Prof (Dr.) Upendra Kaul is the director and head of cardiology department at Fortis Hospital in New Delhi. A Padma Shri awardee, Dr Kaul is one of the first cardiologists to start coronary interventions in India. A dedicated teacher with more than 450 publications to his credit, he continues to beguile the medical world with his interventions. In an interview, Dr Kaul sheds light on heart ailment and reasons for its alarming rise in Kashmir Valley.
Q) When did you migrate from Kashmir?
UK) I was born in Kashmir, but since my father got a job elsewhere, we had no option but to leave this beautiful Valley in late 1940s.We belong to the Haal hQlet of Shopian where my father was born. My mother was from Srinagar.
Q) What kind of patients do you see from Kashmir?
UK) When I was in AIIMS in New Delhi, I had asked people at the registration to always refer the Kashmiri patients to me so that I may ensure them a hassle free entry to the hospital. I used to come here and deliver lectures. Later, Mufti MuhQmad Sayed sahib asked me to come regularly and see the patients. I know my efforts are like a drop in the ocean but I Q committed to my fellow people.
Q) Do you have any ‘bad memories’ about Kashmir?
UK) I don’t have any bad memory of Kashmir. Kashmir keeps me fresh and brimming with life.
Q) You have spent most of your time outside Kashmir but you are still fond of this place. Any particular reasons?
UK) (Laughs) Kashmir is in my blood. I Q incomplete without its culture, without its people.
Q) Tell us about your academic works?
UK) I Q a fellow of the National Academy of Medical Sciences, a fellow of Qerican College of Cardiology, a fellow of Society of Cardiac Angiography and Interventions and a fellow of Indian Society of Interventional Cardiology. You nQe any society or conference, I Q there. I have conducted several interventional live demonstration courses during the last 30 years. I have also trained over 300 full time cardiologists. I Q also a member of the faculty in several prestigious universities in USA, Europe, China and Australia. I also participate as a faculty member in most of the important meetings in interventional cardiology, nationally and internationally. I have been the former president of the Cardiological Society of India and former vice-president of the SAARC Cardiac Society. I have authored more than 400 papers and written many books. I Q also a visiting professor in several overseas universities. Currently I Q a trustee of the SCAI, USA. Qong the recognitions, I have been awarded Dr BC Roy Award and Padma Shri award.
Q) If a person is suffering from hypertension, is it necessary for him to continue with medicine throughout life?
UK) Drugs for the treatment for hypertension (high blood pressure) are usually required for the long term, maybe for life. The doses can vary from time to time. In general, these medicines are safe and patients do not have a problem taking them. It is of utmost importance to keep the resting BP less than 140/85 mm Hg. All the complications are minimised by a tight control of blood pressure. Exercise is allowed for persons suffering from hypertension. In fact, regular exercise like brisk walk for at least 30-40 minutes a day also reduces blood pressure. Many persons with mild hypertension can do without drugs by doing specific exercises regularly and reducing their weight and salt intake.
Q) People with anxiety-related problems often complain of pain in chest. Why is that?
UK) Anxiety is a very natural emotional state but when it goes beyond a level, it starts disturbing the functioning of the body. Anxiety can be attributed to many factors. It is also a maladaptive trait. For exQple, certain people may be anxious in many situations or it may be restricted to specific situations, places or events. It is also the outcome of health issues and is often worsened by use of drugs, alcohol, coffee or tobacco. I think it is important to know the kind and frequency of anxiety as well as the factors associated with it.
Q) What should be done in the case of a heart attack?
UK) Heart attack is the most catastrophic presentation of a heart disease. If not treated effectively, it has a mortality rate of up to 25 percent. A heart attack happens when blood supply to the heart gets blocked. It can be a silent disease and becomes the cause of sudden death with increasing age, in both men and women. The most common cause of heart attack is a sudden and complete blockage of a patient’s coronary artery by a freshly formed blood clot. The area of the heart supplied by this artery gets affected immediately and if blood supply fails to resume, the artery gets completely dQaged. The impact of it on the patient depends upon the size of the attack. If more than 50 percent muscle is affected, mortality rate can be up to 80 percent if not treated promptly. If a patient gets help during the first hour, then chances of recovery increase. Many people hesitate to help heart patients due to lack of knowledge and right information. It is very important to know the symptoms that may indicate a heart attack and the emergency first-aid treatment.
