My feature as 'Pratham Purushi' in Lokmat News Paper

Pratham Purushi

Pratham Purushi

Stress And Heart
Heart is the “romantic” aspect of human life and appears in every poem and love story. From the bottom of my heart means from deep within my mind!

The connection between the heart and the mind is known to us from childhood. A fear would induce feeling of awareness of heart beat (palpitation). Teenage romance would make heart beat faster than ever before. All these experiences start connecting the heart and the mind and one feels heart is the mind! Unfortunately or fortunately, medical science is away from poetic imagination and romanticism. Heart is an important organ which can get affected by stress of the mind.

“Acute” stress is an intense mental stress of short duration. It can affect the heart in two ways. Electrical short circuiting of the heart can take place under acute stressful conditions and lead to sudden cardiac death. This could mean a very rapid heart rate of 300 per minute and sudden stopping of the heart. However in such a situation if medical help is available within minutes the heart can be revived fully. It leaves no residue behind because essentially the heart is normal and was affected by the acute stress. Adrenalin surge means sudden rise in the level of adrenalin in the blood due to severe stress of the mind and it leads to this short circuiting.

Ballooning of the heart is also known to be caused by acute mental stress. A road traffic accident, a sudden extreme fear, unpalatable news, can suddenly lead to ballooning of the heart and leads to poor pumping of the heart. This poor pumping can lead to death within a few days or weeks. However even this medical cardiac condition related to mental stress, can be fully revived if adequate medical help is available.

“Chronic” mental stress is a different ballgame altogether. If chronic mental stress continues, it affects heart in a different way. The chronic stress at work, at home, a legal matter, separation from the spouse, financial difficulties, relationship discords, all these chronic stresses are very well known.

Atherosclerosis is a disease, which affects the arteries of the heart (plumbing system of the heart – coronary arteries). In atherosclerosis, there is a deposition of cholesterol in the arteries which leads to heart attack.

The main risk factors considered for atherosclerosis are diabetes, high blood pressures, smoking, high cholesterol and also mental stress. The other risk factors mentioned above can be tangible or measurable and preventive aspects can be used for these risk factors. However what will cause mental stress in whom is unimaginable. Mental stress cannot be measured and methods to use control stress many a times are ineffective or are unreliable.

Chronic stress leads to high blood pressure. it can lead to diabetes, it can lead to addiction to tobacco, it can lead to lethargy and lack of exercise, increased weight, excessive eating and all these are potentially leading indirectly to atherosclerosis. Acute stress and chronic stress, both are thus related with the heart. Whether we are stressed or not we should be following rules of stress management. These rules and methods can change by way of situation, by age, by intelligence and so many other aspects of life. By following these rules, the negative effect of mental stress can be prevented to a great extent. All individuals of all age and of all strata of the society should strive to keep their mental health intact because as the old saying goes “Prevention is better than cure”.

Only some rules of stress managements are mentioned and these can change over a period of time. Stress is there in the mindset and not in the situation is the first thing to be accepted and once this is accepted, changing the mindset can be easier to achieve.

Write down on paper what is your cause of stress.

Train your mind to live in the present tense by way of yoga, meditation, hobbies, etc.

Involve into a hobby which gives you mental peace other than your routine work.

Diet and exercise should look at the physical health as well, because good physical health is one of the ways of combating mental stress.

Work place and home are the two areas where maximum effort should be put in to improve the surroundings.

An emotional social group or emotional core group is vital in combating stress and working on these and developing this social group or emotional core group as in friends and family helps a good deal.

These small little changes lead to increase in the “depth of the sea” of mind. It may take years to improve the depth. If the depth of the mind is good enough or deep enough, then occasional stresses, occasional anger, occasional mood changes can come on the surface and go away but the depth of the sea will remain intact. It will not have a bad effect on any organ of the body especially the heart because if the “mind is fit then, the heart is hit”.

Mental Stress And The Heart
Mind and Heart are same entities in the poetic world! “Right from the heart” means from the deepest depth of mind! We keep connecting the two from childhood. When one gets scared (in mind) excited/sad, heart beat is perceived and is known as the flutter or palpitation. Realities of medical science, unfortunately are far away from poetic deliberations. Stress can lead to heart disease!

