 Hello friends, welcome to the third episode of Health Vibes, a Facebook live chat show by Manipal Hospital. Health Vibes is an initiative by Manipal Hospital, it's a one such kind of initiative by Manipal Hospital because you can directly ask questions to your doctors, any questions related to health can be asked in this forum directly to the leading doctors of Manipal Hospital. So today's topic is A to Z of heart and Facebook live is from 3 to 4pm and in this slide you can ask any questions related to heart and to solve and answer to your queries related to heart we have one of our experienced cardiologist Dr. Ranjan Shetty. So I would like to welcome Dr. Ranjan Shetty to the show. Hello doctor. So as you know today's topic is A to Z of heart. So we all know that heart is a vital organ in our body since it pumps blood to all the parts of our body but we also know that heart is something that is a popular organ when compared to other organs in our body because maybe every film you see any language, any film, any songs may be Dilta Upagal. I never understood till now how come Dilta Upagal live because it related something to brain. Jokes apart we have many questions lined up today. We have already 46 questions lined up so without wasting time I would like to take some questions but before that to all the viewers who are watching on Facebook Health Vibes I just want to tell that this show is from 3 to 4 pm and we are here to take all the questions related to heart so you can send us questions, hands-on questions till 4 pm and doctor will try to answer all these questions. So with this I would like to ask the first question that is the question is from Meethu. What are the major types of heart diseases? You know heart is a very complex organ so since it is very complex there are lots of disease which is possible which includes disease of heart, the covering of the heart which is called very cardium, the muzzle of the heart which is called myocardium. You can also have problem with the valve of the heart but mostly when people talk about heart disease it is almost always about what we call as coronary artery disease. As you are aware although heart is a very complex organ although it is filled with blood it cannot take the blood which is there in its chamber. So it requires its own blood supply and this blood supply is called coronary artery. There are three such arteries which come from the major artery known as iota and it supplies to our heart and whenever there is a problem in these arteries it is called coronary artery disease or in other common words the so called heart attack. So when people generally talk about heart disease it is almost always about this although there are lot more you know to become a cardiologist a person rates for 11 and a half years so it is not just for one disease it is for many more diseases. And here we have next question from Anisha what are the major symptoms for heart diseases. Yes see if you see the symptom varies according to what disease we are talking about so let us talk about heart attack which is more common. You know heart attack occurs when there is a complete occlusion of the blood flow to that particular area that whatever three arteries I described if there is a complete block that is where the heart attack occurs. When that occurs generally person gets the pain which could be central all towards left it could be to both. The pain is more heaviness other than you know burning or pricking it is more heaviness it is more deeper the person also might experience a radiation to the left arm or shoulder it usually you do not get it beyond your neck or beyond your umbilical but anywhere else the pain can occur. One very important thing which people should know is that you know there could be sweating the pain the sweating is very important symptom. So if anybody has just pain with sweating please do not neglect that because when you are dealing with heart disease time is a better you need to treat within particular time do not neglect the just pain with sweating. But if you have a pain which is like this you know pointing or pricking it is very unlikely to be heart disease but if it is much deeper you know you do not know where it is you know your heaviness is something like this that is very likely to be because of the heart disease or heart attack. Doctor pain somewhere near the left hand? Yes left hand again is very important but then localize you know just one pain point that area that is very unlikely to be heart disease but it is vague it is somewhere there but you are not able to tell exactly where it is that is very very likely to be a heart disease you know heart disease. So we have a next question from Vinayak is high blood pressure related to all the heart diseases. This is a very interesting question if you see that hypertension or high BP what people call the important risk factor for heart disease but not all the heart attack it is an important risk factor but it is also important for disease called stroke where you know people get paralysis it is important for you know the kidney failure it is important for you know the occlusion in the leg vessels producing amputation but it is a very important risk factor. See something to add on with the blood pressure see blood pressure is a disease of age some people would get it in anger age some people would get it in little older age if somebody has a hypertension or blood pressure don't worry about it it's more important to to actually you know treat it get it treated and then then we can we can you know that is the most important aspect. So we have two questions from Prati Gupta the first question what Prati has asked is what are the chances of suffering a heart attack after the bypass surgery and the second question is is heart disease hereditary. Yes that is a very important question again. See bypass or angioplasty is not end of the treatment for heart disease you know the whenever you do printing or bypass that particular area is treated so there is definitely chance of having heart attack or heart disease again it's possible but although the chance is not very high it is low but it is possible it also depends on how well the person is controlled is risk factor for example if a smoker continues to smoke he will almost surely have a repeat event if a blood pressure is not very well controlled if sugar is not very well controlled then you would definitely have a recurrence if you are careful about your risk factors which most people are then the chance of having a repeat event is much much lesser but it's still possible. Coming to the question of hereditary most diseases are hereditary that's what we should realize that means genes have some way to play in most diseases it's sometimes very difficult to you know pinpoint that this is a particular gene which produces this heart disease it is very difficult but then yes there is a hereditary especially if you know parents have a heart attack less than say 50-55 years of age chance of child having a heart disease at that age becomes very very high and you see sometime all the brothers or all