a healthy and hearty discussion

In the week leading up to World Heart Day, four cardiologists from Aster Medcity gathered to share their insights and expertise at a panel discussion organized by The Times of India at the newspaper’s Kochi office, with Aster Medcity as the presenting partner. The event was part of the Times Conversation series, an initiative of The Times of India that aims to bring together relevant voices to discuss relevant issues affecting society.
included in the panel Dr. Anil Kumar R, Senior Consultant – Interventional Cardiology; Dr Rajeev C, Senior Consultant – Director, Advanced Heart Valve Center and Interventional Cardiology; Dr Rajshekhar VermaSenior Consultant – Interventional Cardiology; and Dr. Sunil Roy TNSenior Consultant – Interventional Cardiology, All India Medical Sciences Aster Medcity.
Topics discussed during the discussion included the importance of early diagnosis, advances in cardiovascular care – particularly advances related to AI – and lifestyle modifications to help combat the increasing prevalence of cardiovascular diseases. The doctors clearly took inspiration from their own years. of experience, sharing poignant anecdotes from the field and his daily interactions with patients.
sharing expert perspectives
“We are in the midst of a dual epidemic of diabetes and hypertension. Heart attacks are occurring about 10 to 15 years earlier in the Indian population compared to the West,” Dr. Anil Kumar said, opening the discussion. Faced with irrefutable evidence of the high incidence of heart disease in Kerala, with lifestyle being a significant contributor, doctors lamented the reluctance of the average patient to heed medical advice in the state. “Kerala has a well-educated population. The purpose of education was to encourage people to adhere to prescribed treatments. Instead, we are seeing a worrying trend of skepticism and reluctance to take prescribed medication,” Dr Anil said, addressing the climate of mistrust prevalent in patient attitudes towards medication. Dr Rajiv C said, “Recently, when I gave a medicine to a patient to control cholesterol, he asked if it had any side effects. I told him, ‘Yes—you’ll live a long time!’

opportunity for clarification
The doctors saw the conversation as an opportunity to provide some much-needed clarification. He stressed the importance of distinguishing between heart attack and cardiac arrest, as both terms are often used interchangeably and incorrectly.
Dr. Rajasekhar discussed in depth the complex anatomy of the heart and described it as a muscle that begins pumping blood even before birth and continues until death – making a constant blood supply essential. Is. The heart receives its blood from the coronary arteries and their branches.
By early adolescence, fat begins to accumulate in the walls of these blood vessels. Over time, this accumulation increases, and in certain conditions – such as stress or infection – the inner lining of the blood vessel may burst. When blood comes in contact with this cholesterol-rich lining, it reacts by forming a clot, just as it would if it came in contact with a foreign object. This clot can obstruct blood flow, causing a partial or complete blockage. Partial blockage can cause a minor heart attack, while complete blockage causes the blood supply to stop completely, resulting in a major heart attack, where the heart muscle dies due to lack of oxygen. This condition is called heart attack. “Cardiac arrest, on the other hand, means that the entire heart has suddenly stopped contracting,” he concluded.
youth lost their lives
The panel had a concerned and empathetic discussion about the alarming trend of young professionals becoming victims of heart disease at the peak of their careers. Dr Sunil Roy elaborates, “At the peak of their careers, between the ages of 30 and 50, professionals often believe that they are vulnerable to heart attacks. However, it is important to recognize and accurately identify symptoms such as chest pain, discomfort and shortness of breath to prevent a heart attack.

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His advice to young and old: “All adults should know their numbers.” These numbers are for blood pressure, blood sugar, cholesterol and body weight. “Once you know these numbers, you can get your risk factor assessment with an established risk score. Depending on which category you fall in, you need to take action to prevent complications,” said Dr Anil Kumar. In light of work-related stress contributing to heart attacks, he advocated for management to assess the risk of all employees and institute comprehensive health screening to facilitate effective risk management.

Dr. Anil highlighted that new treatment modalities, combined with standardized therapy, can ensure a higher quality of life in 2024. Dr. Sunil recommends consulting a physician before getting tested, as lab results are just numbers without professional interpretation. Dr. Rajeev said unusual symptoms, such as pain in the lower jaw, may specifically indicate angina. Dr. Anil emphasized that any discomfort between the jaw and the navel should never be ignored. Since an ECG may appear normal in the first hours after a heart attack, troponin testing is often necessary. Dr. Rajeev stressed the importance of understanding individual risk factors, as laboratory values ​​labeled ‘normal’ may not apply to everyone. “A laboratory cannot make decisions,” he confirmed.
Modifiable and non-modifiable risk factors
According to the panel, heart attacks indicate a genetic link to heart disease. Dr Rajashekhar Verma said, “At present, most of the treatments are in the secondary stage of the disease. From a preventive perspective, we must engage the entire population to identify risk factors in those at risk before they develop heart disease. There are many modifiable risk factors including smoking, where complete cessation is essential, and effective management of blood sugar levels. Additionally, it is important to control blood pressure; Even minor improvements can yield significant benefits. Cholesterol management is equally important. Diet and exercise also play an important role, as the change from a sedentary lifestyle to a more active one is fundamental. However, we must acknowledge non-modifiable factors such as age, genetics, ancestry, and ethnicity will continue to make individuals vulnerable to certain health conditions. However, by addressing major risk factors, up to 85% of heart disease can be effectively controlled.
Diet is very important, but even the most stringent dietary control has its limits in individuals with extremely high cholesterol. “Only 10 to 15 percent of cholesterol comes from our diet, so dietary changes alone cannot effectively control high cholesterol,” he explains. level. However, adopting a low-carbohydrate diet that reduces fat and added sugars may be beneficial. It is advisable to include fruits and vegetables with fish, while limiting red meat, except shellfish. Egg whites and poultry can be included as healthier options.”
Modifiable risk factors for heart health