“Acute” Stress of a short duration, if severe, can damage the heart in two ways. Heart’s electrical system can get a short circuit because of acute stress and heart can stop leading to SCD (Sudden cardiac death). If emergency help is available by shock machine, the SCD heart can get fully revived. Such a revival can lead to complete and permanent recovery because basically the heart had no previous illness. The SCD in acute stress occurs because of sudden surge of “Adrenaline” leading of “Short circuit” (Ventricular fibrillation –VF).Ballooning of heart is another cardiac ailment that can result due to acute stress. By extreme fear/ bad news, heart suddenly goes weak and may lead to death. Fortunately this entity can also get reversed fully if treated in time and appropriately.

Chronic stress on the other hand is ongoing for months and years. Work pressures, separation from spouse, court cases, relationship issues are some of the examples of chronic stress. Chronic stress also leads to a major disease of heart – heart attack.

Atherosclerosis, that is clogging of arteries of the heart due to cholesterol (bad fat) build up in the arteries results from chronic stress. This finally will lead to heart attack. Atherosclerosis has several reasons, known as “risk factors”. Diabetes, high blood pressure, Nicotine abuse etc are well known. Equally sinister and important risk factor is chronic stress. The earlier mentioned risk factors can be measured, identified and treated with medicines. Stress unfortunately is intangible. What, now and when will become chronic stress is difficult to guage and treatment of stress is not objective/mathematical. Chronic stress also leads to high blood pressure, nicotine addiction, overeating, obesity, all of which can indirectly lead to atherosclerosis.

Both acute and chronic stress thus leads to heart disease. Hence whether we consider ourselves “stressed” or “blessed”,basic rules of “Mental” health must be observed by all of us. “Prevention is better than cure”. Some tips of stress management are enlisted but they need to be modified by individuals based on situations, education and intelligence.Stress lies in “Mind set” and not in the situations.What causes stress is the reaction given to the situation has to be understood and accepted first. The stress management techniques in details will be updated in November 2013.

Some skeletal hints are:

Write down on paper what is causing stress.

Train yourself to live in the present tense( Yoga, meditation help train this way)

A hobby which is away from work and home.

Diet and exercise to maintain good physical health.

Create a conducive atmosphere around you at home and work place.

Have a close knit emotional core group for “catharsis”.

These small little changes lead to maturity of mind. It is akin to depth of the sea. If the depth is good and sound, surface waves of anger, mood and happiness can come and go without affecting major organs of the body, especially the heart!

Healthy diet for Good Health- Shilpa Shirole Khandelwal
Diet and nutrition are important factors in the promotion and maintenance of good health in the entire life course. Increase in body weight and blood lipids are in fact end results of prolonged faulty dietary habits including excess consumption of refined cereals, high cholesterol foods, saturated fatty acids (SFAs), sugar and fried foods. Improper dietary practices can also trigger underline genetic tendencies towards development of these disease conditions. By adopting a diet of protective foods like fruits and vegetables and less of sugar and oil consumption one can reduce the risk of non communicable diseases. (NCD)

Ithas been rightly quoted that “You are what you eat”, today with therapid changes in the diet and lifestyle, we are facing an increase in diet-relatedchronic conditions like obesity, cardiovascular disease, diabetes, cancer, osteoporosisetc. In many homes today one often gets to see the full square meal beenreplaced by a one snack meal pattern, which often may include a junk food. Eg:pizza or burger. The increase in the availability of ready to eat foods (wafer,kurkure) or instant foods(noodles, pasta, soups) has replaced the fresh foodsin our daily diet, leading to decrease intake of the protective foods (freshfruits and vegetables).

A proper diet as we know is essential from the very early stages of life forgrowth, development and maintenance of an active life. A good diet is merelya combination of foods, which supply the materials vital to the body for itswell being. However, a lack of consumption of these nutrients or foods in theright proportion leads to accumulation of toxins in the body, resulting in chronicdisease conditions. Itis very important to understand the different nutrients we get from food andtheir role in our body. The food that we eat provides macronutrients (carbohydrates,protein and fats) and several micronutrients (vitamins and minerals) which whensupplied in the right amounts support and sustain life and activity. All thefoods in our daily meals can be divided into basic food groups. The food pyramidhelps us understand these food groups in a better manner.

