Dread not the Red in times of need

BM Birla hospital is setting a benchmark, as our team comprising of doctors, nurses, housekeeping staff, and nonmedical staff not only have been working day in out for the patients but are equally enthusiastic in contributing their bit for the future of the society and the patients by donating blood. A week-long blood donation camp (14 th June to 20 th June 2020) is being organized where the phlebotomist wearing protective gear encourages blood donation. All measures are taken to ensure the safety of the blood donors and the staff who are at the blood bank. All protocols are strictly being followed while blood donation activity is being carried on. A complex cardiac switch surgery was done in an infant of only two weeks by Dr. Manoj Daga, complex open-heart surgery and valve replacement were done by Dr. Ratan Das on an elderly patient who was tested COVID negative. Another interesting case was done by Dr. Sabyasachi Pal Pacemaker was implanted in a haemophilia
patient taking all precautions. The requirement of blood during cardiac surgery is a very important factor, within this pandemic situation we have been able to save more than seventy-five lives while conducting complex cardiac surgeries. Maintaining social distance and fear of coming to a hospital has created a situation where the stock of blood is not sufficient for conducting surgeries. Hence blood donation is an important factor to save lives.

Speaking on the situation, Dr. Lopita Bhattacharya, HOD blood bank, BM Birla Heart Research Centre explained “1% of the blood donation by the people in our country, is the minimum to meet the nation’s basic medical need for blood. There has been a remarkable requirement for blood and blood components ever since the spread of the pandemic. The implementation of social distancing and abatement of blood donation had worsened the situation. There has always been a basic urgent need for blood services to move quickly in response to trauma cases, to ensure blood sufficiency for cardiac surgery, emergency surgeries, cancer treatment, and hereditary disorders like thalassemia and other ailments. This internal blood camp will maintain the basic COVID New normal, ensuring both safeties of the medical fraternity and patients as well as further embarking new standards for self-
sufficiency.”

This initiative has once again ensured that BMB a super specialty cardiac center is committed to providing quality cardiac care to its patients and ensures a safe environment with unmatched clinical excellence. During the peak time of the lockdown, we at BM Birla Hospital, have operated on a patient with this medical condition successfully. The perseverance of our medical staff reflects the good health of our patients. We’ve also made virtual medical assistance available for our patient’s convenience. Their good words are what keep us motivated through the tough times. Our team at BMB Hospital is working for the health and goodwill of our patients. We are constantly at the service for building a healthier society and a world. In these tough times, we stand united and strong to keep in check the health of our patients come-what-may.

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CPR (Cardiopulmonary resuscitation) – How to do CPR when the heart suddenly stops

Even after the advancements in emergency cardiac care, the sudden cardiac arrest still remains as one of the top causes of death in India and worldwide. One of the most common reasons for a cardiac arrest includes disturbance in the electrical rhythm, also known as ventricular fibrillation, which can be treated with an electrical shock to the chest. In emergency situations, when an electrical shock cannot be immediately given to the patient, CPR comes in very handy and can help to keep the blood and oxygen running in the body. If CPR is not initiated timely, at least in the first 6 minutes, a person can die in less than 10 minutes. Moreover, CPR buys more time until a defibrillator becomes available. Also, keeping the blood flow active – even partially – improves the chances of successful resuscitation. 

Cardiopulmonary resuscitation is an emergency lifesaving technique that is performed when the heart stops beating. This procedure is performed immediately to keep the flow of blood and oxygen running through the body when the person’s heart and breathing have stopped due to various reasons such as heart attack or drowning. CPR can be initiated by any person – a bystander or medical personnel – and involves basic chest compressions and rescue breathing. CPR has to be initiated in the order of CAB – Compressions, Airway and Breathing. 

How to do CPR when the heart suddenly stops?

CPR can be performed via two methods – Hands-only and mouth-to-mouth resuscitation. It is recommended that an untrained person performs only a hands-only CPR. 

Hands-only CPR

Hands-only CPR is the primary recommendation for untrained people. It involves the following steps:

Surveying the scene: Foremost, the person willing to help should assess if it is safe to help and reach the person in need. 

Open airways and ask for a response: Shake the shoulders of the concerned person and enquire if they are okay. In case of a child or infant, check the reaction by tapping the foot. In case the person is not responsive, immediately call an ambulance. However, if the person in question is a child between 1-8 years or is a victim of drowning, it is critical to begin CPR first and then call for an emergency.

