Cardiac care can be broadly divided into acute management of cardiac emergencies and longer-term prevention and rehabilitation strategies for the heart patient. In this post, we would like to share our experience on how cardiac rehab has evolved with the ongoing pandemic.
During the pre-COVID era, our focus was predominantly on conventional centre-based cardiac rehab where patients and their caregivers would visit our rehab centre on a periodic basis for sessions with the doctor, physiotherapist, dietician, counselling psychologist and yoga therapist. Home-based cardiac rehab offered through tele / online modality occupied a minor portion of our work prior to the pandemic and was reserved for those living outside Chennai or abroad. However, it was gratifying to note that both formats were well appreciated by the participants and the program outcomes were excellent irrespective of whether they were attending in-person or home-based sessions and we have shared our thoughts on this topic in June of 2019 (click the link for the earlier post).
The biggest advantages of in-person care are the personal touch and the ability to examine the patient. Looking back, these are the things we have missed the most in the past year since the start of the lockdown as our entire team of healthcare professionals switched to the work-from-home mode to maintain continuity of care and uninterrupted services for patients.
We initiated HeartHealth@Home, an online
consultation service to cater to patients’ queries and concerns related to cardiac
care while at home during the lockdown. Some common issues for which people
approached us were:
Symptoms like gastritis, heartburn and chest pain for which detailed history was elicited and appropriate guidance given
Doubts about cardiac medications and their dosages as they were not able to contact their primary physician
Questions about COVID-19 related safety measures in individuals with diabetes, hypertension and heart ailments
Queries pertaining to when to approach the hospital and whether it was safe to do so during the pandemic
We realised that our home-based cardiac prevention and rehab program soon became a much sought after service as patients were able to make use of the online services seamlessly and cardiologists and heart surgeons were happy to refer their patients. The initial evaluation, the program planning and the execution of the rehab sessions were all done online and smooth communication was maintained with the enrolling participant, their family members and the referring doctors. Without the technological advances of video calls through smartphones, audiovisual presentations for groups of people using various platforms and online questionnaires and forms to evaluate and track patient progress, the home-based programs would not have been possible.
As we embrace the new normal and gradually resume in-person consultations and regular centre-based programs this month, we are making sure we closely adhere to the COVID prevention protocols and maintain high standards of safety and hygiene for our patients. We encourage all our patients to get vaccinated against the novel coronavirus at the earliest possible time and to continue following personal precautions for the timebeing. Moving forward, patients will have the option to choose centre-based or home-based programs or a hybrid model with a combination of both formats. We are confident that after having pioneered the concept of preventive cardiology in South India and having sailed through the pandemic situation with minimum impact on patient care, we are better poised to continue in our exciting journey of best-in-quality cardiac care for our people.
Consumption of a healthy diet has been scientifically proven to reduce the risk of several diseases and to keep our body and mind healthy. This new year, we urge you to take a resolution to start eating a balanced healthy diet and sustain it for life. As a dietician focusing on improving peoples’ cardiovascular health, I would like to share some of the food-related behaviour patterns I come across frequently and some simple solutions to help you acquire a heart-healthy eating habit.
Pattern 1 – Lacks awareness and is resistant to change
These individuals do not include adequate amounts of fruits and vegetables on a daily basis mainly because they are ignorant about the importance of a balanced diet. Moreover, they are likely to consume packaged foods and eat out very often, which makes things worse when it comes to behaviour modification.
Mr. SC, an entrepreneur in his 50s was recently operated for a heart attack and is currently undergoing cardiac rehabilitation with us. Apart from his smoking habit, which he quit after the heart attack and his high BP that has come under control now, his unhealthy dietary behaviour has been and continues to be the main risk factor for his cardiac condition. He has been habitually consuming unhealthy foods like wafers, sweets, savouries and carbonated drinks on a regular basis, and does not include vegetables and fruits in his daily diet.
Solution – Fruits and vegetables are low in calories and are nutrient dense; in other words, they are packed with vitamins, minerals, antioxidants and fibre. Plain salads and plain steamed veggies can quickly become boring; there are plenty of ways to add taste to your vegetable dishes. Some healthy cooking methods such as boiling, steaming, grilling, roasting, or pan frying enhances the taste of the vegetables. Naturally sweet vegetables such as carrots, beets, sweet potatoes and peppers add sweetness to your meals and reduce food cravings. Bringing in variety to your menu in the form of mixed vegetable soups or a stew, veggie gravy or a raita, vegetables cooked with dhal and garnished with shredded coconuts and peanut crumbs etc. would enhance the palatability of your dishes. Similarly, getting creative with your salads, experimenting with different combinations of fruits and going local when it comes to farm produce are ideal ways to spruce up your fibre intake.