All cereals grains and millets like wheat, rice, chapati, bread, rawa, jowar, noodles etc. and pulses and legumes are at the base of the pyramid indicating that the proportion in which one needs to consume these foods. We get carbohydrates, proteins, vitamins, minerals from these foods. This group is the main food group giving energy to our body. The next level consists of vegetables and fruits give us vitamins and minerals, they are required for protecting our body against disease. The following level is of the protein rich foods like milk and its products, non-vegetarian foods like poultry, fish and mutton. The tip of the pyramid consists of foods giving us concentrated energy like sugar, fats, oils, fried foods, refined cereals like maida and alcohol, indicating that the amount of these foods be the least amount required by our body.

Now it becomes easier to understand the concept of a balanced diet i.e. when one consumes a diet with sufficient quantities of food from the food groups present in the food pyramid, in the suggested proportion, ensuring that the daily nutrient requirement of the body is met, then such a diet is termed as a balanced diet.
After understanding the balanced diet, let us now briefly look at the important nutrients we get from the food we eat in our daily diet. Carbohydrates: Carbohydrates are the principal sources of energy for the body. They include wheat, jowar, bajra, ragi (nachani), rice, pohe, semolina (rawa) , rajgeera, potato, sweet potato, banana, mango, chickoo etc. One gram of carbohydrate provides four calories. Carbohydrates are of two types – Simple and Complex. Simple carbohydrates like sugar produce energy quickly. If taken in excess, they get converted to fat adding undesirable weight. Therefore, foods such as soft drinks, sweets, chocolates and cakes should be avoided. Complex carbohydrates such as whole grains, beans, vegetables and fruits are less likely to add unwanted weight as they contain of fibre and water, They are more filling and much less likely to be eaten in fattening excess. In addition, unlike simple carbohydrates, they provide vitamins, minerals and in many cases proteins. The diet should contain large amount of complex carbohydrates. The daily diet should contain about 55-65 percent of carbohydrates.

Proteins: Protein is an indispensable part of the diet, involved in the body’s vital functions such as growth, maintenance and repair of cells for the production of enzymes and hormones and for energy. Important dietary sources of protein are milk, curd, buttermilk, meat, fish and poultry including eggs, dals and sprouts, nuts and oilseeds. Each gram of protein provides four calories. Every protein is made up of amino acids- smaller molecules known as building blocks of protein. Amino acids are of two types- essential and non-essential. Essential amino acids are those amino acids, which cannot be synthesized in the body, and their requirement has to be met through dietary intake. Non –essential amino acids are those which are synthesized in the body from the essential amino acids. Commonly proteins are known as complete proteins or incomplete proteins. Complete protein foods are those which contain all the essential amino acids in sufficient amounts and ratio to supply the body’s needs. Incomplete proteins on the other hand, are deficient in one or more of the essential amino acids. Animal source proteins such as milk and milk products, meat, fish and poultry are complete proteins. Animal foods are also a source of cholesterol in the diet hence it is important that we include low fat milk, low fat poultry and fish and try to restrict red meat in our diet. Vegetable source proteins such as pulses and legumes, cereal grains- wheat, rice, jowar, bajra etc. are incomplete proteins. However a combination of a vegetable protein with an animal protein or two complementary vegetable protein (a cereal + a pulse) can provide proteins of good quality (complete proteins). E.g. Paratha with curds, dal and rice, idli etc. Our daily diet should contain about 15-20 percent of proteins.

