blood flow through a stent procedure or surgery. While this often saves heart muscle as well as lives, a long-term approach to disease management is equally important. Let us see why.

The most common question that our patients ask us is “will the blocks inside my coronaries go away or are they permanent?” The answer to that is “yes it’s proven that blocks inside coronaries can disappear with time but here is what you need to know…”

  • Coronary blocks get formed over a period of months to years, so it takes time to regress and disappear
  • The younger the person the more likely that the blocks will regress
  • Hardened blocks due to calcium deposits are less likely to regress
  • Most importantly, intensive lifestyle modification in combination with cardio-protective drugs has been proven to cause regression and disappearance of blocks

Smoking cessation, regular exercise, a heart-healthy diet, stress management, health education and counseling are all part of the disease reversal strategy in a cardiac rehabilitation program. While strong evidence is available to support this phenomenon of coronary artery disease regression from developed countries, we are the first to have published our experience on Indian patients recently (https://www.ncbi.nlm.nih.gov/pubmed/27133332).

How a coronary block develops. (1) normal blood flow (2) reduced blood flow due to fatty deposits (3) complete block due to rupture of fatty deposit combined with a blood clot

Take home message 1: Never too old

If you are a senior citizen reading this post, you are probably wondering if disease regression is possible in your age group. While younger men and women have a higher likelihood of disease reversal, it has been proven beyond doubt that intensive lifestyle modification has benefits in all age groups. It can halt the growth of the coronary blocks and aid in the development of newer blood vessels or ‘natural by-passes’ to compensate for the reduced blood flow.

Take home message 2: Never too young

The latest guidelines for the prevention of cardiovascular disease conclude that a healthy lifestyle should be adopted as early as from the age of 5 years. So if you have young children or are a young adult thinking of starting a family, it is important to keep in mind that healthy lifestyle behaviors have to be incorporated in your everyday living rather than on an occasional basis.

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Move ahead with Heart Failure

Heart failure, a growing medical threat across the globe, not only affects the heart but also the functioning of all the body parts. Individuals with heart failure often face various challenges in their day-to-day life like tiredness and exhaustion, shortness of breath, physical weakness, water logging in the body, frequent infections and mental depression. While it may be very frustrating for the affected person and the caregivers to try to overcome the disease, some simple lifestyle measures actually go a long way in improving the quality of life.

In this post, we would like to share with you the heart-warming story of Mr.S, an 84-year old gentleman, who is currently undergoing cardiac rehabilitation with us.

Mr. S is a retired LIC employee . He has had a medical history of diabetes, hypertension, heart attack, chronic kidney disease and heart failure (ejection fraction 40%). He was taking several medicines to keep his illnesses under control. He lived with his family which included his wife, son, daughter-in-law and grandchildren.

Right after our first interaction with Mr. S, we understood that he had multiple health issues and needed individual attention from the rehab team. His main complaints were breathlessness during physical activity, generalized weakness and inability to lead a normal life. He used a walking stick for support and was unable to climb even a few steps. His ambition was to be able to walk at least a kilometer without any hindrance and difficulties.

After ascertaining that Mr. S’s condition was stable, we started him on a personalized cardiac rehab program comprising of supervised exercise, health education, counseling and dietary advice. He visited our rehab centre two times a week and followed our advice for home exercising on the other days. The exercise sessions were very short to begin with. It consisted of a prolonged warm-up period followed by simple exercises like on-the-spot marching with support, and stepping up and down a step a few times, and some cool-down stretches. He needed frequent rests which we allowed.

Breathing exercises were taught to ensure proper breathing technique to help with his breathing difficulty. Education about his current health problems, red-flag signs to watch out for, exercise and its effects, healthy eating and ways to meet his nutritional requirements, role of medications and their importance and adherence to exercise on a long term basis was an integral part of his program.

The rehab team helped Mr. S set weekly health goals that were small but achievable. In spite of a few inter-current illnesses, Mr. S has made progress and is able to do more. He is now cycling continuously for 15 minutes and working with low-weight dumbbells to improve his strength, after a month of continued efforts.

Sometimes, it does take a longer time to see improvement but close monitoring, baby steps and constant encouragement are the keys to success. Mr. S feels that he still has a long way to go before being able to walk a kilometer but we know for sure that he is much nearer to achieving his goal than he was a month ago.

If you or your loved ones are suffering from heart failure, talk to your Cardiologist about cardiac rehabilitation as it is an approved and mandatory aspect of management in the current era.

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Exercise after Heart transplantation

We all know that exercise has multiple positive effects on our body and helps to improve our physical, mental and social well-being. There is ample evidence to show that exercise helps to decrease all risk factors for heart and blood vessel diseases, thereby preventing major diseases like heart attack and stroke in healthy individuals and also controlling and reversing the disease in previously diagnosed persons.

In recent years, organ transplantation techniques and outcomes have advanced commendably and one of the major solid organs transplanted today is the heart. In an earlier post, we had discussed about organ donation in general and heart transplantation in particular: http://www.cardiacwellnessinstitute.com/heart-disease-treatment-prevention/uncategorized/the-most-precious-gift-ever/

Let us look at some interesting facts about heart transplantation and the need for cardiac rehabilitation post transplantation.

As heart transplantation is a major surgery it does take a few weeks of intensive medical care for a full recovery. The immediate post transplant period is challenging as the anti-rejection medications lower the defense mechanism of the body which in turn increases the chances of serious infections. So, adequate rest, regular intake of medications and proper infection control steps are of high priority during this time.

Comprehensive cardiac rehabilitation which includes supervised exercise, appropriate nutrition, psycho-social counselling and alternative therapies like yoga and meditation plays a major role in the long term survival of the transplant recipient. Overall body weakness, reduced muscle strength due to prolonged illness prior to surgery, low level of exercise capacity, decreased chest wall movements due to surgical site pain, and restrictions in daily activities to prevent infections are some of the practical problems faced by the rehab team when dealing with a post transplant individual.

While patients and their family members may be worried about exercise making them more tired, aggravating their pain and even putting them at risk for complications, several research studies have shown that cardiac rehabilitation and exercise in particular not only helps individuals recover faster but also greatly improves their quality of life and long term survival.

Here are some exercise guidelines for heart transplant recipients:

  • Enroll in a cardiac rehab program at the earliest; start exercising 3-5 days/week, at mild to moderate intensity, for 30-40 minutes each day.
  • Aerobic exercises such as brisk walking, stationary cycling, treadmill in comfortable speed and cross trainer can be done. Those who cannot visit the rehab centre on a weekly basis due to distance and other limitations can follow home-based rehab programs as prescribed by their rehab team.
  • Once the surgical wound has healed well, strength training can be initiated with moderate intensity twice per week.
  • Regular follow up with the transplant team and the rehab team is important; any pain, discomfort, giddiness or palpitation during exercise should be reported immediately.
  • All medications should be taken as prescribed and blood levels of specific drugs should be monitored periodically.
  • All dietary advice should be followed closely.
  • Remember to note down your BP and heart rate prior to, during and post exercise for those following a home-rehab program.
  • Try to work out in a healthy environment to avoid infections. Wear face-masks while travelling and avoid crowded places.
  • Adequate warm-up and cool-down should be done to avoid exercise related complications.

In conclusion, exercise is an important aspect of the post transplant cardiac rehab program. If performed properly and with adequate education and supervision, it is the best tool to protect, preserve and promote the functioning of the new heart!