Mr. SC has understood that his diet has been unhealthy all along but it has been very challenging for him to incorporate the recommended 4-5 portions of veggies and fruits daily. We have succeeded in bringing down his intake of empty calories (carbonated drinks) and packaged snacks but he has troublesome cravings as he as been addicted to unhealthy foods. In fact, he did not find quitting smoking as difficult as adopting a heart-healthy diet but is making slow and steady progress and is sure to achieve all dietary goals during his rehab program.
Pattern 2 – Focused on fitness but consumes an improper diet
Some of us are health conscious and
know that we need to exercise regularly to stay fit and healthy. In fact, we
believe we are improving our health by over-exercising and cutting down some
dietary components like healthy fats to a dangerously low level or consuming
too much protein-rich foods which in turn throws the dietary balance away and
affects our health negatively.
Mr. R aged 51 years has been an avid exerciser for over 20 years focusing on power lifting (lifting heavy weights), and has been consuming a calorie-dense diet and multiple protein supplements. He recently suffered a heart attack, underwent an angioplasty procedure and is currently receiving cardiac rehabilitation. His main concerns were whether he could return to power lifting and whether his cardiac condition will have long-term effects on his overall fitness.
Solution – Over consumption of any particular nutrient can cause adverse effects. The daily requirement of different nutrients varies according to age, gender, body composition and level of physical activity. The ideal way to improve your diet is by focusing on the nutrients in your diet and not on the calories, that is, count the nutrients and not the calories. In many instances, the vitamins and minerals found in food sources are better utilised by our body than those in commercially available capsules and powders. Eating healthily gives far greater benefits than opting for supplements and eating poorly. A healthy balanced diet with sufficient fruits and vegetables, whole grains, healthy fats and lean meats along with some naturally available seeds and nuts helps to prevent nutritional deficiencies and fulfils our dietary requirements.
Pattern 3 – Follows multiple fad diets and loses health
A fad
diet is a diet that is popular for a time without being a standard dietary
recommendation, and often promising unreasonably fast weight loss or
nonsensical health improvements. Some of us tend to follow multiple fad diets
with the hope of getting magical results in a short period of time and
unfortunately end up losing our health in the process.
Mrs. DD, a home maker aged 44 years, had tried the paleo diet (high protein low carbohydrate diet), keto diet (high fat diet) and a few other diets in the past but ended up gaining rather than losing weight and becoming hypertensive. The pattern we noticed was she would follow a particular diet for 2-3 months and move onto another diet plan when results were not as expected, without incorporating a regular exercise regimen and making healthy lifestyle changes.
Solution – Some disease conditions may alter our nutrient requirements, but otherwise we all need a balance of proteins, fats, carbohydrates, fibre, vitamins, and minerals in our diet to sustain a healthy body. Instead of eliminating certain food groups from your diet, selecting the healthiest options from each category is the better thing to do. A combination of a balanced healthy diet with proper intake of recommended nutrients, sufficient exercise, good sleep and adequate stress management helps to maintain a normal weight in the long term whereas crash diets may reduce the body weight temporarily mainly by loss of muscle mass rather than loss of stored body fat and is therefore extremely unhealthy.
Making the switch to a healthy diet
Switching to a healthy diet
doesn’t
have to be complicated. You need not completely
eliminate foods you enjoy, and you don’t have to change everything overnight. A
better approach is to make few small changes at a time. Keeping your goals
simple will help achieve more in the long term without feeling overwhelmed by a
major diet. Think of planning a healthy diet as a number of small, manageable
steps like adding a salad to your diet once a day, reducing your intake of
hidden salt present in packaged foods and cutting down added sugar, one change
per week. Once these small changes become a habit, you can continue to add more
healthy choices. When cutting back on unhealthy foods in your diet, it’s
important to replace them with healthy alternatives.
A healthy eating plan should include
A variety of vegetables from all of the subgroups like dark green, red and orange, legumes (beans and peas), starchy, and other leafy vegetables
Fruits, especially whole fruits which are are superior to fruit juices
Choose whole grains instead of refined ones (e.g. whole grain bread instead of white bread)
Fat-free or low-fat dairy, including low-fat milk, yogurt, cheese, and/or fortified soy beverages
A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), nuts, seeds, and soy products
Steam or shallow fry instead of deep fry
Some tips to ensure a balanced wholesome diet
Try at least one new healthy recipe per week
Try to eat a family meal everyday to help you focus on eating healthy meals
Pack a healthy lunch with some healthy in-between fillers like nuts and fruits for work. This lets you have more control over what you eat.
