Dr Naveen Bhamri-Head Of Department & Director Interventional Cardiology at Max Super Speciality Hospital, Shalimar Bagh, New Delhi.

Dr Naveen Bhamri- MD (Medicine), DM (Cardiology), FSCAI (USA), FESC- is HOD and & Director Interventional Cardiology at Max Super Specialty Hospital, Shalimar Bagh, New Delhi. In recognition of his knowledge & contribution, he has been conferred in fellowship of Cardiovascular Angiography and Interventions,- USA and European Society of Cardiology. With 21 years of experience as a cardiologist, Dr Bhamri has performed more than 23000 angiography, 8000 Angioplasties, 600 device implants (Pacemaker, AICD, CRT, CRT D, Leadless Pacemaker), 250 Balloon Valvuloplasty, 500 Peripheral Angioplasty (Carotid, Vertebral, Iliac, Femoral, Popliteal) Coli Embolisation of Tumors and has special interest in management of Pulmonary Embolism by Drugs and Devices. Dr Bhamri has attended various National and International conferences, both as a faculty and presenter, in USA, Europe, Singapore, South Africa, Japan, and has also chaired many conferences. He is also a researcher and has authored many chapters He is a distinguished member of FSCAI, FESC, CSIi, API and IMA. For his contributions, he has been conferred many awards like Vashistha Chikitsa Ratan Award

Blogs by Dr Naveen Bhamri, HOD and & Director Interventional Cardiology at Max Super Specialty Hospital, Shalimar Bagh.

Be True to Your Heart

With rising number of cases, timely medical care and invasive life saving procedures such as angioplasty and coronary artery bypass are known to save lives. Patients who have angina that suddenly worsens, angioplasty and stent placement can restore blood flow to the oxygen-starved heart, easing the pain within 30 minutes — the average time for the procedure. Once the patients recover, they are able to exercise longer than before. In addition, the procedure
lowers their risk of death.

However, every heart disease requires a disease management plan. Cardiology has improved itself, with advent of latest techniques, and the best of stents are now available to improve the results. Invasive coronary angiography is the standard technique since the past four decades. Although it has stood the test of time, many shortcomings also have been uncovered. It is an eye ball evaluation of artery by an examiner. A lesion which may be significant, requiring treatment in terms of stent implantation to one cardiologist, may be insignificant, requiring only medical therapy to another. This becomes a source of immense confusion for the patient’s mind. Newer technologies like FFR help in evaluating the right lesions (point of disease), as functional assessment is more necessary than quantitative assessment by angiography only. This technique help remove dilemma from minds of doctors and patients. It is not always necessary that all patients having coronary artery disease have
to be treated by angioplasty or bypass surgery, sometimes management through medicines alone is sufficient.

Even one of the trials also suggested that patients with stable heart disease might do equally well with medicines only. Medicines include blood thinning medications, cholesterol lowering medications, and medicines to normalise the heart rate.

It is extremely important, if you are a heart patient, that you discuss the possible treatment options with your cardiologist, best suited to your clinical condition. Besides, an active and healthy lifestyle with a balanced diet is equally important to reduce your risk of heart diseases and evade the need for angioplasty.

Save Your Heart with Latest Technologies

Everyday we see an ad on TV suggesting “bhaag daud bhari zindagi mein rukna mana hai”. But then we also come across a scenario where there is an emergency in the form of a heart attack. India is fast the becoming the capital of heart disease. The disease itself is becoming complex in nature and is challenging doctors.

Cardiology has improved with the advent of the latest techniques and the best of stents are now available. Invasive coronary angiography is the standard technique since the past four decades. Although it has stood the test of time, many shortcomings also have been uncovered. It is an eyeball evaluation of the artery by the examiner. A lesion which may be significant, requiring treatment in terms of stent implantation to one cardiologist, may be insignificant requiring only medical therapy to another. This becomes a source of immense confusion to the patient. Newer technologies

like FFR help evaluate the right lesions (point of disease) as functional assessment is more necessary than quantitative assessment by angiography only. Many lesions create confusion in the minds of doctors and this technique helps remove that dilemma. It is also not always necessary that all patients with coronary artery disease have to be treated by angioplasty or bypass surgery, sometime management through medicines alone is sufficient.