Assess the heart with an automated external defibrillator (AED): In case an automated external defibrillator is readily accessible, use it to check the rhythm of the heart. An AED machine will also guide you to deliver one electric shock before performing chest compressions. But in case of children between ages 1 to 8, it is best to perform chest compressions for the first two minutes before using the AED machine. For infants and children under the age of one year, AED is not recommended, and only CPR should be followed. In case, AED is not available, chest compressions should be immediately started irrespective of the age or condition.

Place hands appropriately: In case of an adult, put the heel of one of your hands in the middle of the chest, while placing the other hand on top of the other. Once firm, interlock your raise the hands up while keeping the heels intact between the nipples on the chest. In the case of children till the age of 8, only one hand should be used to give chest compressions. In the case of infants, mere two fingers should be applied. 

Begin CPR: In case of an adult, push down on the chest at least 2 inches by using your upper body for force. These compressions should be performed at a rate of 100 to 120 compressions per minute while giving time to the chest to recoil between compressions. In the case of children between 1 to 8 years, the same procedure should be followed but with one hand placed between the nipples on the chest. However, for an infant, use your upper body and one finger placed in the centre of the chest to push straight down at 1.5 inches at the rate of 100 to 120 compressions per minutes, meanwhile allowing the chest to recoil between compressions. 

Continue Compressions: Keep up with the compressions until the person starts to breathe or medical help is received. 

Mouth-to-Mouth CPR

The foremost step to save lives in an emergency should be to provide chest compressions immediately, enabling the oxygen in the lungs and bloodstream to flow to the brain and heart without delay. Once, the chest compressions as per the method above are followed, you need to go a step further and provide mouth-to-mouth CPR in the following ways:

Open the airway: Place your palm on person’s forehead and gently tilt the head slightly backwards; then lift the chin forward while keeping the hand on the forehead. For infants and children, mere tilting the head slightly will open the airways.

Provide rescue breaths: Once the airways are open, you have to close the nostrils of the person and close/seal the person’s mouth with a CPR face mask. In the case of infants, both the mouth and nose should be covered with a CPR mask. In case a CPR mask is not readily available, you need to cover the person’s mouth with yours and provide two rescue breaths for about one second each. With each rescue breath, the chest of the person should rise. 

Alternate rescue breathing along with chest compressions: Continue to perform 30 compressions followed with two rescue breaths till the time a person begins to breathe normally or medical help is received. 

In all, CPR can effectively help save lives provided it is initiated timely and carried out appropriately. Moreover, a lot of hospitals, education institutions, government agencies, etc. provide training on CPR. 

Myocardial Infarction Treatment and Management

Myocardial infarction or also popularly known as “heart attack” is a condition where the heart stops working because it is starved of oxygen and nutrients (for a prolonged period of time) which are essential for its survival. The heart needs its consistent supply of oxygen and nutrients to ensure there is proper pumping of blood through the body. Our heart is made up of four major arteries that support its pumping function; two of these arteries are large while the other two are small. The large arteries are responsible for delivering oxygenated blood to heart. But when any of these arteries is blocked, narrowed or has a leakage, the function is disrupted and a part of the heart is starved of oxygen, which leads to cardiac ischemia. This blockage is because of buildup of plaque in the arteries due to high cholesterol, high blood pressure, cellular waste, etc. When the cardiac ischemia is prolonged, the heart muscle is deprived of oxygen for too long resulting in death of the muscle, also referred to as a heart attack or a myocardial infarction.

While a myocardial infarction may or may not depict early signs of occurrence, it sometimes might reflect as acute chest pain, shortness of breath, loss of conscious, nausea, anxiety, excessive sweating, pounding heart rate, etc. These symptoms are very generic and may depend on condition of the person. In all cases, whether or not there are symptoms of a myocardial infarction, it is very important to know the guidelines for myocardial infarction treatment.

The most important thing to know about a myocardial infarction treatment is that it is sudden and needs emergency medical help and immediate care. The most widely used myocardial infarction treatment is an angioplasty, a minimally invasive procedure where the doctor inserts a thin, fine tube called a catheter mounted with a tiny balloon into the blocked artery through an incision in the arm or groin. Once the catheter is in the right spot, the tiny balloon is inflated to remove the blockage from the artery and clear the passage to allow blood flow by pushing the plaque build up to the walls of the artery. The procedure restores the optimum blood flow and oxygen to the heart by removing the blockage from the artery, widening the artery for smooth flow, and ensuring optimal heart health and safety. Once the blood supply is regulated, the balloon is deflated and removed from the body. This procedure is often time followed by the placement of a stent – a stainless steel mesh – in the heart of the patient to ensure the arteries do not clog again in future.

