 A warm welcome to one and all. So doctor this is a request by the citizen exclusively one set of apartments who came forward because they were quite keen to know about the fibrillator device. How was it used and you know just because the apartment is working on safety they do have the emergency medical room that is set up despite that they wanted to you know have the defibrillator also with them just to understand and probably your training also is required. So they wanted the session on ground but you know we had a little bit of limited in terms of the audience plus the infrastructure that's how we requested that we would have you on board on a virtual session and then probably you know the demonstration can be done going to their premises. So audience welcome on. So we have a professor and Dr. Ranjan Shetty who's the HOD and consultant of Manipal Hospital's old airport road. So doctor is an expert in left atrial appendage trans iotic valve implantation that is TAVI complex coronary interventions and the septal defect closures just to name a few but I can just go on and on. So doctor has a lot of credibility but just limiting my session here. Also doctor is a member of American College of Cardiology European Society of Cardiology plus India. So over to you doctor. So the whole session is planned in such a way that we have come prepared with set of questions. So I will give you the question and then probably you can elaborate. Then we will you know open the floor for discussion followed by the demonstration of defibrillator. Yeah. So can we begin with our questions today? Sure. So first of all we want to understand what the emergency and what are the conditions that fall under cardiac emergency doctor? Yes. First of all you know warm welcome to all of you and thank you for joining on a Sunday. This shows your interest in this field and you know Bhavana has been driving a program called Guardians of Heart for last two years and we are very happy that you understand the need for defibrillator and you are here to train with us. Now let me elaborate on cardiac emergencies. You know heart attack itself is the biggest emergency. That's what we keep telling people. There's nothing called minor heart attack. All heart attacks are important. So anybody with the chest pain you should not neglect it like you have a chest pain which is on left side or central. It comes to your hand comes to your neck or if there is a sweating please don't neglect it. It could be gastric as you are thinking right now or as you think when you have chest pain but it's still worth a shot to go to nearest medical center. Get an ECG done because only 4% of heart attacks are missed in ECG. So when there is a suspicion of heart attack my advice to all of you is do not try first aid. Do not try to give aspirin or anything you want to give probably it is wasting your time. More important is to reach medical care because the person is conscious he's talking to you and he's complaining of a symptom. It's a very crucial time which should not be wasted. Now the second one which I think we were becoming and where this training comes in is heart arrest cardiac arrest. So people you know interchange these terms they think attack and arrest is same they're not same. Attack is when there is no blood flow to the heart. Heart is crying for blood and your symptoms and you need to rush into medical. Arrest is where you're unconscious you know the person who probably either with chest pain or with the chest pain is directly now unconscious. This is where we want you to act you know not delay but act because the you know that was the whole premise of guardians of heart initiative. So the first step there is to assess and the second step there is to call for help. The third step there is to start CPR you know that's what we are trying to do. So arrest patient does not have any time he's unconscious he or she is just called is down and your window period is just two to three minutes it should be the bystander who does all these things. So that's where we want you to act and that's where we want you to make sure you know you don't waste time. Now what should you do at that time? First assess for signs of life that means look for breathing if the person is breathing not gasping breathing you know simple smooth breathing usually heart is also working at that time you don't have to worry could be a syncope if that occurs look for any signs of that's a different disease altogether but a person still maybe slightly cold is now just gasping for breath or no breath you need to start CPR. So by doing that you could save a lot of life because you know properly initiated CPR the survival you know overall outcome is 40 percent people survive and if no CPR is given to cardiac arrest only seven percent survive that means you could make a 30 to 33 percent difference in your near and near ones you know so that is something we should start and we have had extensive video I'm sure Bhavna will share with you those videos of CPR and how to do it. The next step of CPR is deep umbrella because heart has stopped shocking helps and I'm extremely happy that this community has taken up that initiative to go to the next step so that means there are three steps management of heart attack management of cardiac arrest and shocking the cardiac arrest so I'm sure Bhavna also will be extremely excited because this is what we wanted every community to do and thank you for coming forward to do this. So before we go extensive the difference between heart attack and cardiac arrest so I mean we've just prepared a basic question so for people to understand doctor so first of all people experience something called chest pain for the first time so where exactly the pain is felt and how do they know that this is a cardiac pain not any other pain yes so the pain what cardiac patients you know perceived is very atypical you know it's not one point it's always diffuse people don't know where is it coming from because heart is a deeper organ you don't typically you know pinpoint it if you can pinpoint it if it is freaking tight it's unlikely to be hard if it is heaviness so called bharipan in Hindi or you know chaap in Bengali that you know that if somebody is compressing on your chest