SAAOL E-Magzine

SAAOL

SAAOL News

Covid-19

by SAAOL
August, 2020

At the time of Corona, there is not a lot to talk about our activities. Most of our clinics were closed for the initial days but now we are open and functional. But Saaol has gone online. We started Online or Video consultation with Dr. Bimal Chhajer from May 2020. This was an instant hit as people who could not come to Delhi or did not want to travel could easily consult Dr. Chhajer. This process will continue for the future. The time allotted for this is from 10 to 12 in the forenoon. One can visit our website and book for this teleconsultation.

ONLINE CONSULTATION

by SAAOL
August, 2020

After you book our assistant doctors will take your history and details which may take 30 minutes or so – then you will be allowed to discuss with Dr. Chhajer. The fees have been kept Rs.2500. Saaol is also going very popular on YouTube. Our videos are being watched more and more and the daily viewership has reached more than 100,000 per day. We have more than 500,000 subscriptions on our channel. You can also join us there and also request us for the topics you want Dr. Chhajer to speak.

SAAOL JADOO DIET

by SAAOL
August, 2020

Our Jadoo diet for weight loss is also getting very popular after its launch two months back. The viewership in Youtube has reached more than one million – 1,000,000 on out videos on the Jadoo diet. People are losing weight by 10-20 kilograms in a few months. Saaol has opened two more clinics this month – one in Noida in Delhi NCR and the other in Cherni Road in Mumbai. The official opening had been postponed for a few months due to the corona Crisis. From 11th August 2020, both will be fully operational.

Dr. Bimal Chhajer's Talk

Heart disease is one of the most common but serious diseases of the country and the world. Out of all heart patients that I consult in my clinics 98% are patients of Coronary Heart Disease where the blockages develop in the three major coronary arteries. In these patients, blockages lead to problems of Angina or Heart Attacks. Out of the rest two percent, 1.5% are patients of Irregular heartbeats or Arrhythmia. Heartbeats in a fixed pattern with the rate of beats varying between 50-100 per minute. (most commonly 60-90 beats per minute). The term used for it is called Rhythm. When this Rhythm is broken – this is called Arrhythmia. Sometimes this rate becomes too low or too high and sometimes there are breaks – where the heart skips one or two beats. Most of the Arrhythmias do not give many problems and often disappear after some time. They can be treated with medicines. Two more serious cases need emergency intervention – Complete Heart Block and Ventricular Fibrillation.

The most common cause of these arrhythmias are a shortage of Blood to the Natural pacemaker of the heart called the S A Node. The basic cause is probably a blockage in the tiny Artery called Artery to the S A Node – a branch of Right Coronary Artery. In the initial phase, the heart misses its beats occasionally, which may worsen with frequent misses and ultimately a complete shut down of the SA node – which usually beats at a speed of 60-90 per minute. But this also does not lead to the death of the patient as a second but slower pacemaker A V Node takes over. But the heartbeats at the speed of 40 per minute. This stage is called Complete Heart Block. At this stage, one needs to put off artificial Pace Maker. Unfortunately, most heart hospitals suggest patients Pace Maker even if they have not reached the stage of Complete Heart Block and the heart rate is well above 40/per minute. We, at Saaol, have treated many such early patients with lifestyle change and medicines.

The second kind of emergency – where the Ventricles beat at a speed of about 200 per minute needs emergency treatment by Electric Shock. This stage is called Ventricular Fibrillation or Tachycardia. Most of such cases happen if the heart patients with blocks do not take care and get a major heart attack (which are completely preventable). This is a medical emergency and can be treated in a well-equipped ICU. The Good news is that if we can take care of the food, lifestyle, and control of the risk factors of heart blockages both these emergencies are preventable. Only those who do not take care only to reach such an emergency stage --Dr. Bimal Chhajer

Food Chapter | Zero Oil Bread Pakora

INGREDIENTS (PER SERVING)

Brown Bread Slices - 2
Boiled Potato – 3 Medium
Besan – 50 gm
Onion – 1 medium
Green Chilli – 2-3 chopped
Garam Masala – ½ t
Amchur Powder – 1 t
Haldi – ½ t
Ajwain – 1 t
Lal Mirch Powder - ½ t
Salt – according to taste
Tomato Sauce – for apply on slices

METHOD OF PREPARATION

1. We take a Non-Stick Tawa and bake bread slices from both sides. Take the boiled potato and mash them.

2. Now add chopped green chilies, chopped onion, amchur powder, salt, garam masala. Mix properly. The potato mixture is ready.
3. First, we take tomato sauce and spread it on the bread slice. Then spread potato mixture on the bread slice. Cover it with another slice
4. Take besan and add lal mirch powder, salt, haldi, and ajwain. Add water and make a proper batter.
5. Now cut bread slice into two parts.
6. Put Non-Stick tawa on the flame. Dip bread slice into besan batter and put it on tawa.
7. Change the direction of bread pakora and roast it properly from all sides.
8. Zero Oil Bread Pakora is ready. Serve hot with tomato chutney or dhaniya chutney.