However, in many cases, where the condition of the person is not suitable to be considered for an angioplasty or the patient needs more intense care, the doctors can also resort to a coronary artery bypass graft (CABG) for a myocardial infarction treatment. A CABG treatment restores the blood flow and oxygen to the heart by using blood vessels from another part of the body – such as chest, or leg veins – and connecting them with blood vessels that are below or above the blocked or narrowed artery; hence, leading to a bypass for the compromised artery. The number of arteries used to connect is dependent on the severity of the condition. A coronary bypass graft can be done wither right after a myocardial infarction or could be undertaken once the condition of the patient is stabilised.

For cases where the attack was a minor one, certain prescribed medicine will also work and clear the blockages such as:

  • Blood thinners to rejuvenate the blood flow by clearing clots
  • Thrombolytics to dissolve clots
  • Nitroglycerin to widen the blood vessels
  • Antiplatelet drugs to prevent formation of new clots
  • Pain killers to reduce pain immediately

Once through the suggested myocardial infarction treatment, the patient needs to know what to expect post treatment. A myocardial infarction is sudden and often times, there might be delay in receiving the medical treatment. The effectiveness of a myocardial infarction treatment depends on the timing of the medical care and intensity of the attack, both of which define the severity of damage done to the heart muscle. More the damage, lower be the recovery of the heart post myocardial infarction treatment.

In cases where the heart damage is intense, but still the heart has survived, there are increased chances of developing heart problems such as arrhythmias (abnormal heart rhythms) and could even lead to another attack. While in many cases a myocardial infarction could be minor, some patients however, suffer from depression and anxiety post myocardial infarction treatment. Hence, it is very critical to consult the doctor with concerns to ensure full recovery.

More importantly, the myocardial infarction treatment has to be followed by medications, post-operative tests, and lifestyle amendments such as healthy eating, proper weight, balanced nutrition, no smoking or drugs, regular heath check-ups, and regular physical exercise but no strenuous workouts – to ensure there is no revival or worsening of the situation.

That said, a myocardial infarction is highly common but dangerous and poses a serious threat to precious lives. Hence, it is important to understand the criticality of the myocardial infarction treatment to ensure that the heart is healthy and functioning properly.

What is cardiac rehabilitation?

Cardiac rehabilitation is a programme that aims to medically enhance the cardiovascular health of a patient, who has experienced a recent heart attack, heart failure; or has undergone an angioplasty, angioplasty, heart surgery; or recovered from any other critical heart disease. The rehabilitation programme is conducted under medical supervision and is also called cardiac rehab. 

The ultimate objective of cardiac rehabilitation is to help a patient regain strength, prevent worsening of the condition, reduce future risks and improve the quality of life – after a heart attack or a preventive heart surgery. The programme involves exercise training, emotional counselling, lifestyle education, and more. Cardiac Rehabilitation programmes have known to reduce the risk of death from heart problems, heart diseases and minimise future risks as well. 

Cardiac rehabilitation programmes are customised per individual needs and offer one-to-one supervised training, education and counselling. Through the programme, patient benefits in the following manner:

  • Improve physical health
  • Know beneficial heart-healthy exercises
  • Adopt a nutrition-rich diet
  • Manage cardiovascular risks
  • Follow the prescribed treatment plan
  • Reduce stress
  • Strengthen emotional health
  • Control cardiovascular risk factors (high blood pressure, cholesterol, etc.)

That said, cardiac rehabilitation can prove life-saving for some patients. As per studies, patients who undertake a cardiac rehabilitation programme have 30% lesser fatal heart problems and are 25% less likely to die from heart problems as compared to patients who only opt for standard treatment. Moreover, cardiac rehab helps to lower the chances of a second heart attack and heart surgery. These programmes are comprehensive and provide step-by-step guidance to make long-term health changes.

Some other benefits of cardiac rehabilitation programme include:

  • Lower chest pain and other related problems
  • Fewer medications
  • Preventive care
  • Lower chances of hospitalisation in the long-run
  • Effective weight loss
  • Better nutrition
  • Reduced stress
  • Enhanced emotional well-being

Who should opt for cardiac rehabilitation?