Once a physician decides to stent the diseased artery, then a successful outcome depends on the correct placement of stents with right size and length. Therapies like Optical Coherence Tomography(OCT) help in correct visual assessment, as one can see inside the artery in a 3D manner, for right assessment of the lesion for diameter and length and also helps in checking post stenting results.

These techniques ensure right short and long term safety of the patient with a better quality of life.

Harnessing the Power of Digital Health to Improve Awareness, Prevention and Management of CVD Globally

During the COVID-19 pandemic, patients and their families preferred online consultations to avoid the exposures associated with going to clinics and interestingly, the outcome was quite beneficiary, indicating the benefits that digital health solutions could provide to patients. Cardiovascular disease (CVD) is the main cause of loss of life in most adults around the world. There has been a rise in CVDs in recent years, and preventive interventions are now seen as one of the key public health priorities. Digital technology is on the way to revolutionize heart health care as these tools have a great potential to improve our ability to prevent, accurately track, diagnose and treat disease effectively. These technologies will not only make users more informative about their health but also help in early diagnosis of diseases. The use of smart phones, internet applications, sleep trackers, blood pressure monitors, glucose and oxygen level sensors are providing valuable information to monitor cardio health and a roadmap to improve patient lifestyles and manage heart care easily. It also helps in ascertaining signs of new ailments or the change in prevailing heart conditions.

Many hospitals have started tele/digital health services for new patients and also for those who have undergone surgeries and are recovering.. Post-surgery patients are being equipped with the tools necessary to monitor their own vital signs and reach out to medical professionals. These services are quite beneficial for patients living far off. By harnessing the power of digital health, we will be able to help transform the healthcare system by reducing costs, improving quality health services and patient satisfaction. Investment on digital health will also benefit patients living in remotes having commuting issues to receive specialty cardio healthcare services.

Implantable devices like pacemaker and CVD or CRT devices that automatically record and transmit data can be used for enhanced home-based monitoring as these have the ability to provide continuous observation and identify relevant problems. Digital health also reduces the volume of device clinic visits and provides early detection of patient or device related problems.

Like every innovative adaptation, digital health also has its own challenges especially in India where providing health care facilities to rural parts of India is a real big task. Lack of buying and maintenance capacity of digital health equipment and digital infrastructure will create a major obstruction for overall implementation of digital health.

Even though the effect of digital health technologies on cardiovascular diseases has to go a long way, Keeping in view most cardiologists’ heavy schedules; there is an urgent need to integrate advanced digital solutions into existing medical solutions to get the maximum from digital healthe. There is also a committed need to invest in compiling healthcare and pharmaceutical data and analysing the same by experts to ascertain strengths and weaknesses to improve CVD digital health.

Air Pollution and your Heart Health

The impact of air pollution on people’s health has become a major topic of global health concern. Nine out of 10 people on the planet breathe polluted air, which is increasing at an alarming rate in major cities. The risk of stroke and cardiovascular disease, as well as other chronic diseases, is increasing as the quality of urban air deteriorates. There has been an unusual increase in hospitalisation cases owing to heart illness in recent years, and it is now clear that patients with health condition are more vulnerable to air pollutants. Pollutants can harm your heart and circulatory system by causing damage to the inside walls of blood vessels, narrowing and hardening them, affecting your heartbeats, and making your blood more likely to clot.

How can we protect ourselves from air pollution?
The most important thing is to use techniques to determine air quality. You may do this with your smartphone or air quality monitors. Consume a well-balanced diet rich in green vegetables, fruits, and whole grains, as well as plenty of water, to keep your body hydrated and resist the health risks associated with air pollution. A well-balanced diet rich in important vitamins and nutrients benefits in the body’s immune system’s strengthening. Exercising is essential because it eliminates pollutants from the bloodstream, increases blood circulation, and promotes heart function. When in polluted areas, however, indoor light exercise is advised.

If you experience shortness of breath, chest pressure, or pain, you should stop exercising. Maintain a healthy BMI. Stop smoking, drink in moderation, and wear a mask when outside. Patients with pre-existing medical conditions should take extra precautions and visit their doctors on a regular basis, in addition to taking the steps outlined above on days when the air quality is severe.

Hypertension- Diagnosis & Management

Hypertension, commonly known as high blood pressure, is a condition in which blood pressure is higher than normal. Blood pressure naturally rises and falls during the day, but if it remains high for an extended period of time, it can harm your heart and cause health concerns.