Calories in 1 Zero Oil Bread Pakora – 145 kcl

Calories in 1 Bread Pakora with Oil – 280 kcl

ABNORMAL HEARTBEATS

Introduction

The heart pumps about 70 times in a minute. This beating occurs at a regular interval. An irregularity in the rhythm is called Arrhythmia. An irregular heartbeat is called a cardiac arrhythmia. The heart may beat irregularly, beat too fast, or beat too slowly. Nearly everyone has felt their heart skip a beat, race, or flutter inside their chest. Occasional heart palpitations are common and harmless, even though they’re considered arrhythmias. They may just occur, or they may be produced by something that stimulates your heart, such as stress, tobacco, alcohol, caffeine, appetite suppressants, or cold and cough medicines that contain caffeine or other stimulants. If you have an otherwise normal heart, occasional heart palpitations are rarely the cause of alarm, and most don’t require medical treatment. If they’re bothersome, limiting or avoiding what prompted them may eliminate the problem.

Electrical System of the Heart

Our heart is the most wonderful and complex Pumping machine – probably the best pump in the world. It has to keep on pumping the blood for years at the rate of 100,000 times per day.

It’s not a simple pump – just receiving and pumping the blood. It has to receive the blood – send it to the lungs for purification, receive it back, and then again pump it to the body. So, it’s a double pump. Structure wise, it has two receiving chambers – upper chambers (Atria) and two pumping chambers which can be called lower chambers (Ventricles). The two upper chambers will receive the blood from the body and the lungs respectively. Then both pump the received blood to the two lower chambers (Right and Left Ventricles). These ventricles have to pump impure blood to the lungs and the pure blood to the body. Now all the chambers cannot pump together – then there will be no flow. First, the upper chambers will pump and fill the lower chambers – then the lower chambers will have to pump. The speed of the chambers also has to be the same.

To synchronize these pumping actions – one after another – the heart is fitted with an electrical system. This system starts with the Original Pacemaker (medically called S A Node) – which is a highly active nerve cell of the size of a pinhead. This generates the electrical impulses which start the pumping actions. This usually sends signals of 70-72 per minute – this governs the heart rate or pulse rate.

First to get the SA node electrical signal to pump are the upper chambers (Atria – Right and Left). They pump the blood to the ventricles. The electrical signal now pauses for microseconds at another Pacemaker called AV node – which is situated little away just near the ventricles. Once the pumping of upper chambers is complete and the lower chambers are filled up completely – the AV Node starts sending electrical signals to Both lower chambers to contract. This is done by a Y shaped nerve called “Bundle of His” which has two branches for the two lower chambers. These branches are called Left and Right Bundle Branch. Now, the Lower chambers contract sending the blood to body and Lungs. This completes one cycle – called cardiac Cycle. This Whole cycle takes 0.8 seconds or 800 million seconds. Now the SA Node starts another cycle by sending signals to upper chambers again.

To make a gist – this electrical system has four parts – 1. SA Node 2. Nerves from SA node to Upper chambers 3. AV Node and 4. Bundle of His with left and right branches.

Types of Abnormal Heartbeat

Abnormal Heartbeat can be classified as:

1. Speed of the Heart

A rapid or fast heartbeat is when your heart is beating faster than normal. The normal heart rate is 50 to 100 beats per minute. Heartbeat can be faster or slower.

• Faster (Tachycardia)

Tachycardia is considered a heart rate of greater than 100 beats per minute. If you are exercising or performing any kind of activity, your heart will normally beat faster. This allows your heart to pump blood throughout your body, to provide oxygen to the tissues.

• Slower (Bradycardia)

Bradycardia is a slower heart rate than normal heart rate. If one has bradycardia, his/her heartbeats fewer than 50 beats per minute. Bradycardia can be a serious problem if the heart doesn't pump enough oxygen-rich blood to the body.

