করোনা থেকে সেরে উঠলেও নিস্তার নেই, আশঙ্কা বাড়াচ্ছে হৃদরোগ !

করোনা মুক্তির পর হৃদরোগে আক্রান্ত হচ্ছেন অনেক রোগী ৷

করোনা ভাইরাস থেকে সেরে উঠলেও নিস্তার নেই। বরং আশঙ্কা বাড়াচ্ছে হৃদরোগ। জার্মানির একটি হাসপাতালের একটি গবেষণায় দেখা গিয়েছে, ৭৮ শতাংশের বেশি সুস্থ রোগীর ক্ষেত্রে হৃদপিণ্ডের সমস্যা দেখা গিয়েছে। কিন্তু তাঁদের আগে থেকে কোনও সমস্যা ছিল না।

দিন দিন ভারতে বাড়ছে করোনা আক্রান্তের সংখ্যা ৷ বাড়ছে মৃত্যুও ৷ পরিস্থিতি ক্রমেই খারাপ থেকে খারাপতর হচ্ছে ৷ বলা যেতে পারে দেশের ৫ জন রোগীদের মধ্যে এক জন এখন করোনা আক্রান্ত ৷ তাঁদের হার্টের সমস্যা এবং নিঃশ্বাস-প্রশ্বাসেও সমস্যা দেখা দিচ্ছে ৷ অন্তত ২০ শতাংশ করোনা রোগীর বুকে ব্যাথা, শ্বাসকষ্টের সমস্যার সঙ্গে হৃদরোগে আক্রান্ত হওয়ার ঘটনা ঘটছে ৷ ফলে চিন্তা বাড়ছে ৷

কলকাতার বিএম বিড়লা হার্ট রিসার্চ সেন্টারের ডাক্তাররা জানিয়েছেন, এই বিষয়গুলি যথেষ্ট চিন্তার ৷ এবং এই মুহূর্তে পশ্চিমবঙ্গ সরকারের স্বাস্থ্য সাথী প্রকল্পের আওতায় অন্তর্ভুক্ত সব রোগীদেরই চিকিৎসা করা হচ্ছে এই হাসপাতালে ৷ কার্ডিয়াক রোগীদের কোভিড সংক্রমণের আশঙ্কা অনেকটাই বেশি ৷ তাই তাঁদের সুস্থ রাখতে কয়েকটা বিষয় উল্লেখ করেছেন ডাক্তাররা ৷

হার্ট যাদের দুর্বল বা সমস্যা রয়েছে, তাদের যে সমস্ত বিষয়গুলির উপর নজর দেওয়া প্রয়োজন, সেগুলি হল, ১. নিয়মিত শরীরচর্চা করা ২. প্রতিদিন ব্যালেন্সড ডায়েট বজায় রাখা এবং প্রচুর পরিমাণে জল খাওয়া ৩. বন্ধুবান্ধব এবং পরিবারের লোকজনদের সঙ্গে কথা বলার সময় ঠিকঠাক দুরত্ব বজায় রাখা ৷ ৪. রিল্যাক্স থাকা এবং অতিরিক্ত চিন্তা না করা ৫. কোভিড অতিমারী সংক্রান্ত নেগেটিভ খবরগুলি কম রাখলেই ভাল, যাতে টেনশন কিছুটা কম হয় ৷ ৬. যতটা সম্ভব বাড়িতেই থাকা ৭. সবসময় মাস্ক পরা এবং হাত স্যানিটাইজ করা ৯. চোখে, নাকে, মুখে খুব একটা হাত না লাগানোই ভাল ১০.বাড়ির দরজা, গাড়ির স্টিয়ারিং, লাইট সুইচগুলি সবসময় পরিষ্কার রাখা ৷ যাতে ইনফেকশন না ছড়ায় ৷