According to a study, hypertension affects approximately 33% of urban Indians and 25% of rural Indians. Hypertension has a significant public health impact on cardiovascular health and healthcare systems, it is a major risk factor for heart disease, stroke, as well as heart attack and heart failure, in India, it is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease (CHD) deaths.

Controlling blood pressure is critical for maintaining health and minimizing the risk of some of the life-threatening diseases. High blood pressure can exist without creating any symptoms for years. Blood pressure readings on a regular basis might assist you and your doctor in detecting any changes in the same.

If your blood pressure is high, your doctor may want you to check it again in a few weeks to determine if it remains high or falls back to normal. Blood pressure should be less than 120/80 mm/hg in order to be considered healthy. In most cases, a combination of elements such as genetics, obesity, excessive alcohol use, a sedentary lifestyle, diabetes, and a high sodium intake play a crucial role in the improvement of hypertension.

Reducing risk factors for Hypertension
The best first-line treatment for hypertension is to maintain an active and healthy lifestyle. If you have hypertension risk factors, you can follow the activities outlined below to reduce your risk of the condition and its complications.

Consume more fruits and vegetables
Limit refined sugar and stay away from packaged foods
Reduce your sodium intake by cooking fresh foods more frequently
Limiting your intake of fast food
Set weight-loss objectives by eating a more nutritious diet and exercising more
Relaxation activities such as meditation, yoga, and long walks can help relieve stress.

Things to know about Blood Pressure
There are a few things you should know about blood pressure.

The new blood pressure guidelines don’t offer different recommendations for people younger or older than age 65. The guidelines state that normal blood pressure is under 120/80, elevated- 120-129 and less than 80, High Blood pressure stage 1 =130-139 or 80-89, High Blood pressure stage 2 =140 or higher or 90 or Higher Hypertensive crisis= Higher than 180and/0r higher than 120- Time to call your doctor immediately

E R E C T is simple mnemonic to know causes for High blood pressure
E – stands for Essential Hypertension which means it has no cause and is found in 85% of people
R – stands for Renal/Kidney related cause for hypertension like kidney stones, kidney failure, etc
E – stands for Endocrine causes for hypertension like Tumours of Adrenal gland situated just above kidneys or excess consumption of steroids or oral contraceptives
C – stands for Coarctation of aorta a birth defect in aorta which is major blood vessel coming out of heart which needs correction
T – stands Toxemia of pregnancy which happens during second or third trimester of pregnancy

Facts about blood pressure
And Finally, don’t forget to keep in mind the following facts about blood pressure.

Except for essential hypertension all other causes are for hypertension are curable
The difference between Hypertensive Urgency and Emergency.
Hypertensive urgency is when your blood pressure is extremely high, but your doctor doesn’t suspect you have any damage to your organs. In hypertensive emergency, your blood pressure is extremely high and has caused damage to your organs. An emergency hypertensive crisis can be associated with life-threatening complications.
To monitor your blood pressure regularly, Keep a log of your blood pressure readings and take it to your regular doctor appointments. This can help your doctor see any possible problems before the condition advances.

Heart Attack and Emergency Medical Care

Heart attacks are caused by interruption of blood supply to part of the heart resulting in stopping oxygen supply to the heart. The interrupted oxygen flow can damage or destroy part of the heart muscle. If someone or you have a heart attack, here’s how to get through it.
A heart attack usually causes chest pain that lasts more than 15 minutes, although it can sometimes occur with no symptoms at all. Many people who experience a heart attack have warning signs hours or days in advance.

Symptoms of Heart Attack
Below are the symptoms to know if you’re suffering from a heart attack-

Uncomfortable pressure, Pain in the center of the chest
Discomfort or discomfort moving from the chest to the shoulders, neck, mouth, teeth, one or both arms
Shortness of breath, dizziness, fainting, Sweating, Nausea.

What to do with heart attack patient?
Below are the things a person can do if someone may be having a heart attack

Call an ambulance or your nearest hospital emergency number as soon as possible. If you are alone and find it difficult to contact an emergency number, have a neighbor or a friend drive you to the nearest hospital. The sooner a person arrives at the emergency room, the better are the chances of survival and lowers the degree of cardiac damage
Swallow an aspirin, unless you are allergic to aspirin
Allow the person to get into the position that he/she is most comfortable in
Try to stay as calm as possible. Anxiety increases the heart’s need for oxygen and worsens a heart attack.
Not everyone who has a heart attack needs CPR because not all heart attacks cause the heart to stop beating. Begin CPR if the person who might be having a heart attack and he or she is unconscious.