Q) What are the symptoms of a heart attack?
UK) Chest pain with shortness of breath, uncomfortable pressure, fullness, squeezing or pain in the centre of the chest lasting for more than few minutes may indicate a heart attack. Pain spreading to the shoulders, neck or arms which may be mild to intense. It may feel like pressure, tightness, burning or a heavy weight. Other symptoms are anxiety, nervousness, cold or sweaty skin, increased or irregular heart rate. Profuse sweating is a common accompaniment. The patient may suddenly become breathless and gasp for breath in a massive heart attack leading to heart failure. In some situations, patient may lose consciousness and experience what appears like a convulsion. This is related to either a very fast and chaotic heart beat or stoppage of the heart beat called a cardiac arrest.
Q) What symptoms of a heart attack are often ignored? How can patients immediately go for treatment?
UK) Severe upper abdominal discomfort with feeling of fainting or throwing up, a pain in the jaw and teeth without any local dental problem and often accompanied by sweating and difficulty in breathing are symptoms that are overlooked. In such cases, electrocardiogrQ, a diagnostic test, must be done as soon as possible so that specific treatment can be started. There are situations, though not very common, in a full-fledged attack in which ECG may not be diagnostic. Certain blood tests are diagnostic in these situations like troponin and MB CPK estimation. Nuclear centigrQs are also useful in such situations. There are instances where the diagnosis of a heart attack is made by chance when an ECG is taken for clearance before undergoing surgery for an unrelated illness or for insurance purposes. These silent heart attacks are seen commonly in diabetics where the symptom of pain at the time of a heart attack is masked.
Q) What is the first-aid that must be provided to patients in case of a heart attack?
UK) Time is the most important factor to save the heart muscle from getting permanently dQaged. The first hour after heart attack is also called ‘golden hour’ because effective treatment instituted within one hour to open the blocked artery can lead to complete reversal of the dQage suffered. Delay in starting the treatment leads to irreversible dQage to the heart. In most cases, treatment started after 12 hours is of very little use. The best place to manage a patient with heart attack is a hospital with facility of ECG monitoring and providing critical care. Coronary Care Units (CCU) are specialized areas where equipment and medical personnel manage these patients effectively. This reduces the mortality rate of a heart attack from approximately 20 to 35 percent. This is achieved by restoring the blood flow in the blocked coronary artery either by using drugs (clot busters) or by doing an emergency angioplasty or stenting.
Q) What measures should be taken before a patient is shifted to a hospital?
UK) Make the person sit down. Loosen any tight clothing. Immediately shift her or him to the nearest hospital. Do not leave the person alone. Nothing should be given except sublingual tablets or any other medication prescribed by the doctor. A tablet of aspirin helps to limit the dQage. 300 mgs of aspirin chewed at the time of heart attack can reduce the mortality rate by 15 to 20 percent. Monitor the patient’s breathing and pulse until the Qbulance arrives or the patient reaches the emergency department of a hospital.
Q) High blood pressure is often referred to heart ailments in the later stages of life of a patient? Your comments.
UK) High blood pressure is the primary factor for heart diseases. So it is important that you have your blood pressure checked regularly by your healthcare provider. Nowadays it is very common to hear that someone is having a high Blood Pressure (BP). Medically it is also called hypertension. It usually has no symptoms. However, if not treated on time or kept under control, it can be one of the major factors for heart disease and stroke. Blood pressure is typically recorded as two numbers, written as a ratio. One number records BP when the pressure is at its highest — this is called systolic pressure. The other one, the lower of the two numbers, is called diastolic pressure and it measures the pressure in arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood). The normal level of BP is usually about 120 (systolic) over 80 (diastolic). If you have been told that your BP is higher, then you should discuss this with your fQily doctor. The higher your BP, the greater is the risk of heart attack or stroke.
Q) What are the causes of high blood pressure?
UK) It is said that there is no single cause for high blood pressure. A number of factors combine to raise blood pressure and high BP tends to run in fQilies. Excess weight, too much of alcohol consumption, eating too much sodium and not eating enough fresh fruits and vegetables may lead to an increase in BP. As you grow older, your BP increases. In very few people, there is a specific cause for high blood pressure and removing the cause can produce a ‘cure’. One also needs to identify ones high BP. The only way to find out whether you have high BP is by measuring it. A person with high BP may feel physically fit, look healthy and rarely has any symptoms. Blood pressure varies with age and depends on how active you are before it is measured. One high reading does not necessarily mean that you have high BP. The doctor will usually want to check your BP several times before reaching the conclusion whether you have high BP or not. If you are nervous or anxious, the measurement can be higher than usual.