brothers and sisters having heart disease requiring to undergo sending or by possible there is a significant genetic component there is also environmental component so it's a combination of a genetic and environmental disease. So the percentage of getting heart attack or heart failure in hereditary is higher if there is a parent or you know sibling or a parent with a heart disease the other person the chance is definitely higher than normal population but it's not 100% higher even cholesterol if you see predominantly the cholesterol problems are so closely related to heart disease they are also actually genetic so since they are also genetic it is you know it's likely that is follow. So we have other we have two more questions from Suvidit Chandra what are the risk factors for coronary heart diseases and what recommendation safety precautions would you give to a person who has already witnessed three heart attack? This looks particular serious case. See the risk factors for heart disease once we classify them as so-called modifiable and non-modifiable risk factors. So non-modifiable are something which you can't change they are always there one of the non-modifiable is male. Male have higher risk than women so you can't change it. One more very important non-modifiable is age as people age there is more chance of heart disease. Then the third one is genetic if there is a family history which we already discussed the chance would be higher but it's very important for us to concentrate on modifiable so that's what you can control. The modifiable include diabetes if you can control diabetes of you can prevent it then yes chance of heart disease would be less hypertension which is one more thing we already discussed about that. Dislipidemia or cholesterol which is the change in cholesterol that is extremely important and you know we need to control that. Also you know regular exercise helps to reduce heart disease diet not too much but diet rich in vegetable and fruits also try to reduce. If you can avoid stress yes that can also help. Most important I think which we need to highlight is succession of smoking. Smoking is something which has a direct relation with heart disease and as much as possible it should be it should be completely stopped. That's a very important respect. It's very bad news for all the same smokers. So next question is from Prachi what dietary changes can I make to reduce my heart disease risk? Okay so in diet you know for long we used to tell don't eat cholesterol don't eat oil this was a general recommendation which we also used to give until last year but then last year the guidelines the lipids guidelines have changed that means we are not too much worried about the lipid diet that means fat in your diet or cholesterol in your diet does not matter. Blood cholesterol matters but cholesterol in diet does not matter. So that's a good news for many people but one for me. What matters is actually the sugar. So food rich in simple sugar like glucose or fructose or simple sugar these things if they are used then you know there is lots of that is considered a major factor. So nowadays we have moved from diet to exercise so that you know diet is no longer the key factor for heart disease. The next question is from Shreyaan. What type of exercise are safe for heart patients? Can they do heavy weight lifting exercises in the gym? Okay so it depends on what we are discussing if the person is already I can take it in two different ways. One what are the exercises needed to reduce heart disease and how should a person who has already had a heart disease or had a heart attack how should that person you know leave. So that's the way probably is better to take. Exercise is very important to reduce heart disease because we have already described that this was one of the modifiable risk factors. So what do we mean by exercise should we run to gym and start exercise are we talking about that kind of exercise or regular physical activity is what are we trying to tell. So it is about regular physical activity the most important exercise which we advise is walking. You know if a person walks around 30 to 40 minutes a day for 4 to 5 days a day it is more than enough. You know as we know we classify exercise into trainers and average exercise. So average exercise is one where you can you know talk to your friend and keep doing exercise like you know walking or maybe you know slow cycling walking or even some jogging can be done. So such exercise we recommend 30 to 40 minutes a day for 4 to 5 you know 4 to 5 days a week. And trainer's exercise is where you are you know you are sweating it out and you are not able to talk you know playing some vigorous sports or really running fast. Such exercise even 20 to 30 minutes 5 4 days a week is enough. So this is some kind of exercise which everybody can do we are not talking about going to gym here. Some exercise if you want to do more it's always good but this is what we recommend. Now coming back to the question proper where we ask whether what should a person with a heart attack do. So what's very important is there is some rest which is needed initially whether it's after bypass surgery or after heart attack you know there is a wound and you want it to heal. So that's what we are talking about here you want to heal that wound. So generally what we recommend is first 2 to 3 weeks that they should be in rest doesn't mean bed rest they could be walking around after that every week we advise that they increase their effort exercise by a kilometer that means by 2 to 3 months they would be doing something like 4 to 5 kilometers. Then cardio exercise is better if you want to do weight training and go to gym you can do it but you need to start slow and goes up slowly. The trick is to do it slow. See the person with heart attack or heart disease can do everything but there is a time they have to do it slowly they have to do it with time and later with the time progresses they can definitely do everything. Okay doctor how about doing yoga exercises? Yes. Do your namaskar. Yes. Yes. What I would say is yoga is good if you should be doing it but don't do it as a substitute for your exercise what we recommend to our patients all of them is do all your exercise 30 minutes or 40 minutes also do yoga because yoga again is not controlled you know people can be just shaking their hand and calling it yoga which may not be enough exercise what we recommend so do your walking and also do yoga so it's like don't take it as a alternative. Do both. So we have next question from Prachi. Yes. Do I have to stop exercising after my bypass? I guess Dr. Anjanshtri has already answered this question. Yes. And next question is what you recommend jogging as morning exercise to a heart patient. Yes that's very important as I repeatedly I keep telling you need to start slow and slowly increase now you can do it in the morning or you can do it in the evening that is up to you and whatever time you have the cardiac benefit of morning and evening is almost same but just for people who have hypertension or high BP which we already