বিএম বিড়লা হার্ট রিসার্চ সেন্টারের Interventional Cardiology বিভাগের চিকিৎসক Dr. Dhiman Kahali জানিয়েছেন, ‘‘ করোনা সংক্রমণে হার্টের সমস্যা দেখা দিচ্ছে ৷ তাই সেদিকে নজর দেওয়ার প্রয়োজন অবশ্যই রয়েছে ৷ ভাইরাস সরাসরি কার্ডিওভাসকুলার সিস্টেমের উপর প্রভাব ফেলতে পারে ৷ যাঁদের আগের থেকেই হার্টের কোনও সমস্যা রয়েছে তাঁদের ক্ষেত্রে আরও ভয়ের কারণ থাকছে ৷ কোভিড পজিটিভ রোগীদের মাঝেমধ্যেই বুকে ব্যাথা ও শ্বাস নিতে সমস্যা দেখা দিচ্ছে ৷ যা হার্ট অ্যাটাকের সম্ভাবনাকে বাড়াচ্ছে ৷ ’’ চিকিৎসকদের আরও পর্যবেক্ষণ, কোভিড রোগীদের হাসপাতাল থেকে ছাড়া পাওয়ার পর কিডনি, লিভার, এমনকী চোখেও তাঁদের দীর্ঘকালীন সমস্যা দেখা যাচ্ছে। এতদিনের যা তথ্য পাওয়া গিয়েছে, তার উপর নজরদারি চালাচ্ছে কেন্দ্রীয় স্বাস্থ্য মন্ত্রকের টেকনিক্যাল উইং ‘ডিরেক্টরেট জেনারেল অফ হেলফ সার্ভিসে’-এর একটি যৌথ দল। করোনা থেকে সেরে ওঠার পর রোগীদের স্বাস্থ্যজনিত সমস্যা সমাধানের জন্য কী করা উচিত, সেই সংক্রান্ত একটি নির্দেশিকা তৈরি করা হচ্ছে। সেজন্য দেশের বিভিন্ন প্রান্তের হাসপাতাল থেকে তথ্য সংগ্রহ করা হচ্ছে।

Does COVID-19 damage your heart?

There has been a continuous rise in COVID positive patients suffering from heart disease. Rather we can say that one in five patients suffering from COVID-19 have signs of heart injury regardless of whether they have any respiratory symptoms.20% of covid-19 patients complain of chest pain and shortness of breath and that eventually turns out they suffer heart attack. Even during pandemic, BM Birla Heart ResearchCentreis doing their utmost to treat one who needs immediate cardiac attention in a safe environment. We are very pleased to inform you that we are treating patients who are enrolled under the Swasthya Sathi a health scheme by the government of West Bengal. It is interesting to note that there is no capping on the family size and the parents of both the spouse are covered under this scheme.

As we know that cardiac patients fall into a high-risk category forCOVID-19 infection, it is important to keep certain points in mind to prevent ourselves from getting infected.

  1. Continue doing exercise
  2. Eat a balanced diet, stay hydrated and get adequate sleep
  3. Maintain a social distance while communicating with friends and family
  4. Do not use coping strategies involving alcohol or drugs.
  5. Limit the information you consume about the outbreak and the time you spend on it
  6. Avoid anxiety. Relax and try to remain resilient

7.Stay at home as much as possible.If you have fever or chest infection you should be self-isolate yourself and contact your doctor

  1. Always wear mask and do not forget to sanitize your hands
  2. Avoid touching your eyes, nose and mouth
  3. Clean often-touched surfaces like doorknobs, handles, steering wheels, or light switches, with a disinfectant to remove the virus.

We are assessing thatrecent recovery from the novel coronavirusinfection as determined by RT-PCR which checks for the presence of the virus from swab tests of patients for upper respiratory tract.Speaking on this Dr. Dhiman Kahali, Director, Department of Interventional Cardiology, BM Birla Heart Research Centre said, “The problem associated with COVID-19 is the amount of inflammation the infection causes which affects the heart health. Recent research suggests that there are few mechanisms as to why COVID-19 damages the heart leading to widespread of inflammation the infection causes, the possibility that the virus directly infects and injures the cardiovascular system and overall stress the infection puts on the pre-existing heart condition. It is interesting to note that patients who are COVID-19 positive complain of chest pain and shortness of breath and eventually they have heart attack due to non-occlusive blockage or due to thrombosis in the lumen of the coronary artery.”

Severe COVID-19 infection can cause massive inflammation throughout the body, and if it affects the heart the consequences can be serious. It has been observed that fast and appropriate treatment of people suffering can bring heart rhythms back to normal which can lead to lesser risk in COVID-19.