need not be left side it can be central typically it is above umbilicals and it can go up to the job so any of these reasons are poorly localized pain which is more like heaviness is supposed to be a cardiac pain now the same thing would occur when people walk and when they rest it could disappear this is stable angina you know when they walk they get this pain it comes to the hand sometimes goes to the neck sometimes goes to the stomach sometimes but above umbilicals it's like a heaviness but as you take rest it decreases that that's one kind of pain the same pain now more intensity occurring in at rest is heart attack the same pain you know but more intensity usually associated with sweating so the typical of the differential is gastric some because you're not itiner people tend to explain their symptoms also and they attribute it to gastric and it could be gastric for all you know the pain which you're feeling may not be very classical and it could you know we could go here and there that's where the importance of reaching out and getting an ECG come to play so ECG done properly the chance of you missing a heart attack is only 4% yes doctor so over that I had another question so now how do you differentiate between a gastritis a heart burn and a chest pain see because you are a doctor you can understand but for a layman all the three might appear the same but how is that they tend to understand and come to a conclusion doctor okay so the I will answer in two three two ways Bhavnayal definitely tell how to distinguish but more important is the key point is please don't neglect it you might think it is gastric you might think it is heart attack please don't neglect it reach out for medical help do not try a first day that's the first point second I'll she'll tell you how to distinguish typical is a gastric pain is more abdominal means a little lower down and if you press it you know that you could feel some pain and typically it is associated with birth you know that burping and whereas heart pain is more diffuse you know it's more up can come to hand and can come to neck but even for medical expert it may be difficult to distinguish both and people like diabetes elderly female may not have classical symptom at all you know they might just have breathlessness so keeping all this in mind if you are risk factor better to you know reach out you know don't try your own distinguish don't try to drink and you know you know but go to a medical center but yes once you go there people might tell no it's not heart attack take a you know or give a pass be very happy and come back because your chance of it being heart attack is only 10 percent with all systems two three things I would say do not neglect these red red signs one of them is sweating the pain is associated with sweating pain lasting for five to 10 minutes any anxiety associated with pain because heart is a organ with you know it's a visual organ so usually pain with heart is associated with some autonomic activation which could be sweating which could be you know feeling of anxiety they know sometimes the patient knows that this is not what they've gone through before at all this is different from what they've felt and the bystander may not understand it but the patient understands so any time the patient feels no this is not normal I'm not fine please reach out again as of this one it may be a futile you know journey at middle of the night because heart attacks are also but really made it's worth it because one third of the heart attack patients do not reach hospitals one third it's a big number you know we do a lot of things for heart attack we you know we have you know we open up the cat lab do and the plus the but then we lose one third because they have not even read the hospital so don't do that and I know it's very difficult for people to understand but you know this one message may be more important than learning CPR itself yeah sure doctor why is it called heart burn that means to say there's the chest burn or what is heart burn yeah yeah this is a very good question Bhavani actually heart burn is not a heart attack heart burn is actually gastric so whenever people use heart burn it is a gastric which produces esophageal inflammation so if heart burn is used it's not a cardiac pain but you know that means you can understand even people who coined the term did not distinguish between two you know people who coined so it's very very difficult even for a doctor so don't try it please you know reach hospital sure doctor I think the recent demise of Sadat Shukla indeed pushed all of us into peril you know because he was into fitness and he did follow the diet regime but it was so unfortunate not only him there are many you know celebrities including you know following the fitness regime are prone to heart attack so why is this so that means to say fitness really does not contribute or exercise really does not contribute to maintain heart or how would you want to define this doctor yeah now I think again a very interesting question so you know very important proof to understand the timing of heart attacks and what produces heart attack so we can start a little bit from before the heart attack means blockage in the arteries in the heart so heart arteries you know you the cholesterol in a simple words gets modified and it gets built and it produces some blockage the blockage could be 10 percent 20 percent 30 percent or 70 80 percent now any of us could have 20 10 20 percent blockage you know and people with more than 70 typically have symptoms like when they walk they get chest pain or you know when they when they rest that is the stable angina but attacks are typically like earthquake that means it's difficult to predict it what happens in attack is the covering the plaque which we say that plaque the covering of it gets eroded it gets ruptured so now there is cholesterol block you know block because of cholesterol super added there is a plot to block plus plot together makes it 100 percent so suddenly the pain starts and there is sweating that means whatever test we do prior sometimes does not predict the heart attack which we do occur tonight or tomorrow after itself you know he was obviously fine he was doing all this exercise so there