time is the cure
Dr. Sunil said, when a heart attack occurs, every second counts. “If the brain is deprived of blood for more than six minutes, the damage to brain tissue becomes irreversible. This is why it is important to restart the heart within this window, making CPR an essential life-saving skill.
Dr. Rajiv emphasized that although it may take some time to respond during a heart attack, there is no delay in cardiac arrest. Dr. Anil stressed the need for defibrillators in public places like railway stations, airports and shopping malls. “If you have cardiac arrest, it is important to immediately begin basic life support (BLS) and get access to a defibrillator,” he said.
Doctors advised that if cardiac arrest occurs at home, Basic Life Support (BLS) should be started immediately, help should be sought and BLS should be continued until help arrives. He emphasized that BLS training should be mandatory in schools and colleges. In the event of a heart attack, the patient should reach the nearest hospital immediately, where the clot can be removed using clot-busting injections or angioplasty – ideally within 90 minutes of arrival. The sooner a person gets to the hospital after a heart attack, the better the chance of preventing cardiac arrest.
“Once a heart attack occurs, if treated promptly, heart function can be preserved and the patient can have a normal quality of life,” shared Dr. Anil Kumar. On why this happens, he said that with modern treatment protocols, the possibility of re-occurrence of blockage has reduced considerably.
India needs better emergency response systems
The doctors unanimously agreed on many issues. Given the challenges of securing ambulances in India, there is an urgent need to improve emergency response systems. To address this, he said, volunteer cardiologists are now visiting schools and colleges, training people in basic CPR – an intervention that can be life-saving. Timely treatment is important, as the first six minutes often determine the outcome. While guidelines allow angioplasty within the first 24 hours, after that window, the benefits must be carefully evaluated. If done timely, a patient can be discharged even the next day after angioplasty, if all goes well, provided time is set aside for rest and recovery, Dr. Rajasekhar said.
impact of ai
Dr. Sunil said that AI will significantly increase the safety and effectiveness of medical procedures. With an AI-enabled echocardiogram machine, nothing will be overlooked, and most readings will be captured accurately. Intravascular imaging will also benefit from AI, providing better image quality. For angiograms, the contrast required may be reduced; A single injection can now achieve the quality of images that previously required five or six injections. Furthermore, AI can predict the development of diseases much earlier, allowing us to assess the chances of heart failure from an AI-enabled ECG reading. The precision of these technologies promises to transform patient outcomes. “We must embrace this change,” Dr. Rajeev said. Dr. Anil concluded, “Will AI replace cardiology? No, but cardiologists who do not adopt AI will be replaced.
Following the medical discussion, doctors expressed that the opportunity to share their views in such a conversation, which can affect multiple individuals at once, is invaluable in raising awareness.
Kerala has a well educated population. The purpose of education was to encourage people to adhere to prescribed treatments. Instead, we are seeing a worrying trend of skepticism and reluctance to take prescribed medication.,Dr. Anil Kumar R, Senior Consultant – Interventional Cardiology, Aster Medcity
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At the peak of their careers, between the ages of 30 and 50, professionals often believe they are vulnerable to heart attacks. However, it is important to recognize and accurately identify symptoms such as chest pain, discomfort and shortness of breath to prevent a heart attack. , Dr. Sunil Roy TN, Senior Consultant – Interventional Cardiology, Aster Medcity
,
Adopting a low-carbohydrate diet that reduces fat and added sugars may be beneficial. It is advisable to include fruits and vegetables along with fish, while limiting red meat, except shellfish. Egg whites and poultry can be included as healthier options.,Dr. Rajiv C, Senior Consultant – Director, Advanced Heart Valve Center and Interventional Cardiology, Aster Medcity
,
There are many modifiable risk factors including smoking, where complete cessation is essential, and effective management of blood sugar levels. Additionally, it is important to control blood pressure; Even minor improvements can yield significant benefits. Cholesterol management is equally important. Diet and exercise also play an important role, as the change from a sedentary lifestyle to a more active one is fundamental. ,Dr. Rajshekhar Verma, Senior Consultant – Interventional Cardiology, Aster Medcity
Contributed by Sarah John
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