Eat breakfast, and eat smaller meals throughout the day. A healthy breakfast can jumpstart your metabolism, while eating small, healthy meals keeps your energy up all day.
Avoid eating late at night. Try to eat dinner earlier and fast for 14-16 hours until breakfast the next morning. Studies suggest that eating only when you’re most active and giving your digestive system a long break each day may help to regulate weight.
Shortcuts might help you achieve temporary results, but focusing on sustainable healthy changes will help you maintain good health for decades. Feel free to take professional help if you’re not sure where to start or how to help a loved one with nutritional challenges. After all, we are what we eat and eating healthy is an art that once learnt will go a long way in keeping you healthy and happy!
Hello everyone! Hope you are safe and healthy in the midst of the ongoing pandemic. In continuation with our previous blog post that focused on performing aerobic exercises at home (click here to read about fitness at home) we will enlighten you about what is strength training, why it is important and how to go about becoming physically stronger.
You may be familiar with the names Karnam Malleswari and Gurdeep Singh, weightlifting champions in the female and male categories respectively, who have made India proud in the global arena! While competitive bodybuilding and weightlifting are not for everyone, toned up muscles and a sleek core are some things we should all work for.
What is strength training?
Strength
training or resistance training is a form of physical activity designed to work
our muscles against resistance in order to improve muscle strength, power and
endurance. There are multiple ways of doing strength training, such as:
Use of free weights such as dumbbells and barbells
Use of machines/equipments that consist of adjustable weights
Use of resistance bands
Use of body weight
Benefits of strength training
Improves
strength, power and tone of the muscle
Improves
flexibility and functioning of joints
Aids weight loss
by increasing calorie expenditure
Helps in increasing
bone mass and density thereby reducing the risk of osteoporosis (weak bones)
Also improves
posture, mobility and balance
Impact on heart and lung health
Regular strength training exercises help prevent and control diabetes, hypertension, abnormal cholesterol and obesity, thereby reducing the risk of heart attack, stroke, kidney failure, and liver damage. There is also a direct connection between better muscle strength and improved heart function. That is why cardiac patients are now advised to engage in resistance exercises on a regular basis, so that not only their arms and legs but also their heart muscle will work more effectively and more efficiently.
As medical literature has proven that individuals with chronic lung diseases benefit from a combination of breathing retraining, aerobic exercises and strength training exercises, we teach these exercises to our patients with asthma, bronchitis, and even those who have had heart and lung transplant to improve their breathing efficiency and reverse their muscle wasting.
Body weight exercises
Half Squats Stand tall with feet apart; out stretch your hands and slowly squat down halfway. Keep your knees in line with your toes and your back straight.
Lunges Stand tall with feet apart and extend the left leg forward; slowly go down until your right knee nearly touches the floor and come back up; repeat the same on the other leg in an alternate manner.
Calf Raises Stand tall with feet minimally apart, raise your heel and balance on your toes for 2 to 3 seconds and slowly come down.
Modified Push Ups From a face-down position with your hands shoulder width apart and from a half kneeling position, lift your toes up and slowly go down until your chest is 5 cm above the ground and come back.
Tips for body weight training
Start at a lower level of 8-12 repetitions (1 set) and try to do 1-2 sets
Focus on the quality of the movement throughout the regime
Avoid holding your breath while performing these exercises
Take breaks of 30-60 seconds in between each set and 2-3 minutes between each exercise
What is core strength?
Additionally, adequate amount of time should also be devoted towards strengthening your core, that is, your abdominal and lower back muscles. Core strength will improve your fitness level, enhance your aerobic performance and prevent low back pain and flabby tummy or potbelly.
Core strength exercises
Abdomen curl ups Lie flat on the ground with your knee bent as shown; keep your hands by the sides of your head to maintain your neck in neutral position. Slowly come up as you breathe out and go back down as your breathe in, feeling the tightness in your abdomen.
Alternate/Both Leg Raises Lie supine and keep your hands to the side; now slowly lift your legs high up without bending your knees as you breath out and slowly lower your legs down as you breathe in.
Modified Plank Lie prone on the ground and position your upper limb with elbow support and lower limb on your knees with toes lifted up and maintain this position for a few seconds.
Modified Side Plank Lie on a side and semi flex your knees and with the elbow support lift your upper body and maintain in that position for a few seconds.
The abdominal exercises can be done for 10-12 repetitions per set for a minimum of 2 sets and the plank hold for 10-15 seconds per round and minimum of 2 rounds.