are factors which lead to that plaque rupture they're like earthquake you know whenever we do certain tests we are telling you earth is fine today but can we predict tomorrow's earthquake it's typically no you know the things which produce plaque rupture or produce heart attack are one is smoking second is emotional or physical stress even extreme exercise can produce plaque rupture so as you rightly pointed out exercise is very beneficial it can help a lot but too much exercise can also kill because that means people about 30 35 or definitely about 40 needs to train themselves it's not about one day exercise make sure you do warm up you do cool down properly and then train your body if there's no hurry here and don't over do any exercise that itself could be extremely dangerous you know overdoing exercise we all hear about marathon runners at end of marathon having heart attack or you know people people do get apparently healthy when they complete marathon and then have heart attack most of the time because they have not cooled down properly so warm up cool down exercise all three are important don't overdo anything shy away from old habits and if there is a symptom do not neglect majority do have some symptom with their neglected if you see you know this they would have thought it was gastric or something so do not neglect that so doctor i have one question here see you said warm up you said then exercise cool down yes what what is it is there any kind of duration but what happens to the heart when you have a warm up and exercise and then cool down how how does this prevent from rupturing yes yes this is again a very important question you know heart is an organ which is constantly in action it doesn't know when you are exercising when you are not exercising it's like an engine if your car cannot start at fifth gear right it has to start at first gear so you need to tell your heart i am exercising you know by warming up stretching your muscles making sure the circulation is good making sure you know body breathing becomes normal you're not making it suffer you know i'm sure if you start the car at fifth gear the petrol is not enough therefore is to sustain it and it will choke the same thing happens here again when you're stopping you can't stop at fifth gear right people understand car better than their heart so you know you can't stop you need to get it down so typically although there is a no clear at time what is given what i advise all my patients is five minutes of warm up five minutes of exercise and if you're doing 15 minutes five minutes of exercise five minutes we're doing 20 minutes again five five 10 minutes of exercise and remember both warm up and cool down are important you know do i mean don't don't harm yourself make sure you follow a pattern and do it an extreme exercise is not beneficial to anybody the cardiovascular benefit of exercise is 30 to 40 minutes a day for four days a week it's it's not very high exercise you like you want to do more you do it but for heart benefit this is the exercise we are talking about i think most of them here agree that they would go for a walk or they would step for a walk so if at all it's a walk say about 45 minutes or 15 minutes do they still have to do a warm up and a cool down or walking it's still better yeah i think a slow walk to start with increasing pace later cooling down you know see if you're taking four rounds the first round has to be slow make sure breathing matches what you do then you can go a little faster it's good to do that you know go a little faster some sort of variation also is better rather than one phase and then again last one round it's not that you're extremely tired and you're just sitting make sure you walk half a kilometer and then say a little slow walk you know that that's very important people are so most of the time you know so competitive so intense that as soon as the exercise is over they just want to stand they're so tired just stand don't do that walk for a little more than you do okay doctor so i think heart is something very complex because if you just take diabetes or if you take some level problem all of them have that myth oh it's okay i'm not 45 i'm not 50 to really get it but the youngsters are being prone to heart attack is very devastating so what do you have to talk about the youngsters these days why are they prone to heart attack so there are multiple reasons one of them being the indian itself as a it's not a race problem but what is noted is south east station indians in particular have heart attack two decade earlier than western population invest the mean age of heart attack is 50 55 in india it is 35 to 45 you know we do see younger people it's multifactorial the main reason is being actually risk factor it is the same risk factor but offers earlier in india for example many ingredients that habitat many ingredients are hypertensive and there is increased prevalence of smoking in anger age group there's also a lot of stress now and working from home has only increased the stress it has not decreased and complete lack of exercise you know you know the western if you see the western routine they always have something physically they're always active in something either a sport or a game or no there is something whereas in india it is like complete absent you know when people say they might make a newer resolution but by fab everything is over until next new year there is zero going back to that same question if you rate exercise between zero to ten you know ten being maybe running marathon zero being nothing zero to one has maximum benefit that means doing some exercise worth of doing nothing has maximum benefit that means everybody has to do some exercise which is 30 to 35 minutes of whatever you like for four days a week in india we see all this there's also higher prevalence of obstructive sleep apnea now with more people snoring quality of sleep actually diminishing and you know the younger people who are you know not even thinking about their health you know at 30 35 people think they're invincible and they don't even you know know what they have or what they don't have so doctor let us talk about this comorbid condition here like person with diabetes person who are obese