Aster Clinics
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The highly-qualified team of cardiologists and support specialists at Aster Clinics provides patients with the latest advances in cardiovascular care

Dr Ashik Sasidharan

Dr Ashik Sasidharan, Specialist Cardiologist, Aster Clinic, Al Qusais (Damascus St.)

What do you think is the one most important thing people should know about heart disease?

The most important thing that one should know about heart disease is that to a great extent it can be prevented and if at all it happens, that it can be treated successfully, except in a very few unfortunate circumstances. No write up on heart disease goes without mentioning about the risk factors. Of the many cardiac risk factors, only a few like advancing age, hereditary predisposition and race are non-modifiable and hence beyond our control.

Most of the other risk factors like high blood sugar and cholesterol and high blood pressure can very well be controlled, with or without medications and with a healthy diet and regular exercise. Needless to say, stop smoking, if you do. Stress, not sure whether to classify as a modifiable or non-modifiable risk factor, can lead to acute cardiac events. Even if stress is non-modifiable for many, dont resort to the conventional “stress lowering” activities like heavy drinking or over eating, which could be even more detrimental to the heart than stress itself.

Though not easy, “sleep like a baby” and ensure that you sleep atleast 7-8 hours daily, so that reduced or disturbed sleep is not a reason why your blood pressure stays high. And last but not the least, if you have a symptom, speak up to a doctor and get a proper opinion on how to approach your symptom and don’t resort to social media for symptom relief. Misleading social media information is the latest modifiable risk factor. So eat healthy, live healthy and have trust in yourself and your doctor. Heart disease is not the end; but just a reminder to follow a healthier lifestyle. Go ahead, peacefully.

Dr Sreeram Gopalakrishnan

Dr Sreeram Gopalakrishnan, Specialist Cardiologist, Aster Clinic, Al Muteena, Deira

We know that high blood pressure and cholesterol, smoking, diabetes, and being overweight are risk factors for heart disease. What other risk factors do you think people should be aware of?

Apart from the widely known risk factors for heart disease there are other risk factors that could significantly increase the risk for heart disease. These are:

* Family history of premature heart disease especially for males <55 years old and females <65 years old.

* Metabolic syndrome as defined by at least three of the following five factors — increased waist circumference (men >102cm and women >88cm), elevated triglycerides (>150 mg/dL], elevated blood pressure (>135/85), elevated fasting glucose (>100mg/dl), and low good cholesterol (HDL-C men <40 and women <50). Metabolic syndrome has been shown to increase the risk for heart disease.

* Lack of exercise with sedentary lifestyle could increase the risk of heart disease significantly by contributing to weight gain and thereby the development of hypertension and diabetes.

* For women, a history of premature menopause (before age 40 years) and history of pregnancy-associated conditions such as hypertension during pregnancy.

* South Asians in general have a higher risk for heart disease when compared to other ethnicities.

* Chronic inflammatory conditions like rheumatoid arthritis, lupus, and psoriasis can also increase the risk for heart disease.

* Chronic prolonged infection as in HIV/AIDS increase the risk of developing heart disease significantly.

* Chronic kidney disease has also been found to increase the risk of heart disease.

* Treatment for cancer with certain forms of chemotherapy and radiation also increases the risk for heart disease by affecting either the heart muscles or blood vessels.

* Low thyroid hormone by affecting cholestrol levels adversely could potentially increase the risk for heart disease.

Dr Anil P Rao Kumar

Dr Anil P Rao Kumar, Specialist Cardiologist, Aster Clinic, Bur Dubai (AJMC)

What patients are most susceptible to heart disease?

Extensive research has identified factors that increase a person’s risk for coronary heart disease in general and heart attack in particular. More the risk factors you have, and the greater the degree of each risk factor, the higher your chance of developing coronary heart disease — a common term for the build-up of plaque in the heart’s arteries that could lead to heart attack. The risk factors fall into three broad categories:

* Major risk factors: Research has shown that these factors significantly increase the risk of heart and blood vessel (cardiovascular) disease.

* Modifiable risk factors: Some major risk factors can be modified, treated or controlled through medications or lifestyle change.

* Contributing risk factors: These factors are associated with increased risk of cardiovascular disease, but their significance and prevalence hasn’t yet been determined.

My family has a history of heart disease. Is there anything I can do?

Your genes are what they are throughout your life, meaning they never change. Fortunately, even for those whose genes may predispose them to heart disease, there are ways to prevent it. Exercising regularly, maintaining a healthy diet, not smoking, managing stress, controlling blood pressure and diabetes and periodic health check-ups are some of the biggest ways you can avoid this unwanted family legacy. All of the things we recommend to minimise the risk of cardiovascular disease apply equally, if not more so, to people with elevated familial or genetic risk.