What not to do in case of a heart attack?
Do not deny the symptoms and convince yourself to not call for emergency help.
Do not apply pressure on the chest or cough repeatedly. This is a myth that at the time of heart attack, applying pressure or coughing helps in restoring normal heart beat.
Eating and drinking during a heart attack is discouraged as far as possible because heart attack sufferers have a high chance of vomiting and hence may choke or vomit.
What are controllable risk factors for a heart attack?
Prevention is always better than cure. Take the following steps to control the risk factors associated with cardiac attack/disease:-

Quit smoking
Keep blood pressure, cholesterol, and sugar levels in good control
Exercise regularly to improve heart health
Go for a heart-healthy diet
Limit your alcohol intake.

Poor Heart Function- Causes and Solutions

The human heart is the powerhouse of the body that pumps blood throughout the body via the vessels of the circulatory system, supplying oxygen and nutrients to the tissues and removing carbon dioxide and other wastes to sustain life. It beats (expands and contracts) 100,000 times per day, pumping approximately 2,000 gallons per day.

Blood is pumped out of the two lower chambers (ventricles) of the heart when it contracts. The ventricles are refilled with blood when your heart relaxes or expands. The amount of blood pumped out of a filled ventricle with each heartbeat is referred to as “ejection fraction,” and it indicates how well your heart’s left ventricle is functioning.

The major pumping chamber of the heart is the left ventricle. It transfers oxygen-rich blood to the rest of your body through your main artery. An ejection fraction of 60% means that every time your heart beats, your heart pumps 60% of your blood out of your left ventricle. Generally, the standard ejection fraction range is between 55 and 70 percent. When your ejection fraction goes below 55 percent, you have low ejection fraction, also known as low EF. It indicates that your heart isn’t performing as efficiently as it should.

A low number can have serious consequences. You’re at risk of developing a serious arrythmia or possibly heart failure if your ejection fraction is less than 35 percent. Echo test is the best way to check how well your heart functions.

Low ejection fraction causes
The presence of a low ejection fraction is usually indicative of underlying cardiac disease. Low ejection fraction can be caused by various heart and vascular disorders, including:

Cardiomyopathy – A condition that causes your heart muscle to grow, thicken, or stiffen.
Coronary artery disease – It occurs when plaque forms in the two main arteries supplying blood to the heart, obstructing blood flow.
Heart attack– It occurs when blood flow to the heart muscle is obstructed and damaged.
Heart valve disease occurs when one or more of your heart valves do not open and close as they should. Systolic heart failure occurs when the left ventricle of your heart cannot pump blood as strongly as it should.
Implantable cardiac defibrillator (ICD), a device that provides mild electrical pulses to your heart to reestablish a healthy rhythm, particularly in the case of arrythmias, which cause your heart to stop breathing
Heart transplant when other treatments are unable to help dangerously low ejection fraction and severe heart problems

High Blood Pressure and Winter Season

High blood pressure, also called hypertension, is blood pressure that is higher than normal i.e 120/80. The higher your blood pressure levels, the more risk you have for other health problems, such as heart disease, heart attack, and stroke. Get More details on hypertension diagnosis & Management.

Cold weather causes narrowing of blood vessels and arteries, leading to restricted blood flow, high blood pressure, and a limited supply of oxygen to the heart, causing hypertension to worsen and increases the risk of heart attack and other cardiovascular ailments.

Winter also causes people to skip exercise, eat more greasy foods, and gain weight. People who are healthy and without any medical history may bear the impacts of a weather change, but patients with instances of heart disease will begin to exhibit symptoms that may necessitate immediate medical attention.

If you already have high blood pressure, continue to monitor your readings as the seasons change and consult your doctor when you notice change in your readings. In winters, a rise in the cardiovascular mortality has also been observed.

Tips to control high blood pressure in winter
Follow the below given tips to control high blood pressure in winter season

Limit outdoor activity to reduce sudden changes in heart function.
Avoid extreme exertion
Always cover yourself well, when stepping outside to minimise the exposure to outdoor temperature
Limit your alcohol and caffeine intake
Quit Smoking
Limit your salt intake
Eat well-balanced diet consisting of a variety of vegetables and food rich in potassium and nutrients that help lower blood pressure.
Avoid trans fats, hydrogenated vegetable oils, and processed fast foods
During the winter, the elderly are the most vulnerable to suffer from heart problems. They should keep themselves sufficiently warm to avoid heart discomfort.