or probably uncontrolled the hypertension are all prone to heart disease or a heart attack why is that why is this interrelated okay so these are the risk factors these are traditional risk factors for heart disease heart disease that eight to nine risk factors and whatever you so told are so called traditional risk factors so again discussing about this we talk about cholesterol and we think cholesterol is bad but it's not the cholesterol which gets deposited it is the modified cholesterol which gets deposited that means what modifies this cholesterol these agents it's not as simple as cholesterol going getting stuck into the heart rate it's something with the active process which happens so cholesterol gets oxidized and the reason for that is diabetes where the cholesterol becomes more and more triglyceride hypertension which leads to stress on to the weather world smoking which active you know destroys the the covering of the arteries itself and obviously age which you can't do much about so all these together actually starts make the cholesterol deposit rate so typically by 20 to 30 years little bit deposited is seen in majority of individual after that it grows this growth is like cancer you know it has the mind of its own there is inflammation coming in and it's you know it's it's coming it's not just what you eat it's also all these factors will join together again we're getting back to that end people it's unfortunate that more Indians have multiple risk factors you know that same diabetic patient is hypertensive he's also obese he's also not exercising he's also not eating right he's there he has stress he may be smoking you know versus one risk factor and multiple risk factor going together becomes very complex so just to add on you know just the last week we had three people between 30 to 34 with heart attack so and heart attacks are very very common and we keep seeing it all the time blockage of artery right so which artery are we mentioning is it the whole body artery or is it specific to heart artery what is this artery yes so what we are talking right now is a heart artery you know heart is organ it has four chambers and it's full of blood inside but unfortunately heart cannot take its blood at all it needs a separate set of artery which we call as coronary artery they originating originate from the main artery which is iota very close to its origin so left side there are two arteries right side there is one artery these arteries are not elastic they are like your radial artery they are medium sized artery they are prone to blockages you know so when the cholesterol which we discussed gets modified and gets stuck it's one of the artery which is actually prone and it's one of the artery which doesn't take rest at all you know because there is a constant work it has to do heart is you know because heart is working constantly there's more pressure on these arteries it's also contracting and relaxing that means arteries also get kinked whenever it contracts and you know you can imagine it right so these arteries are unfortunately uh at lot of stress and so the request is you all don't add to its stress so then having said this i envy i'm not very sure in the participants how many female audience are here but why is that women are so prone to heart attack compared to men okay you are so prone i mean i mean that's what i've heard that they are higher risk compared to men why is that is it an artery there are two ways to look at it one in reproductive age group women are protected actually they have less heart attack being male is a risk factor being women is not a risk factor it's beneficial but reproductive age group as long as estrogen and projections are there it is beneficial so typically below 50 women getting heart attack is much lesser compared to men but if there is a risk factor if the women is diabetic hypertensive smoke takes oral contraceptives you know any of these risk factor then all the benefit is lost then they become more you know they get more problem compared to the count counterpart men but otherwise a healthy female actually is more protected than men but it catches up so typically in women the heart attack heart disease comes one decade later but it's still the most important cause of death even in women in men they know it out numbers corona or covid deaths by a mile even in 2021 the most common cause of death world over we have US statistics but India we may not have such good statistics world over is heart attack and heart disease second is cancer the corona comes you know covid comes much later and a risk of heart attack goes higher but we are more worried about premature heart disease you know that is the end people getting heart disease so we have questions in the audience who've been asking about yoga pranayama if we do that do you think you know that really helps in terms of you know probably it helps in maintaining or probably when we heart disease what is that you have to talk about it yeah yeah I think it's a good idea to do that so the way we could put it you know don't do them as a alternative to exercise you know because when you do yoga it's sometimes not quantified yoga could be so mild that you're just sitting and doing shavasana and doing nothing versus you could be doing a very intense hatha yoga kind of you know thing so it's difficult to quantify so my advice to most people is do your exercise as an add-on do yoga yoga does help in stress relief it does bring you know it's a different kind of exercise in exercise you're actually constructing your muscle you're actually stretching so it's very complementary to the exercise which you do it's something which we advise most people you know meditation yoga and relaxation spiritual these are the things which we advise people for stress relief do them but do exercise also as an add-on so doctor there's another question where people are asking if they have cardiac pain so do they have to wait for the ambulance or are they in a condition to drive yeah I wouldn't recommend they drive but I would you know best is to you know if you have a person who can drive use their help to drive and if not wait for ambulance because it's a dynamic condition nothing might happen but the person could faint also