discussed a morning exercise is considered better because in which case the whole day BP would actually be lower so morning unit is up to you but some exercise is what we recommend. I had a question like if you see majority of the cases of heart failure. Yes. Most of the patient goes through this heart failure early during morning. Like earlier on fire, claw, heart attack. Yes. Yes. It's early morning it happens. Yes. I just want to know why is it so. Yes there are multiple reasons this is a very important question because you know the timing of heart attack itself. The heart attack can occur anytime but you know they have some predilection to early morning. There is a reason for that you know going by your if you see the your hemodynamic or your endocrine factors or so-called hormone factors by morning the body is making you get you know it's making you ready to get up and do all the activities. So some hormones you know get activated way before something like 2 o'clock 3 o'clock they're getting you ready for 6 o'clock 7 o'clock so they would get activated and the blood if you have to put it in very simple word I can tell you that blood is tickets in the morning and heart attack is something like a clock so in simple terms that is what happens. So there is a diurnal variation the key point here is what we should probably emphasize is not wait till morning if you have a problem in the night better visit in night because in heart disease or heart attack there is a concept of golden hour. Golden hour is nothing but the first hour the maximum death occurs in first hour. The greatest benefit if you do a procedure which is angioplasty or stenting or giving some you know the 5 million lightening or some less inner medicine the best benefit occurs if you do it in one hour. What we see in our practice most of the time that people you know sleep over it because they think they have to wake up one more person and it is very difficult. It is not so if you have a problem you need to visit fast because the benefit will be the maximum. Any person who can take an ECG can diagnose the heart attack or heart disease so it's very important they get it and in cities like Bangalore traveling at night is much easier so we strongly recommend if there is a symptom you should reach the hospital. So to all the viewers I just want to say like in case if you get any kind of heart pain in your chest or pain in your left hand just don't ignore it just move to your nearby hospitals and just get it checked. I guess ECG would yeah anywhere was the ECG is done you know I mean not that ECG doesn't mean heart attack it does mean but the chance that's a small percentage but it would still pick something like 90 to 95 percent of the heart attack. So moving towards the next question from Arvind Angadi can heart patient walk in steps what is the medicine you prescribe to increase the LVF so yeah so heart patients by meaning people with heart attack can definitely walk in step but slowly that's what we recommend so they should probably be starting taking one flight maybe after two weeks unless it is absolutely necessary if your house is in second floor and you have undergone angioplasty you have no choice in which bladder to you know take breaks in between therefore heart failure is a different disease that's what we should understand when we talk about heart failure your heart muscle is weak so there are many reasons for that one important reason or 70 percent of the reason is actually heart attack you know your blockage and that's why the mother is weak so that's one one disease which needs to be take but there are other reason also where the heart becomes weak so the other could be you know intrinsic problem of the mother could be the well leakage which is producing it if you have to tell it like end result of many many many disease including some infection some inflammation hypertension the VP itself diabetes itself all this can produce a weaker heart to improve it first you know we have to identify why there is weak heart if it is you know because of the block you treat the block if it is because of VP you control maybe if it is because of you know blood sugar you know try to control it you need to manage most of them once you have managed all these it's better if we add some medicines like beta blockers and as inhibitors and there are some drugs which can help there are also devices which can help which are like pacemakers and it can be put those these are the things which can help these people okay so there is a next question from Diane and this is one such interesting question I guess you might get to any kind of the question is can a heart patient drink alcohol is it true that a glass of red wine daily is good for heart very controversial question in a social media what we yeah what we you have to you know be very I should say there should be a warning that this is only for a select subject what we should realize is what we advise is limit alcohol so the amount of alcohol which is say allowed for a heart disease patient or any other patient is 60 ml of hard liquor or 100 ml of wine now this is a very small amount and non-addictive dose not most people cannot stop at this so this dose whatever we are recommending is shown to have some benefit but any excess is shown to have half what we say don't start drinking alcohol to protect anything it's probably definitely not worth it but if you're already drinking limited to 60 ml that is just you know one large bank or two small fact something which most people are definitely not happy about but that's what you should do to protect yourself so it's 60 ml in a day 60 ml in a day and very important thing is you can't drink 240 at the end of a week or Saturday it's not you can't add it up it is just 60 ml a day if you're drinking only on Saturday again it's just 60 ml a day yeah so we was just 60 ml a day you can't add up my weekends you can't know mathematics so the next question is he has asked two questions it's from Karan Kundani can he prevent heart disorder can we how can we stay protected from heart disorder yes there are many ways the prevention as all of us know it's always better and it definitely has a value the prevention depends on the disease which we have. As I told in the beginning there is non-modifiable and modifiable. So prevention aims at modifiable responses. Now what are the modifiable ones? Hypertension, diabetes, lack of you know stop smoking, limit your alcohol, start your exercise, be careful on your diet, see that you don't put on weight. So this is how you you know limit. So by doing this you might be either preventing it or at least postponing your heart disease and that works it. That's what we are talking about when we talk about prevention. Whether a complete stopage is possible I'm not very sure but if you can postpone it by a decade or two it is definitely worth it. Now what should we do is the symptoms for heart disorder comes very fast. Yeah heart attack is like earthquake so it's definitely far. There are two types of heart disease when you talk about coronavirus disease. One is heart attack. Second