One in four people leave work a year after a heart attack

One in four people leave work a year after a heart attack


Dr KK Aggarwal

Most people leave their job within a year of returning to work after having a heart attack, says a study reported in the Journal of the American Heart Association. Patients aged between 30 and 39 years and those between 60 and 65 years reported the highest rate of work dropout after return to work.

About 91% of the 22,394 heart attack patients who were employed before hospitalization for a first-time heart attack, returned to work within a year of the episode. But, within a year of resuming work, 24.2% of them left their jobs and were supported by social benefits.

Comorbid heart failure, arrhythmia, and depression, diabetes were found to be the clinical risk factors for unemployment. Patients with high income and high education level were more likely to remain employed, compared with those with lower educational and income levels.

Several factors – medical, economic, psychosocial – influence return to work following a heart attack. As doctors we take care of the medical factors, drug therapy, managing complications and secondary prevention. But, being part of the multidisciplinary cardiac rehabilitation team, it is equally important to take care of psychosocial factors that may affect recovery of a patient.

This study brings into focus the rehabilitation of post-MI patients and shows that return to work may not be a valid measure of successful recovery of working capacity.

Besides improving functional capacity, cardiac rehabilitation also supports a patient in returning to work following a heart attack. Hence, the rehabilitation of each patient should take into consideration the individual physical, psychological and social challenges of the patient. Post-MI patients, particularly the young patients and those with comorbidities and poorer socioeconomic status should receive increased focus on cardiac rehabilitation so that they continue with their jobs even after a heart attack.

(Source: AHA News Release, October 4, 2017)

Pre heart attack symptoms: Don’t ignore ‘soft’ symptoms

Pre heart attack symptoms: Don’t ignore ‘soft’ symptoms We come across cases of sudden cardiac death quite often. And, upon enquiring from the family, we find that preceding symptoms in the last 24 hours are common. Most heart attacks, to begin with, are often not painful but recognizable enough in that the condition may present as pressure or discomfort or burning pain in the chest, feeling of fullness in the center of the chest, which may come and go, also called ‘stuttering’ chest pain and increase with activity and relieved with rest. There may also be unexplained exhaustion/fatigue, or unexplained breathlessness or anxiety or nausea. Eventually these symptoms increase in intensity and frequency and present as the classical chest pain of heart attack, unless the patient has diabetes. People often ignore such symptoms. At times, they are in denial about the true cause of such symptoms: “I am too young to have a heart attack”, “All my blood tests are normal”, “My treadmill test is negative”, “I am only a casual smoker” etc. Most are unaware that these ‘soft’ symptoms are important enough to be evaluated by a cardiologist/physician. ‘Soft’ symptoms are early warning symptoms that appear before the actual ‘typical’ presentation of the impending disease and often provide a clue to the diagnosis. Hence, if you suspect that you are experiencing early symptoms of a heart attack or pre heart attack symptoms, it is important to get yourself evaluated. Timely consultation with a doctor and treatment at this stage can avert the onset of disease in many cases, which may be potentially life-threatening in some cases. Just as a ‘smoke detector’ detects smoke, an indicator of fire, such ‘soft’ symptoms should be taken note of as they are warning signs of an oncoming heart attack.

Severe psoriasis may trigger heart attack

Severe psoriasis may trigger heart attack
It is imperative to prevent triggers to avoid the symptoms from becoming worse

New Delhi, 28 August 2017: A study that followed over half a million people for about 5 years has indicated that psoriasis may increase the chances of getting a heart attack. The risk of a heart attack was related to the severity of psoriasis in people. The overactive immune system that triggers psoriasis can cause inflammation which can further infiltrate the arteries of the heart. As per the IMA, patients with one illness may be stricken by another condition which may seem unrelated and sometimes more serious. This is known as a ‘shadow disease’.