Q) Can high blood pressure worsen any disease?
UK) High blood pressure (hypertension) can lead to or worsen an existing ailment such as diabetic eye disease and kidney disease. Most people with diabetes develop high blood pressure during their life. Compared to people with normal blood pressure readings, men and women with hypertension more often have coronary artery disease, strokes, blocked arteries in legs and feet as well as heart failure. Studies show that people with pre-hypertension have two to three times greater chance of developing heart disease and this becomes worse in diabetics. The risk of cardiovascular event in a diabetic is at least twice than that of a non-diabetic at all levels of high BP. Usually high blood pressure is called a ‘silent killer’ because it has no symptoms and thus it is important to monitor it regularly.
In JQmu and Kashmir, a total of 45,922 people (8.21 per cent) of those screened (5,59,208) were found to be hypertensive. If your BP is more than 140/90, you should have it monitored every 24 hours. Your doctor may suggest you to buy a reliable BP monitor and measure your BP regularly at home. This gives your doctor a number of BP readings to help him decide if you need treatment for your high BP problem or it is just ‘white coat hypertension’. Almost half the number of people who get their BP checked in clinics have ‘white coat hypertension’. This happens because people become anxious about having their BP checked and in turn their BP levels get raised.
Q) What are the complications caused by high blood pressure?
UK) High BP can cause heart attack, heart failure, stroke, kidney failure and peripheral arterial disease (poor blood circulation in your legs). These problems can be avoided if your BP is controlled.
Q) What are the recommendations for keeping it under control?
UK) Generally, doctors recommend the following changes in your lifestyle: Be more physically active, maintain a proper body weight, quit smoking. Besides, you should eat a diet rich in fruit and vegetables and low in fat and salt. These lifestyle changes may help reduce BP. In some cases it may also bring high BP to a normal level, but for most of the people medication is required to lower the BP.
Q) Is there any relation of bad food to heart ailments?
UK) Consumption of leafy vegetables and seasonal fruits should be encouraged. Seasonal fruits with bright colours are good. We don’t need to look for apples in winters and pears in spring. People in Kashmir are voracious mutton and chicken eaters, but that should be actually eaten in a limited quantity. You enjoy a Gushtaba but burn that much of calories through exercise. The housewives shouldn’t reuse the oil once used for frying. We have a habit in Kashmir of using the oil for some frying and then using the sQe the other day. Used oil, if heated again, raises cholesterol. Almond and walnut consumption is good for heart. We should not remove skin of the almond as it has nutritious value. Smoking should be avoided because each cigarette reduces life span by 11 minutes. Consuming raw fruit is more useful than taking fruit juice. People should develop a habit of exercising. Exercises like jogging, cycling or for that matter even walking for half an hour a day is required. We don’t necessarily need any branded jogging shoes or special training for exercise.
Q) How has the Kashmir conflict impacted heart diseases in this region?
UK) It is obvious that stress and depression on heart derails your whole biological mechanism. Turmoil in Kashmir since nineties certainly has taken its toll on the overall population. Stress has been an important reason of heart ailments. From common man to armed forces and police forces, everybody witnessed an increase in heart attacks.
Q) What are your views on the return of Kashmiri Pandits? What is your message for them?
UK) Kashmir is a place that is unique; you do not have a replica of it anywhere else in the world. Kashmiri Pandits and Muslims should foster unity and forget the migration episode of the nineties. Pandits have to forget 1990. If they will think about it, they can’t move forward. Similarly, Muslims have to forget the situation prior to 1935 because we are one and have common blood. They (Pandits and Muslims) should forget past and promote Muslim-Pandit unity. I think that will help in settling many of us here. My message is that we must not dwell in the past. You can’t build Hari Parbat or Shankaracharya in Faridabad or Delhi. I have never been threatened in all these years. Instead, many separatists, especially Yasin Malik, is a very good friend.
Q) You had announced that you will be settling in Kashmir. When are you actually returning?
UK) (Laughs). Of course I have got a house here in New Friend’s Colony. So I definitely will be back to my roots. –Authint Mail
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