Although people with existing heart disease have a greater risk, a small percent of people with no pre-existing heart issues have also experienced heart damage from COVID-19. It’s important for those with cardiovascular disease to be isolated from people with COVID-19 symptoms and to remain under proper treatment with vaccinations for influenza and pneumonia. We as a team at BM Birla Hospitals, are continuing to learn so that we can give our patients the best possible care. We are taking all the necessary steps and we hope we can fight it back together.

Coronary Angioplasty

Coronary angioplasty is also medically referred to as balloon angioplasty or percutaneous transluminal coronary angioplasty. This is a minimally invasive procedure that is performed to open the blocked arteries of the heart. This allows the blood to flow smoothly to the heart muscle. This procedure is mostly performed after a heart attack to restore the blocked blood flow to the heart. This helps the patient recover and rejuvenate heart health by opening the blocked blood vessels and restoring the supply of blood to the heart muscle.

The blockage in the arteries occurs because of the build-up of lipid-rich plaque in the arteries, which restricts the supply of blood to the heart. The accumulation of plaque is also referred to as atherosclerosis. When the excessive plaque sticks to the walls of the arteries and starts restricting blood flow, the condition is referred to as coronary artery disease.

Causes of Clogged Arteries

As mentioned, the build-up of fibrous and fatty substances – made of fat, cholesterol, and cellular waste – called plaque clogs the arteries. The plaque is formed due to several reasons such as:

· Bad cholesterol

· Consuming trans and saturated fats

· High blood pressure

· High triglyceride

· Diabetes

· Obesity and excessive weight

· Smoking tobacco

· Family history

· Increasing age

· Stress

· Lack of exercise

· Drug abuse

The formation of plaque can begin during childhood or even during the teen years. The process intensifies with age and eventually causes problems by the mid-age. To counteract the accumulation of plaque, the cells of the artery walls multiply and thus, emit harmful substances that further worsen the condition. As the deposits increase, the patient’s arteries narrow and harden, thereby reducing the blood flow.

Preparation for Coronary Angioplasty

Before a coronary angioplasty, the patient is advised to not eat or drink at least after midnight before the due date of the procedure. The patient is advised to take normal and permissible medications with only a limited amount of water. In the case of patients that have diabetes or take blood thinners, the doctor issues special instructions regarding food and medications.

Moreover, it is suitable for the patient to be accompanied by a family member or a friend since he/she is not allowed to drive back on his/her own. However, the return to normal activities and the general lifestyle can begin right after the surgery.

The procedure of a Coronary Angioplasty

Before beginning the procedure, the patient is administered with anesthesia. Once the patient is sedated, the surgeon makes an incision on the arm or the groin of the patient and inserts a thin, flexible tube called a catheter inside the blocked artery. A tiny balloon is placed on top of one side of the catheter and the other, a high-quality camera is set up to provide guidance to reach the exact place of the blockage. The doctor uses special dyes to get clear images of the inside of the body. These are displayed on an X-ray monitor for ease.

Once the catheter is at the exact place of blockage, the surgeon inflates the tiny balloon and removes the blockages from the artery. The inflated balloon pushes the accumulated plaque to the sidewalls of the artery. After the blockage is cleared, the blood is restored smoothly.

Post this, the surgeon deflates the balloon and subsequently removes it from the body of the patient. Often, the surgeon places a stent in the affected artery to keep it from closing again. The stent is typically a stainless-steel mesh, which ensures that the arteries do not clog again in the future. In some cases, surgeons use medically coated stents known as drug-eluting stents and prevent recurrence of blockages.

A coronary angioplasty is very useful in cases where a patient has experienced a heart attack. In other cases, this procedure is also very effective in minimizing the chances of heart failure or related complications. However, for the coronary angioplasty to be successful in restoring blood supply, the procedure must be performed in the first hours or immediately after the heart attack.

Recovery after a Coronary Angioplasty

A coronary angioplasty is considered a very safe surgical procedure since it involves a minimally invasive method to restore blood flow. Generally, the procedure involves a shorter recovery time as compared to those of traditional treatment methods. It takes about 3-4 weeks for a normal person to recover after coronary angioplasty. However, in some cases, the recovery time can extend depending on the severity of the patient. That said, the surgeon will advise a few precautions and modifications to be followed for optimum results.