is a stable disease or stable blockage. So in stable blockage I already described about three coronary artery. In stable blockage the block starts developing and that person gets chest pain while walking when he exerts. When he goes to climb stairs he gets chest pain radiating to arm or neck and when that person takes rest it is it's subside. This is a stable heart disease. This is the minor of the two problems. It is not okay but you can get a treadmill test and get angiogram and you know find out what it is and get treated. The other one the most important one is a heart attack. We already described the symptom of heart attack in sinus. It occurs on chest or you know radiating. It occurs at rest. It continues for more than 5 to 10 minutes. There is associated sweating. When this occurs time is sufficient. That's what this is a reputation we have been already telling talking about this. Golden hour concept hold true if you have to. Anyway go to doctor do it then and if it is night do it night or anytime. Get a ECG done consult a medical professional. It can make lot of difference because as I said majority of the problem you know people who survive are anyway going to survive. The people who will succumb will be the ones who will succumb very early in the disease. So they should get the medical help as soon as possible. It's really very unpredictable. Yes. Like in the previous day of the heart attack the person can be normal. Even if you do angio it could actually be normal. There is no need to have block on the previous day. But at the time of heart attack there will be a block. Now what happens there is good if you can understand this. This is already discussed about coronary arteries which supply the heart. The arteries have little cholesterol deposits what we know and what we described as plaque which are small deposits which are there. During this period the plaque breaks. There is a break in plaque which we call as plaque rupture. It ruptures and then you know body anyway if you have a cut response is to clot. So the blood starts getting plotted. So artery which was 10 percent 20 percent or 70 percent blocked. Now suddenly because of blood clot becomes 100 percent blocked. That's heart attack. So now the heart is actually crying for blood. The pain what you are seeing is the cry of the heart. So you can't neglect it. As soon as possible we need to open it and you know make the channel there and it can be done. Today you know with advanced therapy all this can be done. But your response, your benefit is time sensitive. So that is our essence here. Okay. So next question is from Surendra. He is having a very good question. It goes like I am a cardiology patient and at times I face situations where I can't breathe properly and major shivering happens. This thing is kind of weird. So I am making grammar correctly and I am saying okay and major shivering happens that time. Can you suggest what could be the reason? He means to say that he shivers he is a cardiology patient and he shivers in some instances. And also I am a big fan of having good physics but I can't work out because I am not supposed to work out since I am a cardiology patient and he wants to know what kind of food he can eat if he wants to go to gym. The concept of gym is good here. So what we should do is first of all we should realize what problem he has because it is very difficult to tell exactly what problem he is having. He is definitely a person who has had a heart attack and I feel from the explanation that heart could be weak. That is the possibility here. If your heart is weak, if you are not getting symptomatic at rest, you are not able to do anything, then you need to take some medicines and stabilize it and after that after stabilizing yourself start with minimal activity. Walking or just low intensity cardio. Once we know that you are able to do it and you are better with that that is the time you switch to some gym and muscle but should not try too much trainer activity especially if your heart is weak, should not try too much trainer activity. But gradually you can do and that wise as I told earlier we are not very strict about diet. We just advise to avoid sugar and simple sugar and this fat can be taken, protein can be taken, X can be taken. So diet is not a major issue even when you are doing it. So the next question is from Amisha. How important is diabetes as a risk factor for heart disease? Yes. Diabetes is an extremely important factor. There is no doubt. People believe that diabetes you know if you have diabetes it is as good or as bad as having a heart attack is considered that bad earlier. Nowadays it is considered not that bad but it is still a very important factor. So diabetics tend to get heart attack much earlier. Their heart is much weaker. They tend to have much more heart. It is very difficult to treat them by angioplasty. Most of them require bypass surgery. So it is a very bad risk factor. But luckily if you control it well the things can be better. It is not about being diabetic. The control also does matter. So early on if you pick up and if you control you can actually do better. So the next question is from Sheen. What she is saying is I have my cholesterol level under control through medicine and now in recent report my blood sugar HBA1C is 7. What can you advise me on diet, exercise and look-off age? Yeah. I think this person is probably diabetic and also has a cholesterol problem. So it is very important that 7 is not a bad gly-HB. It is reasonably okay but it is good to get it down maybe to 6.5 if possible. And then you know any exercise is better. The thing about exercise is first step is to do exercise. If you start doing exercise that is much better than not doing at all. So my advice to most people is just start doing exercise. That will be the maximum benefit. And when you do if you can do it for 30 to 40 minutes it is very good. Now the gly-HB phase is a drug which is used for sugar control and it is one of the metformin is a drug and it is one of the very good drugs. And you know it should be if it is prescribed to you you should take it and control your blood sugar. And also diet, diabetic diet is nothing but a healthy diet. It is not the diet which only diabetic should have. I think if the whole world has diabetic diet it is better. Now it is simply telling that you know eat what you can digest. Don't eat too much, pace it out. See that you don't put on weight, decrease your sugar intake. That is all the diabetic diet is. So you just have to follow the diet advice. The next question is from Geet. How common is heart disease among women? Also can children get heart disease? Yes, the women do get heart disease. There is no doubt about that. But there is a difference. That is probably what we are trying to see. Generally women are considered protective during their reproductive age group. But they do get, but they get one decade later. Like if men get it, say 50, if the women get it, they get 60. That is what happens. But if there are rich factors in a woman like if they become hypertensive, diabetes or if there is