Fat: Fats are concentrated sources of energy and provide twice the energy that carbohydrates and proteins furnish. We get fats from cooking oil, ghee, butter etc. One gram provides nine calories. They are needed for several functions and are sources of essential fatty acids. They provide fat-soluble vitamins and are necessary for their absorption. The body stores all the extra calories in the form of fat. The calories obtained from fat are harder to burn off than the same amount of calories from carbohydrates. Animal fats such as butter and ghee as also vegetable fats like vanaspati, coconut oils are high in saturated fatty acids which are implicated in heart disease as it increases the cholesterol level. The recommendation for saturated fat is of the total energy. Therefore, their intake should be minimized. Vegetable oils like soyabean, mustard, groundnut have a higher amount of unsaturated fatty acids and are preferable to saturated fats. The daily dietary intake of fat should be about 25-30% of the entire day’s calorie requirement. Trans fatty acidsare produced during the hydrogenation process used to increase the shelf life of food. Most trans fatty acids intake comes from partially hydrogenated vegetable oils, these need to be limited as they raise the LDL cholesterol. No more than 1% of calories (approximately 1-3 gm/day) should come from trans – fatty acids

Cholesterol: Cholesterol, a word we come across very often in relation to heart diseases, is essential to the human body for the manufacture of hormones and as an important component of cell membranes. Cholesterol is present in all the animal foods and is synthesized in our body by the liver independent of the dietary intake. Hence, when you restrict the dietary cholesterol the human body will produce the require amount of cholesterol for its functioning. An intake of mg per day to a more strict < 200 mg per day is recommended. The dietary sources of cholesterol include egg yolk, mutton, beef, ham and high fat dairy products such as whole milk, butter, cream, cheese and therefore need be restricted in the daily diet. Non vegetarian foods like egg white, boiled, roasted or baked chicken without skin and fish can be consumed more liberally in the diet.

Fibre: Dietary fibres are plant constituents that are resistant to digestion in the human digestive tract. They consist of cellulose, hemicellulose, pectin, mucilages, gums and lignin. There are two types of fibres- insoluble fibres and soluble fibres. Insoluble fibre includes cellulose, hemicellulose and lignin, and soluble includes pectins, gums and mucilages. High intake levels of dietary fibre are associated with significantly lower prevalence of CHD and stroke.

Fibre has several functions in the body: - • Insoluble fibres give bulk to the diet and move the food more quickly through the gastrointestinal tract.

• Fibre delays the absorption of carbohydrates and fats.

• Soluble fibres bind to water and increase the viscosity of the intestinal content, they bind cholesterol and increase excretion of bile acids.

• Fibre is also useful in decreasing the risk of metabolic disorders such as diabetes and also diverticulitis and colon cancer.

• Fibre protects vitamins from being destroyed during cooking.

Dietary sources of fibre are whole grain cereals, pulses, fruits and vegetables. On processing fibre is removed, hence refined and processed food should be avoided. The use of white bread, naan, roomali roti, noodles, pasta and other refined flour (maida) products should be avoided. The minimum recommended intake is about 25- 30 grams of fibre per day, out of which approximately 6-10 grams should come from the soluble fibre in the diet. This dietary intake can be achieved by including whole cereals and sprouted legumes regularly in the diet, five or more serving of fruits or vegetables per day.

Micronutrients : There are a variety of micronutrients like Vitamin A, B, C, D, E, K, folic acid which we get from cereals, vegetables and fruits and minerals like calcium, iron, zinc, selenium etc. from milk and its products, vegetables and fruits, which are required by our body for its functioning. Few of the vitamins and minerals like vitamin A, C, E and minerals like selenium, chromium have got antioxidant properties, which prevent the oxidation of PUFAs in the cell membrane. Dietary source of vitamins and minerals are fresh fruits and all vegetables, low fat milk and milk products, and whole grain cereals and pulses.

Salt: Salt or sodium chloride gives a distinct taste to the food. Sodium keeps the body fluids in balance Excess salt taken in the diet is retained and is likely to precipitate hypertension. In general a sodium restriction of -2400 mg per day is recommended, patients with very high blood pressure may have to restrict the intake of high sodium containing foods such as pickles, chutney, sauces and ketchup’s, papads, chips and salted biscuits, cheese, canned foods, readymade soup packets, dried salted fish. The reduction of salt intake is best achieved by cutting down the use of added salt in the diet.

Once we are aware of the different nutrients in our daily diet and its role in the body following a balanced diet becomes easy. The rule of thumb would be to eat food in moderation and not to overdo on any particular food. Your plate should be multi coloured with a variety of foods from different food groups in our diet.