Psoriasis is an immune-mediated condition affecting the skin and causes red, flaky, crusty patches of covered with silvery scales. The condition occurs when the immune system mistakes a normal skin cell for a pathogen, and sends out faulty signals that cause overproduction of new skin cells.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Psoriasis is an incurable, long-term (chronic) inflammatory skin condition. The severity of the condition varies --- periodically improving and worsening. At times, the condition may not appear for years and stay in remission. In some people, the symptoms can aggravate in the winter months. The spectrum of this disease ranges from mild with limited involvement of small areas of skin to large, thick plaques to red inflamed skin affecting the entire body surface. There are multiple clinical subtypes of psoriasis. Plaque psoriasis, the most common presentation of psoriasis, most commonly presents with sharply defined erythematous plaques with overlying silvery scale. The scalp, extensor elbows, knees, and back are common locations for plaque psoriasis lesions.”

Psoriatic arthritis occurs in about 30 percent of patients with psoriasis, and precedes the skin manifestations in approximately 15 percent of patients. A diagnosis of psoriasis can be made by history and physical examination in majority of the cases. Occasionally, a skin biopsy is needed to rule out other conditions.

Adding further, Dr Aggarwal, said, “Numerous topical and systemic therapies are available for the treatment of psoriasis. Treatment modalities are chosen on the basis of disease severity, relevant comorbidities, patient preference (including cost and convenience), efficacy, and evaluation of individual patient response.”

Some tips to prevent psoriasis flare up are as follows.
• Reduce stress Stress can have a negative impact on people with psoriasis. The body tends to have an inflammatory reaction to stress in turn leading to a flare-up.
• Avoid certain medications Some medications can interfere with the body’s autoimmune response and cause inflammation, thus triggering psoriasis.
• Prevent skin injuries Injuries to the skin can trigger psoriasis in some people. This is known as the Koebner phenomenon.
• Eat a healthy diet Being obese or overweight appears to make psoriasis symptoms worse. Thus, it’s important to manage your weight by exercising and eating a healthful diet.

Timely diagnosis and treatment imperative during a heart attack

Timely diagnosis and treatment imperative during a heart attack ‘Heart attack guidance for physicians: When to suspect, how to diagnose, what to do?’ a comprehensive guidebook by Dr KK Aggarwal and Dr Sundeep Mishra published in the Indian Heart Journal New Delhi, April 23, 2017: Cerebrovascular diseases have become the number one cause of mortality and morbidity in India. Among these, heart attack is one of the most serious conditions associated with very high morbidity and death rate. General practitioners must recognize the signs early on in order to bring down the high complication rate and follow it up with proper treatment by certified cardiologists. An instructive document titled ‘Heart attack guidance for physicians: When to suspect, how to diagnose, what to do?’ has been published by Dr KK Aggarwal, National President of the Indian Medical Association and Prof. Sundeep Mishra, Professor of Cardiology at AIIMS in the special STEMI Supplement of the Indian Heart Journal. It provides simple guidance on how to suspect and diagnose a heart attack, early treatment, and when to refer a patient with this condition. This information is important not only clinically but from the medico-legal standpoint as well because any delay can worsen survival and even result in death. Speaking on the subject, Padma Shri Awardee Dr KK Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) said, "Heart attack, particularly STEMI, can be totally reversible if diagnosed and treated early. The adage 'Time is Muscle' is extremely relevant in the diagnosis and treatment of this disease. The door-to-balloon time when a heart attack patient arrives in the emergency room until percutaneous coronary intervention is performed to restore blood flow also needs to be considered by physicians. It is therefore important that physicians be trained to recognize any such symptoms right at the onset such that the appropriate guidance can be given without losing out on precious time." There is severe chest discomfort during a heart attack. Deaths occur due to abnormal heart rhythm (ventricular fibrillation) due to electrical instability of the heart or heart failure due to massive heart attack. Occasionally, a heart attack can cause a heart muscle to rupture and this can prove fatal. Adding to this, Prof. Sundeep Mishra, Professor of Cardiology at AIIMS and Editor, Indian Heart Journal said, " It is very important for the first-contact physicians to suspect a heart attack early on, confirm it through an ECG as soon as possible, and refer the patient for revascularization to a center that is better equipped. This is where clear cut guidance for physicians regarding when to suspect a heart attack, how to confirm it, and how to proceed when a diagnosis is made assumes utmost importance and the instructive document will be like a comprehensive guide to this and more." Following are the signs and symptoms of a heart attack. • Pain areas: in the area between shoulder blades, arm, chest, chest, jaw, left arm, or upper abdomen • Pain types: can be crushing, like a clenched fist in the chest, radiating from the chest, sudden in the chest, or mild • Pain circumstances: can occur during rest • Whole body: dizziness, fatigue, light-headedness, clammy skin, cold sweat, or sweating • Gastrointestinal: heartburn, indigestion, nausea, or vomiting • Chest: discomfort, fullness, or tightness • Neck: discomfort or tightness • Arm: discomfort or tightness • Also common are anxiety, feeling of impending doom, sensation of an abnormal heartbeat, shortness of breath, or shoulder discomfort. Physicians must also raise awareness about the preventable aspect of heart disease. Simple lifestyle modifications such as consuming a healthy diet, exercising regularly, cessation of alcohol consumption and smoking and effective stress management techniques can go a long way in helping reduce the risk of heart attacks.