Post Coronary Angioplasty

After the procedure, the doctor will suggest specific lifestyle modifications to ensure good heart health and prevent future blockages in the arteries. Some of these changes will include:

· Indulging in healthy eating including green leafy vegetables, fibre, whole grains, fish, nuts, seeds, low-fat dairy, etc.

· Avoiding saturated fats, trans fat, sodium, cholesterol, sugar, etc.

· Increasing the intake of water and reducing the overall consumption of oil, sugar and sodium.

· Increasing balanced physical exercise

· Regular heart monitoring

· Quitting smoking

· Reducing stress

· Limiting alcohol intake

· Maintaining a healthy weight

· Maintaining appropriate blood sugar, blood pressure and blood cholesterol levels

· Taking all prescribed medicines such as blood thinners, thrombolytics, nitroglycerin, antiplatelets, pain killers, etc.

Overall, it is important for a patient to not rush the recovery process and take it slow as per the advice of the doctor. Moreover, physically stressful activities should be strictly avoided for some time unless permitted by the doctor.

Benefits of a Coronary Angioplasty

Coronary angioplasty is a very common procedure to treat patients after a heart attack. This method is minimally invasive and offers some significant benefits such as:

· Efficient and quick restoration of blood flow to the heart

· Immediately effective. Thus, minimizing any further damage to the heart muscles

· Relieves chronic chest pain

· Prevents acute shortness of breath

· Minimally invasive

· Eradicates the requirement for an open-bypass surgery

· Reduces chances of other heart issues

· Improves kidney functioning

· Shorter recovery period

· Less complicated and safer than an open-heart bypass surgery

· Fewer safety measures

· Easy and fast recovery

· Reduces chances of another heart attack

· Increases chances of survival

Complications and Risks in a Coronary Angioplasty

Generally, coronary angioplasty has very low risks and complications. However, some of the risks in coronary angioplasty include:

· Allergies to the special dye used or anaesthesia, stent, etc.

· Bleeding, clotting or bruising at the point of incision

· Formation of blood clots or scar tissue in the stent

· Irregular heartbeat

· Anxiety

· Damage to the heart vessel or valve

· Tear in the artery (artery dissection)

· Hole in the artery (artery perforation)

· Damage to kidney

· Post-surgery infection or complications

· Medication side-effects

· Stroke

· Heart attack

That said, the risks vary per each case and are mostly temporary and can be easily managed with some treatment. For a coronary angioplasty to be successful, the procedure needs to be followed with dedicated and proper care, preventive measures, and follow-up check-ups.

Permanent Pacemaker

A pacemaker is a device that monitors that beat of the heart and records any erratic movement. When an abnormality in the heartbeat is detected, the pacemaker sends small electrical impulses to the heart muscle to regularise the heart rate. It also helps to stimulate the lower chambers of the heart, known as ventricles. A pacemaker is best suited for patients that have problems such as arrhythmia, fainting spells and congestive heart failure.

The main objective of a pacemaker is to control the irregular heartbeat. The doctor implants a pacemaker in the heart of a patient to treat a slow heartbeat after a heart attack, heart surgery or a drug overdose. Moreover, a permanent pacemaker is also aimed to rectify a prolonged irregular heartbeat or to treat heart failure.

A pacemaker imitates the natural activity of the electrical system of the heart and essentially includes two components:

· Pulse Generator: It is a tiny metal container, which hosts the battery and the electrical circuitry that controls the electrical pulse rate of the heart.

· Leads: Also known as electrodes, these are insulated wires that are situated in the chamber(s) of the heart and transfer the electrical pulses to regulate the uneven heart rate.

With recent advancements, leadless pacemakers are also available for implantation. That said, pacemakers only send out electrical impulses when an irregular heartbeat is detected. The pacemaker sends electrical signals to the heart to correct the beat when the heart starts beating slowly. Moreover, with medical advancements in this field, pacemakers now come with a sensory motion detector that function based on the body motion and breathing rate of the person and accordingly sends signals.