A few dietary recommendations to be considered for cardiovascular risk reduction are as follows:

1. Balance the calorie intake and physical activity to achieve or maintain a healthy body weight.

2. Consume a diet rich in vegetables and fruits.

3. Choose whole grain cereals and high fibre foods.

4. Limit the use of saturated fat, trans fats and cholesterol –

       a. Choose lean meats and vegetable alternatives to non vegetarian foods

       b. Select fat free (skim) or low fat dairy products.

       c. Minimize the intake of partially hydrogenated fats

5. Minimize the intake of beverage and foods with added sugars.

6. Choose and prepare food with little or no salt.

7. Make use of alternative cooking methods like steaming, roasting, baking instead of frying. (Can choose steamed idlis instead of fried wadas).

8. When eating outside of home it is helpful if one make a list of foods he is permitted to eat and enjoys what he is permitted to eat rather than crib aboutwhat one cannot.

9. Consume alcohol in moderation.

Cardiac Fitness
Heart Attack is one of the leading causes of death in our society. In our society even young individuals below 30 years are seen to be affected by Coronary Artery Disease (CAD).
Lack of Physical Activity is one of the major factors leading to CAD. Physical inactivity leads to Sedentary Death Syndrome and a shortened life span.
Physical Activity (PA) has plenty of benefits. It helps control many risk factors responsible for CAD and helps attain a good quality of life.

Benefits of exercise

It improves fitness. Fitness includes increased stamina, strength and suppleness. Improved fitness puts less demand on the heart to perform day to day activities.
PA halves the risk of developing CAD.
PA reduces the risk of death after Heart Attack.
It helps people to lose weight healthily.
It raises angina threshold.
It helps to relieve stress.
Sexual Fitness is increased.
Exercise increases average life span.

Regular and brisk exercise, done 5 times a week, lasting about 30 minutes every session (150 min/week) has protective effect on the heart and leads to prevention and control of CAD.

Cardiac fitness is the most important component of Health Related Physical Fitness. Cardiovascular fitness is achieved through Aerobic Exercise. Aerobic exercise involves major muscles of our body, is dynamic in nature and demands continuous supply of O2. It requires to be done for 20 to 30 minutes with a high level of intensity. Examples are brisk walking, jogging, cycling, swimming, circuit weight training, team sports like volleyball, etc

Regular exercise increases cardiac fitness by causing many beneficial physiological changes such as: Improves collateral circulation in the heart muscles where new capillaries open up and develop. It increases blood and O2 supply to the heart.

It reduces resting heart rate, which means heart beats lesser number of times to do the same work.

Both these changes help to prevent Heart Attack.

Risk factors which are controlled by exercise are:

Hypertension: Individuals doing less PA are 3 to 6 times more likely to develop hypertension. Regular exercise significantly reduces systolic and diastolic blood pressure in hypertensive patients.

Diabetes: PA reduces the chances of developing diabetes. Exercising muscles use 7 to 20 times more glucose than non exercising muscles, thus blood sugar is better maintained even with lower dosage of medication.

Cholesterol: Exercise has preventive and therapeutic effect on Hyperlipoproteinemia.

It decreases total cholesterol level in the blood.
It reduces LDL.
It causes reduction in triglycerides.
It increases HDL- which has cardio-protective role.
Stress: Exercise helps reduce stress significantly.
It enhances psychological well being.
It reduces anxiety and depression.
Heart attack : Regularly exercising person fairs better during heart attack due to better “collateral” circulation.

Exercise Plan for Cardiac Fitness:

Type of Exercise: Aerobic Exercises involving large muscle groups are essential. Strength, resistance and flexibility exercises may also be included.
Intensity: Moderate (70 % to 85 % of Maximum Heart Rate should be achieved)
Duration: At least 30 Minutes per session.
Frequency: 5 days per week.