Tips for core exercises
For abdominal exercises, remember to breathe out as you come up and breath in as your go down and avoid breath holding
In planks, see to it the position is well maintained and focus on breathing throughout the duration
Focus on the quality of the movement and do it at an appropriate pace for a better rhythm
Some
of the prerequisites one should have in mind prior to performing strength
training are:
Perform on a non slippery, safe surface to avoid injuries
Adequate warm-up and cool-down should be done for better performance
Allow adequate rest of 24-36 hours before performing the next session
Beginners may experience muscle soreness; application of ice packs on the localised area will help in relieving pain and discomfort
Performing these exercises at home will not only make you fit and healthy but also provide you with the confidence that exercise is simple and fun and can be done without any fancy equipment!
Exercise your way out of the COVID-19 crisis
Today, all of humanity is doing one of these three things: trying not to contract the infection, fighting the infection actively or coping with the post-infective period having survived the infection. Exercising regularly, eating a healthy diet and keeping up the positive attitude are 3 things that will help all of us irrespective of which phase we are in. Let us support one another and get through this crisis together!
Everyone of us wants to lead a healthy and happy life. We like to be fit and active and avoid being sick or afflicted with disease. There is no doubt that any chronic health problem brings with it physical and mental strain due to the need for multiple drug therapy, surgical treatment and other invasive procedures. In fact, very often our fitness goals and competitive attitude take a back seat when diagnosed with cardiovascular or cardiometabolic diseases like heart attack, hypertension or diabetes.
Everyday, we at Cardiac Wellness Institute meet
clients of different fitness levels with a recent cardiac diagnosis,
angioplasty or bypass surgery. Some of them are depressed and disheartened that
they will be unable to run the marathon they had signed up for or continue
their passion for sports like swimming or cycling. It is during their
personalised cardiac rehabilitation with our team that they begin to believe in
themselves and that they can actually achieve their goals.
Let me share some real-life examples with you.
A 45-year old entrepreneur based in Delhi suffered a massive heart attack and immediately underwent an angioplasty where a stent was placed to restore blood supply to the heart. He was married and had a young child. He was worried and anxious about returning to work, leading a normal life and the impact this disease would have on his future wellbeing. He enrolled in our Home-based Cardiac Rehabilitation program right after his procedure and we initiated him on smoking cessation, dietary modification and graded exercise training. He was counselled about getting back to work gradually, about coping with the stress of a cardiac condition, about resuming normal sexual activities and about the actions and side effects of medications.
He had been a physically fit person aiming to participate in marathons when the heart attack had struck suddenly. After about 20 months of cardiac rehab, he is a very confident man who understands that his medical condition is not a barrier for his dream of participating in marathons. He trains regularly covering all aspects of fitness namely aerobic exercise, overall strength and core fitness. He eats a heart-healthy diet, manages his stress levels well and leads a normal work life and social life. His motto has been “try, try, try until you succeed”.
A 58-year old advocate, social activist, organic farmer and a badminton enthusiast suffered a heart attack for which he underwent bypass surgery. He had a poorly functioning heart as a result of the heart attack and that caused him great anxiety. His dream was very simple – to get back to his active life at the earliest. He enrolled in our Cardiac rehabilitation program after a month of bypass surgery and has been extremely consistent in following our exercise training, dietary advice, education sessions and psychological counselling. He was very glad that his physical stamina, exercise capacity, blood pressure control and cardiac function all showed improvement within 3 months.
After completing his intensive rehab program, he signed up for the monthly maintenance program with us and goes to a fitness centre near his residence regularly. He is back in action with more energy and confidence in his daily routine and says, “I believe in things that help me to do better. Regular exercise, appropriate diet and keeping the mind healthy are among them”.
It is clear from the above stories that cardiac
rehabilitation can help individuals with heart problems achieve their fitness
goals. Some things to be kept in mind are:
An expert rehab team has to assess your fitness level, medical history and presence of signs and symptoms prior to enrolling you in a rehab program and giving you an exercise prescription
You have to start with mild to moderate intensity exercise with adequate intervals between each exercise and then increase the intensity gradually
If you are passionate about running, cycling, swimming, hiking etc. guidance of a fitness instructor or physiotherapist with adequate knowledge about cardiovascular physiology will help
Taking care of your emotional wellbeing through psychosocial counselling is very important to help you overcome your fears and chase your dreams
In conclusion, performing exercises the right way, eating the right type of food, keeping your mindset positive and avoiding tobacco and alcohol are keys to overcoming your cardiac ailments and leading a healthy life. Dreams are meant to come true and goals are meant to be fulfilled irrespective of your health barriers; the right guidance is all you need.