more. So if any such factor is present all the benefit of being a woman actually goes. There is no benefit then. They behave worse than men. So one other way is in women the symptoms are very very atypical. They have you know little different. Whatever we describe that classical symptom may not be present. Sometimes because of this the presentation will be delayed. So women should not neglect if they have a symptom. And it's important for women also. It's the number one killer even in women. That's what we should realize in western world and it's catching up in India. So children having heart disease is a different story altogether. When we talk about children having a heart disease, we do not describe it's not the same heart disease what we are talking. It's not coronary artery blockage or coronary artery disease. When they have heart disease it is more to do with something called as hole in the heart which is a communication between a left side and right side. As you are aware heart has a left sided chamber and right side has a chamber and they don't mix with each other. There is a separate. You can take it as two hearts which are put together. The left side doesn't mix. If there is a hole then the blood from left comes to right and in which case they have hole and then they have breathing difficulties. They have repeated pneumonia and they don't gain weight and they become very thick children. Infants as well as newness very thick one and they need some therapy. The holes can be closed by surgery or pulmonary. The way we do angiograms the holes can be closed. The other kind of heart disease which children have is the mixing of impure and pure blood. The right sided blood now goes to left. Such babies are called blue babies. Children appear blue. That's again one more disease. If there is a blue baby it needs to be treated early. It should not be neglected at all. The holes also needs to be treated but you get some time to treat them. Do they actually go blue? Yeah, the blue babies actually go blue. Because of the mixing you look at their legs they will be blue and their hand will be blue. The mother can. It's not blue only when the child cries it's blue all the time. Some kids become blue the whole day of breast and become blue. That's called breast holding spell. They just hold their breath but that's okay. That's not a serious disease. But the child who is tired all the time, which is blue in the face and blue in the arm, their fingers are generally swollen. That's called the blue. That's the symptom and that needs to be treated. So the next question is from Aminash. How is cholesterol linked to heart? Is red meat bad for your cholesterol? Yes, again a good question. Cholesterol is definitely linked to heart. But to specify it is blood cholesterol which is linked to heart. That means anybody who is above 21 should get their cholesterol set and if it is high you need to be treated. 90% of the blood cholesterol is actually genetic. It's not from what you eat but it is what you are made of. It's genetic. Hence it's very important for you to get it treated and just diet may not work. So since diet is not important the red meat does not matter. Now people if they want to consume they can. Egg white was anyway considered good. Egg yellow is also okay. Because whatever extra cholesterol you take your body can digest it. If you are not eating cholesterol, body can as well produce cholesterol. So dietary cholesterol does not matter. Blood cholesterol does matter. So doctor I had a question. I wanted to know what exactly is the bad cholesterol and what is the good cholesterol. If you see lipid profile, if you get a lipid profile then if you multiple reports and some of them give it in red then people get scared looking at the red. It's difficult to interpret. Red circle and red but not all reds are bad and not all blue are okay. There is some science into it. But then generally your LDL cholesterol or low dense cholesterol is considered a bad cholesterol. So higher value of this is definitely bad. So anything about 190 is definitely bad and anything less than 100 is good. That's where we go with LDL. Low dense. The other cholesterol which we talk is called HDL. Or high dense lipoprotein HDL cholesterol. HDL cholesterol is considered good. That means higher the value, it is better. So that's where we are. One more cholesterol which is very common in Indians and which you get is called triglyceride. So if your triglyceride is high then it is intermediate cholesterol. It's not bad, not good but definitely it's not good. But it's not that bad. That's how we can put that triglyceride. So related to what you take. HDL and LDL cannot be modified that triglyceride can be. Diabetics will have higher value. If you eat lots of sweets, lots of fats, your value will be higher. That's where triglyceride is. Triglyceride above 500 produces pancreatitis. Hence it is bad. The lower value you need to correlate with other reports and treat it. So it's not just a knee jerk reaction, not looking at a value and treating. It's more about treating the whole patient rather than just the value. So next question is from Rajat. What cholesterol level is recommended for a heart attack patient? Yes that's very important. Again as we discussed there are multiple types of cholesterol. LDL less than 70. Very good for a heart attack patient. If the patient has a heart attack or a bypass surgery or is under one angioplasty then it's preferable to have LDL less than 70. But less than 100 is also okay. More than 100 is not acceptable. So that's what you do. And to do this it's not possible with diet as we repeatedly discuss. It's important we do it with drugs. So most of the time people with heart attack or heart disease will be on lifelong medicines for cholesterol lowering. Which is good for them. They should take it. So the next question is from Mudit. Does smoking can cause heart disease? Can the heart rebuild its strength of quitting smoking? How long before it gets back to normal? Yes. It's a very serious question. Smoking is definitely associated with heart disease. It's the process of repetition we are just telling it. You know person who is perfectly normal one cigarette can produce heart attack. And you know you have done the enjoy it normal. Because it is one of the important factors for plaque rupture. So stopping it definitely helps. So the benefits are immediately but some harm might be left. You know it's like a scar. So scars heal but you know they leave some marks. So something remains. But definitely as the time passes from the event like 5 years quit smoking, 10 years quit smoking is definitely better than not. So whoever is thinking of quitting should quit it now. So for the viewers quit smoking. Smoking is injurious to health. Just keep this in mind and start smoking. Are both control pills a contributor to heart disease? It's a very important interesting question. Yes there is you know earlier they were considered extremely safe. They are not that safe. They can increase heart disease or heart attack which is there. They also increase thrombus formation. But