Cardiac Rehabilitation

Cardiac Rehabilitation has proven to reduce cardiac mortality by 26% and all cause mortality by 20% (Taylor et al, 2004). Exercise training is the cornerstone of Cardiac Rehabilitation. It helps a patient return to his/her formally active lifestyle or a lifestyle as functional as possible after an acute Cardiac Event.
We conduct Cardiac Rehab Program under the leadership of Dr. Jagdish Hiremath. Patients who have CAD and/or risk factors to develop CAD participate in the program.
In this supervised exercise program we conduct warming up/callisthenic exercises, aerobic exercises, weight training, flexibility exercises, and different forms of ball games, followed by cooling down exercises.
This program has been successfully run since the last 17 years; totalling more than 8000 sessions and around 10000 patients have benefited and are leading an active and healthy life.

Women & Coronary Artery Disease
It is generally believed and it is to a great extent true that women suffer less heart attacks as compared to men. Many men believe that women are heartless but it is not so! Incidence of coronary artery disease (the disease which leads to heart attack) is less in women as compared to men but is definitely on the grow and special attention should be paid to prevent coronary artery disease in women. 

Women have a natural protection of hormones till menopause therefore the percentage of heart attacks in women before menopause is almost half of what men suffer. However after menopause this protection of hormones is removed and there are equal number of heart attacks in men and women after the age of 50. Paradoxically or peculiarly breast cancers and uterine cancers are discussed more about women but the number of women dying by heart disease is atleast 100 times more as compared to breast cancers; therefore awareness related to heart attacks in women is extremely essential.

REASONS OF HEART ATTACK IN WOMEN:These reasons are technically called risk factors and these risk factors are exponential. (hey don't add to each other but increase the risk exponentially.) Diabetes is one of the major risk factors and women can get diabetes in pregnancy. Same is true of hypertension. Some women can start hypertension in pregnancy and then continue with it in the rest of their life. Women who smoke have a higher chance of developing heart attacks than men who smoke. Lack of exercise, obesity, mental stress, over ambitious (Type A personality) are also known as risk factors as they are known in men. 

Women who consume oral contraceptive pills for long time have a certain tendency to develop clots and they can suffer from heart attacks and clots in other areas of the body like the brain. Women generally lead a more stressful life and diseases related to chronic stress like high blood pressure, heart attacks, appear to be on the grow in women in modern day life where more women have taken up to working. Job pressures and home pressures together have doubled the stress in women and have led to increase in the number of heart attacks in women. 

Vitamin B12 deficiency, Vitamin D deficiency are also known as risk factors. A sister having suffered a heart attack makes a big risk factor in women and if one sister suffers a heart attack the other should be on guard and start protecting and investigating themselves. Women who are short, obese, diabetic and with family history of sister having suffered generally should be on high alert to get checked for heart attacks.

SYMPTOMS OF HEART DISEASE IN WOMEN:The clear cut symptoms of chest pain, in the center, coming on exertion relieved by rest and sweating need not be seen in women. Women have "atypical" symptoms. They could be in the form of just exhaustion. It could be just profuse perspiration, it could be in the form of breathlessness or restlessness at the end of the day and it should be recognized or investigated for heart related ailments. In women, many symptoms look like a heart attack but may not be the case and these are called "false alarms". Many women get investigated for these false chest pains and left arm pains and ECG changes but they don't turn out to be having coronary artery disease. 

HEART ATTACKS IN WOMEN:When a women suffers heart attack, her average time of reaching the hospital is longer as compared to a man. This is related to centuries of social upbringing and social systems. Women tend to be more tolerant and would carry on with the pain or discomfort longer than a man does. This means they present to the hospital late and lead to more complications as compared to men. The disease tends to be more severe and they need to require longer stay in the ICUs and suffer from major complications of heart attack like heart failure, etc. 

TREATMENT FOR HEART ATTACK IN WOMEN:The treatment for heart attack in women however does not differ from that in men. Reaching the hospital as early as possible, getting treated with blood thinners and later on getting treated with angioplasty and bypass surgery is the same in women as compared to men. The response given by women to treatment is the same as compared to men. They however have slightly different coronary arteries. Their coronary arteries tend to be thinner, smaller and more curvaceous (tortuous) as compared to men. 

REHABILITATION FOLLOWING HEART ATACK:Women tend to rehabilitate much better than me because of their inherited discipline. They follow rules laid by the doctors much better. Their ability to take medicines regularly is much better. Because the rules prescribed in the form of diet, exercise and medicines are followed well, the rehabilitation programmes meant for women always get more rewarding results than men.