Types of Permanent Pacemakers

Generally, pacemakers are of the below three types:

· Single-chamber pacemakers that transfer electrical impulses to the right ventricle of the heart

· Dual-chamber pacemakers that transfer electrical impulses to the right ventricle and atrium of the heart

· Biventricular help to regulate the abnormal beats by stimulating the lower chambers of the heart

The Procedure of a Permanent Pacemaker Implantation

To prepare the patient for the pacemaker implantation, the doctor gives specific medications through an intravenous line. Moreover, the patient is given local anaesthesia but remains awake throughout the procedure. Once, the patient is sedated, the incision area is sanitized and then the surgeon inserts one or more flexible, insulated wires into a vein situated under or near the collarbone.

These wire/wires are directed to the heart with the help of X-ray images that are displayed on a monitor. One end of the insulated wire/wires is connected to the pulse generator that is implanted under the collarbone skin.

Once the pacemaker is placed, the doctor determines a minimum heart rate and sets the pacemaker accordingly. If the heart rate drops below the specified rate, the pacemaker automatically generates

an electrical impulse, which passes through the lead onto the heart muscle. This, in turn, contracts the heart muscle and creates a heartbeat.

After a Permanent Pacemaker Implantation

Once the pacemaker is permanently implanted in the heart of the patient, the doctor keeps the patient under observation for a day or more as per the condition. If there are no complications and the patient is stabilised, he/she is discharged. However, a family or a friend should accompany the patient back home.

The battery life, the working and the overall heart health can be monitored by the doctor remotely. After the surgery, it is generally recommended to avoid any activities that can cause an exertion to the heart muscle. Moreover, any pressure at the site of the implantation should be avoided. In case, there is any discomfort, pain or other troubling symptoms, medical attention must be sought immediately.

To ensure the pacemaker plantation is successful, the doctor will advise the patient to follow a few precautions such as:

· Using the cell phone from a minimum distance of 6 inches from the pacemaker

· Avoiding activities that involve lingering or leaning against a metal detector

· Maintain a safe distance, not less than 2 feet, from any power-generating objects such as welding machines, high-voltage transformers, generators, etc.

Moreover, in case the patient undergoes any other surgery, test or imaging exam in the future while the pacemaker is in place, the concerned doctor should be duly informed beforehand.

Risks of a Permanent Pacemaker Implantation

A pacemaker implantation surgery is considered a very safe surgical procedure and has minimal risks. Some of the risks associated with rare cases include:

· Infection at the pacemaker implantation site

· The allergic reaction of the special dye or anaesthesia used during the procedure

· Chances of swelling, bruising or bleeding at the site of the incision

· Injury to the nearby blood vessels and tissues

· Collapsed lungs

Results of a Permanent Pacemaker Implantation

The pacemaker helps to regulate the heart rate of the patient and ensure a healthy heart. It is a close-to-natural imitation of the heart’s electrical activity. However, a patient with a pacemaker might need to follow some specific precautions to ensure there are no complications and the pacemaker continues to function effectively.

The patient must discuss all fears, lifestyle modifications, precautions, medications, safety measures, etc. with the doctor after the surgery. That said, a pacemaker is not a hindrance in life, instead it effectively improves the quality of life of the patient. In some cases, the patients can take a few days to adjust to the pacemaker. But as days pass by, the body starts to naturally adopt the new machine. Hence, the patient can easily carry on with everyday life without thinking about it.

Overall, a pacemaker improves the heart condition and rectifies issues that occur due to slow heartbeat such as fatigue, fainting, lightheadedness, etc. But to maintain the heart-health, it is important to get the condition of the pacemaker checked every three to six months. Further, if there are any symptoms such as swollen legs, fainting, unexplainable weight gain, etc. – the patient must inform the doctor. Also, typically pacemakers have a battery life of 15 years and need to be replaced via a small and simple procedure.

Angioplasty and Stent

Heart attacks have been a major cause of human mortality since ages. Most of the deaths occur due to improper treatment of the patient. That said, procedures such as angioplasty and stenting have proven very useful in treating patients after a heart attack or in other conditions that require restoring blood flow to the heart muscle.

Angioplasty

Also referred to as balloon angioplasty or coronary angioplasty, this procedure involves restoring the blood flow to the heart after a heart attack or otherwise in case of blockages. An angioplasty helps to remove the blockage in the artery caused due to build-up of plaque. This minimally-invasive technique eliminated the blockage, widens the artery for smooth flow of blood, to ensure good heart health. 