Cardiac rehabilitation is an effective programme for people suffering from a variety of heart diseases or people who are at higher risk of heart problems. In particular, people who have the following medical history are most likely to benefit from the programme.

  • Heart attack
  • Heart failure
  • Stable chest pain (Angina)
  • Cardiac stenting
  • Angioplasty
  • Coronary artery bypass surgery
  • Heart valve repair or replacement
  • Heart or lung-transplant
  • Coronary artery disease
  • Peripheral artery problems
  • Cardiomyopathy
  • Congenital heart problems
  • Pulmonary hypertension
  • Abusive heart health (due to smoking, excessive alcohol, etc.)
  • Stress-related heart problems
  • High heart-health risk factors (high blood pressure, cholesterol, etc.)

There is no age limit for the programme; it is beneficial for people of all ages and gender.

What are the risks of cardiac rehabilitation?

A cardiac rehabilitation programme is not fit for everyone who has or had a heart problem or surgery. The doctor will assess the patient’s heart condition, overall health including past medical records, and conduct several physical tests to ensure the patient is fit for the programme. 

In some rare cases, the patient might suffer injuries, strained muscles, sprains, etc. due to exercising. But it is temporary and can be treated easily. The team will monitor the patient’s health regularly and provide guidance on how to avoid injury at home. 

What to expect during cardiac rehabilitation?

A normal cardiac rehabilitation is about 3 months long but in some cases, the duration might exceed this depending on the patient’s need and health condition. On the other hand, there are also intensive programmes that last for only one or two weeks. The programme includes supervision, guidance and monitoring by a team of professionals including:

  • Cardiologists
  • Nurse
  • Dieticians
  • Exercise specialists or physical therapists
  • Mental health specialists
  • Occupational therapists

The programme includes various stages:

Medical Assessment: The doctor along with the team of healthcare professionals will conduct initial checks to assess the physical abilities, medical condition and other limitations of the patient. These checks will also be monitored during the course of the programme to detect deviations and alarms timely. The tests will help the team design a cardiac rehabilitation programme designed specifically to meet the needs of the individual and as per the health conditions. 

Physical Activity: This is a very important step that involves light physical exercises such as cycling, jogging, walking, rowing, etc. to improve the cardiovascular health of the patient. These exercise sessions are held at least three times in a week and are conducted such to avoid any injury to the patient.The team will also guide the patient on warming up, cooling down exercises, as well as muscle-strengthening including weight lifting, resistance training, etc.

Lifestyle Education: This stage involves educating the patient about the present medical condition and helping them adopt an active and healthy lifestyle. The team of professionals including the dietician will provide guidance on the diet, nutrition, physical exercises, healthy weight, etc. They will also suggest certain lifestyle modifications such as quitting smoking, minimising alcohol intake, etc. Moreover, the programme will provide education on how to manage present risk factors such as high blood pressure, high cholesterol, diabetes, etc. 

Support: The most important and unique aspect of these programmes is the medical support and supervision provided by healthcare professionals. They provide counselling to cope with trauma, depression, anxiety, stress, and other feelings which could otherwise harm the individual and also adversely impact the cardiac rehabilitation programme.

Overall, a cardiac rehabilitation programme can help a patient rebuild life and gain both mental and physical strength. It is safe, highly supervised and very effective. 

Causes of Cardiac Arrest

Cardiac Arrest is a sudden loss of heart function, breathing, and consciousness. This condition occurs because the heart which generates and pumps blood in the body is disturbed and stops functioning leading to no flow of blood in the body particularly the brain and resulting in death. Cardiac arrest is abrupt, sudden, and different than a heart attack where the blood flow to a part of the heart is blocked; though a heart attack may lead to a cardiac arrest in some cases. 

A cardiac arrest is a very critical situation where the heart – that makes blood (in its upper chamber or atrium) and pumps blood to all other organs of the body through the heart valves – crashes and seizes to function. This sudden failure of the system leads to loss of heartbeat, no flow of blood in the body, loss of organ functions, and ultimately death. The bottom chambers of the heart (ventricles) stop beating and start behaving like mere thick gooey masses leading to no production of heartbeat or supply of oxygen and blood into the body. This abrupt crash of the system if not resurrected timely can lead to immediate death. As per records, 95% of people who suffer from a cardiac arrest succumb to death. According to research, each year in India, 10% of deaths happen because of cardiac arrest, which is also the most common cause of death in the world.