In spite of the strong medical evidence for the positive role of exercise in preventing and reversing obesity, diabetes, hypertension, dyslipidemia, heart diseases and stroke, not many are able to incorporate regular exercise into their busy lifestyles.
Due to time constraints and workplace issues, interval training might be the answer for the younger generation. Interval training is a type of exercise training, which involves periods of intense exercise and recovery. High Intensity Interval Training (HIIT) is a type of interval training that has been investigated a lot in the recent past and has shown promise both in heart disease prevention as well as in cardiac rehabilitation programs.
HIIT involves short bouts of high intensity exercises, with recovery periods that involve mild intensity exercises. There are different types of HIIT regimes, but the basic algorithm is to have a good warm up, short bouts of the combination of high and low intensity exercises for a time period and cool down.
Sample HIIT
regime
5-minute warm up + [(4-minute high intensity exercise& 1-minute low intensity exercise) x 4 times = 20 minutes HIIT] + 5-minute cool down
This is different from Moderate Intensity Continuous
Training (MICT) which has been followed for a very long time with well
established evidence, in the following ways:
HIIT duration is
relatively shorter than MICT (20 minutes vs 30 minutes)
Calorie
expenditure is higher in HIIT than MICT
HIIT aids in
weight loss and increasing muscle mass at a faster rate than MICT
HIIT is applicable for both aerobic training as well as resistance training
However, prior to enrolling in a HIIT program, there
are some things to be considered:
An individual
should be following at-least a mild to moderate intensity exercise regime for 2
months before starting HIIT, so it’s not for those of you who are beginners to
exercise
It is advisable
to have a fitness instructor or a physiotherapist initiate the HIIT and monitor
you in the early stages
If you are a healthcare
professional, remember to assess the physical activity level and exercise
capacity of your client prior to initiating HIIT
Every exercise regime has some limitations, some of the
disadvantages in HIIT are:
It is not advisable for high risk individuals (uncontrolled hypertension, angina, arrhythmias, valve stenosis, pulmonary complications, recent heart attack, exercise intolerance) and senior citizens
Chances for injury are higher in HIIT if adequate warm up and cool down aren’t done
The recovery period for a HIIT program is comparatively longer than other training, which might affect one’s adherence
With this introduction to
HIIT, my aim as a cardiac physiotherapist is to help each and every one of you
out there find the exercise regimen that best suits your health, work and
lifestyle requirements. The secret to success is being regular with your
exercise over continuing periods of time and enjoying every bit of it!
Before explaining about home-based cardiac rehabilitation, let me recall a few important things about cardiac rehabilitation. Cardiac rehabilitation is a medically supervised program for individuals with chest pain, heart attack, heart failure etc. and for those who have undergone any cardiac procedures or surgeries. It is a proven risk-reduction therapy and includes education, exercise training, nutritional guidance and psycho-social counselling. Fewer complications, freedom from repeated hospitalization, ability to do more things and improved health related quality of life are some of the key benefits of cardiac rehabilitation.
Conventional cardiac rehabilitation consists of 4 phases namely:
Phase 1 – Counselling and expert advice during the period of hospitalisation with heart ailments
Phase 2 – Recovery phase lasting a few days to a few weeks after hospitalisation, surgery or any other procedure
How did Home-Based Cardiac Rehabilitation come about?
“Home Based” cardiac rehabilitation has been in vogue for a while now in developed countries. As the distance from the rehab facility and the logistics of commute back and forth are the main bottlenecks preventing maximum utilization of cardiac rehab services, home-based cardiac rehab became popular. It typically replaces phase 3 of the conventional cardiac rehabilitation program. Instead of attending 2-3 rehab sessions per week at the cardiac rehab centre, the individuals exercise in and around their home as advised by the rehab team. They also get dietary and psychosocial counselling through phone and/or video calls.
The rehab team at Cardiac Wellness Institute has been providing conventional as well as home-based cardiac rehabilitation for the past 5 years. Please read on for some Patient Stories:
Gentleman based in Singapore: Ram (name changed), a 45 year old gentleman from Tamil Nadu working in Singapore, suffered a heart attack and underwent a stent procedure. He and his wife were in a state of denial and disbelief that he had suffered a heart attack at such a young age. They had a daughter in kindergarten and were worried for her future. Moreover, there was a strong family history of young sudden deaths due to cardiac cause on Ram’s side and the recent demise of his brother had come as a major shock to them.