2. Related to Upper Chambers (Atria)

The abnormal rapid rhythms that start in the upper chambers of the heart (the atria) are called Atrial Arrhythmias. Several kinds of abnormal heart rhythm (arrhythmia) occur in the heart's upper chambers (the atria). The most common include:

• Atrial Fibrillation

During atrial fibrillation, the heart's two upper chambers (the atria) beat irregularly. The heart rate ranges between 100-200 beats per minute.

• Atrial Flutter

Atrial Flutter is a problem in which heart beats very fast. The atria beat regularly, but faster than usual. The heart rate is more than 250 beats per minute.

• Superventricular Arrythmias

Arrhythmias that begin in the atria (the heart’s upper chambers). “Supra” means above; “ventricular” refers to the lower chambers of the heart or ventricles. SVT is defined as the abnormal fast heartbeat that originates above the ventricles in the atria.

3. Related to Lower Chambers (Ventricles)

The abnormal rapid rhythms that start in the lower chambers of the heart (the ventricles) are called Ventricular Arrhythmias. These types of arrhythmias cause your heart to beat too fast, which prevents oxygen-rich blood from circulating to the brain and body and may result in cardiac arrest.

• Ventricular Tachycardia

Ventricular Tachycardia is a condition in which the heartbeat is very fast but often regular. The rates are most commonly 150 to 250 beats per minute but ventricular tachycardia may occur at relatively slow rates such as 110 to 150 beats per minute, sometimes due to medications that slow the ventricular tachycardia or advanced degrees of heart impairment.

• Ventricular Fibrillation

Ventricular fibrillation is an extremely rapid heartbeat occurring in the lower heart chambers, usually at over 300 beats per minute. The heart pumps little or no blood. Ventricular Fibrillation quickly leads to cardiac arrest.

Causes of Abnormal Heartbeat

Temporary/Non-Serious Causes

1. Strenuous Exercise | Inadequate Sleep

2. Excess Alcohol | Too much of Tea, Coffee

3. Stress and Anxiety | Dehydration

4. Fever | Low Blood Sugar

5. Anemia | Drug Abuse

6. Uncontrolled Diabetes or high BP | Hyper Thyroid – over active Thyroids

7. Few medicines: Asthma medicines (Salbutamol, Deiphylline), BP medicines (Hydralazine,Minoxidil)

Some Anti-Histamines (Terfenadine), Anti-Depressants (Citalopram, Escitalopram)

Other more serious causes:

1.Blockages in Heart Arteries - Ischemia

2.Heart Attacks or Cardiac Arrest

3.Injured heart areas due to previous Heart Attack

4.Valve Diseases: Congenital or Acquired

5.Cardiomyopathy | Heart Failure – Acute or Chronic

6. Previous Heart Surgery or Complicated Angioplasty

Diagnosis of Abnormal Heartbeat

To diagnose an abnormal heartbeat, doctor will review your symptoms, medical history and conduct a physical examination.Several test can help to diagnose an abnormal heartbeat. These may include:

1. Medical History

To diagnose an arrhythmia, doctor asks about eating and physical activity habits, family history, signs and symptoms and other risk factors for abnormal heartbeat.

2. Physical Examination

During physical examination few points are checked by the doctor:

• Checking for swelling in your legs or feet, which could be a sign of an enlarged heart or heart failure.
• Checking of your pulse to find out how fast your heart is beating.
• Listen to the rate and rhythm of your heartbeat.
• Listen to your heart for a heart murmur.
• Look for signs of other diseases, such as thyroid disease, that could be causing the abnormal heartbeat.

3. Diagnostics Tests

Blood Tests: to check the level of certain substances in the blood, such as potassium and thyroid hormone, that can increase your risk of abnormal heartbeat.
CT Coronary Angiography: to know the blockages.
Echocardiography(echo): This tell about the size and shape of your heart and how well it is working.
Chest X-Ray: to know your heart is larger than normal

Electrocardiogram (ECG): This tells how fast the heart is beating.

Holter monitor : This portable ECG device can be worn for a day or more to record your heart's activity as you go about your routine.
Implantable loop recorder: to detect abnormal heart rhythms.
Ultrasound: to diagnose a suspected fetal arrhythmia in the womb.
Stress test: Some arrhythmias are triggered or worsened by exercise. During a stress test, you'll be asked to exercise on a treadmill or stationary bicycle while your heart activity is monitored. If doctors are evaluating you to determine if coronary artery disease may be causing the arrhythmia, and you have difficulty exercising, then your doctor may use a drug to stimulate your heart in a way that's similar to exercise.
Tilt table test: Doctor may recommend this test if you've had fainting spells. Your heart rate, EKG reading, and blood pressure are monitored as you lie flat on a table. You lie on a table that moves from a lying-down position to an upright position. The change in position may cause you to faint.