Living alone after heart attack can be risky

Living alone after heart attack can be risky New Delhi, April 7, 2017: "Living alone after a heart attack increases the chances of death in the next four years. Heart patients are more prone to depression and mental health issues making family and social support crucial," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and National President IMA. Citing a recent study published in the American Journal of Cardiology, Dr KK Aggarwal further added that the chances of death one year after a heart attack was roughly the same for individuals living alone compared to those living with someone else. However, patients who lived alone had 35% greater risk of death at four years after the heart attack. “Social support greatly influences the outcome of an illness. It not only enhances physical health but also mental health. Family support, including that of their friends, helps these patients to recover and lead a good quality life”, said Dr RN Tandon, Honorary Secretary General IMA. Lack of social support in people who live alone hampers their recovery. They do not have the assistance they need to take their medicines, the motivation to follow the prescribed exercise regime, and keep up with follow-up visits to their doctor.

Your BMI is valuable to calculate your risk of heart attack

Your BMI is valuable to calculate your risk of heart attack High body mass index is a major risk factor for a variety of cardiovascular ailments. Keeping obesity in check through regular BMI monitoring can significantly reduce a risk of major coronary episodes, including heart attack. New Delhi, March 14, 2016: Certain risk factors contribute to the risk of a heart attack in an individual. Some of these risk factors are beyond our control and hence unmodifiable. However, the environmental componenst of predisposition to heart attack can be modified. One such factor is body mass index and it has a huge contribution to the development of a future heart attack. The body mass index (BMI) is the most practical way to evaluate the degree of obesity. It is calculated from the height and weight as follows:
BMI = body weight (in kg) ÷ square of stature (height, in meters) Overweight is defined as a BMI between 23 and 30 kg/m2 and obesity as a BMI greater than 30 kg/m2. Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA) in a joint statement said, “Diet has a huge impact on the development of a cardiovascular disorder. Being overweight makes you more likely to develop hypertension, diabetes and atherosclerosis. These conditions can put you at high risk of cardiovascular disease, including a heart attack. It is important to be aware of one’s BMI value to understand your risk of future heart attack. To determine if your weight is linked to an increased risk of heart disease, two measurements are employed- Body Mass Index and waist circumference. Together these values can help you assess if you belong to a high risk category. This will allow the start of preventive measures and lifestyle changes as early as possible.” “If you are less than 40 years of age, male, with a strong family history of diabetes, blood pressure or heart disease, have a normal weight as judged by body mass index (BMI) but have a pot belly, or have gained more than 10 kg since the age 18, do not ignore this and go to your cardiologist to reduce your chances of a future heart attack.”, adds Dr K K Aggarwal. Following are some guidelines dictating how BMI and heart attack correlate: 1. Subjects with a BMI of 23 to 30 kg/m2 may be described as having low risk, while those with a BMI of 30 to 35 kg/m2 are at moderate risk. 2. Subjects with a BMI of 35 to 40 kg/m2 are at high risk, and those with a BMI above 40 kg/m2 are at very high risk from their obesity. 3. At any given level of BMI, the risk to health is increased by more abdominal fat (increased weight to hip ratio, WHR), hyperlipidemia, hypertension, age less than 40 years, male sex, and a strong family history of diabetes, hypertension, or heart disease.

