Morning MEDtalks with Dr KK Aggarwal 14^th August 2018

Pumping Heart Attack vs Electrical Cardiac Arrest

The most common confusion is the difference between a heart attack and cardiac arrest. A heart attack (myocardial infarction or MI) is defined as damage to part of the heart muscle caused by inadequate blood flow to that area. Most of the time, this happens due to a blockage in one of the heart’s arteries. Known as a type 1 heart attack, such blockages typically occur when cholesterol-laden plaque lining an artery ruptures. A clot forms, obstructing the vessel.

While a heart attack is a plumbing problem, a cardiac arrest is an electrical problem. Cardiac arrest happens when the heart’s electrical system malfunctions, causing it to beat rapidly and chaotically — or to stop beating altogether. Without blood circulating to the brain, lungs, and other organs, the person gasps or stops breathing and becomes unresponsive within seconds.

A heart attack is a common cause of cardiac arrest, but most heart attacks do not lead to cardiac arrest. Other possible causes of cardiac arrest include heart failure, a clot in the lungs, a serious imbalance of potassium, magnesium, or other minerals in the blood, a drug overdose, or a blow to the chest.

The term “widow maker” refers to a heart attack caused by a blockage near the top of the left anterior descending (LAD) artery, the main artery that supplies blood to the front of the heart. However, heart attacks that involve the LAD are not necessarily fatal, and those involving other arteries can be deadly, too.

Common heart attack symptoms include:

1. Uncomfortable pressure, squeezing, or pain in the chest
2. Pain or other uncomfortable sensations in an arm, the back, neck, jaw, or stomach
3. Shortness of breath
4. Sudden nausea or vomiting
5. Lightheadedness or dizziness
6. Unusual fatigue.

Signs of cardiac arrest are a sudden loss of responsiveness and abnormal breathing (either not breathing or only gasping). Give hands-only cardiopulmonary resuscitation (CPR) until help arrives.

Single parenting is a “dangerous concept for society”

Hon’ble Madras High Court Judge Justice N Kirubakaran expounds: Single parenting is a “dangerous concept for society”, leads to behavioural changes in children. He said, “Child needs the affection of both mother and father.” One cannot compensate for the other and the lack of such affection and love might cause behavioural changes, causing the child to turn against society”.

The Bench was hearing a Contempt plea moved against Secretary of the Union Ministry of Women and Child Development for allegedly failing to comply with direction issued by Court to check child abuse.

The High Court observed that it is high time to “bifurcate” Union Ministry of women and child development and establish a dedicated ministry for child development. (TOI)

Studies of bereaved children show that many children develop nonspecific, subclinical, and transient behavioral disturbances in the year following a parent’s death. However, one in five children are at risk for a psychiatric disorder, and a subset of these may be vulnerable to depression.

Controversial digital contraceptive natural cycles cleared by FDA for US marketing

Natural Cycles, a mobile-phone application that can be used to prevent pregnancy, was cleared by the US Food and Drug Administration on Friday for direct-to-consumer marketing. The app, “digital contraception” tells women when they are fertile and should avoid sex or use contraception. The app relies on temperature readings from a basal body thermometer to track a woman’s menstrual cycle, since minor temperature rises occur around the time of ovulation.

According to the FDA, clinical studies involving about 15,600 women determined that, when the app is used perfectly, the failure rate meaning women getting pregnant was 1.8%, while, with typical use, or women sometimes not using the app correctly, the failure rate was 6.5%. Women in the study used the app for an average of eight months. By way of comparison, condoms have a perfect-use failure rate of 2% and a typical-use failure rate of 18%; for IUDs, typical- and perfect-use failure rates are below 1%.

The FDA says the app should not be used by individuals for whom pregnancy would be a major risk to the mother or fetus, nor by women who are using contraception that inhibits ovulation.