Treatment of Abnormal Heartbeat

There are few points that one should follow if he/she has a problem of abnormal heartbeat:

1. Healthy Lifestyle Changes

To prevent heart arrhythmia, it's important to live a heart-healthy lifestyle to reduce your risk of heart disease. A heart-healthy lifestyle may include:
• Eat a heart-healthy diet
• Stay physically active and keep a healthy weight
• Reduce blood pressure
• Control cholesterol level
• Avoid tobacco smoke
• Avoid caffeine and alcohol
• Reduce stress, as intense stress and anger can cause heart rhythm problems
• Use medications with caution, as some cold and cough medications contain stimulants that may trigger a rapid heartbeat

2. Medicines

Some medicines are used in combination with each other or together with a procedure or a pacemaker. If the dose is too high, medicines to treat arrhythmia can cause an irregular rhythm.

• Adenosine to slow a racing heart. Adenosine acts quickly to slow electrical signals. It can cause some chest pain, flushing, and shortness of breath, but any discomfort typically passes soon. treatment

• Atropine to treat a slow heart rate. This medicine may cause difficulty swallowing.

• Amiodarone is used to treat irregular heartbeat or Ventricular Ectopics. It is used to maintain a regular, steady heartbeat.

• Beta blockers to treat high blood pressure or a fast heart rate or to prevent repeat episodes of arrhythmia. Beta blockers can cause digestive trouble, sleep problems, and sexual dysfunction and can make some conduction disorders worse.

• Blood thinners to reduce the risk of blood clots forming. This helps prevent stroke. With blood-thinning medicines, there is a risk of bleeding.

• Calcium Channel Blockers to slow a rapid heart rate or the speed at which signals travel. Typically, they are used to control arrhythmias of the upper chambers. In some cases, calcium channel blockers can trigger ventricular fibrillation. They can also cause digestive trouble, swollen feet, or low blood pressure.

• Digitalis, or digoxin to treat a fast heart rate. This medicine can cause nausea and may trigger arrhythmias.

• Potassium Channel Blockers to slow the heart rate. They work by lengthening the time it takes for heart cells to recover after firing, so that they do not fire and squeeze as often. Potassium channel blockers can cause low blood pressure or another arrhythmia.

• Sodium Channel Blockers to block transmission of electrical signals, lengthen cell recovery periods, and make cells less excitable. However, these drugs can increase risks of sudden cardiac arrest in people who have heart disease.

3. Procedures

• Electric shock or Cardioversion: It is a medical procedure by which an abnormally fast heart rate (tachycardia) or other cardiac arrhythmia is converted to normal rhythm using electricity or drugs.

• Cardiac ablation: It is a procedure that can correct heart rhythm problems (arrhythmias). Cardiac ablation works by scarring or destroying tissue in your heart that triggers or sustains an abnormal heart rhythm. In some cases, cardiac ablation prevents abnormal electrical signals from entering your heart and, thus, stops the arrhythmia.

• Implantable Cardioverter Defibrillators (ICDs): Defibrillators are devices that restore a normal heartbeat by sending an electric pulse or shock to the heart. They are used to prevent or correct an arrhythmia, a heartbeat that is uneven or that is too slow or too fast. Defibrillators can also restore the heart’s beating if the heart suddenly stops. Different types of defibrillators work in different ways.

• Pacemaker: Electrical impulse from our heart muscle, the myocardium causes heart to beat (contract). This electrical signal begins in the Sino Atrial (SA) (specialized are of muscle which has inherent property to generate electrical impulse) node known as natural pacemaker, located at the top of the right atrium (chamber-1). SA node is called pacemaker as it produces impulse & sets the pace for contraction of heart. When this natural pacemaker of the body goes wrong, artificial pacemaker are implanted in many people and they take over the work of this natural pacemaker i.e. SA node in producing impulses.

Identification of Arrhythmia

Palpitation, Breathlessness, Chest Pain, Dizziness, Fainting (Syncope), Tiredness, Uneasiness, Light Headedness.

Risk factors

Certain conditions may increase your risk of developing an arrhythmia. These include:

1. Coronary artery disease, other heart problems and previous heart surgery

2. High Blood Pressure | Congenital Heart Disease

3. Thyroid Problems | Diabetes | Obstructive Sleep Apnea | Electrolytic Imbalance

Complications

Certain arrhythmias may increase your risk of developing conditions such as:

1. Stroke or Paralysis

2. Heart Failure

3. Sudden Cardiac Arrest

4. Worsening Arrhythmia

Few important terms

LBBB or RBBB (Bundle Branch Block)

Lots of people come to know from their ECG that they have some defect in the Pace Maker System of the heart but they are told that since they do not have any symptoms they do not any treatment. One of them is Bundle Branch Block – it may be the right or Left Bundle Branch. This kind of heart disease is called RBBB or LBBB.