How do medical providers support to patients in managing chronic heart disease?

Working with your primary care provider, can help ease your worries and make navigating healthcare a bit easier. Depending on the condition, doctors appreciate if patients are tracking their chronic condition — blood pressure or blood sugar — in some way. Those types of measurements can be helpful because it shows that the patient is engaged and it’s a really good way to make adjustments in their medication. Many people are living with multiple chronic diseases, so it’s good to draw clear lines as to which physician is handling what illness.

Dr Arun Asok Cheriyan

Dr Arun Asok Cheriyan, Specialist Cardiologist, Aster Clinic, Discovery Gardens

What are the main causes for arrhythmia or irregular heartbeats? How can the Heart Rhythm Clinic best serve patients suffering from arrhythmia, what are the procedures on offer?

Arrhythmias can be primarily two types — tachyarrhythmias (when the rhythm is fast) and Bradyarrhythmias (when the rhythm is slow). The most common form of tachyarrhythmia is sinus tachycardia where our own normal heart beat originating from the normal SA node (a specialised area in the right upper chamber of our heart) goes at a faster rate. The next commonest form of tachyarrhythmia is ectopics or extra beats. These can be from the upper chambers of the heart when it is called atrial ectopics or from the bottom chambers of the heart when it is called ventricular ectopics. These can be dangerous if not treated as it can cause issues such as heart failure, stroke, loss of consciousness (syncope) or even sudden cardiac death.

The commonest form of Bradyarrhythmia is sinus bradycardia where our own heart beat slows down. This can normally be seen in those undergoing fitness training or sports but when it is abnormal, then it can mean that the SA node is diseased — a condition called sick sinus syndrome. The other forms of bradyarrhythmia are blocks — sino-atrial blocks and atrioventricular blocks. Unlike the blocks in the arteries on top of the heart, which causes heart attack, these kind of blocks are in the electrical system inside the heart. A pacemaker may be needed if these blocks are advanced in nature. Bradyarrhythmias usually present as dizziness, tiredness or even with loss of consciousness.

A heart rhythm clinic (arrhythmia clinic) is where issues such as palpitations, skipped beats, syncope, pacemaker or cardiac resynchronisation therapy programming are sorted out through procedures such as Holter recording, which is a 24-48 hour ECG ambulatory or home ECG recording, ECHO — used for evaluation of cardiac structure and function, for optimising CRT programming and for bubble study that looks for a hole in the heart especially when a young person has a stroke or a person has a stroke in an area, which cannot be explained by a single block in the artery. The tilt table test is another procedure available for evaluation of unexplained syncope or repeated syncope or a syncope without warning.

Dr Mohit Kejariwal

Dr Mohit Kejariwal, Specialist Cardiologist, Aster Clinic, Silicon Oasis & Aster Clinic, Al Khail Mall

Considering the rise in cardiovascular disease in the UAE and large parts of the world, what would you recommend to those at risk from the condition and to keep it at bay?

Since the 1970s, the UAE has undergone a tremendous transformation to an affluent modern state with a high standard of living. This has resulted in drastic lifestyle changes among the inhabitants of the UAE, and, consequently, increase in cardiovascular diseases (CVD). The UAE has a higher prevalence of CVD risk factors among developed countries, and the prevalence of deaths associated with CVD is also higher than the global average. Thus, CVD is the main health threat in the UAE.

Being overweight, high blood pressure, high cholesterol, smoking, mental stress and diabetes are the main modifiable risk factors associated with CVD. I would like to recommend the following changes in lifestyle to all UAE residents to have a healthy heart:

* Anyone above 21 years of age should get his/her fasting blood sugar, total cholesterol and blood pressure checked up once every year and consult a doctor if anything is abnormal.

* Those with blood pressure above 130 systolic and/or 80 diastolic should take low salt diet. Avoid refined salt, salted butter and packed foods. Switch to natural rock salt/Himalayan pink salt.

* Those with fasting blood sugar above 100 mg/dl should take low carbohydrate diet. Avoid rice, potato, sugar, jaggery, honey, fruit juice, cold drinks and refined wheat flour/white bread. Switch to whole wheat flour/brown bread.

* Those with total cholesterol above 200 mg/dl should follow a low fat diet. Avoid refined oil, fried foods, full fat dairy products, red meat and egg yolk. Switch to virgin, cold pressed or filtered oils.