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India to bear largest burden of heart diseases globally

Dr. Sai SudhakarWednesday, November 15, 2017, 08:00 Hrs  [IST]

High blood pressure and diabetes contribute significantly to the heart’s inability to pump sufficient blood to meet the body’s needs. India is estimated to account for 60 per cent of heart disease patients worldwide. Heart diseases have emerged as the number one killer among Indians according to findings of the Registrar General of India (RGI) and the Indian Council of Medical Research (ICMR). As the ever changing lifestyles not only continue to increase the incidence of heart diseases but also making patient conditions even more complex.

In India, out of the estimated population of more than 1.27 billion dispersed across various geographical regions, about 45 million people suffer from coronary artery disease. According to current estimates, India will soon have the highest number of cases of cardiovascular disease in the world. It is estimated to account for 35.9 per cent deaths by the year 2030.

Heart failure (HF) is a major problem in the West world and is likely to become a major problem in India. As per projections there are at least 8 to 10 million patients with heart failure in India with a prevalence of about 1 per cent adult population.

Telangana State has the highest percentage of deaths related to heart and pulmonary ailments, according to the Union Home Ministry's report on Medical Certification of Cause of Death (MCCD). The data reveals that the state lost as many as 96,982 lives to diseases of the circulatory system. This accounts for 57 per cent of 1,70,145 medically registered deaths. This is highest in the country, where the national average is 32 per cent.  Andhra Pradesh stood slightly higher than the average at 32.7 per cent. One in five persons with chronic heart failure (CHF) will die within a year of diagnosis

Patients with heart failure in India are younger, sicker and have a much higher morbidity and mortality as compared to their western counterparts. They also do not tolerate the high level of medications recommended in western guidelines. Similarly, devices and other advanced therapies are often too costly and out of reach of many of our sickest patients.

Heart failure is a condition characterized by inability of the heart to pump enough blood to meet the body's needs. Heart failure is a common, serious, costly and potentially fatal condition that requires immediate medical care. In the first year after diagnosis the chance of fatality is about 35 per cent.

Conditions that damage or overwork the heart muscle can cause heart failure and the heart weakens over a period of time. Heart failure often develops after other conditions have damaged or weakened heart. The heart does not need to be weakened to cause heart failure. It can also occurs if the heart becomes too stiff. In heart failure, the main pumping chambers of heart may become stiff and not fill properly between beats. In some cases of heart failure, heart muscle may become damaged and weakened, and the ventricles stretch to the point that the heart cannot pump blood efficiently throughout body.

The most common cause of heart failure is coronary heart disease (CHD), high blood pressure, and diabetes. There are many other diseases and conditions that also can lead to heart failure, such as cardiomyopathy or heart muscle disease, heart valve disease and arrhythmias or irregular heartbeats. Other factors like treatments for cancer, such as radiation and chemotherapy, thyroid disorders, alcohol abuse or cocaine and other illegal drug use or Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) can also injure the heart muscle and cause heart failure. The symptoms of heart failure include tiredness and shortness of breath, excess fluid in lungs, excess fluids around lungs, swelling in abdomen and swellings in ankles and legs, fatigue and weakness, rapid or irregular heartbeat, reduced ability to exercise, and persistent cough or wheezing with white or pink blood-tinged phlegm.

Earlier in time heart failure had no cure but could only be managed through medical management. But, now with the advances depending on the cause Cardiac Resynchronization Therapy (CRT),  Implantable Cardioverter Defibrillator (ICD), ventricular assist devices or a heart transplant may be recommended. Cardiac Resynchronization Therapy is an important new treatment for symptoms associated with heart failure. The Cardiac Resynchronization Therapy procedure involves implanting a small coin size pacemaker just below the collar bone. Some people with severe heart failure or serious irregular heartbeats are candidates for implantable defibrillators. An implantable cardioverter defibrillator is a small device that is placed below the collar bone. An Implantable Cardioverter Defibrillator uses electrical pulses or shocks to help control life-threatening arrhythmias, especially those that can cause sudden cardiac arrest. Implantable cardioverter defibrillator acts as an emergency room in the heart and prevents sudden deaths. Some people have severe, progressive heart failure that can not be helped by medications and lifestyle changes. In such cases a heart transplant may be the only effective treatment. the damaged heart is replaced with a healthy one taken from a donor who has been declared brain dead. The outlook for people with heart transplants is good nowadays with the availability of latest generation immunosuppressive agents and because of this the chances of rejection post transplant have become less. Also due to more awareness and due to increase in the availability of donors more heart transplants have become a reality and a boon for patients with refractory heart failure. Where people who have lived a healthy life after undergoing a heart transplant for more than 20 years and the longest surviving patient is living even after 31 years after a heart transplant. Even for those with a healthy heart precautions should be taken to prevent heart diseases. To reduce heart ailments, one must follow a healthy diet which includes a variety of fruits, vegetables, whole grains, lean meats, poultry, fish, beans and low-fat milk or milk products. Daily exercise and nutritious diet must be added to daily regime.

(Author is chief cardiac transplant physician, senior interventional cardiologist and director of Gleneagles Global Hospitals, Hyderabad)

 
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