in between so I think make sure you have somebody who knows to drive two people you should always know somebody who knows to CPR and somebody who knows to drive these two will help so doctor so we just spoke about you know the heart attack the cardiac arrest although I mean the cardiac arrest is almost not the topic now because heart attack is something that we all have been reading so what is the treatment plan for heart attack what is this door balloon time and when would they reach the hospital correct so door to balloon see heart attack stand sensitive so typically we classify heart attack into major heart attack and minor heart attack that's common terminology but there's nothing major minor heart attack is heart attack it has to be respected it has to be treated so when the ECG is taken if ECG shows FT elevation ECG you know then doctor tells you it's the major heart attack that's a very time sensitive condition that means quicker we open up the artery where by open up we don't mean a surgery it's an angioplasty the better is the benefit so that means that is a common dictum which we use now typically what we say is door to balloon that means you reach hospital door to the time we put angioplasty we put stand it has to be less than 90 minutes that is the door to balloon time but then it is a hospital door to the angioplasty room if you delay at home then the benefit is lost imagine you take six hours to reach hospital and then doctor does it isn't within one and a half hour still total time of damage is seven and a half hour you reach in 30 minutes doctor does in one and a half hour the total time of damage is only two hours so door to balloon is for us and we do follow this very very whether it is day or night we do not wait the teams are always ready the technician is already there the anesthetist is there you know most hospitals do have a habit in Manipal we are very particular about that the whole system is actually said to treat you as soon as you come but what is important is you shouldn't neglect I would be happy if your door home door to the angioplasty is within two hours rather than six hours wasted here and we rush in midnight to do the changes may not help you so much so remember shift the hospital door to your door so that you reach in 20 minutes to the hospital so before I have last question and you move to the demonstration so I have one thing to ask see everybody talks about stent is there a variance I mean a different form of stent or whether it is male or female do we use a common stent okay so I know people are you know the stents are you know the stent is a material which is which hope helps us to open up the artery and keep it open now there are many types of stent earlier there is to be absorbable stent it would completely get absorbed but unfortunately it didn't stand you know trial or logic and got withdrawn so it didn't stand so the present stents have three components they have materials they have metals then they have covering as which is like a plastic like material and inside that they have drugs so they have three components but stent is not your enemy here because only a small putting a stent is like putting a patchwork on your tire you know in your tube when there is puncture somebody puts a patchwork on that it's not replacing the tire it's just treating that particular heart it's typically inert by one month the drug is released and body's tissue growth inside and it's typically inert it's not about fighting the stent drugs medicines will continue whether we put stent or whether we don't put stent rarely or sometime what happens is we remove the block you know whenever there is a block we remove the block once we remove the block we don't see what we do is we don't put a stent but stenting or no stenting does not matter what matters is having the artery flowing when people come with heart attack and stent is not your enemy here so doctor there's one private chart that has come how many stents can be used in one person and suppose a person has already undergone one stent and he's on medication is he still prone to block I mean get a hard block is what they ask him yeah yeah I think it's a good question so one person if you looked at the world literature I think 69 stents were put in one person so it's not about the number it's about it can be put more than one it can be put but typically when when the blocks are in all three arteries the main arteries and there are too many blocks we send the patient to get the bypass surgery done because we don't prefer putting too many stents but there are times it is needed especially the main arteries fine the branches have problem it is needed to put more stent now the other question yes once after getting one heart attack or one blockage if the person is on stent there is still chance of that person getting stent again it's typically like what we keep telling it's like your if I go to the same analogy of your tube puncture or tire puncture if there is one puncture what does it mean that you are actually prone for more punctures it may not be the fault of the person who has done the first puncture job it is because the risk factor remains and there is more area to get puncture so that is what happens most of the time the first stent related problem is within one year so after one year if you're getting new new block it's not because of the first stent that area is more protected it is the other area so you have to modify your lifespan you have to modify your risk factor very important what we know now is if you keep your LDL cholesterol very low by very low I mean 55 the normal LDL is around 800 but if you can keep your LDL cholesterol less than 55 or in diabetics less than 40 your chance of new blocks becomes very less you know but people after sometime get tired of their medicine you know they even start coming and bugging us how many tablets should I take is it must take life the answer is yes to prevent a future block which could come five years down the line or 10 years down the line sometime it's such a slow process that it doesn't come next year and you don't realize you're happy your doctor has reduced your medicine but make sure that you modify your risk factor remember one puncture itself is a risk factor