Pulmonary Embolism: Symptoms & Prevention

Pulmonary Embolism is a condition in which one or more arteries in the lungs are blocked by a blood clot. It is a life-threatening condition that is caused by a blood clot in the leg known as deep vein thrombosis that breaks free and travels via the bloodstream to the lung. Pulmonary Embolism can result in irreversible lung damage, low oxygen levels in your blood, and damage other organs as a result of the low oxygen level.

Unfortunately, diagnosing PE is challenging, especially in those who have an underlying heart or lung illness. Your doctor can make a diagnosis based on your medical history, blood tests, and imaging tests such as echocardiography, CT Pulmonary Angiography, Ventilation-Perfusion Scan (V/Q scan), Pulmonary Angiography or MRI.

Pulmonary Embolism Symptoms
Some of the Symptoms of Pulmonary Embolism are:-

Shortness of breath, Chest pain
Cough, which may contain blood
Leg pain or swelled leg
Back Pain
Unreasonable sweating
Dizziness or light headedness
Blueish lips or nails

Prevention of Pulmonary Embolism
PULMONARY EMBOLISM (PE) can be prevented by not allowing clot formation and this can be done so by

Lifestyle changes with healthy eating, exercise, and quitting smoking
Using compression stockings to prevent deep vein thrombosis (DVT)
Moving your legs, when sitting for lengthy periods of time, or when on bed rest for medical or post-surgery reasons

Avoiding continuous long driving and long sitting
If you have PULMONARY EMBOLISM (PE), you should seek medical treatment straight away. The treatment’s purpose is to break up clots and prevent new clots from developing.

Treatment options include blood thinners (anticoagulants), clot dissolvers (thrombolytics), and surgical clot removal treatments. It’s critical to take your medications exactly as directed because the effects of some anticoagulant medications can fade off within a day.

To avoid repeated blood clots, you will normally be advised to take these medications for at least three months. Some persons with life-threatening pulmonary embolism, repeated clots, or an unprovoked clot, on the other hand, may be advised to continue taking the medicine continuously.

Is coughing a symptom of heart failure?

The majority of cough symptoms are frequently linked to lung problems. However, few people are unaware that a chronic cough can also be a sign of heart failure.

People with heart failure may experience a chronic cough that may contain blood on occasion. This is most common when heart failure has progressed to an advanced degree. People must know whether their chronic cough is an indication of heart failure and, if so, what steps they should take to maintain a healthy and safe life. Here’s everything you need to know about the link between a cough and heart failure.

What is Heart Failure?
This medical problem develops when the heart muscles cannot pump blood effectively. This is a chronic and progressive heart problem commonly caused by coronary artery disease, hypertension, and heart valve disease, among other disorders.

Cough and Heart Failure: Is There a Link?
Congestion in the lungs is a problem that arises when the heart muscle is weak. This occurs when blood flowing from the lungs to the heart backs up, causing fluid to leak into the lungs’ airspace (alveoli). As a result of the congestion, a cough develops.

Heart failure coughs are often accompanied by heavy wheezing and hard breathing. Patients in the advanced stages cough with frothy sputum and blood droplets.

There’s one additional thing patients should remember
Coughing isn’t always an indication of heart failure; it could also be a side effect of the heart failure medicines you’re taking. The cough that develops as a side effect, on the other hand, is irritatingly dry and causes throat irritation.

One can consult a cardiologist to clarify any questions about this differentiation in a cough. Here you can contact Dr Naveen Bhamri, the best interventional cardiologist in delhi, providing world-class cardiac treatment to their patients. He not only focuses on the treatment but also educates patients about the treatment and the medication’s negative effects, if there are any.

Symptoms of Heart Failure
The following symptoms, in addition to coughing, can indicate heart failure:-

Heartbeats that are fast or irregular
Swelling of the abdomen
Shortness of breath when doing anything activity
Fatigue and weakness
Urination is more frequent at night.
If a person has the symptoms listed above plus a persistent cough, they should see a doctor instead of guessing about a possible health problem.

A cardiac cough is usually an indication of deteriorating heart failure. The best thing a patient can do to avoid a deadly situation is to get treatment as soon as possible and begin living a healthy lifestyle.