"Every sixth patient with heart attack is below 40 years of age. Young Indians have a five to 10 fold higher rate of heart attacks and deaths as compared to Western population. Indians all over the world have the highest rate of mortality and morbidity for heart attacks whereas the incidence of heart attack have halved in the West during the past 30 years. " Heart health DR. J. SHIV KUMAR
With heart disease assuming epidemic proportions, it is essential to do what we have to save ourselves. http://www.hindu.com/mag/2008/09/07/stories/2008090750250600.htm Photo: M. Vedhan Sedentary habits: Exercise regularly to protect your heart. One Sunday morning a 24-year-old executive went to a fitness centre for the first time. After working for half an hour, he complained of pain in the left shoulder. The trainer asked him to continue, as it was his first day. After about 20 minutes this young executive suffered severe chest pain when he was rushed to hospital. He collapsed and cardiac resuscitation was done. His ECG showed Extensive Heart Attack for which an emergency angioplasty was done and patient survived. After investigations his LPA levels were 130mg. Hence a word of caution for all fitness freaks. Heart disease and heart attacks have assumed epidemic proportion in India over the past two decades. It is one of the leading causes of death and long-term disability. Based on the evidence, heart diseases will double by 2015 and become the single largest contributor to mortality, accounting for almost one-third of all deaths. Early manifestation Not only is the incidence of heart attacks increasing significantly, but the blockage of coronary arteries manifests at least a decade earlier. Every sixth patient with heart attack is below 40 years of age. Young Indians have a five to 10 fold higher rate of heart attacks and deaths as compared to Western population. Indians all over the world have the highest rate of mortality and morbidity for heart attacks whereas the incidence of heart attack have halved in the West during the past 30 years. Irrespective of gender, religion and social class, the high rates of heart attacks in Indians are in sharp contrast to very low rates in other Asians such as Japanese and Chinese. The most important reason is a combination of nature and nurture — genetic pre-disposition (nature), urbanisation with affluence (nurture). Genetic pre-disposition is reflected by levels of Lipoprotein–A (LPA), which is higher in Indians. Sedentary habits and western lifestyle leads to decreased physical activity, increased consumption of junk food results in obesity, insulin resistance and atherogenic lipid abnormalities. High LP (A), high triglycerides, high levels of bad cholesterol and low levels of good cholesterol predispose heart diseases and heart attacks.What you can do Lifestyle modification is of prime importance. One should walk about five kilometres in 45 minutes at least five days a week. Unaccustomed exercises should be avoided. Preventive measures should be undertaken in those with risk factors but without established disease i.e., counselling for tobacco use, early diagnosis and treatment of high blood pressure, diabetes mellitus and dietary measures to treat lipid abnormalities. All these are important in those individuals who have a family history of heart diseases. The family physician should be trained to recognise signs and symptoms and ECG evidence of heart attacks and institute first aid measures and prompt referral to a hospital where definite therapy can be given. The writer is a Consultant Cardiologist based in Secunderabad. Save your kidneys DR. S.C.TIWARI http://www.hindu.com/mag/2008/09/07/stories/2008090750270600.htm Warning signs: Burning or difficulty during urination An increase in frequency of urination, nocturnal Passage of bloody urine Puffiness around eyes Swelling of hands and feet Pain in back just below ribs High blood pressure Advances over the past three decades have improved the ability to diagnose and treat those who suffer from kidney disorders. Photo: S. James Removing waste from the body: Dialysis is crucial for a person with kidney failure. The twin bean-like organ located on either side of the spine is better known as the biochemist of the body. The kidneys filter about 200 litres of fluid every 24 hours and return it to the blood stream. Approximately 1.5-2 litres is eliminated from the body in the form of urine, and the rest is retained. The production of urine involves highly complex steps of excretion and re-absorption, which is necessary to maintain a stable balance of body chemicals. Kidneys perform crucial functions, which affect all parts of the body. But the kidneys are also vulnerable to a range of problems from a minor urinary tract infection to progressive kidney failure. Advances over the past three decades have improved the ability to diagnose and treat those who suffer from kidney disorders. Kidney diseases usually affect both kidneys. If the kidney’s ability to remove and regulate water and chemicals is seriously damaged, waste products and excess fluids build-up, causing severe swelling and symptoms of kidney failure. Different kinds The different types of kidney diseases are characterised as Hereditary, which can be transmitted to both males and females and generally produce clinical symptoms from teenage years to adulthood; Congenital, which usually involves some malformation of the genitourinary tract leading to obstruction; Acquired, also known as nephritis or inflammation. The most common is “glomerulonephritis”. Kidney failures are not always permanent. Some get better after treatment. With acute kidney failure, dialysis may be needed until the kidneys get better. In Chronic or End Stage Kidney Failure, there is no improvement and dialysis is a must for the rest of the patient’s life. If the patient is in a fit condition, kidney transplant can be one treatment option. Unfortunately, many kidney diseases are still of unknown cause. Some can be successfully treated while others progress to advanced kidney failure, or End Stage Renal Diseases (E.S.R.D) requiring dialysis and/or transplantation. Dialysis is performed routinely on persons who suffer from acute or chronic renal failure, or who have ESRD. It involves removing waste substances and fluid from the blood that are normally eliminated by the kidneys. Dialysis may also be used for individuals who have been exposed to or ingested toxic substances to prevent renal failure. Treatment Haemodialysis removes waste products from the blood by passing it out of the body, through a filtering system (dialyser) and returning it, cleaned, to the body. While in the filtering system, the blood flows through tubes made of membranes that allows the waste products (which are much smaller than the blood cells) to pass out. The waste products pass through the membrane into a dialysis solution (dialysate), then out of the machine. The clean blood is returned safely to the body. This cycle is repeated throughout the dialysis session. It takes about four hours to complete a session and it needs to be done thrice a week. In Peritoneal Dialysis, instead of being cleaned by an artificial membrane outside the body, the blood is cleaned inside the body, through the Peritoneum (a thin membrane that surrounds the outside of the organs in the abdomen).The peritoneum allows waste products to pass through it and is very rich in small blood vessels. By running a dialysis fluid into the peritoneal cavity through a tube called Catheter, and then out again, waste can be filtered from the blood. Two types There are two types of peritoneal dialysis: Continuous Ambulatory Peritoneal Dialysis or CAPD is done without machines. The patient can do it himself, usually four or five times a day at home or at work, while continuing with regular life. Automated Peritoneal Dialysis or APD is a more refined version. In this the dialysate solution is changed by a machine, at night, while the patient is asleep. In both cases, the patient can travel, as the bags can be delivered to the visiting areas. In APD the small size of the machine makes it easy to travel. Kidney transplant or renal transplantation is the organ transplant of a kidney in a patient with end-stage renal disease. There are two sources of kidney donors: Living and Deceased. But before opting for transplant one should thoroughly consult his doctor and get a physical examination done. The writer is a Consultant Nephrologist based in New Delhi. With Regards Abi