for one more car tire puncture the same thing is with the heart if you have something that becomes a risk factor for the next event to make sure you you know you take yourself more serious thank you doctor so do because I think audience are kind of very keen what is that defibrillator and how does it I'll do that mama so can you see the yeah yeah so we can see that we lost you doctor yeah hello yeah we can hear you but we can't see you and see you one second so should I yeah now can you see yes yes doctor so yeah yeah now you can see here right yes yes doctor we can see you I just took the medication here yes doctor this is the defibrillator which is on my left I think the training is done they have but we would be going there for a demonstration before that they were keen to know about the defibrillator so yeah cpr is something that we would kind of hand hold and tell them but the defibrillator yeah you could just explain and just demonstrate how does that work look like so the cpr also I'll just briefly tell you how to do it as well I think start off because the person is lying down unconscious first thing all for help make sure people come second start cpr so when you start cpr there are two aspects of cpr breathing as well as compression now we have gone away from breathing we don't have to worry about breathing at all so we have realized more compression the better it is so find this area we usually find the lower part come here keep your arm straight you know arm straight this straight and start compressing two inches down hundred times the width so that's how you do compression so as soon as you realize person is not breathing is not moving you know breathing is very important you could look down see whether the test is getting expanded or and see whether the person is breathing if not breathing do not waste time you have just one minute or two start cpr immediately and we'll send you lot more review so once you do that after two minutes you need to reassess the patient and talk hardly is the next victim and I'm happy you are thinking about the detail later so this is all the detail later look you want to turn the camera slightly here so this is all the detail later look so all you need is you need to switch it on the detail later and then these are what we call as automatic AED they are automatic ED because we know that for a common man understanding EDG is difficult and we don't want you to do that so what is that so there are two paddles which are available here once it is on you could take the make sure patient shed is removed which is typically done even during cpr and then you can see here it's connected here you know this part once you connect the machine fixed up the EDG the machine fixed up the EDG is diagnosed so if you see my screen now it's actually telling ventricular tachycardia or here that means it's asking my shop so what I'm supposed to do is it put it to whatever charge needed so typically there is a knock where you turn the number to 200 you know when you are in doubt 200 we do much lesser keep it here the first paddle is on the left lower part the second paddle is on the effect as far away from each other keep it here there's a button here it says charge so you could charge there so you could charge here this button once you charge you call for clear nobody should be touching the patient and these are the buttons here simultaneously press these buttons and release the charge now I'm supposed to stop the mannequin it might it might just burn out so but this is how we do it so keep it here as wide as possible it's all self explanatory see this card tells me where to keep it in the lateral part this tells me keep it on the shelf separation as much as possible need it and give a shot it is a child give much lesser shot with rudders give 150 or 200 150 is ideal because these are wide basic condition if it is a child it's actually around two to three kg so for a say 20 kg child it will be 60 you know you don't give too much for a child for others this is what you do most of the time the mission guides you what to do if it's automatic I would recommend you buy an automatic one but as soon as you collect the mission tells you what to do sometime it takes shockable rhythm shock sometime it tells continue to be a that is the kind of mission you should buy rather than these missions because you could do harm person is unconscious we are heart rate if you shock you could do harm so follow the mission instruction before you do one question when do I know when should I be stopping this you know using the fibrillator yes Bhavna sorry when do I know that I should be stopping the fibrillator or is there any command that yeah you know these missions are they explain okay so if you put it on the chest it will shock it will use it will tell shock and then it will tell you continue cps okay which talk oh okay I think that was amazing doctor so total will you be giving access to the participants so that they have their question answered or do I just read from the chat box okay the chat is already there doctor there is one question does popping painkillers help okay don't help the heart attack and you know they can be harmful okay painkillers can be harmful so you know don't because you know using a non aspirin painkiller actually increases the risk in heart attack so better not be using okay so kota are we having any are you giving access to yes yes yes doctor there are a few question and answers I will unmute the audience they will ask questions yeah so first question by abhijit one minute I think I read the chat box I took those questions okay just unmute them in case if they want to can you speak abhijit yeah I think the Bhavna already asked the first question so that's that part is done by the by the way Bhavna there are also questions in the link that I shared with you the please have been at questions please take a look yeah have you sent it through chat box no through WhatsApp I had sent it to you through WhatsApp okay one minute okay okay sure sure so second question by Bala I am unmuting the Bala one minute yes Bala can you can you ask directly doctor hello yeah Bala so I had actually no raised a few questions I think you know Bhavna had taken it up yeah kota I think I've