Being aware of the increase in the incidence of heart attacks in women, simple methods like improvement in lifestyle, diet, exercise, regular checking of parameters, regular follow up with dotors is required to prevent disease, to identify the disease early and to lead a better overall healthy lifestyle. More information is available on a special website

New Abc Of Healthy Lifestyle
After the relative control of infectious diseases, new crop of diseases called like lifestyle diseases have appeared on the surface. The longevity of life increased with control of infectious diseases and sedentary lifestyle, various other aspects of human evolution came into play. This led to lifestyle diseases like Diabetes Mellitus, Hypertension, Mental stress and stress related illness, atherosclerosis, myocardial infarctions and so on. In order to combat the lifestyles diseases, right from our childhood, certain guidelines have to be followed. These guidelines have been discussed by our grandparents for centuries together. Now it is the real time to implement them seriously so that the incidence and the prevalence of lifestyle disease goes down and health burden on the society is reduced. 

The New ABCD of lifestyle is A - Anxiety (Mind control) B - Body (Diet & Exercise), C - Cigarette and addiction, D - Direction in which we are moving, E - Exercise, F - Friends , G -Guru or God and H - Humour. In this ABCDEFG of lifestyle, if an individual gets 7 or 8 out of 10 marks every day, he is leading a healthy lifestyle. Trying to get 10 out of 10 adds to mental stress !

A:Anxiety:It is well known that chronic stress and anxiety states leads to diseases like hypertension and atherosclerosis. The pace of life and the greed of life have led to these diseases. If one has goal of just two meals of the day, then anxiety diseases don't trouble him. In order to steady the state of mind, the basic happiness of the mind needs to improve. This is like the depth of the sea, happiness and anger are like surface waves but what matters is the basic happiness or the depth of the sea. This comes out of observation, reading, assimilation, good friend circle, yoga, meditation, Pranayam and hobbies.

B : Body:Having a beautiful body is a bonus but a healthy body is absolute essential. Our "poor" country is suffering these days by a disease called central "obesity"! This leads to metabolic syndrome. Being close to the ideal weight will always help. Controlled diet with more of proteins and less of fats and carbohydrates is required for everyone. The pattern of eating should be in the form of inverted pyramid. Heaviest meal of the day should be breakfast and lightest meal of the day should be the dinner. Use of uncooked food in the form fresh fruits and salads should be encouraged. 

C : Cigarettes:Any addiction like alcohol or tobacco or exercise or money (these are also addictions) can be damaging to overall health. Tobacco and alcohol are known for its deleterious effect, but the other two are glorified! 

D : Direction:In the zest of life and orientation towards career, success and money, the direction of life gets lost and the near and dear ones get neglected. Smelling roses on the way to success should never be forgotten. There is always someone who needs you even for minor things and they all never should be forgotten. 

E : Exercise:Importance of exercise cannot be underestimated. 150 minutes of aerobics exercise per week is definitely required for all. Doing gym like exercise and weight training will also help great deal to improve muscular skeletal system and prevent osteoporosis. 

F : Friends:The emotional core group yours helps you to stand all the stress. It also adds to the quality of life and improving your basic happiness. We have been taught from centuries that guests should be treated as god but the near and dear ones around you, in the family, at work place should be treated like god. Suddenly you are surrounded by Gods! 

G : Guru or God:Some higher power than you always helps you to guide you. It need not be in the form of temples or mosques or Gurudwaras but it comes in the form of a guiding light which will show you a bigger picture and will make you rise above small matters of life and make you feel and face life well. 

H : Humour:There is always sounds around us but a transistor catches the song and we can hear it. Humor is like that; it is always around us. We have to develop special antennae to catch the humor and the entire life can be a smiling journey for you and people around you. Humor is very philosophical. You heard it, you assimilated it and you laughed at it means you lived that present moment, which is the essence of all philosophy! 

Based on this ABCDEFGH, one can formulate your own circle of life. It should be full circle working on various aspects of life, like social health, personal health, financial health, Spiritual health and mental health. This is not to be started when the diseases starts appearing. This should be the Sanskar in the families and children also should be aware of what is this new ABCDEFGH - Happy learning!!