The defect in these cases is delay or default in the Bundle of His – the nerve that transmits electrical signals to the Left or Right lower chambers of the heart or ventricles (which ultimately lead to their pumping action). This block is in the electric signals – which now reach directly through the muscles and the ventricles beat almost normally. So, the work of the heart goes on as usual. The patient does not need any treatment or have any symptoms.

The cause of the interruption is mostly a shortage of blood due to the death of the area of the heart muscles through which the nerve thread passes. This occurs because of fat deposits in the branch of the coronary arteries supplying that area. This is like a very minor heart attack – which goes unnoticed. Such patients, if they do not take care of their diet, lifestyle, and blood lipid levels, further progress to the next stage – Bi Fascicular Block (both RBBB and LBBB together) and then Complete Heart Block. The Complete Heart Block ( it is an electrical signal block) needs External Pace Maker Implantation.

Though the most common cause of Bundle Branch Blocks is coronary artery blocks/heart attacks – the other uncommon causes of LBBB or RBBB are genetic defects in the heart (from birth), Cardiomyopathy, Myocarditis, High Blood Pressure or Pulmonary hypertension.

Ventricular Ectopics (Missing beats)

Almost all the heartbeats that we have, generate from the S A Node or original pace Maker of the heart which is located in the wall of the Right Atrium. They first stimulate the Atria (the two upper chambers) and then the Ventricles (the lower Chambers). This leads to a normal heartbeat. But sometimes the ventricles contract on their own without any signal from above. This leads to an extra beat in the heart called Ectopic Beat or VPC (Ventricular Premature Beat). It can be felt by the patient if we count the pulse as a missing beat. Many healthy people can get it and till 3000 VPCs per day (3%) it may be considered normal. They may be because of stress, extra caffeine, extra alcohol, and strenuous exercises.
But if they become too frequent or come in doubles or triples – it can lead to giddiness or fainting. This needs treatment. There are medicines (like Amiodarone) that can control them – but the underlying cause is again Coronary Heart Disease or Shortage of blood to some part of the heart due to Coronary artery fatty deposits.
If the reasons (called Risk factors) of the fat deposits (like Cholesterol, Triglycerides, High BP, High Sugar, Smoking, stress, lack of exercise, obesity) is not withdrawn they may worse and lead to Ventricular Tachycardia or Ventricular Fibrillation. This condition now becomes very serious as the ventricles continuously generate Ectopics – which may even lead to death. Such patients immediately need Electric Shock (Cardioversion) to restore normal beats. If the preventive care is still not taken - Later on they may need to be repeated electric shocks using ICD device.

P -SVT or SVT (Paroxsysmal Supra Ventricular Tachycardia)

This is a kind of rapid or very fast heartbeat (130-200) and occurs for a short duration. Patients feel uneasy and can feel the high speed of the heart. This is caused by the existence of some of the electrical signal generators in the atrial wall near the main pacemaker or S A Node. They sometimes become active and generate fast signals which take over the SA Node function. This is mostly called AVNRT (Atrio-Ventricular Nodal Re-entrant Tachycardia).
Since it is a temporary fast beat – it is never life-threatening. It is usually stimulated by Stress, Anxiety, caffeine, drugs, or Alcohol. It does not usually need treatment, but it occurs very frequently can be treated with drugs like Calaptin. Vagus nerve stimulation by massaging in the back of the lower part of the ear can revert it on many occasions.
The Hospital system usually wants to do RFA (Radio Frequency Ablation) in such cases which is not only invasive but often fails as they try to burn the suspected nerve areas on the wall of the Atria by trial and error method. This should be tried only if the lifestyle and medicines fail.

EPS or EP Studies (Electro Physiological Studies)

This is an invasive testing procedure to study the origin of certain types of Arrhythmia or irregular heartbeats. This usually needs inserting a catheter in your body – which is pushed to the selected chamber of the heart. Electrodes are also pushed along the catheter to study the electrical activity of the areas of the heart to search for the origin of the abnormal nerve location. It is a complex study and very few experts can give exact opinions on the test. However, it can be done if all methods of control of the irregular beats fail. It costs usually Rs. 30000-50000.