Around the globe

1. The Centers for Disease Control and Prevention (CDC) says a popular Kelloggs cereal has been linked to a salmonella outbreak that has infected 100 people in 33 states. "Do not eat this cereal." The agency says it found salmonella in samples of Honey Smacks, which has been subject to a voluntary recall by Kellogg since mid-June.
2. People are continuing to get sick from a nasty parasitic infection the CDC has linked to McDonalds salads, UPI reports. The number of people hit with the Cyclospora parasite rose to 436 this week, up from 395 last week, with cases clustering in the Midwest (Illinois especially) and spreading across 15 states. 
3. As per the WHO Global Status Report on NCDs-2014, India shares more than two-third of the total deaths due to NCDs in the South-East Asia Region (SEAR) of WHO. NCDs contribute to around 5.87 million deaths that account for 60% of all deaths in India. This is a cause for concern given the fact that the figure was 37.9% almost two decades ago, when more than half of the deaths (53.6%) were due to communicable, maternal, neonatal and nutritional diseases.
4. According to International Diabetes Federation (IDF) Diabetes Atlas (7th Edition), China has the largest number of diabetes (11.43 cr.), followed by India (7.29 cr.) in 2017. As per the National Family Health Survey (NFHS-4); 2015-16, 5.8 % women and 8.0 % men in India are having blood sugar level above 140 mg/dl, in the age group of 15-49 years.

Two days walking, 2 days strengthening exercise and 2 days aerobics

Strength training (with free weights, weight machines, or resistance bands) can help build and maintain muscle mass and strength. Strong muscles lead to strong bones. And strong bones can help minimize the risk of fracture due to osteoporosis. A combination of age-related changes, inactivity, and inadequate nutrition conspire to gradually steal bone mass, at the rate of 1% per year after age 40. As bones grow more fragile and susceptible to fracture, they are more likely to break after even a minor fall or a far less obvious stress, such as bending over to tie a shoelace.

Numerous studies have shown that strength training can play a role in slowing bone loss, and several show it can even build bone. And strength training, in particular, has bone benefits beyond those offered by aerobic weight-bearing exercise. It targets bones of the hips, spine, and wrists, which are the sites most likely to fracture.

Anant Bajaj, MD of Bajaj Electricals, dies at 41

Bajaj Electricals managing director Anant Bajaj. Bajaj, who was 41 years old, died of a heart attack on Friday evening.

Although coronary heart disease primarily occurs in patients over the age of 40, younger men and women can be affected. Most studies have used an age cut-off of 40 to 45 years to define "young" patients with heart disease or acute heart attack. In the Framingham Heart Study, the incidence of a heart attack over a 10-year follow-up was 12.9/1000 in men 30 to 34 years old and 5.2/1000 in women 35 to 44 years old. The incidence of heart attack was 8 to 9 times greater in men and women aged 55 to 64 years. In other studies, 4 to 10 percent of patients with MI were ≤40 or 45 years of age.

Although heart attacks are uncommon entity in young patients, it constitutes an important problem for the patient and the treating physician because of the devastating effect of this disease on the more active lifestyle of young patients.

Younger patients with heart disease more often have a family history of premature heart disease. Cigarette smoking is the most common and most modifiable risk factor in young patients. Diabetes mellitus and hypertension appear to be less common in young patients with heart disease than in older patients. Other risk factors such as cocaine use, factor V Leiden, and oral contraceptive (females) use are more common in younger individuals.

The clinical presentation of heart disease in younger patients is different from that in older patients. A higher proportion of young patients do not experience chest pain and often heart attack is the first manifestation of heart disease.

Younger patients have a higher incidence of normal coronary arteries, mild luminal irregularities, and single vessel blockage than do older patients.

Mantras

1. If you can walk 500 meters in six minutes you do not have significant underlying heart disease
2. Everyone should learn the life saving technique of CPR.

Video to watch: What is endothelial dysfunction? https://www.youtube.com/watch?v=sGxHtpvR2oc

Dr KK Aggarwal

Padma Shri Awardee

President HCFI

Vice President CMAAO