Ram enrolled in a home-based cardiac rehab program with us as he felt that the cardiac rehab program in Singapore was inadequate in addressing his dietary concerns (pertaining to South Indian diet) and his psychosocial problems (working in a foreign country, lack of support of extended family etc.). Once our rehab team had reviewed all his reports and was convinced that he was clinically stable and ready for home-based rehab, we went all out to provide him the moral support, exercise training, evidence based guidance on what to eat and what to avoid, and stress management advice, all through phone calls, video demonstrations and sharing of study material through internet. Ram successfully completed his 3-month rehab program and has been on a maintenance program for the past 6 months.
We have faced some challenges like for instance when Ram and his wife would get anxious and call us to check about a new-onset pain in the left shoulder during stressful situations or a bout of gastrointestinal symptoms with some food changes. We had to explain to them that long-distance rehab programs are not conducive for emergency health advice as we cannot see and examine the individual.
Gentleman from closer to home: Rathnam (name changed) is a 68 year old gentleman from Namakkal, Tamil Nadu, India, running his own business. He suffered a heart attack recently and was treated with a stent procedure. His risk factors were diabetes, hypertension and obesity in addition to sedentary lifestyle, lack of balanced diet and work-related stress. He and his wife were able to come in person for the initial evaluation and initiation of cardiac rehab program (3 day stay in Chennai near our rehab centre) following which they have had weekly communication with the rehab team on a home-based program. In the past 3 months, Rathnam has had days when work-related travel would come in the way of exercise but he keeps a log of his physical activities and his dietary intake and reports to us systematically. He is scheduled for a repeat in-person evaluation to quantify his progress and to discuss the next steps.
Advantages of Home-Based Rehab
Simple, feasible and convenient; avoids the hassle of commute and can be done in home surroundings
Sessions are administered through phone or video chat
Working individuals have the flexibility of doing the exercise at their convenient time
Individuals living in other cities or towns in India or residing abroad can also enroll in a home-based program
Participants do not get over dependent on the rehab team or the rehab facility.
Disadvantages of Home-Based Rehab
Cannot be administered for individuals
with high risk of complications
Chance of miscommunication or misinterpretation
is higher
Lack of a fixed exercise schedule may
hamper their adherence to our guidelines
Due to long distance communication, the rehab
team is unable to provide any emergency medical advice
Participants might not take the home-based program seriously and may not derive maximum benefit
Hence, home based cardiac rehabilitation is an alternative to conventional cardiac rehabilitation and can be offered to most individuals who aim for a complication-free recovery and enhanced health-related quality of life.
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.
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.
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.
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!
We all love to receive gifts, be it simple or expensive, or practical or exotic. We value the gifts and hold them very dear to our hearts for a long time. They bring back fond memories whenever we see them. Many of us give our time, money or material possessions for a charitable cause. We might not know the name or the identity of the people benefitting from the good deed but we nevertheless donate when the cause appeals to us. Have you ever wondered what the most precious gift or donation is?
I believe it is donating an organ to a person in need! It is nothing but literally gifting the opportunity to live a disease-free healthy life to someone who has been deprived of that. I recently registered myself as an organ donor at the Tamil Nadu Organ Sharing Registry portal https://tnos.org and am very happy to have done so. I will not be alive to see the person(s) whose lives and whose health improves after receiving my organs, but I will rest in peace knowing that a part of me will continue to live on meaningfully.
While blood and eye donation are things many of us have heard of, solid organs like heart, lungs, kidneys, liver and pancreas are successfully being transplanted from a deceased individual to a diseased individual with good outcomes these days. Medical advances are so commendable that within a couple of hours of (brain) death of an individual, multiple organs are harvested and transplanted into different needy individuals if the individual was and/or the family members are willing to donate. There is a government registry that connects the transplant team in hospitals with the family of the deceased individual and the families of sick people in need of organs. As there is always a greater demand than there is availability of organs, priority is given to patients based on certain criteria like date of registration, severity of illness, age and other associated illnesses.
A heart transplant is advised to individuals with severe heart failure resulting from various underlying heart problems and not responding to medical, surgical or device treatment. Chennai has become one of the leading heart transplant hubs in India today. Individuals from various parts of the country are being referred to hospitals in Chennai for the procedure, as the experience and expertise of the transplant doctors here are superior.
The cardiopulmonary rehabilitation team at Cardiac Wellness Institute provides pre and post transplantation rehab for heart and lung transplant patients. It is not only important to take care of the new organs and the new lives by adopting a healthy lifestyle but also equally important to prevent diabetes, hypertension, dyslipidemia and coronary heart disease which are much more common in people who have been transplanted with a new heart and other solid organs.