An angioplasty has recently gained a lot of popularity because it is a safer procedure than open-heart surgery. In this method, the surgeon makes in an incision in the arm or the groin of the patient and then inserts a thin, fine tube called a catheter mounted with a tiny balloon into the blocked artery. The catheter is guided to the exact place of the blockage through the use of special dyes and X-ray images. After the catheter is in the right place, the tiny balloon mounted on top is inflated. This pushes the plaque that caused blockage to the sides, thus, clearing the artery and allowing the blood to flow to the heart muscle in full. After the blockage is removed and the blood flow is restored, the surgeon deflates the balloon, removes it from the patient’s body and then closes the incision. 

Stent Placement

In some cases, after angioplasty, the patient still requires a definitive treatment to stop the recurrence of the blockage. Hence, the surgeon places a stainless steel mesh, called a stent in the blocked artery to keep it from closing again. These stents are put on top of the balloon on the catheter. When the catheter opens the balloon inside the heart, the stent also opens up and reinforces the walls of the artery. This helps to avoid blockage and thus, improve heart health for a long-term. Some patients are given medically-coated stents to avoid narrowing of arteries.

Life after Angioplasty and Stent Placement

Both angioplasty and stent placement are very critical surgical procedures to ensure good heart health and save the lives of patients after a heart attack. Moreover, since this is a minimally-invasive procedure, the benefits outweigh the risks. However, the recovery can take a few weeks and must be done with consultation from the doctor. Moreover, to ensure lifelong heart health, the patient will need regular checkups, a review of the stents timely, and certain strict lifestyle amendments, such as:

No Smoking: After angioplasty or stenting, the patient is not allowed to smoke tobacco or related products. These products damage the lining of the arteries, thus, triggering the creation of fat, known as plaque. This further leads to narrowing and then blocking of arteries. However, even non-smokers should be very cautious since passive smoking can also have similar effects on heart health and increase the risks of blockages in arteries.

Regular Medications: In all cases, post an angioplasty or stent placement, the doctor will recommend certain medications to the patient. The patient must ensure to take all medicines timely to enhance the recovery of the heart, allowing it to gain strength. Some medications that are usually prescribed for heart patients suffering from blockages include:

  • Blood thinners to restore blood flow
  • Thrombolytics to dissolve clots
  • Nitroglycerin to widen blood vessels
  • Antiplatelet to prevent new clots
  • Pain killers to ease discomfort and pain

Healthy Diet: After angioplasty and stent placement, the patient will need to adopt a healthy diet to avoid recurrence of the problem. All kinds of unhealthy food items such as carbonated drinks, packaged food and other items high in high in cholesterol, sodium, trans fat, etc. should be avoided. The patient should include more green leafy vegetables, whole grains, seeds, low-fat dairy, fibre, etc. in the diet. 

Easy Physical Activity: A major cause of artery blockage is physical inactivity. Hence, to ensure that the blockage or narrowing of the artery does not happen again, the patient must adopt a balanced physical activity regime. However, no strenuous workouts such as weight lifting, bodybuilding, etc. should be done without first consulting the doctor. Generally, it is advisable to follow low-to-moderate physical activities such as walk, jogging, etc. No item weighing more than 10 pounds should be picked up by the patient up until six weeks of angioplasty and stent placement. Also, sexual activity should be resumed only after speaking to the doctor.

Healthy Weight: After the surgery, weight management for the patient might become a critical issue. Unhealthy weight increases or obesity can further increase the risk of heart problems. Hence, the patient must ensure to maintain a healthy weight after the surgery. Soft, supervised and balanced physical exercise along with healthy eating should be adapted to ensure good heart health overall.

Limited Alcohol Intake: Alcohol is limited and in most cases is restricted for patients recovering after stent placement or angioplasty. However, in cases where the alcohol intake is only minimized, a patient must set strict limits on the quantity and frequency of drinking. Excessive consumption of alcohol increases the risk of high blood pressure, obesity, cardiomyopathy, stroke, etc. 

Follow-up tests: A patient also needs to get more attentive, alert and take necessary precautions to ensure the problem does not occur again. Regular heart check-ups must be done to keep a check on blood glucose levels, cholesterol levels, etc.

Overall, angioplasty and stent placement can provide effective results for a lifetime, provided appropriate care and precautions are taken to ensure good heart health.

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