Which Diagnostic Test You would recommend ?

A 58-year-old man is referred to your OPD with a new weight loss. GI Specialist diagnosed

a gastric ulcer on endoscopy, which persists despite regular medical treatment.

Gastric surgery is recommended by the surgeon. The patient also has a history of Coronary Artery disease, which was treated with CABG approximately 4 years ago. The patient is smoker, but he exercises regularly, walking approximately 3 KM a day within an hour. He does not have any complains( dyspnea,angina).

Before giving him clearance for operation, from a cardiac perspective you would recommend

which of the following?

a. A symptom-limited exercise test

b. Resting echocardiography

c. Coronary angiography

d. Sending patient directly to operation Theater

e. Exercise Thallium Test

Please  Leave your comments and explanations in the box below

What Will be the next step in Management of this Patient?

A 69 year old female with significant history of DM Type 2, Diabetic neuropathy, Hypertension and Congestive heart failure is seen at your OPD for regular check-up. Her last echocardiography was done 5 months ago and it revealed an ejection fraction of 50%. Her medications include gabapantin, Sitagliptan, Hydrochlorthiazide and glyburide. Her vitals are BP of 1130/85, HR 88, RR 19 and Temperature 98.4F. Currently She has no fresh complaints . Her physical examination is also normal. There is no jugulovenos distension and her chest is B/L clear on auscultation. Which of the following is the next step in management of the patient?

A. Continue with current therapy and see her in 2 months. 
B. Add Lisinopril
C. Add Carvedilol
D. Add both carvedilol and lisinopril 
E. Stop Hydrochlorthiazide and prescribe Lisinopril. 

Please  Leave your comments and explanations in the box below

Which Drug can Restore the sinus rhythm?

A 55 year old businessman presented in the OPD with a weird fluttering sensation in his chest but it is not so severe. The sensation lasted for last 18 hours. ECG shows AF with Ventricular rate of 135 beats per minute. Which of the following drugs can most likely return sinus rhythm.

1. Verapamil
2. Flecainide
3. Bisoprolol
4. Digoxin
5. Adenosine

Please  Leave your comments and explanations in the box below

Cardiology Clinical Scenario - ECG Analysis

A 50 years old male admitted in the emergency with c/o severe retrosternal chest  associated with sweating.  Patient is a chronic smoker otherwise no other risk factors. Here is the ECG.

Please analyse the ECG and Leave your comments, Diagnosis and explanations in the box below

Clogging Up Of Arteries - Tackle It Before It Happens

Prevention is better than cure.  This simple principle is applicable to everything concerning us, including health matters. Clogging up of arteries is one of the most deadly and common problems related to health that we face these days.  Most people are ignorant on how this happens, why this happens and what are the best measures to prevent this from occurring.  This ignorance is the biggest reason why people die in millions around the world due to heart attacks and other related issues every year. 

Good eating habits and lifestyle practices can help prevent this, but we also need to know about the most effective ways to unclog arteries, in case clogging occurs.  There are three types of arteries in the body that can become clogged.  These are the coronary arteries, carotid arteries and the peripheral arteries.  Clogging up of any of these would result in life-threatening situations. 

Medical science, of late, has advanced so much and as such, there are several types of effective steps available to detect problems in the artery.  It is always better to undergo such tests periodically, after you cross a certain age, to ensure that no impending threat to your heart exists.  The most common and effective diagnostic measures available now are ultrasound, stress tests and angiogram. 

Ultrasound is a non-invasive and simple process that is best suited for people who are doubtful about the condition of their arteries.  In simple terms, we can call it the artery check-up, which is a great tactic to prevent the advent of serious arterial clogs.  It is no wonder that the number of people resorting to this test is increasing day by day. 

Another effective method is the stress test, which is done clinically with the help of a treadmill or similar stress-inducing gadgets.  The subject is made to walk on the mill after attaching wires to his or her body. Once the mill is started, the heart rates would increase, and the doctor would assess, with the help of modern machinery, how the blood vessels and the heart are functioning under the increased work load.  Those unable to use treadmills are put on chemical stress tests, which are almost equally effective. 

Then comes angiogram, which is an invasive test administered on patients suffering from acute artery blockage problems.  The process involves making an incision in the groin area and sending a camera to the heart through the slit.  Colored dye is induced into the blood stream, which helps medical experts to probe into each and every artery leading to the heart.  This method is very effective and can help pinpoint the problem area accurately.  If at all a block exists in any arteries, angioplasty, which is the process of opening up the blocked area with a balloon, is done immediately. 

Even though these medical procedures are available to detect and cure arterial blockages, it is always better not to allow your arteries from getting clogged.  Good eating and lifestyle practices like consuming foods that prevent forming of bad cholesterol, exercising regularly, ingesting enough water and giving preference to foods that provide good cholesterol to the body would greatly enhance the health of your heart, and in turn, your longevity.

What will be the next step in diagnostic evaluation ?