not in everybody it is a little susceptible. HRT on the other way which is called hormone replacement therapy which is given in older individuals after their menopause to prevent symptoms. There are hormones which are known as HRT. They are also quite harmful. More than you know oral contraceptives HRTs are much more harmful because you give it to older subjects and it's taken for a much longer time. They are more harmful. So you need to discuss with your doctor before you start. That's a very good question. The next question is from Avinash. Do most overweight people develop heart disease? There is an interesting question. Overweight people do get more heart disease compared to the lesser weight people. That is true. But one good part is that they do better than the thinner people. When they get heart attack or heart disease the obese people do better than their counterpart. That is called obesity paradox. Although they get more disease when the disease actually comes they do better. It's true for many diseases. Not just heart disease. It's true for the infection. It's true for the septic infection. Some kidney disease. Most diseases are actually true. But how is it better actually? No, this is just a study that we show that they cope up with the illness better. That is what. But then obesity is not just or being sad is not just one thing. In medically we classify obesity into just obey and metabolically obey. Now these metabolically obese are ones who have so called insulin resistance. They have higher insulin level but they need not be sad. This metabolically obese do worse than real obese. There are some people who are obese but they don't have diabetes. They don't have BP. They don't do that bad. But there are some thin people with diabetes and BP and they may be actually metabolically obese as you put it. That's bad. It's a little complex when you talk about obese but losing weight helps. There it is sure. So next question is from Anish. He has two questions. First one is can stress cause heart disease? Second one is vitamin E for heart disease. Does produce heart disease? It's very difficult to quantify how exactly it does it. But it does produce heart disease. So it believed that when you have acute stress you tend to get acute heart disease like heart attack. When you have chronic stress you get more like blocks like a chronic disease. That's what happens when you have acute and chronic heart stress. Now coming to vitamin E it's never been totally proved that it is very beneficial. So if it's given to you for some reason you can take it but don't take it just to prevent heart disease. So the next question is from Dave Bali. Are diet pills bad for heart? I'm not sure what diet pills are. Yes, yes. There are lots of diet pills which are available. Some of them are caffeine, and some of them are... It's also reducing weight? Yeah, that's what they mean with diet pills. There are injections which are available. Some of them are are bad. You don't know what is there in that. That's the first thing. Some of them are not very safe. So if somebody takes it they should take it for a short time rather than a long time and try other pills. So diet pills is something, supplement what we take protein shakes or something? No, I don't think so. I think it's more like instead of diet you take a pill that's how it looks like from the question. Probably trying to, you know, pill to reduce weight and you see lots of them in internet anyway. How about taking supplements? Supplements like you take a breakfast and have some bar which contains all the nutrition. I think it's not very useful the idea because see what we realize is when naturally when you take something there's a lot more than what you... you know, you can't take glucose, I mean you can't take protein just like that. These fibers do have their role. You need to take natural things than supplements. Maybe we can leave the supplement to astronauts who need to take it. Others should probably take natural things. So the next question is from Anisha. Are cardiac scans a good way of treating heart disease? What exactly is a cardiac scan? Yeah. So yeah, there are lots of cardiac scans. I think the person is probably referring to echocardiogram. Now echocardiogram is a test which is just like ultrasound of the heart. Just like you do ultrasound anywhere, you do ultrasound of the heart. When you do that, you get lots of information which includes the pumping, whether the heart is pumping well, whether the heart well has a problem, whether your heart is thick because of this one or the other person has had a previous heart attack. So you get all this good information. But then blockage cannot be picked by that. See, that's what people are interested in, whether I have a heart block. The echo is not a good test for that because the rest thing, when you are resting, you are fine and you take an echo, it's a resting echo. It's not very good. To pick up blockage, you need test like TMT or a treadmill test which pick up. There are also other heart scans like taliums and such taliums and such tests which are available. They are also useful in getting some picking of heart blockage. So there are lots of tests available. Each of them have their advantage and their limitations. So probably they should be done when your doctor advises you rather than you opting for it without considering it. Better if somebody sees this. So the next question is from Vaigo Sharnam. How to spot a mini or harmless heart attack? He has one more question that is, does heart disorder have any specific prone age? Yes. And I think there's one more question which I can see that whether aspirin should be taken every day. This must be from the same person. So I think we can answer all of them, all of Vaigo's questions. So what is the first question? The first question is how to spot a mini or harmless heart attack. This is something which people talk about a heart attack as a major heart attack and minor heart attack. See, what we need by major heart attack is, you know, where there is a complete block with the one which I explained at that time, where the treatment has to be done immediately, that is major heart attack. Minor heart attack is where you have or mini heart attack is where you have a small blockage, you know, small changes and then, you know, sometimes it is closing sometimes it is closing. So we tend to describe this as a minor heart attack. But there is nothing minor about a minor heart attack. So what does the minor heart attack tell us is that, you know, we don't have to do angiogram that night. You might do it next morning. It gives us some time. You know, if it is a major heart attack, if it is night, we have to do it in the night. There is no choice. I can't say, you know, I'll do it tomorrow. That's not possible for a major. But minor, we know that with medicine you can stabilize and you can do. What's very important is untreated minor heart attack. It's worse than a major heart attack or as bad as major. If you don't take a heart attack as minor or as major, you need to treat it well. That is very important. About