While the transplantation team continues to be the core team involved in the care of transplant patients, especially their medication schedule and monitoring for organ rejection, infections etc., the rehab team supports the lifestyle needs of the patient such as nutritional requirements, exercise needs, mental wellbeing and psychosocial aspects. A strong relationship is established between the patient, family and the professionals in the rehab team during the weeks to months of the rehab program and this helps in addressing any anxiety or worries the the patients and their family members may have. In fact, the disease burden as well as the surgical procedure and the post-surgical recovery have such huge impacts on the psyche of the affected individual and the immediate family members that the comprehensive support of a wellness physician, a psychosocial counselor, a physical therapist, a yoga instructor and a nutritionist become very valuable.
The new lease of life that individuals get is something they are thankful for the rest of their days. So if you’re convinced that the most precious gift is donating your organ(s), why not register yourself as an organ donor?
Education or knowledge-sharing is the most important aspect of Cardiac Prevention and Rehabilitation Programs. For someone who has had a heart attack or myocardial infarction, having a reliable and knowledgeable professional to talk to and get answers to some pertinent questions makes a big difference. This is what health education is all about. The British Association of Cardiovascular Disease Prevention and Rehabilitation very aptly describes the 6 core components in this artwork:
Health behaviour change, which is the first and fundamental step in improving the cardiac and overall wellbeing, depends hugely on proper education. Let us take the common example of hypertension. We all know that high blood pressure is not good for our body and most of us are also aware that reducing salt intake can help reduce our blood pressure. However, only when an experienced dietician understands the food pattern of an individual and educates him/her about obvious and hidden salt in our daily diet, the simple ways by which salt can be cut-down in the household and what are the alternative ingredients that can be used to enhance taste in low-salt cooking, that person is actually able to make that particular health behaviour change of reducing salt in their diet and sustaining that change.
The healthcare team at Cardiac Wellness Institute is not only involved in educating patients and their families about the risk factor management, heart-healthy nutrition and exercise principles but is also actively engaged in training healthcare professionals from other parts of India so that more such comprehensive and high-quality cardiac rehab services become available to the people who need it, close to wherever they live.
If you are under the impression that a heart attack and a cardiac arrest are the same, you are mistaken. Both these terms refer to different conditions of the heart; let us see how.
Heart attack: sequence of events
When someone has reduced or lack of blood flow in the blood vessels supplying the heart muscle, or in other words, one or more critical block(s) in the coronary arteries leading to deficient oxygen supply to the myocardium, the individual is said to have a heart attack.
This usually manifests as chest pain, chest tightness, lower jaw, neck or upper back discomfort or heartburn. Breathlessness, giddiness, excessive sweating, nausea and vomiting can accompany the pain or be lone symptoms. Silent attacks can occur too.
A heart attack (or myocardial infarction) can lead to a cardiac arrest.
So what is a cardiac arrest?
A cardiac arrest is when the heart suddenly stops pumping blood, mostly due to abnormal electrical signals or arrhythmias within the heart. There is a sudden lack of blood supply to all the body parts including the brain leading to a loss of consciousness and collapse.
Cardiac arrest is a deadly condition, which can lead to death within a few seconds to minutes. By providing immediate cardiopulmonary resuscitation (CPR) and defibrillation, a cardiac arrest can be reversed. An automated external defibrillator or AED is available in many public facilities these days for this purpose. However, only people trained in CPR and emergency healthcare should volunteer to resuscitate someone, as incorrect maneuvers can be dangerous.
There are several reasons for a cardiac arrest; the commonest is a heart attack.
Some other causes of cardiac arrest are cardiomyopathy (due to diabetes, hypertension or other causes), heart failure, valve abnormalities, abnormally formed coronary arteries, recreational drug use, certain medications, certain electrical abnormalities of the heart like Wolff-Parkinson-White Syndrome and inherited genetic abnormalities like Long QT Syndrome.
Important points to note:
Heart attack leads to death of heart muscle tissue which if untreated can lead to death of the individual; however, a massive heart attack can cause instant death. Whether sudden or not, the usual mechanism of death following a heart attack is cardiac arrest.
Cardiac arrest is a deadly condition that can cause death in a matter of seconds to minutes; immediate CPR can reverse the arrest.
Treatment for someone who has had a heart attack often includes lifestyle modification, medicines, angioplasty or bypass surgery and cardiac rehabilitation.
A cardiac arrest survivor is managed with lifestyle advice, medicines, cardiac device like pacemaker or implantable cardioverter defibrillator (ICD), surgical denervation if necessary and cardiac rehabilitation.
Sudden cardiac arrest or death in a healthy individual below 40 years of age may be due to a genetic cause; thorough evaluation by a cardio-genetic team often helps prevent future arrest/death.
Both heart attack and cardiac arrest are preventable by healthy lifestyle, regular health checks and adherence to medication.