A 56-year-old man with limited CAD risk factors presents with a 7-month history
of DOE and exertional chest tightness. He has had frequent orthopnea and one episode
of PND. He is a known alcoholic since 20 years.

■ ECG shows Nonspecific ST abnormalities
■ Echocardiography shows Moderately dilated LVEF 25% and global hypokinesia

What will be the  next step in diagnostic evaluation 

1. Transplant consultation
2. Stress test with measurement of maximal consumption of O2
3.  Coronary Angiogram
4.  Exercise MUGA Scanning

Please Leave your answers and explanations in the Comment Box below.

Reducing Cholesterol The Natural Way

Heart diseases, rising from accumulation of bad cholesterol in the blood, can be deadly to human beings if not controlled in time.  As per estimates, heart ailments worldwide are on the increase, and a handful of reasons, including wrong eating habits and bad lifestyle practices are responsible for this.  Contrary to common belief, not all cholesterol is bad.  In fact, there are two types of cholesterol, one good and the other bad, namely HDL and LDL respectively. 

Even though a number of factors govern the quantity of bad cholesterol in the body, ingestion of foods that are known to induce large amounts of bad cholesterol into the blood is the singularly most common factor.  We presently live in a fast-paced world where we have no time to indulge in healthy eating.  Fast foods, items containing very high quantities of fat, salt, sugar etc, fried foods that are too oily to eat etc coupled with the total lack of healthy foods like fresh vegetables, fruits, whole grain breads etc in the diet poses great risk to your health. It is no wonder that cases of heart ailments are growing at an alarming pace. 

The most common foods that can be termed as the biggest culprits here are fried items, fast foods, foods with large amounts of preservatives, processed food items etc which we all consider as delicacies.  Red meat, butter, pastries etc also come under this head.  The need of the hour is to increase the intake of foods that reduces bad cholesterol while religiously avoiding the above mentioned food items. 

The best foods for reducing bad cholesterol include olive oil, rapeseed oil etc other than the well known health foods like fruits, vegetables, oat bran etc.  In addition, home-cooked foods that are carefully selected and cooked also can work wonders in keeping bad cholesterol under check.  

Medicated cures are available for keeping cholesterol levels down, but it is common knowledge that drugs and other forceful methods can prove to be very dangerous to the body in the long term.  Therefore, those in the know how always prefer to go natural in their fight against blood cholesterol, obesity, heart ailments etc. 

A great defensive strategy against accumulation of bad cholesterol is a four-pronged tactic involving eating healthy foods, giving up on harmful items, undertaking good physical exercise regimes and drinking enough quantities of healthy drinks like clean water.  Those who are careful to live the natural way can expect greater overall health, including a healthy heart.

How to Lower your cholesterol naturally with Good Eating Habits

The first step to prevent bad cholesterol accumulation in the body is to desist from eating foods that promote its growth.  These foods, which deposit dangerous cholesterol on blood cell walls and cause blockages, include items containing excessive quantities of saturated fats, trans-fats, sugars, salt etc.   

On the other hand, food items containing rich fiber content, like nuts, cereals, vegetables and fruits etc, have the capability to neutralize bad cholesterol.  They also aid in strengthening the walls of blood vessels. 

The best low cholesterol diets contain le with Gss calories while being rich in vitamins and minerals.  This aids in reducing body weight along with assisting the body to function at its optimal efficiency.  The added benefits include fewer chances of deadly illnesses like cancers and heart diseases while keeping terminal illnesses like diabetes and hypertension at bay. 

There is no difference of opinion regarding the efficacy of whole grains, fruits and vegetables in reducing bad cholesterol, but experts are divided in their opinion when it comes to the case of meat, whether lean or fat.  Whatever the case, there is no doubt that consumption of meat can promote obesity, and this is manifested in the present day American population, of which many are obese due to consumption of meat regularly. 

Regulating food intake and consuming foods like soy milk, oat bran, fruits, almonds, oat meal, olive oil etc for breakfast, lunching on fruits, vegetable soups, oat bran bread etc and consuming excellent low fat foods like fresh fruits and vegetables with a handful of nuts thrown in, would  greatly reduce the risk of getting affected by bad cholesterol.  Undertaking regular physical exercises and consuming copious amounts of water along with this diet is also essential to maintain a proper balance. 

For those who are looking for sound advice regarding ways to reduce the risk of bad cholesterol, the following paragraphs may be of immense importance.  First of all, the basic principle of a cholesterol reducing, weight lessening diet is that it must contain natural foods like garlic, foods with good amounts of fiber, fresh fruits and vegetables and whole grain breads.  Those who love to eat fish stand to gain much more since fish is a great source of Omega-3 fatty acids, which is great in digestion and bowel movements. 

Again, make sure that the foods you consume are rich in antioxidants, Vitamin A, Vitamin C, Vitamin E etc.  Supplement this with drinking 2 to 3 liters of water daily, which would help in flushing toxins and bad cholesterol. You also need to consume foods with unsaturated fats while eschewing consumption of those with saturated fats.  Limiting alcohol consumption to the minimum and eliminating foods like butter that reduce the levels of good cholesterol can also go a long way in ensuring you a problem-free physique. Consulting a physician occasionally on all matters of food consumption is also necessary here. 