aspirin question, which Vaibhava has asked again, see, everybody needs not take aspirin. Take it only if it is recommended. No drug is absolutely safe. There are issues with the heat of the drug. So if it, you know, the aspirin also produces the gastric blade. Sometimes it produces brain blade. The benefit is not high. But there are subgroups where we give aspirin but everybody need not take it. I guess Vaibhava Sharma has got answers to all three questions. One more, I think about that pill, which we have already answered. Yes, yes. I guess Vaibhava has lots of questions regarding heart. When it comes to heart, everyone is concerned. I don't know why is this. When it comes to heart, everyone is concerned. Next question is from Gulharsan. Is it true that higher the age, higher is the risk of heart disease? Yes, yes. It's definitely true. Age is important for heart disease. Age is definitely true. But just to share with you the sad state of our country, that anger also gets harder. You see, in western world, they get heart attack in 50, 55. Or maybe even 60, 70. That's what they get in western world. But in India, we have been having heart attack two decade earlier. That means 30, 35 and 40 people have heart attack. Although older get it. But our country, the anger get it. This produces tremendous economic burden on our growing economy. Because now, there is an anger person with a bread winner who has a heart disease. And you know, some of them change their profession. They have to, you know, their lifestyle changes. It's very sad. But that most people do have some respect for smoking being the most important one in anger in future. It's very important that, you know, people control it. We have seen people having heart attack even at the age of 20 and 21. The age is an important factor. Doesn't mean anger are protected. They are not protected. But older tend to get more. That's where it is. Next question is from Ayushree. Should one eat different foods if he has heart disorder? To put, I think we have discussed, it's more about limiting your sugar. Not really about your fat and oil. See, one question which we tend to get all the time is what oil to take. Whether coconut oil is okay. Whether, you know, that olive oil and all that. Now, we can tell you, it doesn't matter. Whatever oil you take, it doesn't matter. Don't take too much. See that you don't gain weight every day. Just limit it. That's what we choose. And yellow is okay. That's one more common thing which is that. So, whole egg can be taken if you want to take it. Any amount of egg? Any amount of egg is okay. Again, I think the most important thing is maintaining a balance. Just because something is okay doesn't mean we need to take it too much. Or something is bad we don't have to stop it. The balance is the key thing. You know, it has to be balanced. So, there is a next question from, she has three questions from Josie Choi. Should I start any exercise to make my heart stronger? I guess your heart is especially strong. How often do I need to visit doctor? What can I do to feel less stress during heart problems? Okay. So, I'm sure you don't have a heart problem. So, there's no this one. So, what's important is the visit to doctor is little controversial. It can vary. If there is, see one, it's very important. After age of 21, it's better to get one cholesterol done. After 40, better to get your sugar done. So, this is something we must get done. So, during this time, you can actually have your health checkup what you're doing. Otherwise, if you're not very symptomatic, you don't have to visit your doctor. Do visit if you have symptoms. If you're perfectly fine, you may not visit your doctor. And stress, as you rightly pointed out, stress has a role. But stress is individual. That means it comes from within. It's not the outside people who make a stress. We are stress. So, we have to control it yourself. We have realized sports and yoga and relaxation exercises do help itself. People should opt for it if they are stress. So, the next question is from Vivien Kumar. Is heart disorder, can be cancer if we don't take precautions off? What he means to say is, will heart disorder turn into cancer? No. That's a good part probably. That heart disease do not turn into cancer. But they're as bad as cancer. If you see, in today's era, some cancer people do survive more than 5 years. Maybe 60%, 70% survival is seen. There are people who get cured of cancer. So, I'm not here to talk about cancer. But then heart disease could be equally bad. Like heart failure, some of them don't live up to 5 years. Heart attack, sometime it is very difficult. So, these are two bad diseases to manage. But they have their own way. But they don't lead to one another. Otherwise, sometimes people with cancer have heart attack. Which is also seen. And they need therapy if it is advanced. Sometimes medical therapy is given. There is one interesting question from Vinay Kipsaniya. I was expecting this question actually. I wanted to ask you this question. But Vinay has asked this already. If anyone gets a heart attack, what should we do at first to save them? Get to hospital? The key would be to go to hospital. Otherwise, if you are sure it is heart disease, then aspirin in this juncture helps. Some people have, if they already have a disease, they will have a tablet called nitrate or sorbitrate, which is there in their pocket, which can be put. But whatever said and done, the importance of early re-vascularization. The artery which is blocked 100% is not going to get open just by sitting. So it is very important for people to, they seek medical help. Get an ECG, get an ECG especially and get it treated. So that is what we need to do if there is a heart attack. Get medical help. Don't neglect it. See what we see as you rightly pointed out. People are sometimes having neurotic. They are really worried about heart disease. But when it really happens, they don't come. They neglect it. They neglect it. They think it is not. It gets put on that particular day. But when it is atypical, when it is not, they do come and get lots of tests done. It is very important to, you know, have a balance. Do that, but do this also. And it's not a, it's okay to come and get your ECG and know that it is a gastric and not a heart disease and go back. It's okay. It's not the wrong thing to do. You don't have to worry. Nobody is going to laugh at you because you have come in night for your chest pain. We all understand it is a serious symptom and we respect that. You can visit the doctor in night and get this visit. Okay. So this is a question from Rathi Gupta. Is there any avoidance or effort to be done to avoid heart disease? I guess the doctor has already answered this question. Then it's from Aigosh Sharma again. What do, if symptoms are really coming quickly in heart disorder? I think this is the answer. This is the answer. You need to read. Yes. Yes. What precautions shall I take to not give stress on heart? What she means to say is, what should she do to maintain stress or avoid stress? No, I think it's specific stress on heart. In