answered those okay okay one okay doctor I think I have the question here how to recognize I think probably we just did speak about the cardiac arrest and heart attack so there's another one which says that differentiating a stroke versus a low sodium sugar collapse versus a seizure collapse so what is it yeah this is a neurological symptom but it's a very good question so if the person is unconscious I think that's where they are worried about heart attack versus stroke the person is unconscious the reason could be seizure which is fits it could be a syncope which is a transient unconscious or the worst still is the cardiac arrest so the breathing is the key generally if it is a medical person we ask them to check pulse but for you know for for people it's not easy to pick up pulse to look for signs of life or signs of breathing if chest is nobody can stop their breathing right so if the chest is expanding the person is breathing and if the breathing is regular that also means heart is beating well and if there is any purposeful morning purposeful moving or you know some painful movement like this all these are good signs in the sense that at least the heart is beating a still patient not breathing is a worry and low sodium also can lead to unresponsiveness but they are typically breathing but all these are medical emergencies there's no question about neglecting them the question is only whether you need to start CPR or no they're not breathing starts CPR if they are breathing take them to medical so can you suggest a blood thinner to be kept at home or should be used only in case of emergency yeah aspirin is the blood thinner to be kept at home but then you know I wouldn't recommend it if the person is conscious talking to you fine take them to hospital and then do or you could give aspirin and then take them to hospital only problem is aspirin and if it is a gastritis it will only worsen with aspirin so you know to distinguish it it's better to take to hospital what all and echocardiograms are there non-intrusive diagnostic method for detecting block non-angiogram is it safe yeah yeah that's a good question what eco does is eco looks at the valve it looks at the muscle it looks at the you know the pumping but does not look at the block in the heart to pick up blocks major block we need to do a stress test which could be a threat meal or stress value to answer that non-invasive method the answer is CT angiogram today's era CT angiogram can be done it's non-invasive dye is used can pick up both minor as well as major block there are major block we suggest them to undergo a conventional angiogram and angioplasty bar medication if there is a minor block we ask them to take lifelong medicine so that this block don't progress so when should we actually use aspirin it's a life-saving medicine yes any where you suspect that it is a heart attack aspirin could be used but if you suspect stroke don't use but don't waste time you know the whole point is time it's all about time so are you recommending any kind of heart attack people do use aspirin at a sublingual level keeping under their time yeah anybody who does not even have a heart pain earlier can still use aspirin no no they shouldn't they shouldn't if you don't know or if you just for sake of using aspirin you shouldn't use thinking that it will protect tomorrow's heart attack it may well medicine is orbit rate a nitrate so people with heart disease we ask them to use a sublingual nitrate but again you know it doesn't work if it is a heart attack if it is 100 block nitrate does not relieve it you know so be time sensitive remember time is everything here don't try too many first days that's the message I want to give yeah so there would be a need to do too many things during a cardiac emergency with only a few members present at home what should be the order of priority yes order of priority is call ambulance call for help if it is one person call for help one more person should call ambulance call your neighbors and the third person in a cardiac arrest should start CPR so if it is one person don't just start CPR call people because it's needed you can only give CPR for two minutes and that's not enough at all you'll be fatigued and tired and you need to change over to the next person so I think call for help is the first thing what is what is that because if you have help they can activate the ambulance or the system uh doctor there's one sensitive question where they say that most of cardiac arrest patients when brought to the hospital it is declared as dead why is that so how can we prevent it yeah that's the way I think it's a very important question Bhavna that is the very thing which is worried because one person is unconscious because of a cardiac arrest the chance of the we can save them only up to next five minutes there's no way you can reach a hospital in five minutes the CPR cardiac permanent resuscitation should start within a minute latest by three minutes but unfortunately this is the time when people panic you know they just don't know what's happening they are near and dear one whom they were talking is now just on the ground so it should be like a fire drill they should practice these things you know learn a CPR but it's not learn and forget because if you learn and forget you're not going to use it when you need it so there should be a constant ways of like fire escape you know most buildings have a fire escape plan there is there are always demo sessions which go on once you learn you should be able to manage that scenario and understand and use it when you need it so I think Bhavna the little bit on us is on us also once we train them we should have repeated training or you know mock sessions to make sure people can do it it's difficult even for doctors or trained professionals to act in the time of need you know outside hospital setting it's difficult for doctors also to act it's very important that we are ready with these things and only that can save if you have missed the heart attack arrest then most likely it will be declared dead yeah annual heart medical checkup mandatory for all or do you recommend any specific type of tests like treadmill ECG yeah so what is important is to know the risk factor as we have been