Timely action is of key essence while dealing with patients who have suffered a heart attack, sudden cardiac arrest or stroke

Timely action is of key essence while dealing with patients who have suffered a heart attack, sudden cardiac arrest or stroke New Delhi, 06th October 2016: In India, around a third of the population suffers from degenerative diseases like ischemic heart issues, chronic obstructive pulmonary problems and stroke. These diseases also known as the leading killers were also accountable for 30 percent of all deaths in 2013. Stroke and heart disease are leading causes of death and disability in India. The estimated prevalence rate of stroke in the country ranges from 84-262 per 100,000 population in rural and 334-424 per 100,000 populations in urban areas. Approximately 40% of patients with stroke succumb to their illness. Both heart attack and stroke are caused by interruptions in the normal flow of blood to the heart or brain, the organs that are the most essential to life. This happens when the cells present in the heart and brain don’t get enough access to the oxygen-rich blood and other nutrients. In such a case, these heart and brain cells begin to malfunction and die. This cell death can set off a series of harmful effects throughout the body resulting in familiar symptoms of a heart or brain emergency. However, one must remember is that heart attacks and strokes are not the same. While one affects the heart, the other damages the brain. Speaking about the issue, Padma Shree Awardee Dr KK Aggarwal, President Heart Care Foundation of India and President Elect IMA said, “Stroke-like heart disease is a lifestyle induced ailment aggravated due to obesity, physical inactivity, regular heavy or binge drinking, smoking, hypertension, high cholesterol levels, diabetes, sleep apnea, family history and heart disease. Timely recognition of symptoms and seeking emergency help is key to saving lives. Just like in sudden cardiac arrest deaths every minute lost in performing hands-only CPR decreases the chances of a person's revival by 10%, every minute lost in getting medical attention increases chances of death and disability. India is facing a stroke and heart disease epidemic, and we must work towards amending our high-stress lifestyle to reverse this trend and save lives. ” The most common symptoms of heart attack include crushing chest pain and difficulty breathing. A heart attack might also cause cold sweats, racing heart, pain in the left arm, jaw stiffness, or shoulder pain. Additionally, many don't know that women often have different heart attack symptoms than men. For instance, instead of having chest pain during a heart attack, women may feel exhausted and fatigued or have indigestion and nausea. The symptoms of stroke include sudden difficulty seeing, speaking, or walking, and feelings of weakness, numbness, dizziness, and confusion. Some people get a severe headache that’s immediate and strong, different from any kind they’ve ever had. It is important to differentiate the conditions and seek immediate help when faced with such situations. One should never neglect the even the smallest symptoms. In the case of stroke, the F.A.S.T technique should be used to detect the conditions and save lives. • Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person's smile uneven? • Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward? • Speech Difficulty – Is speech slurred? Is the person unable to speak or hard to understand? Ask the person to repeat a simple sentence, like "The sky is blue." Is the sentence repeated correctly? • If the answers to these questions are yes, then it is Time to call your doctor immediately. Lifestyle changes are also a must. People often remain unaware of the consequences of their choices on their health. The risk of a stroke and heart disease in a smoker is double when compared to a non-smoker. Smoking increases clot formation, thickens the blood, and increases the amount of plaque build-up in the arteries of both he heart and brain. In addition to this, obesity puts a strain on the entire circulatory system. It can also make people more likely to have high cholesterol, high blood pressure and diabetes, all of which can increase stroke and heart disease risk. Alcohol use is also very dangerous. A healthy diet comprising of fruits, vegetables, and low trans fats is a must for the prevention of lifestyle diseases.