the sense, how do I not stress my heart? She went, what precautions shall I take to not to give stress on heart? You know, people believe that some particular thing produces stress on heart. But you know, when your heart is normal, more you stress it, it's better. More you exercise, more you stress it, stress the heart. It's actually better for heart. So there should be less stress to your mind and more to heart. That means you do more exercise, but don't take tension. That's better for heart and mind both. Doctor, what heart rate is good to be rated? Heart rate is very variable. The normal heart rate varies from 60 to 100. Anybody can have it. Lower heart rate need not be bad. You know, especially lots of athletes, if they are very trained and exercising, heart rate actually comes down to something like 50. There are people with 30 and 35 also. It's considered a sign of good. The best heart rate is between 50 and 60. The maximum survival, if you see, is between 50 and 60. But then it's just one predictor. So don't go by that. Because now you'll get lots of gadgets. So see your heart rate. I think they should not panic just by your heart rate. Changed heart rate is sign of life. So there is nothing. Heart rate will change if you are living. So you accept it. And the question from Sovati Chandra, how do the symptoms of heart attack differ between men and women? Yes, but it's a very interesting question. Just to read this one. Yes, women have little atypical symptoms. The symptoms are not very specific. They should not neglect it. Just because their chances less in particular age give does not mean they won't get it. They will get it. And I mean, they can get it. And they can prevent it or protect themselves. So they should not neglect it. That's lots of atypicality. The tests which we do are also not very sensitive. You know, TMT, which we do, in men, it's very reliable. In women, it's not that reliable. So women also has to be more careful. We have some more questions. Miha got mine. It's from Nikita. My aunt, what she wants to say is, my aunt experiences severe chest pain every time she climbs the stairs. Can it be serious symptom of heart disease? What do you suggest? I think it is, Nikita. So what you're dealing with here is not a heart attack, but a stable heart disease, in which case probably there is block in our coronary arteries, the arteries which supply. And when she's walking, she's getting pain. And when she's resting, she's okay. So this is what we know as a stable heart disease. Such a person should see their doctor, get a echo done to rule out any heart attack, maybe get a treadmill done, or directly go for angio, because this is a textbook description of a heart, you know, a block in the coronary artery. So maybe they should get angio done, and fix the block. But again, since she's a female, it's not necessary there are block. Sometimes there are no block, but that's your lucky day. But with this symptom, you should take it very seriously and get it treated. So the next question is from Edison. I have been experiencing random left chest pain for the past two months. I also noticed my resting heart went up from 54 to 77. Should I be concerned? Yes. I mean, this Edison may not be a heart disease, but there's no way to be sure. If it's just random, comes for two minutes, three minutes, and it's just freaking or burning, it may not be. But then it's very important that you get yourself evaluated which might include an ECG and a treadmill test. A treadmill test will be very important when you have symptoms like this. And if a treadmill is normal, I don't think you have to worry. You see the first person's symptom was so classical. The second is not very classical. So heart disease symptoms keep varying. It's not about just any chest pain. When it's classical, we do know from history itself. So next question is from Rohan. What he wants to say is, I am 23 years old. My father expired because of a heart attack. I'm not an alcoholic or a smoker, but I have lived a stressful life in the last five years. I want to do a heart checkup. Which test should I do? Yes. I think, Rohan, what's important is you have a risk factor, but it's not a must that it gets transferred. One important thing to get it done is your lipid profile. You need to get your lipid profile and locate your LDL cholesterol. Because one way it passes genetically is lipid test itself. If lipid test is abnormal, you need to treat it. It's also worthwhile for you to get one equal. And that means just to be sure there is nothing much. And trust as we keep discussing is very indigenous. So you need to, you know, find out a way that, you know, trust you for a life. The next question is from Shreya. Does depression increase the risk of cardiovascular disease? I think so. Yes, it does. Because depression itself is a very stressful condition. We already discussed the stress as a direct relation with the heart disease. So it's very important that people, you know, all these diseases needs to be treated. They need to be taken seriously and they need to be treated. There is a depression treated. There is a way to get it treated. So because then, you know, they all get added up and it all, you know, affects your heart and, you know, even common words, you know, common language also, they think it's a heart broken and heart break and all that. But some of them do affect heart really. So coming towards the end of this episode, we have the last and final question that's from Nasreen. Is pacemaker really helpful in heart failure cases? Yes. This is an interesting question. It's not really called a pacemaker, but the therapy is almost the same. If the ejection fraction is less than 35%, if you're pumping normally 60, it's less than 35. And you have certain features in VTG. Then a pacemaker-like device called a CRT, cardiac resynchronization device helps them. The way to put it is just put like pacemaker. Normal pacemakers have two leaves, but this has third leaves. It has three leaves. So you just put that and it does help in a select group of patients. So there is a role for these devices. These are called device therapy. And there is a role for this. There is also a role for medicines as well as this. So Doctor, we have come to the end of the show and questions are done. So I would really like to thank you on behalf of all the viewers because you have given a valuable time to us and enlightened us with your knowledge and given us some vital facts about heart disorders and heart problems. So I'd like to really thank you once again for coming and being the part of the show Health Vibes and making it a successful one. And also I want to thank all the viewers who have been the part of this Health Vibes Facebook Live Chat. And I would like to tell you one more thing that will be coming up with the next episode of Health Vibes very soon. And meanwhile, please like this video and share this post on your Facebook and also like our page Manipal Hospital on Facebook. So with this I would like to tell thank you. Stay fit, stay healthy, stay happy. Signing off, it's Nisha. Thank you. Thank you.