Choose the Best Combination of Drugs

A 60 year old Farmer with history of Anterior Wall MI has developed increasing shortness of breath on exertion. He is now breathless on climbing one flight of stairs. He does not have orthopnoea. Echocardiographic studies shows severely impared LVF and akinetic anterior wall. Which combination of following drugs will improve his prognosis.

1. Spironolactone, Beta blocker, Angiotensin - II Blocker
2. ACE Inhibitor, spironolactone , Beta Blocker
3. Spironolactone, Angiotensin - II Blocker, ACE Inhibitor
4. ACE Inhibitor, Angiotensin II Blocker, Beta Blocker

Please Leave your answers and explanations in the Comment Box below

Optimizing Your Cardiac Health : The Easy Way

The human body is designed as a machine that never ceases working and the heart is the engine that drives it.  As such, this organ needs to be kept in optimal health if your body is to function as a wholesome unit.  Unfortunately, the stressful lifestyles that the present day rat race has brought on us have reduced the resilience and health of our body in particular and the heart in general.  However, a little bit of caution and restraint in our eating habits can greatly reduce the risk of running heart diseases by a great deal. 

There are four cardinal guiding principles when it comes to fortifying the heart.  These are, eating a balanced, healthy diet, undertaking regular exercises, improving lifestyle practices and desisting from habits that are known to be injurious to physical and mental health. Let us examine each of these aspects one by one. 

First of all, a healthy diet plays a great role in ensuring that your heart is always in the pink of health.  The emphasis today is on eating small quantities of foods at regular intervals rather than ingesting large quantities at one go.  This allows better metabolism, which further ensures that no additional fat is deposited at unwanted places in the body.  Fresh fruits and vegetables are the best bets here, since they provide essential nutrients and calories without clogging up the body.  Foods that contain very less fat and calories but rich in nutrients must form the lion’s share of your daily intake and a little restraint and care here would ensure that your heart is perfectly alright.  Add eight to ten glasses of water to this low fat diet, and your heart would thank you for your tender care. 

The second step is to undertake regular physical exercises.  It is common knowledge that lack of exercising, whether it is your body or any machinery for that matter, would result in it getting rusted and useless.  Here also, it is the same case.  Your heart needs to be exercised properly as per the prescribed formats so that it remains robust, sturdy and healthy at all times.  It is highly important to undertake only the essential workouts, that also as per the ability of the body to take strain without breaking.  This is something many newcomers forget.  Regular exercises speed up blood purification, toxin expulsion and waste excretion processes. They also make the heart stronger. 

The third very important factor governing heart health is lifestyle practices.  Of all these, getting proper sleep at regular patterns is very essential.   Six to eight hours of sound sleep is a must and you must never forget this, lest you may suffer in the long term.  Also, keeping away from stress, undergoing meditation etc also are good lifestyle practices that not only strengthens the heart, but also enlivens your entire physique. 

Finally, there comes the need to keep away from bad habits.  Smoking is definitely bad for your heart in particular and your body in general.   Excessive intake of alcohol, drugs etc also result in heart fatigue and failure.  In short, the health of your heart is more or less the overall sum of your lifestyle practices. 

Choose the Single most Useful Diagnostic Method

A 48-year-old woman  with ankle edema and typical clinical findings of right sided heart failure
comes to you for the first time. She immigrated to the United States from
Vietnam 8 years ago. Her personal and medical history is not remarkable except family
history of tuberculosis.
The heart sounds are quiet, and both the lungs are also clear.
Chest x-ray is normal. ECG shows low voltage in the limb leads
but is otherwise normal. A Transthoracic Echocardiogram is inconclusive because of poor acoustical
windows.
The single most useful test in this situation is:

1. Holter Monitor
2. TEE
3.  EBCT
4. Cardiac MRI
5.  PET with 18F FDG

Please Leave your answers and explanations in the Comment Box below.

World Congress of Cardiology and Echocardiography, Gurgaon India

I took part in  International cardiology and Echocardiography Conference- Worldcon 2011, which was organized in Hotel Leela, gurgaon- It was a big Success! I had a great time and met lots of friends and senior professors. I have added some pics at the end of the post. Have a look ....

This was first ever medical conference in India where  26 countries represented with more than 1000 delegates.  The theme of the conference was " Blending cardiovascular imaging with clinical cardiology" . 

This congress was organised by Dr. Rakesh Gupta, Secretary General, ably supported by Navin C Nanda, International President, Dr. (Col ) S.K. Parashar , Congress President, Dr. R.R. Kasliwal, Dr. H.K. Chopra, and Dr. Manish Bansal, Chairmen of key organization committees. After India, this prestigious congress will be held at Brazil (2012), Italy (2013), Romania (2014), Mexico (2015) and Germany (2016).