discussing people should know whether they're diabetic people should know whether they're hypertensive people should know that the what is their cholesterol value so beyond age of 21 everybody should know their cholesterol value we keep checking your BP and keep checking your sugar now coming to the cardiac specific test like treadmill they're good to do but a normal treadmill does not preclude from a heart attack or heart arrest we need to understand I've had patient who have come done excellent treadmill went back in auto had a heart attack and came back in the same auto a negative treadmill so a negative treadmill does not because I think the TMT exercise can induce heart attack no the TMT must have induced the heart attack in him rarely it can happen so even though you have met the doctor the same day the doctor says you're okay you should still be vigilant your chances are less but rarely it happens if it happens go back again in the night so is there any quick fix to know if my risk factor is high for a heart attack yeah typically it is basically traditional respect for which is hypertension diabetes having diabetes it's like having one heart attack so they are at a very high risk smokers one cigarette is like you are at risk there is no doubt about that if you have a family history young people having heart attack blockages again it is a big risk factors and these are something but predicting the time of heart attack is still very difficult exact time is difficult for anyone so what is the limit of the number of compressions to be done while doing the CPR a number of just 100 per minute so it's very tiring for the person to do that you need to compress two inches down allow it to require and then do it again it's not easy without the training it's like you're going to a gym that day and your stomach starts starting next day if you do a good CPR don't break ribs we will obviously train you how to do it in your centers go through it you don't have to do mouth to mouth and after two minutes whether you feel tired or no replaced by the next person the next person should be opposite if you're on left side they have to be on the right side so that there is no time gap if you have AED in the center connect it it comes with pads it comes with pads don't waste time again if it says continuous CPR continuous CPR if it says shock shock first five minutes are very very crucial make sure you don't waste time in first five minutes because if they have to come back they will come back by that. Dr. there's been a question from one of the audience I don't know who's asked him to advice to have a drink a day but the drinking two times is what I hope he means thus drinking two times is harmful as there has been advice to have a drink per day I'm not sure what is this yeah you know the my talk is never complete without answering this question so you know people always ask about honey in water hot water and this question so I'm always surprised if it doesn't come up so the drink or alcohol the general advice is to limit it less than 60 drinks per day but you don't have a weekend quota but unfortunately for us Indians even a little alcohol is shown to be harmful in India there is no doubt about that the western literature says little alcohol in them is beneficial but very little taken regularly but Indian literature and there's huge literature there which says even a little alcohol is harmful so we do not advise anybody to take drinking and we ask almost all of them to stop and if they can't limit it to very minimal but general advice top okay so how do you reduce the inflammation in the body I hear that prolonged inflammation is one of the main factors for heart disease yes excellent question that is true so to reduce inflammation you need to exercise regularly non you know the we didn't discuss much about diet today it is non you know low carb diet carbohydrate sugar is the one which induces inflammation more than the fat so it's low carb diet maybe you know decrease the stress by taking regular break meditating well you know doing these kind of things actually help one last question doctor considering the time limit what we have today so can regular statins help prevent plaque buildup yes it does it does there is no doubt about it but what is very important is who should get a statin it's not everybody so anybody with LDL see we don't look at total cholesterol we look at only LDL LDL more than 190 is high for everyone they should be on good dose of statin for diabetes LDL more than 70 is abnormal so they should be on good dose of statin for people with heart disease LDL 70 or even 55 is abnormal as we discussed they should be on statin there are good non you know there are one or two other medicines which have recently come to market but till then statin is the king it's the single most drug which has shown big big reduction of cholesterol and heart events so if your doctor advises you need to take it but for life three months doesn't help three months postpones heart attack by three months that is of no good to anybody you know instead of getting March if you get heart attack in October I don't think it will help anybody if you are to take after your doctor's it is for life so I think with this we come to the end of our session a big shout out to you because despite being the Sunday you get just one Sunday to relax and you know we really had to pull your time out for this engagement and also another big shout to Abhijit because he's been in contact with us although I know a few people who have been you know writing Pradeep is actually very close to us who've been working closely with us and thanks to the audience and thanks to you and thanks to Kota as well you know despite Sunday also he helped us in you know coordinating for this event and thanks once again doctor and we wouldn't keep in touch with you when the fibrillator is being installed in the apartment so they are kind of you know discussing amongst themselves should this be a need you know for them to have it so thank you so much doctor it was a wonderful session very informative and again thanks to everyone who've been you know joining this discussion thanks once again thank you bye thank you thank you thank you doctor thank you doctor bye