The healthcare team at Cardiac Wellness Institute provides comprehensive services for individuals and families with heart attack and cardiac arrest; you may contact us for any further questions or clarifications.
If you are feeling anxiety, fear, guilt, confusion, anger, depression or just drained of energy after you have been diagnosed with a heart problem – you’re not alone. It is extremely common for individuals to experience emotional disturbances when their routine life gets shaken up by a cardiac problem.
Questions often arise in our minds when a sudden health calamity strikes. While some of them have straightforward answers, some questions can only be answered with passage of time and especially after tiding over the acute phase.
Worries are to be expected. It is only natural that you are worried about your health and the thought about what is in store for you.
Your needs will vary depending on your health condition, your age, your social support and other factors, but everyone has needs that must be addressed by the healthcare team.
Let us see what emotions two of our patients felt.
As seen in the picture above, Mr. Arun (name changed) was rushed to the emergency department directly from his office within 30 minutes of the start of acute chest pain. He was 44 years old, married and had 2 young children. He was working in a multinational IT company as a project lead. He had never had a health check before this episode and was paranoid about what the doctors are going to say. He was diagnosed with a heart attack due to a severe block in an important coronary artery and advised angioplasty immediately.
Why me? Is this the end of my career? Will I live to see my daughters grow up? Can my block be reversed? …. These are just a few questions running through his mind prior to angioplasty.
Another individual, Mrs. Neela (name changed) was in her 70s and taking treatment for diabetes and hypertension when one day she suddenly collapsed to the ground while climbing stairs at home. Her maid who was at home at that time did not know what to do, panicked and called the family doctor’s phone. He promptly alerted the ambulance and instructed the patient to be admitted to the emergency department. The first aid crew in the ambulance provided CPR and successfully revived the lady. She was diagnosed with severe heart failure (Ejection Fraction 22%) and was initiated on multiple medications. Mrs. Neela was better within a week but she had several questions, concerns and unaddressed needs.
How do I prevent a future collapse? What should my caretakers do if I collapse? How can I improve the function of my heart? How often should I see the doctor? Can I carry out my daily duties?
This is where a cardiac rehab team comes into the picture. By providing answers to health-related questions, alleviating worries and offering evidence-based guidance and advice, our team of healthcare professionals work side by side with the doctors and nurses in the hospital, to establish a rapport with the patients and their family members. They provide ongoing emotional support during the hospital stay, the recovery period and most importantly during the intensive rehabilitation period of 3-6 months after the disease sets in.
Have you ever wondered, “Why is there such a hue and cry about heart diseases and more so, why is it much more now than a decade or two ago?”
The disease burden
Diseases of the heart and blood vessels such as heart attack, stroke and hypertension, known as cardiovascular diseases, are not only claiming more and more lives across the globe but are also posing an acute threat to the economic development of our subcontinent. While the statistics can make you dizzy, all you need to know is cardiovascular disease is the Number 1 killer disease amongst men and women today. The rising incidence of health problems like diabetes, high cholesterol and obesity, combined with harmful behaviors like smoking, alcoholism, unhealthy diet, inadequate physical activity and high stress levels are contributing equally if not more to this health crisis.
Cardiovascular diseases are multifactorial in origin, meaning there are several environmental and biological factors causing them. Though you might not be exactly sure what caused you or your loved one(s) to acquire the disease, you can be very sure of one thing: The lifestyle choices you make on a daily basis play a major role in causing as well as controlling the disease. There is therefore an urgent need to spread awareness about the risk factors and empower people with ways and means to better manage their health.
The risk factors can be broadly classified into modifiable (those that can be modified by us) and non-modifiable (those that our beyond our control) factors.
Psychosocial factors (such as chronic stress, anxiety, depression etc.)
Non-modifiable risk factors
Hereditary factors (genetic predisposition that runs in families)
Ethnicity (racial factors)
Age
Sex
I personally believe that the non-modifiable risk factors can also be modified but let’s save that for another day.
Healthy Lifestyle Choices
You would be surprised if I told you that your diabetes, hypertension and heart condition could be reversed. A healthy lifestyle characterized by regular physical exercise, balanced nutrition, and positive and healthy mindset is the building block for prevention and reversal of all cardiovascular diseases. While medical and surgical interventions are critical, addressing the risk factors by making the necessary changes to your lifestyle will go a long way in improving quality of life and keeping complications at bay.
A cardiac rehabilitation program is something you (and your family) should consider if you have had a heart attack, angioplasty or stent procedure, bypass surgery or other heart surgeries. Keep reading my blog entries for more useful info.