While a cardiac arrest is sudden and occurs without any prior symptoms or warning leaving a slim chance of detection, yet proper knowledge and awareness about cardiac attack symptoms are useful to get immediate medical help. Some of the general cardiac attack symptoms that people might experience are:

  • Abruptly racing heartbeat
  • Extreme anxiety
  • Dizziness
  • Dangerous heart rhythm
  • Fluttering ventricles
  • Frozen body temperature and numbness 
  • Sudden collapse
  • Painful and difficult breathing
  • Loss of pulse

Most of these symptoms occur very near to a cardiac arrest, whereas there are a couple of cardiac arrest symptoms that if paid heed to could signal the upcoming dysfunctionality. These might include:

  • Chest pain or discomfort
  • Shortness of breath
  • Fatigue 
  • Weakness
  • Palpitations

However, you can always seek advance medical help to know if there are any irregularities in heart functioning. You should see a doctor if you experience any of these:

  • Chest pain or discomfort
  • Rapid or irregular heartbeats
  • Continuous unexplained wheezing
  • Shortness of breath
  • Extreme heart palpitations
  • Loss of consciousness
  • Dizziness and blurriness of sight

Most cardiac arrest symptoms are short timed and do not leave much time to act before the arrest, hence, the best way to save a life is to avoid all cardiac arrest causes and stay clear of reasons and factors that can trigger a cardiac arrest.

Causes of Cardiac Arrest

Sudden cardiac arrests occur without a warning and hence, it is very crucial to know why cardiac arrests happen to avoid/remove those causes and be prepared for the worst circumstances. Some of the major reasons for cardiac arrests that one must know are:

Heart Conditions that can lead to a Cardiac Arrest

Coronary Artery Disease: One of the most common cardiac arrest causes is a coronary artery disease in which the coronary arteries of the heart are narrowed or clogged. These arteries can be clogged due to building up of cholesterol and fatty items called plaques. This plaque tends to stick to the inner walls of the arteries, restricting the blood flow and thereby causing a system malfunction.

Heart Attack: A heart attack is different from a cardiac arrest but could lead to one in severe cases. A heart is most likely a result of severe coronary artery disease and can lead to ventricular fibrillation causing sudden cardiac arrest. A heart attack also leaves a scar tissue; any disturbance around the scar tissue can cause abnormalities in the functioning and beating of the heart.

Cardiomyopathy or an Enlarged Heart: An enlarged heart is another cause of cardiac arrest as it indicates weakened heart muscles, coronary heart disease, or a valve problem. This is caused when the muscles of the heart are overly stretched, enlarged and thickened, limiting the flow of flood from the heart to the body.

Congenital Heart Disease: Congenital heart disease such as Brugada syndrome (BrS) and long-QT Syndrome (LQTS) are disordersof the heart that cause abnormal heartbeats and rhythms. These defects are present at birth and lead to severe complications for adolescents and children. Patients who have undergone surgery to correct the congenital heart disease are also at high risk of cardiac arrest.

Valvular Heart Problem: A valvular heart problem is characterized by damage or defect in any of the four heart valves. This problem does not let the valves function normally because of leakage or narrowing of the valve, causing the heart muscles to stretch and thicken restricting the blood flow. This stress caused by the valves leads to enlarged or weakened chambers, resulting in the irregularity of heartbeat and rhythm.

Often, a person may not be suffering from any of these heart problems but could still have higher chances of a cardiac arrest because of the following risk factors. These factors listed below contribute towards the conditions of a cardiac arrest:

  • Age – Men above 45 and women beyond 55
  • A history of heart attacks
  • A family history of heart problems or cardiac arrest
  • High blood pressure
  • Excessive Smoking
  • Uncontrolled consumption of alcohol
  • High blood cholesterol
  • Overweight and Obesity
  • Diabetes
  • Lack of physical activity
  • Abuse of drugs
  • Acute lack of potassium and magnesium
  • Fatal kidney diseases

While causes of a cardiac arrest are vital to know, it is also important to understand that immediate medical help and treatment is the only way for survival. One needs to be prompt and have immense presence of mind to ensure that the right and quick approach is adopted.  Immediate emergency help can help revive a person if treatment is initiated within first minutes of an arrest. However, every minute lost reduces the chance of survival by 10%.

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