Up your good Cholesterol knowledge (HDL)!

Heart Failure- A Weak Heart (LVF, CCF)
Heart Failure- A Weak Heart (LVF, CCF)

Heart failure is a loosely used term. It is akin to stoppage of heart and death in the imagination of non doctors. For doctors, it indicates a weak heart. Normally, heart has "output" of 5 litres of blood per minute. In various heart conditions, like heart muscle disease, heart attack, damaged valves, etc the "output" from the heart can drop to lower levels. Upto 3.5 litres per minute can be considered mild heart failure and below this, moderate and severe heart failures are diagnosed. (Inability of the heart to pump desired amount of blood to the body). In technical terms, heart's "ejection fraction" (normally 60 to 70%) drops below 40%.

Causes of heart failure:Heart Failure/Inefficient heart is commonly due to heart muscle damage due to heart attacks, defective heart valves, due to chronic alcoholism (cardiomyopathy), following viral infection, or due to some anti-cancer drugs.

Diagnosis of heart failure:Heart failure patients have symptoms of breathlessness on exertion and this breathlessness is likely to get worse as the heart failure worsens. A person breathless by rest indicates an advanced form of heart failure. Heart failure also leads to swelling on the feet and swelling on the face and extreme weakness and lack of appetite. Heart failure is correctly diagnosed with the help of an ECG, X- Ray chest and further investigative tools like Echo Color Doppler study, Coronary angiography and PET scan of the heart. 

Medication in Heart Failure:Heart failure is usually treated by doctors with diuretics, which makes the person pass more urine. Additional medicines are directed towards the cause of heart disease. A person of heart failure should avoid casual use of day to day medicines like pain killers. The only pain killer that is safe in heart failure is Paracetamol. Most other pain killers can retain fluid and make the heart failure worse. Any nutritional supplements or food stuffs containing high Sodium (includes ENO taken for gasses) will worsen the heart failure. Sodium is hygroscopic, "holds water around it", so any sodium containing food stuff like salt , pickle, Papad, chutneys, namkeens will make the heart failure worse by holding water in the body. Excess water overloads the already failing heart. Simple decongestants used for nasal stuffiness also can make the heart failure worse. In short all the medicines [even normal day to day medicines] should be enquired with the treating doctor before consumption by a heart failure patient. 

Quality of life in a patient of heart failure:Major restriction of heart failure is Sodium and water. Depending on the heart failure the restriction of the sodium is to the tune of 2 - 5 grams per day. [A teaspoonful filled salt will make about 6 gms of salt]. Water restriction will be guided by according to the heart failure. Generally less water and liquid should go in the body and more water should come out of the urine to unload the heart which is already failing. Most of the times heart failure patients are asked to rest the heart but once the heart failure improves, regular cardiovascular exercises are prescribed by the doctor which are graded and strengthen the heart muscle. 

Isometric activities like pushing/pulling of heavy objects, lifting heavy weight can worsen the heart failure. Other areas which can help heart failure is obviously quitting of smoking. Many times alcohol is a cause of heart failure and alcohol needs to be completely curtailed. 

Maintaining a daily weight chart is a very simple way of managing heart failure well at home. Every day a patient of heart failure should weigh himself or herself in the morning. If two kilograms of weight is gained within two days it means accumulation of fluid and water in the body and on that day, extra medicine can be taken and salt can completely restricted. High blood pressure, cholesterol, diabetes, kidney failures, anemia, thyroid have to be managed by the doctors for better control of heart failure. 

Treatments for heart failure:If the heart failure is because defective valves, the valve surgeries can control the heart failure. If it is because of less blood supply a bypass surgery can improve heart failure to a great extent. For "cardiomyopathy", (heart muscle weakened by virus / alcohol), a special pacemaker called CRT (BV pacemaker) is implanted which improves the heart failure to a great extent. When the heart failure has reached a stage which is irreversible and none of the above mechanical treatments are useful, this patient is considered for heart transplantation. Heart transplantation is beginning in our country and in the years to come it will be become one of the important treatments for heart failure. Artificial heart is on the horizon too, for "end stage" heart failure.